Stop and get medical help
If you get chest pain or pressure, feel faint or dizzy, are unusually breathless, or your heart races or beats irregularly during exercise, as our plans advise. The American Heart Association says these need immediate medical evaluation.
Source 52
Call 999 (911 in the US)
For chest pain that feels tight, heavy or squeezing, or spreads to your arms, neck, jaw or back; a sudden, extremely painful headache, especially while straining; someone who faints while exercising; or palpitations that don't go away, or come with chest pain, breathlessness or feeling faint. Don't drive yourself to A&E.
Sources 55, 56, 57, 58, 59, 60
Breathlessness
Severe difficulty breathing (gasping, choking or not able to get your words out) is a 999 call; being more short of breath than usual is a call to NHS 111, as the NHS advises.
Source 61
A headache with effort
Ask for an urgent GP appointment or get help from NHS 111 for a headache that's triggered or made worse by coughing, sneezing, bending down or exercising.
Source 57
After a first sled session or many heavy drags
Same day (call NHS 111, or go to A&E if you feel very unwell): after a big or unusual session, such as hundreds of pull-ups, push-ups, dips or curls, a challenge or a new class, muscle pain, swelling or weakness far worse than the session explains, and dark pee (red, brown, tea or cola coloured), sometimes starting hours or days later. Dark pee isn't always there, so muscles far sorer, more swollen or weaker than the session explains still need the same-day check. It can be rhabdomyolysis, a breakdown of muscle that can harm the kidneys.
Call 999 for sudden, severe pain in a swollen, tight muscle, as our pain guides advise.
Sources 62, 63, 64
Your knee
Pain from 0 to 2 out of 10 is fine, and up to 5 is acceptable if your knee is back to its usual level by the next morning; for tendon pain just below or above the kneecap, keep it to 3 or less. Sharp, catching or giving-way pain, or new swelling, means stop. That's our knee guides' rule.
Get advice from NHS 111 now: you cannot move the knee or put any weight on it, or it is very painful, badly swollen or has changed shape; or the knee locks, gives way or clicks painfully. Painless clicking is normal.
Source 65
A pop at the front of the knee
A pop or tearing feeling at the front of the knee, then you can't straighten it or lift the straight leg, there's a dent above or below the kneecap, or the kneecap sits higher or lower than the other: go to A&E or an urgent treatment centre, or get help from NHS 111, as our patellar tendon guide says.
A snap at the back of the heel or calf
Same day: a sudden snap or pop at the back of the heel or calf, or a feeling of being kicked there, then walking flat-footed and being unable to push off or stand on tiptoe. It could be an Achilles tendon rupture: go to A&E or a minor injuries unit, or contact NHS 111, as our Achilles rupture guide says.
Also call 999 for pain and swelling in one leg with breathlessness or chest pain: it can be a blood clot that has reached the lungs.
Sources 66, 67
A trip or fall walking backwards
Call 999 or go to A&E if you heard a crack, the joint or limb has changed shape or points at an odd angle, it's numb or tingling, or the skin looks blue or grey or feels cold. Get help from NHS 111 (in the US, urgent care) if it's very painful, very swollen or bruised, very stiff, or you can't put weight on it or walk more than a few steps.
Call 999 if someone has hit their head and has been knocked out and not woken up, can't stay awake, has a fit, has fallen from a height of more than 1 metre or 5 stairs, has problems with their vision, hearing, balance, walking or speech, or has new numbness or weakness. Get help from NHS 111 after a head injury if you're being sick or feel dizzy. If you're told to go to A&E, don't drive yourself.
Source 68
Your shoulder or elbow in rows and pulls
Keep shoulder pain to about 5 out of 10 or less during the exercise, back to its usual level by your next session, as our shoulder guides advise. A sharp pinch means lower, lighter or stop.
A pop or snap with sudden pain at the front of the elbow, especially with bruising, a gap at the front of the elbow or a bulge in the upper arm, can be a torn biceps tendon. Go to an urgent treatment centre or A&E (in the US, urgent care) the same day, and don't wait for it to settle, as our biceps guides say.
Sources 69, 70
Your lower back
Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.
See a GP if pain spreading down a leg hasn't improved after a few weeks of home treatment, is getting worse or stops your normal activities. Sciatica on both sides, or weakness or numbness in both legs that's severe or getting worse, is a 999 call or a trip to A&E.
Sources 71, 72
A hernia
See a GP if you think you have a hernia, a bulge or lump that may get bigger when you strain and smaller when you lie down. Get help from NHS 111 if you have a hernia and pain in or around it, a bloated tummy, you feel or are sick, you're vomiting blood or your vomit looks like coffee grounds, you're constipated, you have a high temperature or feel hot, cold or shivery, or you've suddenly become confused. Call 999 or go to A&E for a femoral hernia (a small lump at the top of your thigh, in your groin) with very bad tummy pain, sickness, being unable to fart or poo, a high temperature or sudden confusion.
The NHS lists lifting heavy weights among the causes of a femoral hernia. After an inguinal hernia repair, avoid heavy lifting or strenuous activity for at least 4 to 6 weeks.
Sources 73, 74, 75
Before you start
Speak to your GP first if you haven't exercised for some time or have medical conditions or concerns, as the NHS advises. Get advice before hard or straining work if your blood pressure is uncontrolled (140/90 or higher at a clinic, or 135/85 at home), or you have heart disease or chest pain when you're active, a pacemaker or defibrillator, diabetic eye disease, glaucoma, a hernia, recent eye or tummy surgery, or you're pregnant, as our breathing guide lists.
With controlled high blood pressure, the American Heart Association considers low- to moderate-intensity strength training with proper breathing safe. Breathe out as you lift, as our breathing guide advises.
Check with your GP before hard intervals if you're inactive and have heart, metabolic or kidney disease, or symptoms when you're active, as our HIIT guide says.
Sources 76, 77, 52
Sore, or hurt?
Muscle soreness for a day or two after a new or harder session is common and fades. Sharp pain, or pain that builds during a set or lingers into the next day, isn't: swap to an easier version, and see a clinician if it persists, as our plans advise. The NHS says to stop exercising straight away if you feel any pain or become unwell, and to get help from 111 if symptoms worry you or don't go away.
Source 78