In Injury and in Health... Training Through Injury

So, you've injured yourself—hopefully nothing serious—perhaps a muscle strain or a minor sprained joint, or a minor case some sort of "-itis" brought on from overuse and/or poor movement patterns. It's not going to kill you or permanently disable you, but it's enough to piss you off and get in the way of your training; and now you're left, angry and in pain, wondering what the next step is. When will you be able to get back to training? Are there any movements you can do to keep up progress while you recover? Is there anything you can do to speed up recovery? 

I've found myself in this situation a number of times, and each time I come out of it with a little more wisdom, patience, and insight. It's one of those things that, while difficult and incredibly frustrating, gets easier with experience, and can ultimately teach some very valuable lessons.

Injury is something of an inevitability if you spend long enough training or participating in sports. Proper movement and intelligent training will aid in preventing injury and optimizing performance, but accidents do happen, and sometimes optimal training and recovery don't fit in with the demands of ordinary life, and we make a mistake and end up with a pulled muscle or strained joint. When this does happen, it's important to know how to handle it without making the injury worse and without letting all training and progress come to a screeching halt. The good news is, most injuries will not require you to completely abandon your training. And a few basic principles can help guide you through answering the above questions for yourself and help you get back to making progress and feeling happy and healthy as soon as possible. 

Sound of Mind, Sound of Body
Hopefully this is obvious, but it should probably be mentioned anyway: if your injury is serious, or you think it may be serious, or your buddy keeps telling you it looks serious, see a doctor. If your femur is sticking out of your thigh or you can't move half of your body, you should probably get your business taken care of and not worry about keeping up on your training for the moment. Having a full knee replacement at 28 years old because you're too macho to be slowed down by serious pain or injury doesn't make you a badass. Seriously, when in doubt, see a medical professional.

So, rule one: don't be stupid. 

I could probably just end the post here—this principle will take you pretty far in training (and life)—but I like to hear myself talk, so I'll press on. 

Because in the end, running on a sprained ankle is still better than being eaten.

Most of the time we know when we're about to do something really stupid; yet, fueled by hubris or stubbornness, we press on and make a mild injury worse or delay our recovery. The body does a pretty good job at letting us know when it's injured and telling us what movements are going to make things worse. So, unless you're being chased by a pack of pissed off, hungry bears, you probably shouldn't be running on the ankle you just sprained. Curiosity kills cats and cocksure stupidity kills athletes' knee joints. Don't be that guy!

Listen Up

Rule two: listen to your body. 

This one pairs closely with not being stupid. The body wants to protect itself. It does not want you to destroy your already abused tissues. Fortunately (or unfortunately), we have the pain response. Pain is a powerful mechanism that allows your body to tell you what's going on inside. While it is not always an accurate measurement of tissue damage or injury (damaged tissues can be asymptomatic and pain is sometimes not associated with injured tissues), it's wise to take heed of the pain signals your body is sending to you. There's a chance your body may be sending an "inaccurate" message, but usually (particularly with acute pain) the pain signal is being sent for a reason. And it's better to play it safe than to "tough it out" until you need of a new kneecap. 

To take this all a bit further, let's consider an example. You tweaked something in your left shoulder doing a snatch last week. There's no swelling, and no real loss of range of motion, but your shoulder feels a bit achy and swinging your arm overhead doesn't feel great; but otherwise, doesn't seem too serious. Today's workout calls for dips. You get up on the dip bars and start your first rep only to find that you get some pretty serious anterior shoulder pain in the bottom of the dip, and your left shoulder feels pretty shaky and unstable. The pain isn't excruciating, but it's enough to give you pause. 

So, should you press on (no pun intended) and impress your bros and brodettes? 

Well, is there a $30 million contract on the line? Does your life or the life of a loved one depend on getting these dips done today? If the answer to both of these is 'no,' then you should probably stop dipping, pronto. Your body is telling you, loud and clear, that this position and/or this movement is taking your damaged tissues to a place they shouldn't be. Push it too far, and there's a chance your irritated labral tissues are going to turn into completely torn labral tissues. And that's just not cool.

Know Thyself

Rule three: understand what's injured, and understand how those tissues are involved in movements. 

If you can figure out, even in a very general sense, what tissues are injured and to what degree, you can generally extrapolate what kind of movements you should avoid until you're healed up and what kinds of movements you can do to keep your training progress up and speed recovery. With minor aches, strains, and pulls, there's usually no need to see a doctor and order an MRI or CT scan to get an insider's view of the damage, so you'll have to do a bit of detective work. With an acute injury that came from some sort of trauma or mishap, it's pretty easy to get a general idea about what's injured. 

For example, if you were running, rolled your ankle, and now you have lateral swelling and bruising, it's safe to say you caused some damage to some of the ligaments on the outside of your ankle. From here, you just need to do a bit of thinking about what movements are going to put stress on those tissues and avoid those movements. On the other hand, radiating pain from nerve compression or the like can be a bit more mysterious. Shooting pains in the leg can be caused by an issue in the back, shoulder and arm pain can be traced back to neck injury, and so on. However, some Google-fu can generally shed some light on the root of the problem. Understanding what nerves run along the path of your pain, and the origin of these nerves can give you a pretty good idea of what you're dealing with. For example, shooting pains down the leg and into the foot that seem to appear out of nowhere may be caused by irritation of the sciatic nerve, which originates from the L4 to S3 vertebrae. Knowing this can help you decide what movements will be off-limits and what movements will help your recovery. 

For most minor injuries, some due diligence in educating yourself on the injury and anatomical structures and thinking about how those tissues are involved in movements should give you a pretty good blueprint for what should/should not be done while you're recovering.

Less Pain, More Gain

Rule four: figure out what you can do pain-free and with proper function.

Again, lucky for us, our bodies have provided us with a pretty simple and effective tool for assessing whether a movement is a going to make things better or worse—pain! While it may not be 100% accurate, and while there are times that painful movements actually should be done will help with recovery, these exceptions should be left to healthcare professionals. In addition to pain, injured tissues can also cause some pretty massive instability in an injured joint. If your shoulder gets shaky and feels like it's going to pop out of the socket when you try to perform a push-up, you probably aren't in any shape to being doing push-ups right now (and should probably see a doctor). The general rule for training through an injury is this: if it hurts or it feels super sketchy, don't do it. Simple stuff. 

It's important here to also recognize the difference between injury pain and soreness or some other types of pain. If you did 50 heavy back squats in your most recent workout, your legs are probably going to be sore. While soreness is painful, it is not injury. With soreness, it's actually generally a good idea to push through the pain and do some lightweight movement of the sore tissues. This will increase blood flow to the area, prevent excessive and perpetuating stiffness, and will help alleviate the soreness quicker. 

It's also important to recognize the pain involved with soft tissue work and mobilization and how this differs from injury pain. Unless you have the tissues of a young and supple demigod, rolling your quads on a lacrosse ball can be seriously painful. But this pain is not the same as that caused by doing pull-ups when you have elbow tendonitis or trying to "stretch" your back after you just pulled your lat. The difference is generally pretty evident if you're paying attention to the signals your body is sending, so listen closely. 

Know your pain! Stretchy pain is very different than torn ligament pain.

A little bit of quick trial and error can pretty clearly reveal what movements can be performed as you work around your injury. After you've completed the previous step and figured out what's injured and how those tissues are involved in movements, you can start exploring what movements you can utilize in your training as you heal up. Start with light (bodyweight or empty bar), basic movements, and go easy and slow. As you figure out what movements you can perform without pain and instability, you can establish how much of your program you can continue to perform as prescribed, and figure out what exercises you can substitute in for the exercises that would cause pain. And, as your injury heals and start getting closer to feeling 100%, you can perform movements that directly involve the injured tissues and include exercises that were previously painful with very light weights to begin to re-establish stability and strength and encourage blood flow to the recovering tissues.

Let's return to our injured shoulder example for a moment. Let's say that today's workout calls for snatches, back squats, dips, and pull-ups. You start by putting your arms overhead, in a position similar to that in a snatch (with no weight) and it brings up a dull ache in your shoulder, so no snatches today. You do some squats with just the bar, and those feel fine on your shoulder. You slowly add weight to the bar, and it doesn't seem to aggravate the shoulder, so you're good to go on squats. You establish quickly that the bottom position of the dip is painful and sketchy, so those are out of the question. Finally, you start with some light lat pull-downs to mimic the movement of a pull-up. It doesn't seem to bother your shoulder, so you move on to strict pull-ups, and can include those in your workout without issue. So, you're hunting for substitutions for snatches and dips. Snatches are an explosive hip extension exercise, so something like box jumps, standing broad jumps, or even snatch pulls (assuming those don't bother your shoulder) could provide a similar stimulus without putting stress on the injured tissues of the shoulder. For dips, given what you've figured out about the injury of your nature and how those tissues are involved in movement, you're aware that most horizontal pressing movements will be out of the question, as will overhead work. However, you could still get a somewhat similar stimulus by working the triceps. Banded tricep pushdowns, skull crushers, and cable tricep pushdowns might all be good options. You could also include some hollow rocks to mimic the midline stability demands of the dip.

It may take a bit of creativity and trial and error, but often you can find ways to stick closely to the prescribed training stimulus while allowing your injury to heal.

Patience, Young Padawan

Rule five: don't rush it. 

Healing takes time. A muscle strain, even if it doesn't seem all that major, can take months to fully heal. One of the biggest mistakes (and one that I think many athletes make) is rushing back into things. Two weeks after straining a muscle in your low back, you wake up with no more pain and are so excited to be pain-free that you jump right into a workout consisting of heavy deadlifts, pull-ups, and atlas stone loads. Probably not going to bode well for you. Being symptom free means you're symptom free, not injury free. I've made this mistake more times than I care to admit, and I've learned that it's much better to give your body a few extra days to heal than to jump back into too early. The most frustrating thing you can do is take an almost-healed injury and make it worse. What should be a three week recovery turns into a total of seven weeks of recovery when you try to get back to it too soon and make everything worse. Strength is something that is pursued over a lifetime. An extra week is not going to ruin all of your gains and make you weak, but it can keep you from hurting yourself more. 

Always Look on the Bright Side of Life

¹Cheer up bro! Bench press and pull-ups for days!

Rule six: keep a good attitude.

I hate being injured. But, I find that I always come out of injuries with a bit more knowledge and perspective. You tend to learn a lot about your body and the way it moves when you are forced to pay close attention to your movements to avoid pain and allow tissues to heal. In addition, it can be a good opportunity to focus on something that you've been wanting to add to your training or improve on. If you rolled your ankle and can't squat for a few weeks, use that time to apply extra focus and effort to increasing your bench press or your pull-ups. The worst thing you can do when you're injured is throw the baby out with the bathwater, adopt a dismal outlook on the whole ordeal, and give up on getting something positive from the whole experience. Keeping a positive outlook will help you trudge through the pain and inconvenience and can help you see the lessons that you can learn from your injury. Don't be a gloomy Gus and don't let your injuries be for naught.

Those Who Don't Know History are Doomed to Repeat It

Rule seven: figure out why you got hurt, learn from it, and don't make the same mistake again.

As I mentioned before, injuries, however inconvenient and painful, can provide us with some valuable lessons. Engaging in some self-reflection and pattern recognition can shine light on some movement deficiencies, poor postural or movement patterns, or weaknesses that you were previously unaware of. 

If it is an acute injury, think about what you were doing when the injury occurred. If you were benching and tweaked your shoulder, ask: What did my bar path look like? Where were my elbows? Is my descent slow and controlled, or herky-jerky and uncontrolled? Am I creating torque on the bar? Are my shoulders staying locked into a stable position, or are they shifting all over the place? 

If it is pain or injury that you can't trace back to an acute trauma—for example, development of sciatic nerve pain—you need to take a close look at your posture and movement patterns, and recognize what patterns may be have been gradually contributing to this injury that's now rearing its ugly head. Are you sitting, completely idle, for 15 hours every day, and then rushing into the gym to perform a 30 minute high intensity workout without any warm-up or cool down? Are you sitting, walking, running, and lifting from an overextended or flexed position? Do you perform routine mobility to maintain your body and help your tissues recover from all the abuse you throw at them? 
Figure out what went wrong, and fix your business. 

You know what's worse than getting injured? Getting injured in the same way again because you didn't correct the problem. Use your injury as an opportunity to learn from your mistakes and become a better, stronger person. 

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In future posts we will delve into specific exercise substitutions and strategies for common training injuries.
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1 photo credit: via photopin (license)^↩