Training Through Injuries

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Training Through Injuries

Over the past thirty years of my competitive career and personal general health training I’ve had so many injuries, that when filling medical application I run out of space on the forms. I’ve broken several bones, sprained ankles, overextended knees, torn hamstrings, adductors, gluteus and rotator cuff.

I have had severe pain in most of the body parts: ankles, knees, hips, lower back, shoulders and neck.

hip resurfacingTo the most serious cases though I have to include 2 times hips resurfacing which made me officially a bionic man.

I acquired most of these injuries while training ITF Taekwon-Do during the competitive as well as coaching phase of my career.  Some other happened during regular strength training. Along the way, I’ve learned how to recover physically, psychologically and mentally from injuries while continuing to train and improve. After my hip resurfacing surgeries I have learned how to get motivation from my physiotherapy and recovery training.

Without risk there is no reward, and with hard training comes the risk of injury and missing significant time away from the gym.

Here’s are few points to keep in mind:

  • Recovery is your responsibility. Don’t assume that physician professionals will tell you everything you need to do to recover.
  • Spend your downtime focusing on the basics and mastering your movement patterns.
  • All recovery is aerobic in nature. Aerobic conditioning can help to speed recovery.
  • Move every day, including the injured area if possible.
  • Work around specific injuries. Just because you got shoulder injury it doesn’t mean you can’t train your core or lower body.
  • Taking a month off from heavy lifts isn’t a bad idea. If you concentrate on posterior chain and core work, you’ll hit new PR’s when you resume squatting and deadlifting after you have recovered from the injury.

Fix Your Mind

The most important element of training through any injury is mindset. You have two options:

  1. Dive in self pity and allow yourself to regress while you slowly recover to your new, lower baseline. In some cases never come back to the regular training.
  2. See the injury as an opportunity and challenge to correct weaknesses and recover as quickly as possible.

I strongly encourage you towards number two. Your mindset will dictate how successful your recovery is.

Know when to tough it out

It is very important to know the difference between a real injury and pain. During a workout, you may tweak something and experience pain.

Your initial reaction might be, “Ouch … but OK, I’m not bleeding, let’s tough this out.” If you have pain, stop working out right there and evaluate your symptoms to check the severity. Don’t just try to walk it out and hope for the best.

Of course we all want to be tough and gut it out, but the consequences for continuing to train and not taking enough time off to heal can be severe. Most of the time, it is a good idea to just stop and heal up before training again.

Of course, small, nagging aches and pains are all part of training and you should definitely tough it out and work through those types of situations, especially if you are in contest prep, but if you have a legitimate injury, it is always best to stop and evaluate.

The most obvious symptom of an injury is pain. So if you experience severe pain, stop or take a break until the pain is manageable enough to continue. If the pain refuses to go away, just stop and see a doctor.

There is a large grey area between what is a “real injury” and what is just a nagging pain, and only a doctor can truly determine which one you have. I always say that, when hurt, get checked out by a doctor.

Injury types

So how do you know if you have a real injury? Generally there are three types of injuries: acute, sub-acute, and chronic.

  • An acute injury occurs immediately, and a few examples are spraining an ankle, tearing a muscle, or breaking a leg.
  • Poor nutrition, failure to warm up, bad lifting technique, and even bad luck can be contributing factors. These injuries are usually serious, and hard training is not recommended.
  • A sub-acute injury is one that builds up over months or years. Examples are muscle strains and various wear and tear injuries that progressively get worse.
  • These can be the most frustrating injuries of all because although you can still train, you can’t train at your maximum intensity level and performance is hampered.
  • Chronic injuries can be devastating. Examples are joint injuries such as rotator cuff injury, shoulder bursitis, or tendonitis.

These sorts of injuries must be handled with caution because just one tweak and you could end up in the operating room. Be sure to take good care of a chronic injury and follow your doctor’s instructions to the tee.

Keep in mind that recovering from injury becomes much harder as you get older.

Older muscle fibers, tendons, and ligaments need more time to recover. If you have a nagging injury, remember that age plays a very important role in determining when it is safe to return to normal activity.

Use the rice method

riceIf you have an acute injury you will probably experience mild to severe swelling around the site of the injury. This is due to the fact that damaged tissue usually swells. This swelling can cause pain, loss of motion, and frustration because you won’t be able to effectively use that area.

RICE (Rest, Ice, Compression, and Elevation), is a great way to treat that injury, reduce swelling quickly, alleviate pain, protect the injured area, and accelerate the healing process.

Ice: Using ice is still the best way to treat an acute sports injury. Ice helps reduce swelling and provides temporary short-term pain relief by reducing blood flow to the injured area. I recommend using ice post-workout for 15 minutes at a time for up to an hour. 15 minutes on, then 15 minutes off.

Tip: Never use heat on an acute injury. Heat dilates blood vessels, accelerates blood flow, and increases swelling, which can make an injury much worse. Ice reduces blood flow to tissue and by doing so, reduces swelling. Use ice instead!

Compression: Just like ice, compression can help reduce swelling. Getting rid of swelling is important because when swelling occurs, the injury can take longer to heal. I recommend using an ACE bandage wrap plus ice because this combo is much more effective at reducing swelling than by just using ice only.

Elevation: This is another useful tactic to keep swelling in check, and it works best when the injured area is raised above your heart. For example, if you have a sprained ankle, prop it up on a few pillows while you lie down. Most injuries can be effectively treated using RICE, but if you have a more serious injury, you may need to see a doctor, especially if you experience any of the following:

  1. Three or four weeks go by and you have not healed, or still have persistent pain.
  2. You can’t move the injured part.
  3. You experience radiating pain.
  4. You have a joint injury that causes swelling.
  5. You feel tingling or numbness in the injured area.

Remember, if you are in pain, the most important thing to do is get your injury looked at by a doctor.

Use proper form

squatTraining injuries can occur for a variety of reasons, but the most common reason is a failure to use proper form when lifting.

Incorrect technique can place your muscles, tendons, and joints in awkward positions and increase the likelihood of a freak injury such as a muscle or tendon tear. If you are already in pain, bad form will increase your injury risk even more.

The human body has very specific biomechanical pathways that we must adhere to if we want to remain injury-free, and technical proficiency when lifting can dramatically reduce your risk of injury. Keep in mind that your limbs can only move in certain ways, and contorting, jerking, or twisting, to lift a weight can put you at extreme risk.

Warm up properly

The saying goes: An ounce of prevention is worth a pound of cure. The same logic applies here. I see many people in my gym walk in and go straight into their workout with little to no warm-up at all. Even though this is an easy habit to fall into, it is a risky one. A proper warm-up is important.

If you quickly flex or place tension on a cold muscle, you increase your risk of injury to that muscle. But if you gradually raise the temperature of the muscle and then slowly stretch it out with static stretching you will help relax and elongate the muscle, and place it in an injury-resistant state. So be sure to stretch and warm up before you train!

As an added bonus, stretching can also help you build more muscle because it can help promote circulation and helps increase fascia elasticity.

Recovery is Your Responsibility

Don’t assume that the medical practitioners you’re working with will be instructing you on everything you can do to recover as quickly as possible. This isn’t a knock on doctors or physical therapists. Most of them spend an extremely limited amount of time with patients and can hardly get them to do the minimum amount of rehab. From my experience I have even met a physiotherapist who having learned I was a coach, told me that I surely know what I needed to do. Well, at that point I didn’t. I was not a physiotherapistJ.

In fact, studies have shown that most people are so apathetic that they won’t even take life-saving drugs more than 50% of the time, let alone do anything that involves more than stuffing a pill in their mouth.

Having a successful and speedy recovery is your responsibility, no one else’s.

How Injuries Affect Training

Your immune system is intricately tied into your body’s response to exercise. When you lift a heavy weight or smoke a conditioning workout, cellular damage occurs. This causes a cascade of other responses that end with you becoming bigger, faster, or stronger. This dynamic interaction means that your body’s response to the same stimulus is constantly changing.

Any injury that causes a large systemic immune response will disrupt your body’s response to training and ability to tolerate stress. You need to modify your training to account for how stressed your immune system is throughout the recovery process. Exercise beyond your body’s ability to recover is a “pathogenic” stressor and slows recovery instead of stimulating it.

Rehab & prevention

I cannot understate the importance of proper injury treatment and rest, but once your pain starts to go away you’ll probably think about jumping back into hardcore training right away. This is a very common mistake many athletes make post-injury.

The primary concern here is reinjury. When you miss significant time from the gym due to injury, the rapid atrophy and degeneration of your muscle tissue that takes place can put you at high risk for re-injury once you start training again.

If in fact you do jump the gun and reinjure yourself, you’ll have to endure the entire painstaking rest and treatment process all over again. Not only is this cycle frustrating, but it is usually preventable.

If you have a serious injury, always get the approval and recommendation of your doctor before returning to the gym, because developing a long term injury just isn’t worth it. If you are in serious pain, put your training on hold and see a doctor.

I know that many people hate going to the doctor because they believe that their injury may miraculously disappear the next day, but resting when injured is critical because you protect the injured tendon, ligament, and muscle from further injury and damage.

pcc_0_57444100_1405520623_rBe sure to follow your doctor’s recommendation for when you can return to the gym, how hard to push yourself, what types of exercises are best, and the type of rehab you should be doing.

Don’t try to avoid a nagging injury. It is far better to miss two or three days now than to be forced to take two or three months off down the road.

So there you have it: all the need-to-know information about training with an injury. Make sure you apply these tips so an injury doesn’t get you down!

Basics of Recovery

Nutrition

This is number one on my list, not only because nutrition is often underrated and overlooked, but also because it’s likely the most important factor in injury recovery.

Healing from an injury can take weeks or even months (healing time can vary from person to person), but you can dramatically accelerate the healing process by getting adequate nutrition and maintaining a healthy lifestyle.

Healing is largely dependent on blood supply, and the stronger the blood supply, the faster you can heal because blood supplies the injured area with important oxygen and nutrients which help the injury heal.

Certain foods can promote inflammation within the body, while others have an anti-inflammatory effect.

Avoid inflammation-promoting foods such as fried foods, processed white flour, eggplant, cayenne, tomatoes, potatoes, and hot peppers, and eat more foods that are high in omega-3 fatty acids.

Be sure to drink plenty of fresh juices made from fresh, organic, raw veggies, because raw veggies are high in important enzymes and vitamins that can speed up the healing process.

Garlic, radishes, and beets are especially helpful. You can also mix in a bit of fresh ginger; ginger has powerful anti-inflammatory properties and helps reduce pain and soreness.

To create an optimal healing environment and get back on your feet quicker, be sure to eat 8-10 servings of fruit and vegetables daily.

Important nutrients that aid recovery:

  • Multivitamin: Very important. Helps prevent vitamin and mineral deficiencies. Aids tissue repair.
  • Zinc: Important in tissue repair.
  • Vitamin C with Bioflavonoids: An important antioxidant which helps tissue repair and growth.
  • Manganese: Strengthens wounded tendons and ligaments.
  • BCAA’s: Help promote the healing of muscle tissue, bones, and skin.
  • EFA’s (essential fatty acids): Speed up recovery and promotes cellular health.
  • Vitamin B Complex: Helps reduce injury related stress.
  • Glucosamine Sulfate: Helps strengthen and form tendons, cartilage, ligaments, and joint fluid.
  • Calcium: Helps repair connective tissue.
  • Silica: Important for calcium absorption and connective tissue repair.

 

Work on your weaknesses

sports-injury-therapyTraining what you suck at, well, sucks. But take this as an opportunity to improve. Most people like to train what they feel comfortable and good at. Leaving all the difficult stuff aside, getting better in what they are good at and getting worst in what they are not so good at already. There are plenty of areas in which you can improve; maybe you need better aerobic capacity, movement, and breathing. In addition to that, you’d likely benefit from spending some time focusing on the basics and dialing in movement patterns again.

If you don’t know what you suck at, just ask yourself what you dread training the most. Better yet, ask a training partner or friend who isn’t afraid to hurt your feelings about what your weaknesses are.

Figure out weaknesses and attack them.

Don’t ignore conditioning

All recovery is aerobic in nature. Blood flowing around an injured site as well as throughout the body promotes exchange of waste and the rebuilding of cells and speeds recovery.

Aerobic conditioning also develops the fat oxidation capacity of your liver, which allows it to clear out immune system waste products more quickly. In addition, aerobic conditioning allows for greater parasympathetic tone, which promotes rest and recovery.

I can hear the excuses now. “I’m trying to gain muscle.” “I don’t want to get weak.” These bullshit excuses are the plaintive cries of mediocrity. Unless you’re an elite-level power lifter, Olympic lifter, or bodybuilder, you have no excuse to be deconditioned.

Similarly, no one who weighs 80kgs is too heavy to have a decent aerobic capacity. You have no excuse. Get to work.

So, do your aerobic conditioning. Work up to 2-3 times per week for 60-90 minutes. Circuits of various low threshold movements can be a substitute for steady state aerobic work.

Movement is nutrition

Whenever you injure a soft tissue (muscle, ligament, tendon), movement is your best friend. As long as you use common sense and stay within the range of motion and loads your medical practitioners outline, you’ll be doing your body a favor. Movement stimulates increased blood flow around the injured site, thus feeding nutrients and getting rid of waste byproducts.

Movement is also a stress (a positive one when you listen to your body) and it stimulates scar tissue formation. This is important because scar tissue develops in specific formations to handle the stress that it’s placed under.

If you don’t stress the injured site during recovery, you won’t develop scar tissue that can handle the movements and types of stress that it’ll be under when you’re healthy and return to full speed. Known movements, performed at a low intensity for reasonable volume, speed up recovery.

Within the context of your specific limitations, move every day, even the injured area if possible.

Breathing matters

This could be a whole other article, but, to summarize:

Breathing stimulates the lymphatic system, digestion, blood flow (oxygenation of tissues), immune system, and helps “clean” the organs. All of this stimulates faster recovery.

Opioid intake (pain killers), pain, and anxiety due to injury or surgery all have significant effects on your autonomic nervous system, which disrupts breathing patterns. If not addressed, this disruption can compromise recovery due to suboptimal acid-base balance in the body and the cascade of ensuing negative effects.

Most of the immune cells in your body are created by the bone marrow in the heads of the ribs. Proper breathing stimulates blood and lymph flow around the ribs, supporting optimal immune cell production. Non-optimal breathing also affects cognitive function. This impairs your ability to make good decisions and changes your perception of everything.

Learn how to use 3D breathing properly and practice every day.

Working Around Specific Injuries

Here are some basics for working around injuries. Apply these within the context of your specific situation. Be smart and do what works for you. These strategies are suggestions, not instructions. Don’t do something just because it’s listed here.

Shoulder, Hand, Wrist, and Elbow Injuries

Upper body injuries are the easiest to train around. You still have your lower body, core and one unaffected arm to train.

Train the other arm. Just because one of your arms is injured doesn’t mean the other one can’t be trained. Try:

  • Single Arm Dumbbell Rows
  • Single Arm Dumbbell Bench Presses
  • Single Arm Dumbbell or Kettlebell Overhead Presses
  • Single Arm Pulldowns

Give your spine a break. Taking a month or two off from squats and deadlifts isn’t necessarily a bad idea. I did that following my most recent back injury and after a few months of hip lifts and lots of posterior chain and core work, I returned to squatting and deadlift. I was hitting PR’s a few months later because I fixed my weaknesses. My back also thanked me. Spine deload exercises include:

  • Rear-Foot Elevated Split Squat (weight in one hand + weighted vest)
  • Lunge Variations (weight in one hand + weighted vest)
  • Hip Thrust

Incorporating dynamic work is a great way to overload the lower body without having a lot of weight on the spine. Examples of dynamic exercises:

  • Box Jumps
  • Hurdle Jumps
  • Depth Jumps
  • Split Squat Jumps
  • Squat Jumps

Knee, Ankle, and Foot Injuries

Lower body injuries can be difficult to work around, but with a few good strategies you can continue to train and retain most of your strength throughout your recovery period.

Train the Upper body. This may seem obvious, but most people think any injury means no training. You can still train the upper body with very few modifications and a good training partner.

Train the uninjured leg. Some options:

  • Single Leg Squats
  • Single Leg Hip Lifts
  • Single Leg Deadlifts

Core Training. A lot of core training involves the lower extremity and without one leg, finding core exercises to do can be difficult. Some of my favorite core exercises for clients with a lower body injury:

  • Dead Bugs
  • Leg Lowering Exercises
  • Reverse crunch
  • Hanging Unilateral Leg Raises

Lower Back, Hip, and Abdomen Injuries

Injuries around the middle of the body are the hardest to train around. However, that doesn’t mean that you can’t continue to train.

Train the Upper Body

For people with lower back and abdominal injuries, start with a lot of low intensity upper-body work that doesn’t stress the injured area. This usually means simple exercises such as floor presses and chest supported rows. Experiment with supported variations that require less core involvement until you find something that works for you.

Replace intensity with volume and density. It’s unlikely you can lift heavy while recovering from this type of injury, so instead focus on doing a lot of high quality, low intensity work in short periods of time. The formula outlined below stimulates blood flow and parasympathetic (rest and recovery) activation.

  • Movement Work – Light-Weight Lunges, Squats, Deadlifts
  • Breathing exercises between sets

Here’s an example of a circuit combining these different principles:

  • Kettlebell Romanian Deadlifts (very light with slow lowering phase)
  • Dumbbell One-Arm Bench Presses
  • Half-Kneeling Cable Rows (hold at top for 3 seconds)
  • TRX supported lunge
  • TRX One- hand Row

Four sets of 5 reps of all exercises. No rest between exercises; the breathing exercise is the rest between sets.

Stages of Recovery

Initial

The initial recovery period will range in length from weeks to months depending on the severity of the injury. During this time your body is in a constant state of systemic inflammation and recovery. The goal during this period should be to feed the recovery process and correct weaknesses without doing too much and inhibiting recovery.

Balance-Pad-Blue-In-Use-800Use the following guidelines to craft a training plan:

  • Perform aerobic activities at least 2-3 days per week.
  • Do some type of movement (squats, hip hinges, rows, presses) every day, but keep the intensity and volume fairly low.
  • Perform breathing exercises daily.
  • Focus on correcting weaknesses.
  • Include injured area targeted isolated movements.
  • Eat a clean diet. Gut health contributes to sleep quality, immune response, and your overall internal health.
  • Perform soft tissue work daily over the entire body including around the injured site.
  • Sleep a lot.
  • Move throughout the day. My favorites are going on five minute walks or performing short sets of 20-25 air squats, light kettlebell swings, push-ups, and pull-ups every one or two hours (or whatever movements I can do).
  • Avoid heavy lifting, anaerobic conditioning, or crushing yourself in any other way during a training session.

Middle

The middle stage of recovery begins when you’re off all pain meds and are able to start more aggressive physical therapy or training without feeling awful for several days. The systemic hormone response from these days should actually speed the recovery process. Aerobic and other low intensity work should be performed on all “off” days.

Use the following guidelines for the middle part of your recovery:

  • Alternate between moderately difficult and easy training days.
  • Easy training days should consist of movement and aerobic work.

Hard training days should follow the set/rep/intensity/rest scheme outlined below because it stimulates a large GH and testosterone response but won’t crush your nervous system:

  1. Perform variations of the big lifts: squats, deadlifts, presses, rows, pull-ups.
  2. Do full body workouts, 3-5 main exercises, 3-5 sets per exercise, sets of 5-10 reps.
  3. Perform supersets of 2-4 exercises allowing full recovery between sets.
  4. Use moderate intensity. Leave at least 2-3 reps in the tank and focus on perfect technique.
  • Light sprints (10-15 seconds) can be performed 1-2 times per week. These are not “all out” days but more like 80-90% effort.
  • You shouldn’t accumulate fatigue over the course of the week. You should feel close to 100% before you perform another strength session.

Back to Normal

The final 10-20% of recovery is always the most frustrating. Working with skilled practitioners can help restore movement and function much faster than if you decide to go at it alone. Key tactics of the final stage of recovery:

  • Slowly return to full intensity workouts.
  • Focus on restoring proper mechanics and movement up and down the chain from the site of the injury.
  • Listen to your body and have training partners critique form or record form on all big lifts to ensure proper movement.
  • Have a long-term mindset. One training session or season is meaningless in the context of a lifetime. Don’t take unnecessary risks in the name of short-term satisfaction.

Now, these are just recommendations and are far from comprehensive. Develop a relationship with the team of people you’re working with and make a plan that works for you. It’s your body and it’s your responsibility to make the best of the situation. Be creative, listen to your body, and most importantly, buy in to the fact that you’re in control of how you recover from an injury.

2016-07-12T13:40:41+00:00