You’ve finished a 10-hour install. The back is locking up by the time you’re packing the truck. The knees are stiff before you’ve even climbed in the cab. Your wrists feel like they’ve been holding a hammer drill all day, because they have. Welcome to trades pain.
It’s not weakness. It’s not aging. It’s not bad form. It’s the predictable outcome of doing physical work for a living, on bodies that haven’t been given the right kind of treatment to keep up.
This is the long version of what I tell tradies in the clinic. The four areas that break first, why they break, and what actually resolves them.
The four pain hotspots
If you’ve been on the tools for any meaningful stretch of time, the pain shows up in roughly the same four places. Different trade, same patterns.
1. Lower back
Plumbers under sinks. Sparkies twisted into roof spaces. Chippies hunched over framing. Concretors swinging shovels. The lower back takes the load nothing else can.
What’s actually going on:
- Repeated flexion (bending forward) under load
- Twisting under load — the worst combination
- Long static positions in awkward postures
- Carrying heavy gear up scaffolds, ladders, or stairs
These add up to compressed and irritated lumbar discs, sensitised facet joints, and tight, fatigued paraspinal muscles. Pain often shows up not from one big lift, but from the cumulative load of years of small ones.
Why it gets worse over the years:
The body adapts to chronic load by stiffening up — fascia thickens, joints lose their normal glide, and pain signalling becomes more sensitive. Without active treatment, you spiral down: less mobility leads to more compensation, more compensation leads to more pain, more pain leads to less movement. More on why back pain keeps returning →
What actually helps:
- Hands-on mobilisation of stiff lumbar segments
- Soft tissue work through the paraspinals, glutes, and hip flexors (which always get tight in this group)
- Targeted strength work — short, specific, not a long program
- Practical changes: micro-rests, body positioning awareness, lift mechanics that don’t require you to “just stop bending”
2. Knees
Kneeling on hard floors. Squatting in tight spots. Hopping in and out of trenches. Walking on uneven ground all day.
What’s actually going on:
- Compression at the front of the knee from kneeling — patellofemoral pain, sometimes prepatellar bursitis (“plumber’s knee”)
- Wear in the meniscus from repeated deep squatting under load
- Quad and hip imbalances built up over years of biased loading
- Knee pain that’s actually being driven from above (weak glutes) or below (poor ankle mobility)
Why it gets worse:
The knee compensates for restrictions elsewhere. If your hips and ankles stop moving well, the knee absorbs the difference. Add repeated kneeling pressure, and the structures around the kneecap start grinding.
What actually helps:
- Manual therapy on the patellofemoral joint and surrounding soft tissue
- Hip mobility work — opens up the load above the knee
- Ankle dorsiflexion work — opens up the load below
- Knee pads that actually fit (most don’t), and conscious off-loading during the workday
- Targeted strength: glutes, quads, calf — short and specific, not a 25-minute home program
3. Shoulders
Overhead work is brutal on shoulders. Sparkies running cable in roof spaces, plasterers, painters, anyone doing extended above-head tasks. Plus the lifting-and-carrying side: power tools, equipment, materials.
What’s actually going on:
- Rotator cuff irritation from repeated overhead loading
- AC joint compression at the top of the shoulder
- Postural changes from years of bracing the shoulders forward (driving, holding gear in front of you)
- Sometimes impingement under the acromion as the cuff tendons swell
Why it gets worse:
Shoulders are deceptively complex. The ball-and-socket relies on muscle balance and scapular control. Years of pushing, gripping, and reaching forward create a posture where the cuff is constantly under tension and the scapula rides forward. The pain that finally shows up is the result of years of micro-irritation.
What actually helps:
- Manual therapy on the rotator cuff insertions, AC joint, and surrounding soft tissue
- Dry needling for the upper trap, levator scap, and infraspinatus — usually loaded with trigger points in this group
- Thoracic spine mobility work (a stiff mid-back drives bad shoulder mechanics)
- Specific cuff and scapular stabiliser strength — not a generic shoulder rehab program
4. Hands and wrists
Carpenters and chippies grip a hammer all day. Mechanics torque tools through awkward angles. Sparkies strip wires for hours. Plumbers lean on pipe cutters and wrenches. The hands take a hiding most other workers’ bodies never see.
What’s actually going on:
- Tendon overuse — tennis elbow, golfer’s elbow, de Quervain’s at the thumb side of the wrist
- Carpal tunnel from repeated wrist flexion combined with sustained gripping
- Loss of grip strength — paradoxically, from gripping too much (the muscles fatigue and tighten rather than strengthen)
- Vibration-induced damage to forearm tissue and small wrist joints
Why it gets worse:
Hand and forearm tissue doesn’t get a chance to recover between shifts. By the time pain shows up, the structures have been working overtime for months. Most tradies push through — which compounds the damage.
What actually helps:
- Targeted manual therapy on the forearm, wrist, and hand structures
- Dry needling on the forearm trigger points (usually a quick win for grip pain)
- Activity modification where possible — even small grip changes matter over a week
- Specific eccentric loading for tendon issues, not just rest
More on hand and wrist therapy →
The myth of “just work through it”
There’s a culture in the trades of pushing through. I get it — bills don’t pay themselves, and taking time off feels like weakness. But pushing through pain that’s been around for months isn’t toughness. It’s slow damage.
Acute pain (a few days old) often does settle if you keep moving sensibly. Chronic pain — pain that’s been there for weeks or months and keeps flaring — does not. Working through it just adds load to a structure that’s already inflamed. The pattern entrenches.
The tradies who end up with the worst long-term injuries are almost always the ones who pushed through the longest before getting treated. Not the ones who got it sorted early.
Why most physio fails tradies
Three reasons:
1. The model is exercise-only
You finish a 10-hour shift, drive to a 5pm appointment, and get given a list of band exercises to do at home. That’s not treatment for someone whose body has just done a full day of physical work. It’s homework. And homework alone doesn’t resolve a body that’s been loading hard for years.
More on what hands-on treatment actually involves →
2. The schedule doesn’t fit
Mid-week appointments mean leaving site early, losing income, or not going at all. Weekend availability is rare. So tradies either push through or stop seeing the physio.
3. The advice is generic
“Lift with your knees.” “Take a break every hour.” “Stretch your hips.”None of it is wrong. None of it is specific to your job. If you’re laying drainage in a trench, you can’t take a break every hour. The advice has to fit the work, not a slide deck.
What to look for in a physio if you’re a tradie
A few things that actually matter:
- Hands-on first. If the appointment is mostly talking and exercise demonstration, you’re at the wrong clinic.
- Weekend availability. If you can’t get treated without losing a day’s pay, you won’t come back.
- Understands your work. A physio who’s never been on a job site can still treat you well — but they need to ask the right questions about what your day actually looks like.
- Realistic about timelines. No physio should book you in for 12 sessions sight-unseen. You should know within 2–3 sessions whether the approach is working.
- Honest about what you can and can’t change. Some things at work just have to be done. The treatment plan should work around that, not pretend it doesn’t exist.
One last thing
I’m a physio who still works as a plumber alongside the clinical practice — three years on the tools, nine in physio. So when you tell me your knees are gone from kneeling on slab all week, I’m not nodding along from a textbook. I was on a job site recently. I know what your day looked like.
That’s the whole reason I treat the way I do. The patient gets a physio who hasn’t lost touch with what bodies actually do for a living.