Disclaimer: this information is to serve as a guide and provide general information. It is not meant to give specific medical advice. If you need help with your specific situation, contact me for consultation via email: caleb@retrainbarbell.com, or consult a healthcare provider
People often believe that lifting weights, especially heavy weights, is dangerous and potentially injurious. At the recommendation to lift heavy to improve pain, they would certainly gasp, dramatically, and scoff at the idea. In this article I am going to attempt to convince you otherwise and present evidence for why you need to lift heavy to improve pain and injury.
High-intensity resistance training does not increase the likelihood of injury, provided that patients are gradually introduced to heavier loads through periodised resistance training. (7)
Resistance training protocols (~70% of 1RM) in the rehabilitation of musculoskeletal injuries have shown that this approach is well tolerated by patients and clearly ameliorates rather than exacerbates symptoms. (7)
I have also explained and presented evidence of how relatively safe lifting weights is in my other article: Lifting Weights Is Not As Dangerous As It Seems
Structural changes and strength improvements generally are going to require a certain amount of weight and heaviness. The stimulus has to be high enough in magnitude to cause these changes. If the weight is too light, it will not be sufficient enough to cause change. If someone is completely new to resistance training and unadapted to it, then relatively light weights can be stimulative to begin with. However, once this is adapted to, it will no longer be sufficient and needs to be progressed to heavy weights.
In order to improve muscular hypertrophy, strength and endurance, we know that muscle and associated connective tissues need to be progressively overloaded in order to adapt. Conversely, when tissues are not stimulated or utilized, the opposite can occur, with muscle wasting and a reduction in muscle strength/endurance (3)
Danneels et al showed that low-load motor control training was insufficient to restore muscle CSA (cross-sectional area) in this case; controlled application of progressive overload after low-load training to improve motor patterns was required to produce hypertrophy in the multifidus (back muscles) and reduce pain/disability. This is supported by results of a recent systematic review. (4)
free-weight exercises with higher intensity loading (75–83% RM vs 55–83% RM) to maximize the motor control challenge and mechanical stimulus. Adaptations to this type of resistance training include altered agonist antagonist coactivation patterns, or an un-freezing of degrees of freedom, and muscle hypertrophy. It is possible that the combined effect of these differences led to larger improvements in pain and disability (1)
It is widely accepted that an exercise intensity >70% of 1RM is the threshold above which neuromuscular adaptations occur in response to resistance training and where the training can be classified as high-intensity. The methodology of Harts et al consisted of a ‘high-intensity’ group exercising at 50% of 1RM, an exercise intensity which is insufficient for eliciting strength gains in a healthy population. Unsurprisingly, the authors failed to see significant strength gains even in the ‘high-intensity’ group, indicating that sufficient exercise intensity is needed to elicit neuromuscular adaptations even in an injured population. (7)
There is a time and place for light resistance training. When something is very sensitized, i.e. very painful, and the load/weight is the primary sensitizing factor, then lighter weights are more appropriate for the time being. In this instance the primary goal is to allow the sensitivity to calm down to a tolerable level while continuing to move and train, thus should not be forced with heavy, more pain sensitizing weights. However, once the pain has come down to a tolerable level, then the weight will need to be progressed heavier. If not, then the remaining pain and sensitivity, although lower than initially, may linger for a longer period of time than it should.
we propose that, in contrast to the gentle specific exercise advocated in the acute phase, subacute rehabilitation requires training with progressive resistance (4)
A high-intensity approach (>70% of 1RM) appears to be more effective than a low-intensity approach. (7)
When talking lifting heavy, that does not necessarily mean maximally heavy such as a 1 rep max or close to it. In the literature, heavy and high intensity is generally considered around 70% or greater. While 70% is relatively heavy, it is not a max effort lift. So, just because it needs to be heavy, this may not be as heavy as you think.
Rehabbing through lifting weights should be similar to normal strength training. Especially when it comes to load on the bar.
This intervention applies many of the concepts that would be commonplace in training sporting populations, including progressive overload and high intensity resistance training with the aim of changing the way the participant moves. This study demonstrates that it is possible to impact many of the factors that have been suggested to contribute to LBP (low back pain) by applying basic RT practices. (1)
If you have been lifting relatively light for a while due to an injury or pain issue, say several weeks or longer, and the pain continues to linger and is not improving, then there is a good possibility that you need to start loading and lifting heavier now. The initial sensitivity has likely calmed down by this point and the chronic nature of the pain now likely requires some challenging training stress and heavier progressions. Oftentimes chronic pain states need to be challenged a little more, working through some discomfort and potentially heavier resistance to improve vs when an injury or pain issue is in an acute and very sensitized state.
One area in particular where heavier loads are likely required, with research indicating the need for this, is tendon related pain issues.
… reporting tendon changes at a lower load (60% RM), and others reporting upwards of 90% of RM being necessary to see sufficient strain. Because of this, in a clinical setting it may be better to view prescriptions based on loads of >70% as a “good starting bet” to increase the probability of achieving the necessary tendon strain for adaptation. (5)
A recent study by Kongsgaard et al reported superior effects after 12 weeks of heavy slow resistance training … positive effects included reductions in tendon swelling and vascularisation along with increased collagen turnover. These findings are interesting because this is the only study in patellar tendinopathy which has used an exercise intensity of sufficient magnitude to elicit neural and morphological adaptations. (7)
…general strengthening approach did appear to effectively alleviate the symptoms of patellar tendinopathy. Furthermore, at the 6-month follow-up, the patients who had completed the heavy resistance training programme were more satisfied with their treatment outcome than those who had undergone an eccentric-only training programme. (7)
recent studies indicate that participation in a heavy resistance training programme may offer additional benefits over both eccentric only and low-intensity resistance training in patients suffering from patellar tendinopathy by improving a wider range of outcome measures. Also, based on the current literature in chronic lower limb tendinopathy, it appears that resistance training is effective at reducing symptoms in both young and old patients alike and that this effectiveness persists regardless of gender. (7)
It is ok for older individuals to lift heavy. It is possibly required and certainly beneficial to lift heavy later in life. Even older individuals can tolerate, adapt to and respond positively to heavy lifting. The importance of improving strength and preserving or even increasing muscle mass becomes further paramount as we age. Heavy lifting is the key to facilitating this.
All resistance work should be performed at sufficient intensity, however, to confer the many benefits associated with strength training. With this improved capacity, older adults can expect to live more productive, active, and independent lives. (2)
it is evident that high-intensity resistance training (>70% of 1RM) can be used successfully to elicit improvements in maximal strength, RFD (rate of force development), muscle morphology and functional performance. It appears that these beneficial results can be achieved even in older patients (+60 years) who take longer to regain strength after a period of disuse/immobilisation than younger individuals. Nevertheless, the positive effects of resistance training are still evident despite an advanced age. (7)
Pain symptoms stemming from arthritic joints can also be alleviated through resistance training and in particular, heavy resistance training. This certainly seems counterintuitive as we have historically believed that arthritis is a “wear and tear” situation-however, pain is a very complex experience AND even arthritic joints can positively adapt to the stresses imposed by heavy lifting.
Jan et al observed a trend towards better results (with knee osteoarthritis) with high-intensity RT with regards to improving strength, reducing pain and improving functional ability. (7)
Lange et al reported that participation in a progressive high-intensity RT programme, using an exercise intensity of ~ 80% of 1RM retarded disease progression in knee osteoarthritis patients by favourably impacting cartilage morphology, thereby disproving the notion that high-intensity RT is not feasible in knee osteoarthritis rehabilitation. (7)
Heavy resistance training and lifting can also be beneficial for people who have hypermobile or decreased stability in their joints.
In the current study, the young women with knee joint hypermobility ended up being able to lift and control very heavy loads corresponding to 5RM (using 6 to 10RM or ~75%-85% loads for 3-4 sets taken to failure), which for some of the participants translated to, e.g., more than 200 kg in the leg press exercise. This points to notice of the importance of applying sufficient (heavy) load to effectively develop and maximize the neuromuscular response in rehabilitation in individuals with knee joint hypermobility (6)
However, the relatively low loads typically applied might be suboptimal for targeting all elements in active joint stability for individuals with GJHk (knee joint hypermobility) (6)
In clinical practice, individuals with hypermobility spectrum disorders and knee pain are typically offered different combinations of low-intensity resistance training and neuromuscular exercises. In fact, heavy resistance training has traditionally been considered in-appropriate in this population, probably due to participants ‘and/or health professionals’ fear of pain increase, risk of injuries, or other adverse events. Contrary to these beliefs, we observed no major adverse events during the intervention period, and none of the four participants lost to follow-up reported any complications related to the intervention (6)
Bottom Line:
To experience meaningful changes and improvements in pain and function, you are going to have to lift heavy at some point. This may not be right away depending on the nature of the pain and acuity of the injury, but eventually will be warranted. Conditions such as arthritis, tendinopathy, low back pain, and joint hypermobility can all respond favorably to heavy lifting and likely will need heavy weight to meaningfully improve. If the dosage of intensity and volume is tolerable, it can be adapted to and progressed over time no matter what age you are or the injury/cause of pain. Heavy may not be as heavy as you may think. It does not have to be a grinding, max effort, but should still be a challenge. If you are going to lift (AND YOU SHOULD), then why not lift heavy enough to actually get something out of it? It’ll be ok, and better in the long run.
References:
Welch N, Moran K, Antony J, et al. The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI defined lumbar fat infiltration and functional crosssectional area in those with chronic low back. BMJ Open Sport Exerc Med2015;1:000050. doi:10.1136/bmjsem-2015-000050
Knutzen KM, Pendergrast BA, Lindsey B, Brilla LR. The effect of high resistance weight training on reported pain in older adults. J Sports Sci Med. 2007 Dec 1;6(4):455-60. PMID: 24149478; PMCID: PMC3794485.
Tataryn, N., Simas, V., Catterall, T. et al. Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis. Sports Med - Open 7, 17 (2021). https://doi.org/10.1186/s40798-021-00306-w
Hodges, Paul W. and Danneels, Lieven,Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms,Journal of Orthopaedic \& Sports Physical Therapy,volume49,6,464-476,2019,10.2519/jospt.2019.8827,PMID: 31151377,https://doi.org/10.2519/jospt.2019.8827
Morrison, S., Cook, J. Putting “Heavy” into Heavy Slow Resistance. Sports Med 52, 1219–1222 (2022).https://doi.org/10.1007/s40279-022-01641-y
Henriksen, Peter, Junge, Tina, Bojsen-Møller, Jens, Juul-Kristensen, Birgit, Thorlund, Jonas Bloch, Supervised, Heavy Resistance Training Is Tolerated and Potentially Beneficial in Women with Knee Pain and Knee Joint Hypermobility: A Case Series, Translational Sports Medicine, 2022, 8367134, 11 pages, 2022. https://doi.org/10.1155/2022/8367134
Kristensen J, Franklyn-Miller A. Resistance training in musculoskeletal rehabilitation: a systematic review. Br J Sports Med. 2012 Aug;46(10):719-26. doi: 10.1136/bjsm.2010.079376. Epub 2011 Jul 26. PMID: 21791457.