Fight the Injury Blues: Keep Lifting!
by Kevin Neeld
Your doctor just told you to take six weeks off from lifting. Screwwww him! Here's how to heal that blown shoulder or hamstring while still making progress!
Whether you're an athlete, competitive lifter, weekend warrior, plumber, accountant, or secretary, chances are that you're gonna get hurt sooner or later.
While some activities and lifestyles are more likely to result in traumatic injuries than others, Kendall et al. have this to say in Muscles: Testing and Function with Posture and Pain: "Basic to the understanding of pain in relation to faulty posture is the concept that the cumulative effects of constant or repeated small stresses over a long period of time can give rise to the same kind of difficulties that occur with a sudden, severe stress."
This idea, that accumulated stress can be just as damaging as an acute trauma, explains why no athlete, neither powerlifter nor ping-pong player, is completely free from the risk of injury. It's how we deal with these injuries that allows us to continue to train effectively during the recovery process.
No athlete is completely free from the risk of injury.
You should! Suffering an injury can have a profoundly negative effect on your physique and mental health. I've seen countless athletes go into a mild state of depression after getting hurt. They tend to focus on all the things they can't do now that they're hurt and abandon their training in favor of bed rest.
Generally, injuries necessitate complete rest to minimize localized edema (swelling due to inflammation), for 2-7 days. Considering the importance of training consistency, it's of paramount importance that training resumes as soon as possible.
The typical injury process goes something like:
• You get hurt
• You go to the doctor
• The doctor gives you drugs, and tells you what not to do
• You take the drugs, and don't do what you're told not to do
In The Proactive Patient, Eric Cressey explains why you should go to your doc prepared with a list of questions regarding what you can do to facilitate recovery, opposed to just accepting their list of contraindicated activities. Some doctors will be open to this conversation and provide you with some better recommendations.
However, just like in every other profession, some doctors just aren't good and probably won't give you much more than a, "You'd better just lay off it for several weeks." As a personal example, following an acromioclavicular (AC) joint separation that was accompanied by a partial tear of the upper trapezius off the posterior aspect of the distal clavicle, I had a collegiate sports medicine doctor tell me I would never bench again, ever.
Thanks doc, for that very helpful prognosis.
So I basically ignored his pronouncement of doom, and embarked on my own self-therapy, as follows:
Waking up the muscles responsible for scapular stability
Straight-arm dumbbell dip
Inverted scap row
Lat pulldown scap depression
Improving internal ROM of the humerus
Like the pectoralis major, the fiber orientation of the infraspinatus (one of the rotator cuff muscles) changes from a horizontal direction to a more diagonal direction as you move from the top down. In order to maximize the effectiveness of stretching the external rotators, it makes sense to stretch these muscles at two angles, 90¡ and 135¡.
2-way sleeper stretch — 90¡ Stretch
2-way sleeper stretch — 135¡ Stretch
Strengthening the rotator cuff
Lying internal rotation
Improving grip strength
Try heavy dumbbell and barbell holds, focusing on squeezing the bar as hard as possible for time.
To do these, load up a bar or grab a pair of dumbbells that you can hold for about 20-30 seconds. Chalk up your hands. Breathe in against a braced core, and pick up the bar. Lock your shoulder blades back and down and squeeze the bar as hard as possible for the allotted time.
To make this exercise slightly more difficult (and effective), add a slight perturbation by rapidly performing small-amplitude shrugging motions. The purpose of this is NOT to shrug the weight all the way up, but to challenge your grip to a larger extent. The light perturbations will make it feel like the weight is prying your fingers open and challenging the reactive performance of your rotator cuff musculature.
The exercises in the videos and pictures above aren't a comprehensive list of everything I did, but after several months of this therapy, I was able to bench again, pain-free. Doctor 0, stubborn strength coach 1.
This morning I consulted with a female runner suffering from knee pain. In her words, "I just want to know what I can do to keep running." Now, there aren't enough hours in the day for my "I hate distance running, especially for females" rant. However, I restrained myself in this instance, because even if I gave it to her, she wouldn't listen. Instead I showed her a few foam rolling techniques, some glute activation exercises, and a couple of body weight exercises to take her knees and hips through a full range of motion.
A full range of motion is important for running.
When athletes and lifters are passionately interested in whatever it is they do, they don't want to hear that it's bad for them. If you tell them it's detrimental to their health and they should stop, they'll think you're an idiot, ignore you, and keep doing what they're doing. I try to meet my athletes half way under these circumstances. And if they do suffer an injury, there's always something they can still do. Almost everyone can and should keep training hard.
What You Can Do
Assuming you have a unilateral injury, you should be training the hell out of your good side. Not only will this provide the psychological benefit of keeping your training intensity high, and the physical benefit of keeping your "healthy side" strong, it'll also significantly improve the strength of your injured side.
Significant improvements in strength can be gained without ever moving the limb. This tactic may be a fair compromise between the doctor's "you need to rest" and the athlete's "I need to stay strong".
The idea that training one side results in strength improvements on the contralateral side is referred to as cross-transfer or cross-education and is well-established in the research literature. Improvements are seen in both upper and lower extremity training, with reported strength gains of the contralateral limb generally between 10-77% of the healthy limb.(1-5) The large range is due to the type of contractions used.
In general, isometric contractions produce the worst contralateral carryover, and eccentric contractions produce the best.(5) As you may expect, the contralateral benefit is also movement-specific,(6) so you don't need to drop your squat, deadlift, horizontal and vertical pressing and pulling patterns in favor of single-joint exercises. Compound exercises will still result in greater strength gains than single-joint exercises, even in single limb training (the exception being the single-leg stiff-legged deadlift, which is technically a single-joint exercise).
While there is the idea that increased blood flow and consequent oxygen delivery may be partially responsible for strength and endurance improvements, the carryover is almost entirely due to neural adaptations. As a result, you can train your good side to maximize neural gains in strength and power exactly as you would if you were healthy.
In consideration of the research, a few general guidelines are to slow down the eccentric phase to a 3-5 second negative, maximize concentric acceleration, use high intensity loads (just because you're on one leg doesn't mean you need to take out the pink rubber coated dumbbells), and perform 3-6 sets of 3-6 repetitions.
A few great exercises to include are:
1) Back leg raised stiff-legged deadlift
2) Single-leg stiff-legged deadlift
3) Single-leg squat
4) Single-leg crossover squat
If you don't currently possess the strength or balance to perform these movements, find a way to balance and unload yourself. Heavy bands and cable columns serve this purpose well.
Single-leg squat with heavy band
Single-leg deadlift with contralateral cable extension
Performing these exercises while you're hurt should allow you to improve, or at least maintain, the strength you have in your good leg, and minimize the losses on your injured side. As an added benefit, it'll allow you to keep pushing yourself, which will help you keep a positive outlook on the experience. While this is beyond my area of expertise, I know there's research in support of a positive/optimistic outlook facilitating a faster recovery.
When your injury heals, remember that you haven't been loading the spine heavily like you may in bilateral training (squats, deadlifts, etc.), so you'll want to ease yourself back into these exercises. It would be a tragedy for you to spend all this time and energy training through an injury to have you strain a paraspinal muscle on your first day back to squatting. It won't take long for the strength of these muscles to return, so be smart (and patient). You'll be stronger than ever in no time.
About the Author
Kevin Neeld, CSCS has helped athletes of all ages fulfill their athletic potential. Through the application of functional anatomy, biomechanics, and neural control, Kevin specializes in guiding athletes to optimal health and performance. He can be reached by e-mail, or through his website.
1. Enoka, R. (1997). Neural adaptations with chronic physical activity. Journal of Biomechanics, 30, 447-455.
2. Munn, J., Herbert, R., & Gandevia, S. (2004). Contralateral effects of unilateral resistance training: a meta-analysis. Journal of Applied Physiology, 96, 1861-1866.
3. Lee, M., & Carrol, T. (2007). Cross Education: Possible mechanisms for the contralateral effects of unilateral resistance training. Sports Medicine, 37, 1-14.
4. Duchateau, J., & Enoka, R. (2002). Neural adaptations with chronic activity patterns in able-bodied humans. American Journal of Pysical Medicine & Rehabilitation, 81, S17-S27.
5. Gabriel, D., Kamen, G., & Frost, G. (2006). Neural adaptations to resistive exercise: Mechanisms and recommendations for training practices. Sports Medicine, 36, 133-149.
6. Rutherford, O., & Jones, D. (1986). The role of learning and coordination in strength training. European Journal of Applied Physiology, 55, 100-105.
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