How to Train Through Chronic Injuriesby Lee Boyce, CPT on September 7, 2013
How to Train Through Chronic Injuries
It’s not always a cakewalk to be a regular in the gym, training hard, and attempting to train smart. If you’ve got a history of “bad shoulders”, for example, chances are something is going to nefariously sneak its way in to bother you at some point. The same goes for other common “problem spots” on the body. Most of us reading this are pretty serious about our training, and for that reason, it’s almost out of the question to be sidelined by some nagging injury for the course of your rehab time. Here, I’m going to go over 3 of the most typical injury sites (and also common types), and also show just how we can train around and through them to still get the most out of our workouts. A “do’s and don’ts” as it were. Take note that this doesn’t deal with acute injuries – if you’ve torn a muscle or had a major trauma to one of your joints, you need the help of a practitioner, and likely a lot of rest. That’s outside of my jurisdiction – I’m talking about the chronic stuff. Allow me to compile my arbitrary thoughts.
How to Train Through a Crappy Rotator Cuff
Out of all sites of chronic pain or poor quality, the rotator cuff has got to be the number 1. The simple reason is this: dudes love to press. And we don’t love (or just don’t know how) to take care of our shoulders so that we can continue pressing. The strength of our pressing exercises, like the hallowed bench press and also the military press is directly dependent on the stability of our rotator cuff muscles. The rotator cuff is comprised of a group of four muscles named the supraspinatus, infraspinatus, teres minor, and subscapularis. Instead of grabbing a 3lb dumbbell and trying to “isolate” these muscles through tiny, rotational movements, take heed of the fact that strengthening your rotator cuff comes down to looking at the origin of the muslces – the scapula. More pulling exercises in general will definitely get you more stability in the rotator cuff since your scapulae have to retract by way of their muscles contracting. A pair of set shoulderblades equals a happy shoulder joint.
Okay, got it. Get your back strong by blasting it with pulling exercises that involve the scapulae. This is all good to know for preventive care, but what happens if you’re reading this AS you experience rotator cuff pain? It’s not as simple a task to reverse what damage has been done. With that said, it’s time to employ some strategy. See, you can still press, but you have to make sure that your tissue quality creates the most ideal environment to do so pain-free.
In a bodybuilding workout, this is going to sound like hell – it’s true. Lifting heavy weights usually sounds best when it’s paired with rest. But spending your rest time doing something productive to set the shoulders up for the next set is definitely a good idea if pressing usually leaves them on fire. And guess what – the answer is pulling. Take a lightly loaded weight in any form and just get your reps in. In between sets of your bench or strict press, you can do a single set of 15-20 reps of any upper back dominant pulling variation in order to restore blood to the upper back and get the shoulderblades pulled tight. It also will decrease the range of motion the scapular muscles have based on the fact that they’ll be mildly pumped. This is a good thing where pressing is concerned. After you’ve finished your active rest, don’t wait too long to commence your next set of pressing. My favourite intra-set scap exercises are:
- Light seated rows
- Light db bentover reverse fly (palms forward)
- Inverted rows (bodyweight)
- Band pull-aparts
- Band resisted rows
We have to remember also that tissue quality can play a role on the opposite side of the body too. A tight pair of pecs will act to negate shoulder retraction and overall shoulder health. Static stretching the pecs between sets of pressing, and before sets of pulls, are a great way to dull the nervous system just enough to accomplish what we’re after. The muscles will regain their strength in time for your next pressing set, so don’t worry about getting weaker.
Also, avoid any exercises that make the lifter bear load from an internally rotated position. That will create undue stress on the shoulder capsule and risk impingement on subacromial bursae. It’s worth bringing this up because exercises like bench dips, upright rows, and even in many cases, the bench press, can act as shoulder killers – especially if you’re predisposed to injuries.
Getting into habits like the above will definitely yield positive change where your rotator cuff pain is concerned. Soon your presses won’t be nearly as painstaking as they’ve been, and you’ll be showtime ready.
How to Train through Bad Knees
As a sports athlete in high school, I didn’t have a fun time being tall and trying to play sports that involved plenty of explosiveness. I was naturally gifted with a very high vertical jump and lots of short-burst power which enabled me to be a fast sprinter. However the impact that it would have on my knees was the worst, ever. It wasn’t until university when I had been a student of kinesiology, along with a varsity athlete that I realized a proper coach could diagnose and address ways to minimize knee stress that I experienced on a day to day basis from my events.
A Look at the Patellar Tendon
The patella is a “floating” bone that’s held in place by the patellar tendon attaching from its bottom end (the apex) and below it to the tibial tuberosity, and above it and articulating into the quadriceps. There are many reasons why this overuse injury comes, but is usually boils down to some form of overuse that causes the tissue to be strained. The long and short of this is simple. The more muscles we have contributing to the knee’s function, the better off we’ll be. Step 1 (much like my shoulder section) would be to ensure that the hamstrings and glutes are firing properly and doing what they’re supposed to be doing on the opposite side of the body. It doesn’t help the situation if your training comprises of many single joint isolation exercises that shut the muscles out of the picture. I know it’s a bodybuilder’s delight, but exercises like the leg curl and leg extension machine can produce shear forces since muscles on both sides of the leg don’t get to contract simultaneously. It’s a better idea to use squat and deadlift variations, Lunges, and even the leg press as the bulk of your workout program. They all encourage a co-contraction of the quads and hamstrings to eliminate shear forces which stress tendons and ligaments.
The Hip Flexors Matter
This is a muscle group that are often directly responsible for patellar tendinitis issues. The rectus femoris is a quadriceps muscle that actually crosses over the hip joint also. If you have tight hips, stretching and soft tissue work to the rectus femoris and hip flexors can act to relax the entire quadriceps, and get rid of the tugging it’s doing on the patella. As a by-product, the pelvis will likely be in a better position to facilitate glute and hamstring activity, which is always a win. Applying this all to workouts is just as logical as it was in the last section. Static stretch the hips and quads immediately between sets of squats so that they don’t take the entire load. The lowered involvement neurologically will allow the glutes and hamstrings to kick in for a much better quality (and feeling) squat. Ditch the leg extensions and curls, and focus on more compound exercises. If you’re still dealing with pain, choose exercises that encourage a much more vertical shin position. That will allow for no forward tracking and less quad dominance. Great exercises to choose would be:
- Box squats (with a wider stance)
- BB Deadlifts and RDL’s
- Rear leg elevated split squat
- Reverse lunges
Once you’ve reached a point where you can go through movements like these and have no problem, it would be in good interest to focus on making the muscles surrounding the knee itself stronger so quad loads don’t shift to the connective tissue. The following 2 videos are my favourite preventative maintenance exercises for lousy knees, and should be used daily3 for sets of 10-15 to make them bionic. Thank me later.
Peterson Step ups
Terminal Knee Extension
How to Train through a Bad Low Back
Spinal issues are a different animal, and for that reason, this section will be short. I don’t want to cross over into territory I’m not familiar with, especially since I’m not a practitioner.
As a trainer, many of the issues I notice when it comes to back problems either have to do with pelvic obliquities or tilts. A pelvic obliquity usually refers to a difference in level from a lateral perspective (i.e. the left side of the pelvis sits higher than the right). As a result of this, the body has to adjust. In order for the person experiencing this to not feel imbalanced or walk around “crooked”, the spine undergoes a localized compensatory scoliosis to keep the eyes and ears level for balance. In English, it basically means the spine disfigures itself to make up for the fact that the pelvis is throwing off the lifter’s balance.
For this issue, you may feel lower back pain that’s more localized to one side of the back. That’s likely where the compression is. My best recommendation is to go see a good chiropractor who also practices A.R.T. A couple of quick adjustments and release techniques should have you feeling as good as new. Depending on the severity of the compression, you may need to revisit him to spot up.
A pelvic tilt refers to a forward or backward angle. When I was working with Team Jamaica at the Penn Relays, it was the most common issue the sprinters displayed – and very prevalent among athletes or athletic people in general. Anterior (forward) pelvic tilting shortens and tightens the hip flexors and lower back, and usually deactivates the glutes and pulls the hamstrings tight. In the posterior chain, the glutes shutting down is bad news bears. In functional movements, they’re ideally the first muscle on the rear side to fire. Then the hamstrings, then the lower back. In their absence, the hams and lower back have to take on the load the glutes forfeit.
This one is a little more multi-faceted. The first choice is easy – make sure you get your glutes to fire. Bridging, hip thrusts, box squats, and walking lunges are 4 great exercises I personally use when I want to really hit the glutes. It often doesn’t take much weight to really make them work, if they’re having issues firing (see video below). http://www.youtube.com/watch?v=AZdU08X9CVs
The second choice is to think of spinal compression versus spinal decompression. An overarched back means compression on the lumbar vertebrae. Exercises that create traction on the vertebrae to decompress them are exactly what the doctor ordered to fix this problem.
Lat Pulldowns, Hanging Leg Raises, Pull ups, Dips – These are all good examples of hanging exercises that will allow the spine to completely relax and hydrate the intervertebral discs. These are money exercises for folks with low back problems from pelvic tilts (I especially like to use the leg raises – bring those knees up to shoulder level!). Just make sure not to overarch while performing them, as it’ll defeat the purpose.
Reverse Hyperextensions-if you’re fortunate enough to have one of these machines at your gym, jump on it like Will Smith. The hamstrings and glutes contract downwards, whereas the hips and quads contract upwards. Attaching the machine to the heels and lifting the legs is a great way to let that downward contraction pull the spine out of compression from below. Not to mention an awesome exercise to hit the posterior chain.
- When squatting, choose front squats and goblet squats as often as possible. They encourage a much more vertical torso, meaning a shorter lever arm for the low back to bear, and less shearing forces on the vertebrae.
- Don’t focus on loading up the deadlift. Chances are pelvic obliquities and tilts are a product of lack of recruitment efficiency in the lower body. Make sure you’re hinging properly in your squats and deadlifts, and train for quality first.
- Foam roll like crazy – tissue quality is too important to salvage when we’re dealing with the low back.
Without taking a super medical approach, that’s what I got for training through chronic pain. Whether you’re training to compete in a sport or show, or just a recreational lifter – as long as you’re dedicated, the sad truth is, you’ll hit a stymie in some form down the road. In my opinion, I’ll be the first to say it’s best to be prepared. A little planning goes a long way in the road to health, safety, and gainz gainz gainz!
Lee Boyce is based in Toronto, Canada, and works with strength training and preventive care clients. He is the owner of leeboycetraining.com and is a contributing author to many major publications including Musclemag, TNATION, Men’s Health, and Men’s Fitness. Check out his website www.leeboycetraining.com and be sure to follow him on twitter @coachleeboyce.