Never Waste An Injury
Training Around Injury
Nothing kills momentum in one’s training like an injury. However, it doesn’t have to. Instead of thinking about progress coming to a complete hault, think of it more as changing course. A different path to the same destination if you will. Being injured whether it is from overuse, getting slid tackled in soccer, or being scheduled for a knee replacement in a few weeks does not mean we need to stop training. Most of the time when people get injured, they take time off and are scared to go back to their normal workout routine, makes complete sense. They don’t want to return to the activity that wrecked them in the first place. What ends up happening is they give it up altogether which leaves them deconditioned and worse off when they do decide to get back to activity.
One of my favorite sayings is “Never waste an injury.”
The fact is if your goals are worthwhile and you are training hard, injury will happen at some point along the way. It is inevitable. Injury happens when load being placed on the body exceeds its capacity to recover. We will never know or understand our upper limit if we never push past this threshold. This is how we learn at the end of the day. The type of learning that can’t be taught in a textbook only through experience. Every human body comes from a different physical background, genetic makeup, injury history, and relationship with exercise.
Therefore, it is impossible to generalize injury prevention, and what leads to breakdown of the body. Now, injuries related to trauma are just bad luck and there is really little we can do to prevent that. There is no such thing as “bulletproofing yourself” through an exercise plan unfortunately. Overuse injuries however can be mitigated by listening to your body when the signs present itself. Usually with these, it is important to nip them in the butt fast before it comes a chronic issue and tissue degeneration starts to occur. At that point, the recovery process takes much longer. Overuse injuries can come in many forms.
Some signs of overuse are:
- Constant joint stiffness/ aching throbbing
- Pain at night/ sleep disrupting
- Joint or muscular pain at end range of motion
- Radiating/ referral pain down limbs
- Excessive morning stiffness (not the good kind)
If you are experiencing any of these, it does not mean a more serious injury is right around the corner, but just be cautious. The brain is basically shouting at you that something in your routine needs to change.
Injuries are not the end of the world, and can become a positive experience for a number of reasons:
1) Set new short-term goals- Like I said before, never waste an injury. There is so much out there to keep training. Say you sustained a knee injury and squatting is bothersome. Why not make hinging dominant patterns the main focus for the time being? For instance- heavy RDLs, good mornings, deadlifts, or hip thrust variations. Who knows, when that knee is fully recovered you may even come back a stronger squatter because the posterior chain is now much more developed. The beauty of this is that you end up training areas you usually don’t put much of a focus on when you are healthy. Areas like the abs, low back, and calves… I hate training these fyi.
2) Build up weak links- Continuing from the previous point, we want to build up weaker areas that may have contributed to biomechanical inefficacies in our movement patterns. However, we also want to make sure we are loading the injured tissue just enough to stimulate fibroblast and collogen production in the correct lines, so adhesions are not formed. In that previous example for instance: Building up weak links in glutes/ low back/ hamstrings, etc while still keeping in or gradually implementing some knee dominant exercises at a tolerable level. Potentially avoiding forward knee translation with exercises like wall squats or Spanish squats.
3) Work on other things- If you are a training junky, this is the toughest part of injury- finding some other activity to spend your time doing. Lucky for you, I’m preaching to continue training so you won’t need to worry about that. Continuing to exercise during injury is absolutely necessary due to the host of general benefits it provides such as increased circulation, growth hormone production, and exercise induced analgesia (pain relief). However, the physical side of rehab is just one piece.
Pain is a multifactorial emotional experience and keeping stress levels low are just as important as staying moving. Try not to worry and dwell on the injury. Accept where you are at and understand that time will be on your side if you let the body do what it does best and heal itself. Spend time with family/friends, laugh A LOT, get out in nature, take up a new hobby, read (something I’m trying to do more of), eat well, etc. Get your mind off your injury. The nervous system can be a stubborn B**** sometimes, and we want to prove to it that this painful experience is not ruining your life. If it perceives this, then the pain will last much longer. Trust me on this. Care just a little less, and focus on what you can do.
That being said, if you are dealing with an injury we should still train HARD! Before adjusting any parameters in the programming or setting new goals, a few things need to be addressed:
1) Establish an upper limit- see how much of the original painful activity you can tolerate without exacerbation of symptoms. The goal is to get back to the activity you love pain free, so might as well keep as much of it in the programming as we can to avoid detraining.
2) See how little of training you can get away with (Minimal effective volume)- You will never get a black eye to heal if you keep punching yourself in the face right? Same with soft tissue injuries. The priority during rehab is to maximize recovery so inflamed tissue can heal. At the same time, our physical capacities such as strength, conditioning, flexibility, and muscle mass should at least be maintained or progressed upon slowly. Luckily, it takes very little to maintain capacities. I’ve actually progressed in some exercises by only training 1 intense working set a week! Imagine the resources this leaves for a different training focus, and recovery of injured tissue.
When it comes to symptom provoking exercises that need modification, here are some of my favorite parameters to adjust:
1) Load- This may seem obvious. Just go lighter, right? People often drop the intensity all together when they drop load. They’ll use less weight and just go through the motions of an exercise that may be painful. Current research supports the fact that we can build muscle in ANY rep range as long as we are reaching close to failure. If muscle building is a goal, perhaps lighter loads and higher repetitions close to failure can help offload joints compared to heavy loads and lower reps closer to failure. However, technique starts to break down with higher repetitions, so it is best this is not done with compound exercises and instead done with safer isolation exercises.
If strength is a goal, we need to continue to load heavy. Something helpful would be using a similar weight done with less reps and higher sets if it equates to similar volume. For example, you are used to doing 4 x 6 reps at 225lb in a squat, and knee pain starts worsening after the 3rd rep. Switching the loading scheme to 8 x 3 at 225 with 60-90 sec rest in between will equate to similar overall volume. The difference is the reps are being cut at the point that pain worsens so technique, speed, and quality of movement becomes a greater focus. This has more carryover to strength development anyways,. Granted this is for minor injuries/aches and more serious injuries will need further modification than just lightening loads.
2) Speed- Manipulating tempo can do a few good things. For one, it forces us to use less load while maintaining similar time under tension of a given muscle. This still drives a huge metabolic effect to the muscles while taking stress off the joints. Second, we can focus on weak points along the strength curve by adding pauses. Say we are weak in the bottom of a squat. Adding a 3-5 sec pause can be a great way to train strength out of the hole and mobility by getting rid of the stretch reflex.
In contrast, we can increase the velocity of an exercise. Force= mass x acceleration and many people never focus on the acceleration aspect. Typically, increasing speed of a movement can elicit more pain to injured tissue. This can be used effectively when an injury elsewhere limits intensity from a target tissue. For example, an athlete has compression based back pain with heavy squatting with axial loads. This can be a great opportunity to ditch the barbell and focus on plyometric exercises or squats done with high velocity and loads less than 50% of 1 RM. This gives the back a chance to heal without limiting the legs from getting adequate stimulation. Training at higher speeds and lower loads can actually help the athlete eventually produce more force when heavier loading comes back.
3) Range of Motion- End range is typically where pain is worse in most joint/ soft tissue injuries. In this case, pushing into pain is not wise, and training to a range that is just outside of the painful zone is warranted. Partial range training or fractionating ranges is often used in powerlifting to strengthen sticking points or points along a range of motion where the exercise tends to fail. This can also be very useful in a rehab setting to give the nervous system a target to reach which will decrease apprehension in an exercise. For instance, if we know squatting past 90 degrees will be painful, the body may start compensating in other ways to avoid the pain as it gets close to 90 degrees. If we place a box around the 80 degree point, we know we have a safe target to prevent us going any lower and the focus can then be placed on the intensity of the movement. Having a target also lets us be objective with the rehab process as we can progressively overload range before load used.
5) Use Isometrics, Eccentrics, And Concentrics as a standalone- Each of these forms of exercise offers its own benefits.
Isometrics have been shown to build specific strength at the angles being trained, but also have an analgesic effect to painful tissue.
With Eccentrics, the tissue can handle heavier load compared to the concentric portion of an exercise which means we can overload the lowering phase without being held back by the fact that we must get the weight back up. The eccentric is also where most hypertrophy/ stretch tolerance mechanisms take place.
Concentrics are great for rate of force development training at low reps and great for driving blood flow at high reps, without the soreness and excess recovery demand of the eccentric portion.
Training isotonics (full eccentric and concentric motion) is not always needed. The transition from the eccentric to the concentric of a given movement typically is where the most shear force occurs at the joint. Therefore, focusing purely on isometric, eccentric, or concentric alone in the given activity can offer great benefits for pain relief, strength maintenance, and hypertrophy.
5) Closed vs Open chain- Closed chain activity typically has a more functional usage since our feet are on the ground. Open chain exercises are when the limb is moving in free space. The benefit with open chain exercise is it helps educate how the muscles are supposed to function in a more functional closed chain scenario. Strength training aside, I find manipulating the type of exercise to be a very good approach for flexibility training if there is pain or a previous injury that occurred in a given stretch. Many times, people injure themselves during a loaded stretch that they were not prepared to handle. The somatosensory cortex of the brain will then re program the nervous system to sense this range as painful. At this point, giving the brain slight variety at a lower overall stimulus can trick it into accepting this range as safe again. In other words, train the range with the same intent but differently than when you were hurt.
Let’s use straining an adductor when stretching the side splits as an example. Using something like a wall adductor fly with kettlebells on your toes can be a great way to re pattern the nervous system’s perception of this range, as the exercise changes to a different vector of loading then the original injury. Now that the stretch is open chain, we have more control of the load being used and can gradually work our way back to a closed chain supported side split over time.
Basically, providing a different stimulus and offering the nervous system variability is key to re programming the pain pathways in the brain!
I’ve had similar results with powerlifters and olympic lifters coming back from rotator cuff injuries. Swapping out bench press or barbell pressing movements for something like a tempo ring push up for 6 weeks drastically improved their pain without adding any fancy rehab drills in. They were still able to drive an adaptive stimulus while the novel stimulus allowed them to strengthen overlooked stabilizer muscles around the shoulder girdle.
6) Compound vs Isolation Exercises: The body tends to self-select patterns to offload and avoid stressing painful areas during compound movements. This can cause overuse in other areas, and inadequate loading of injured tissue. Thus, there has to be a happy medium between isolating the muscle and gradually exposing compound multi joint movements. So, in my opinion, it is best to have both in a program along a spectrum where isolation may be more appropriate in acute stages, and compound exercises can be of greater emphasis in later stages of rehab. Forcing poor patterns under load is not very productive during a rehab process, but at the same time gradually exposing painful patterns is necessary at some point to eliminate apprehension.
Lastly,
I wanted to discuss when pain is ok to push through or “flirt with” in a given exercise. We know pain is not always related to tissue damage, and is a normal phenomenon. Therefore, if pain is present in an exercise, we shouldn’t always shy away from it. I will give some recommendations but always consult with a licensed Physical Therapist before applying as everyone will respond differently and need a different prescription.
When we should poke into pain:
1) The pain does not get worse along the duration of the set
2) The pain is getting better along the duration of a set/sets.
3) The pain returns to baseline after a set/ workout
When we should NOT poke into pain:
1) Pain is getting worse rep to rep
2) Pain does not return to baseline after a set
3) Pain is worse the next day after the workout
4) Pain is keeping you up at night
5) acute strains/ fractures/ trauma
Pain is a request for change. Luckily there is a TON you can change in your current program, and I hope this offers you some insight into some parameters that can be adjusted. More importantly, I hope you can understand that there is a bright side to injury and can offer more opportunities than you think!
If you would like help structuring a plan to train around injury, I do offer online coaching for this and would be happy to guide you a this is a great passion of mine.
Now stop resting and get after it!