Updated: Sep 8, 2020
Maybe you’ve been there. You’ve been doing your best to be active, showing up to the gym. You are feeling great, getting stronger and making progress. And then it happens. You tweak something. Whether it’s your shoulder, your back, your knee…whatever it is, it’s not fun.
The knee jerk reaction to an injury like this is usually to take time off. While that’s the common response, it’s not necessarily the best route to go. Our tissues respond to load. This means in order to heal and remodel to withstand the loads we put through our tissue, we have to load them! Taking time off may make things feel better in the short term, but if we jump right back in to trying to load them again without readying the tissue for the load, the injury will just “flare up” again.
So what do we do?
Check Your Programming
You can have the best form in the world, but if the volume of training is too high, you are at an increased risk for injury. With an acute increase in workload, injury risk increases. I’m not advocating for staying home from the gym everyday to cut down on volume, however volume management may be enough to decrease irritation, allow things to calm down, and then slowly build up.
One indicator of volume of programming is utilizing the acute to chronic workload ratio, which is a fancy term for what you do within one week in comparison to what you have been doing in the 4 previous weeks. There is a sweet spot for this ratio (0.8-1.3), where our body will make positive adaptations, as well as a number that indicates undertraining (<0.8) and one that shows overtraining (>1.5-2). Undertraining and overtraining both pose an injury risk. This can be an easy number to arrive at for runners, because looking at distance ran per day is easy to track. It gets a little messier with weightlifters or cross fitters because it involves calculating tonnage.
Tonnage=load x sets x reps
A real world way to look at this, because let’s be real a lot of people won’t calculate that, is to look at overall volume of movements. If you are a cross fitter, and your box has started a cycle with pull ups programmed every workout around the same time your elbow pain flares up, it’s possible that your injury is related to the volume of pullups, and modifying the volume may be enough to knock out the pain.
If changing the volume doesn’t work, change the intensity and load
If modifying the volume you are performing the movements still bugs it, it’s time to look at the movement itself. This can take many different forms. Slow it down and add tempo work, play with your foot position and stance, decrease the depth of the movement are all great options. This doesn’t have to be a forever change, just while things are irritable. If squatting to full depth lights your knee up, regardless of if it is one squat or 15, or 80% of your 1RM and 40%, try squatting to a box to decrease the range of motion, or perform tempo squats and really dial in what is happening at each position as you do the movement. Tempo work gives you time to feel what it is you are doing and make corrections as you are doing the movement, rather than assessing after the fact.
If changing the load and intensity for a given movement still doesn’t get rid of the pain, it’s time to swap out that movement for a SIMILAR exercise that works the same muscles in a different way.
When you have tried to modify volume with no results, and have tweaked aspects of the lift but still have pain with it, it may be time to take a break from that specific movement. By taking time off the movement, we allow sensitized tissues to calm down. It’s important to note that this is NOT the last step of rehab-once we take out a movement, the plan is to add it back in in the long run. However, we can’t rebuild a house if it is still on fire. We have to put that fire out, then start from the ground up.
How long do we take the aggravating movement out? This is variable from person to person, and several factors will come in to play on this decision-how long the pain has been occurring, stress and sleep level of the athlete, and frequency of training. I typically tell athletes to give it a minimum of 3 weeks before adding back in the agitating movement.
If back squats are bothering you, try:
Supported squats on a rig or rings
Kettlebell goblet squats
Change the position of the bar-high bar vs low bar
If deadlifts are bothering you, try:
Good mornings (banded or barbell)
Cable pull through
Trap bar deadlift
If bench press is bothering you, try:
Push ups (knees, to an elevated surface, with a band)
Floor dumbbell press
If strict press/jerks are bothering you, try:
Dumbbell press (bilateral or unilateral)
Reintroducing the aggravating movement
This is the key to successful rehab, and where many therapists and trainers drop the ball in management of an athlete. We don’t want to tell someone they just can’t squat for the rest of their life if squatting is something they want to do (and let’s be real, squatting is one of THE most functional movements out there, I would argue we ALL need to squat!)
When reintroducing a movement into programming, it is important to start light. I’m talking 40% of your 1RM light. This sometimes gets a lot of push back from athletes…after all, you have been modifying movement for 3-6 weeks by this point and you are ready to dive back in! The reason we start light and build from there is that specific demand has not been placed on your tissues in several weeks. If we go from not doing the movement and jump right back in at the load that contributed to the pain in the first place, we are setting ourselves up for a reoccurrence of pain. It is important to build tissue tolerance to load at this point.
Instead, start lighter. If you are programming your own workouts, try to train the lift 2-3 times a week, 3 sets of 4-6, increasing the weight by 5-10 pounds along the way. If you are a member of a gym and are not in charge of your own programming, instead I suggest continuing to modify the movements in metcons (decreasing the weight to a load you can tolerate under fatigue without reproduction of symptoms OR continuing to perform one of the similar movements in place of the aggravating one), and swapping strength work that may be programmed for wherever you are in your return to lifting at that time. If your gym programs 4x3 at 75% of your 1RM, but you are in the process of reintegrating that movement, swap it out for 4x3 at 50% of your 1RM (or wherever you may be in your percentages). Add in one to two extra sessions of working that movement as accessory work. At this point, doing the movement IS your rehab!
It's never fun to have to make these changes, especially when you feel like you were in such a good groove with your training. However, if your ultimate goal is to CONTINUE to train throughout your lifetime, respecting tissue healing time and listening to your body are important. Longevity of training is the goal so we can remain healthy, rather than hammering an angry tissue and ultimately ending up stepping back from lifting or feeling like we "just can't do" whatever sport or movement aggravated it in the first place. Our bodies are resilient, trust the process and get back to the barbell!
This is not intended to be medical advice. If you are experiencing pain, consult your local physical therapist. To book a session with Disrupt Physiotherapy, email firstname.lastname@example.org.