A client messages you on a Tuesday. Their shoulder has been "playing up" since Saturday's pressing session, it is worse overhead, and they want to know whether they should push through Thursday's workout.
You are not qualified to tell them what is wrong with their shoulder. You are also not going to delete their program and tell them to come back when they are better, because that is how clients quietly stop training and then quietly stop paying. The whole skill sits in the space between those two responses, and most of it is knowing which parts of the problem are yours.
Your job is to program around it, not to fix it
A fitness coach does not diagnose, does not treat, and does not rehabilitate. Those are three different jobs done by people with different qualifications and different insurance. What you do is build training for the body in front of you, including the parts of it that currently hurt, while someone qualified deals with the part that hurts.
That distinction is not a formality. Diagnosis is naming the thing — a tear, an impingement, a disc problem. You cannot see inside a shoulder, you are working off a text message and possibly a phone video, and a guess with a medical-sounding name attached becomes what the client believes and repeats to their doctor. Treatment is the intervention aimed at the injured tissue. Rehabilitation is the structured plan to return that tissue to load. All three require training you have not done.
What is left is still substantial: choosing what the client trains, how heavy, through what range, at what pace, and how that changes week to week. That is a full job.
This is also why this article contains no list of exercises for shoulder pain, no protocol for a tweaked lower back, and no framework for working out what is wrong. Those articles exist and they are the single most common way a well-meaning coach ends up outside their scope. An exercise that helps one shoulder makes another one worse, and the difference between the two is a diagnosis you are not making. Anything specific enough to be useful is specific enough to be a treatment plan.
The useful version is a decision process. That is what follows.
The signs that mean stop and refer, today
Some reports are not a programming problem. When any of these appear, the answer is not a modified session — it is a doctor or physiotherapist, and the client should be booking it that day.
- Pain that wakes them at night, or that is there at rest with no position that eases it.
- Numbness, tingling, or pins and needles anywhere.
- Loss of strength or sensation, including a limb that feels weak or unreliable for no obvious reason.
- Pain that started with a traumatic incident — a fall, a collision, a load dropped, something that gave way under them.
- A joint that locks, catches, or gives out.
- Any chest pain, breathlessness, dizziness or palpitations, during training or otherwise.
Say it plainly and without hedging: "That one is not something I should be working around. Please see a GP or physio this week and I will program around whatever they tell you." You are not being dramatic and you are not passing the buck. You are the person who noticed.
Two things make coaches slow to do this. The first is not wanting to seem alarmist. The second is worrying that referring out looks like you cannot help. Neither survives contact with the alternative, which is a client who trained on for six weeks with a symptom that needed imaging. Referring early is the most professional thing you do all month, and clients read it that way.
Everything below this line assumes you are dealing with the other category: an ache, a niggle, something sore and localised, no red flags, and ideally something the client has already had looked at.
The first 48 hours after a client reports pain
Do not open the program builder yet. Ask first, and ask in writing so you have the answers to refer back to.
Where is it, exactly — get them to point on a photo or describe it in one sentence. When did it start, and what were they doing. What makes it worse and what makes it better. Is it getting better, worse, or staying the same over days. Have they had it before. Have they seen anyone about it.
Then reply the same day, even if the reply is "I want to think about how to adjust this — do not train tomorrow's session until I have sent you the change." Silence is what makes clients decide for themselves, and they usually decide either to push through or to stop entirely.
| What the client reports | What you do | Who owns it |
|---|---|---|
| Any red flag above | Refer, and pause the affected work until they have been seen | GP or physiotherapist |
| Sore during a specific lift, fine otherwise | Substitute that lift, keep the rest of the session | You |
| Sore for two or three days after a session | Reduce load and volume on that pattern, review next week | You |
| Ongoing niggle, no improvement in two weeks | Refer while continuing to train around it | Physiotherapist, with you programming |
| Already under a physio's care | Ask for their restrictions in writing, program inside them | The physio |
| Post-surgical or post-fracture | Nothing until you have written clearance and restrictions | The treating clinician |
The column that matters is the third one. Once you have decided who owns a problem, the coaching decisions get much simpler, because you are no longer trying to solve something that was never yours.
Substitute the movement pattern, don't delete it
The instinct when a lift hurts is to remove it. The better move is to keep the pattern and change how it is loaded, because the pattern is what the program was built on and a hole in it does not fill itself.
Four levers, roughly in the order you should reach for them:
Range. The same lift through the range that does not hurt. A floor press instead of a bench press, a box squat to a depth that is fine, a rack pull instead of a deadlift from the floor.
Implement. The same pattern with a different tool. Dumbbells instead of a barbell, a trap bar instead of a straight bar, a machine instead of a free weight, a cable instead of either.
Load and rep range. The same movement, lighter, for more reps, with more of the set left in reserve. Often the only change needed for a grumpy joint.
Position or stance. Neutral grip instead of pronated, split stance instead of bilateral, incline instead of flat.
Work down that list and stop at the first option that is pain-free. Only if all four fail do you drop the pattern for that block, and even then you replace it with something that trains the same muscles through a different joint action rather than leaving the slot empty.
Two rules on top. The substitution must be pain-free on the day, not merely tolerable — "it is only a bit sore" is how a two-week problem becomes a two-month one. And test it before it goes in the program: have the client run a light set and report back, or send a video. If you already run video review, this is the highest-value use of it — remote form checks tell you whether the substitute is being done as you intended before they load it.
When alternates are set on the exercise itself in Fitsly's training tools, the client can swap to one mid-session on their own, which covers the sessions where something is sore on the day and you are not awake to be asked.
The other ninety per cent of the program still has to be good
A sore shoulder is not a reason to have a bad month. Coaches under-program injured clients far more often than they over-program them, usually out of caution, and the result is twelve weeks of maintenance for someone who could have made real progress everywhere else.
If one shoulder is off limits, the legs are not. Neither is the other arm, the trunk, or their conditioning. A block spent building the lower body and aerobic base while an upper-body problem settles is not a compromise — for most clients it is the training they have been neglecting for two years anyway. Say that to them explicitly, because otherwise they experience the block as a punishment.
Unilateral work is worth knowing about here as a matter of coaching convention: training one limb while the other is unavailable is a normal way to keep a client progressing, and it means less to rebuild when they come back. It is not a treatment, it is just sensible programming.
Keep the progression running on everything that is not affected. Injured clients are the ones most likely to be left on the same weights for a month because nobody updated their program, which they notice. The normal rules for progressing a client's exercises still apply to every lift that does not hurt.
The reason to bother with all of this is not only physical. A client who keeps training keeps their routine, their check-in rhythm and their sense that they are still someone who trains. A client who is told to rest for six weeks loses all three, and a good proportion of them never restart. Keeping them in the gym on a modified program is, in plain business terms, the difference between a client and a former client — and it is also the thing they will thank you for later.
Working with a physio the client is already seeing
If the client has a physiotherapist, that person is running the injury and you are running the training. It works well when the roles are clear and badly when they are not.
Ask the client to get the restrictions in writing. Not a verbal summary passed on second-hand three days later — an email or a note that says what to avoid, for how long, and what the review date is. "He said take it easy on overhead stuff" is not a restriction; "no overhead pressing for four weeks, reassess 12 March" is.
Then program inside them, without exception and without negotiating them down. If a restriction seems overly conservative, that is not your call to reverse, and going around it is the fastest way to lose both the client and the referral relationship. If you genuinely think there is a problem, ask the client to ask, or ask for permission to contact the physio directly.
Never contradict the physio to the client. Even mild scepticism puts the client in the middle of a dispute between two people they are paying, and it usually ends with them following neither of you properly.
The relationship is worth building on purpose. Physios refer clients to coaches they trust to stay inside a restriction, and being the coach who emails a clear summary of what the client is doing in the gym is unusual enough to be memorable. That referral pipeline is a genuine business asset and it is built entirely out of not overstepping.
Reintroducing the lift once they're cleared
Cleared does not mean back to where they left off. The load they were using is now a target, not a starting point.
A workable sequence: start at roughly half the weight they were last using and keep every set well short of failure. Add load across sessions only when the previous session was pain-free both during and for the next two days. Restore range before you restore weight — full range light is a better place to be than partial range heavy. And expect this to take somewhere between two and six weeks, depending on how long the lift was out and how much they lost.
The two-day rule is the one to give the client verbatim, because it is the only feedback loop that catches a problem early. Pain during the set is obvious. Pain that turns up the following afternoon is the one they forget to mention, and it is the more informative signal.
Reintroduce one variable at a time. If you add weight, change the implement and add a set in the same week, and something flares, you have no idea which change did it. This is slower and it is the only version that produces usable information.
If the same lift flares twice on reintroduction, stop reintroducing it and send them back to whoever cleared them. Two failures is data, not bad luck.
Write down what you changed and why
Every modification you make needs to be recorded somewhere that is not your memory and not a chat thread. Six weeks later you will need to know what the original program was, what you changed, on what date, on whose advice, and when it is due for review. In the rare case that anything is ever disputed, that record is also the only evidence that you acted reasonably.
Keep it short and keep it consistent. What the client reported and when. What you changed and why. Who you referred them to, if anyone. What restriction you were working inside and where it came from. The review date.
The client profile is the right home for it rather than a personal spreadsheet, because it needs to be there when you open their program. Fitsly keeps a private limitations list on each client's profile alongside their goals and notes, and the limitations and notes are visible only to you — which is what you want for a note that says "physio restriction, no overhead until 12 March, reassess".
The same discipline is what keeps a modified client from getting lost on a busy roster. If you build from shared templates, an injured client is exactly the case where one person needs their own version of the block — which is a normal part of running programs across a full roster, not an exception to it.
Two more habits worth having. Screen for this at the start rather than discovering it in week three — a good intake form asks about current pain, past injuries, surgeries and anyone the client is currently seeing. And ask about it at every check-in, not just when something goes wrong, because "any aches or niggles this week" catches problems while they are still small. If your check-in process does not have that question in it, add it.
