Modification for Constant Progress
I see two extremes among fitness enthusiasts in the way that they handle injuries. The first is “Meathead Mike” who has the “no pain, no gain” mentality. Mike has pain but he ignores it, keeps exercising the painful area, and the pain increases. Eventually, the pain impacts other exercises and activities of his daily life outside of the gym. Finally, when he can no longer comfortably drive his car to work or can’t pick up his children, he goes to the doctor to be diagnosed with severe tendonitis, a torn rotator cuff, or meniscus tear. Mike doesn’t know how to quit, so even with his diagnosis, he will continue to train.
Our next personality is “Delicate Delores” who panics and stops training for any ache or pain. A fractured wrist after a fall on the ice somehow means that her other arm, core, hips, and knees can’t be trained either. Life is full of setbacks, aches, pains, and more serious injuries if you live long enough in this world. When we stop training entirely especially at older ages, things tend to decline. We lose lean mass (bone and muscle), strength, power, less resilient to future injury, and less capable of taking on the tasks of daily life. This all leads to more injuries. For long term minimal injury, follow my basic guidelines:
1) Train unilaterally: One of the simplest ways to modify is to simply train the unaffected side. If you have an injured right foot you can always train your entire left leg. Training the non-affected limb preserves muscle mass of the injured limb. You can also train around the foot by using open chain movements such as leg extensions, leg curls, and hip adduction/abduction exercises where the affected foot isn’t a barrier.
2) Lighten the load: Often, a movement only is problematic or causes pain when the load gets too heavy for the joints, tendons, or muscles. Try going through an exercise without any weight to see if the pain occurs. Then simply increase the weight until you find the maximum load that can be tolerated before pain starts. This is your max training load. Over time, you should be able to get increase this with pain or discomfort being your limiting factor. To make a movement more challenging, you can simply slow down the tempo of the movement, add more repetitions, or reduce your rest periods between sets.
3) Choose a different variation: Changing the variation of an exercise can eliminate pain and discomfort. For upper body movements, you can try a different grip (underhand, neutral, overhand) or apparatus (barbell, dumbbell, kettlebell, suspension trainer). For lower body moves, you can change the load placement (goblet, racked, suitcase, barbell, specialty bar). This allows individuals to continue to train hard and pain free.
4) Alter volume and frequency: Some clients will notice that doing two sets of an exercise is fine, but three or four sets cause pain. In this situation, we can usually maintain the same weekly volume by doing less per session, but doing more sessions per week. For example, rather than training the legs one day per week for eight total sets, train three days of three sets.
5) Get a better warm up routine: For some clients, discomfort gets worse with more sets, but we also often find the opposite. The first set of a movement will be achy or cause pain, but as more are done, things start to loosen up and feel better. This is a good indicator that a warm up is needed. At Fenton Fitness, we take each joint and muscle group we are going to train that day through a full range of motion and a mild to moderate stretch. However a couple simple things that are often overlooked that usually work even better is to simply get more heat and blood flow to the affected area. Field warm ups such as ladder drills, skips, bounds, shuffles, etc. will get more heat and blood flow to the affected area. You can also hop on a bike, treadmill, or elliptical for 2-5 minutes to work up a light sweat. For stronger individuals, adequately warm up with an exercise before starting the “working sets”. For example, for three sets of eight goblet squats with a 24 kg kettlebell, warm up like this—bodyweight squat for 15 reps, 6kg squat for 8 reps, 12kg squat for 4 reps, 18kg squat for 2 reps. This will gradually load the movement pattern and bring blood and heat to the area to be trained.
6) Limit range of motion: This is typically our last option as we try to maintain full joint range of motion at all times. However, there are certain joint issues such as severe arthritis or bone spurs that will simply not allow joints to travel past a certain point without causing pain. Similar to our “lighten the load” tip, we find the maximum range of motion to use without pain or discomfort. As you get stronger with this limited range of motion, try to increase the range of motion and see if pain occurs. When attempting to increase range of motion, you will want to decrease your load.
Remember that the best practice is consistent training over a prolonged period of time. It’s better to always train something then to take prolonged periods away from training. As we age, we lose muscle and bone more rapidly with periods of inactivity, and have a harder time getting them back. It’s best to do all we can to maintain lean tissue, balance, speed, and power then to allow them to fade away and then try to get them back. Come see Physical Therapist Mike O’Hara at one of our Saturday Solutions or schedule an assessment with Program Director Jeff Tirrell to get some ideas on how to train around your injury.
Jeff Tirrell, CSCS, CFSC, Pn1