5 Training Considerations when Returning from an Injury

I’m going to say something that’s probably not a great marketing strategy: sometimes when people train with me, they get hurt.

That doesn’t mean my clients get hurt often. In fact, it’s a rare occurrence. And I’m not talking devastating injuries like a Mortal Kombat fatality. More like a cranky shoulder here, an achy lower back there, and other nagging injuries that interfere with an athlete’s ability to train the way we originally planned. Nobody’s getting their spine ripped out of their torso on my watch.

When training for high levels of performance, whether that’s in powerlifting, bodybuilding, team sports, etc., there’s risk involved. When you push the envelope, you’re going to get the occasional paper cut. My clients understand the risk, and the majority of them are willing to take that risk of training really hard to order to chase their lofty goals.

In this article, we’ll discuss some of the reasons why athletes get hurt. More specifically, I’ll outline some of the strategies I use to reintroduce certain strength training movements once an athlete is ready to train again.

WHY DO ATHLETES GET HURT?

Strength coaches often tout their methods as “injury prevention”, making the leaping assumption that simply by lifting weights, athletes will magically prevent themselves from getting injured. This is naive at best and arrogant at worst.

Truthfully, we can’t prevent injuries. Freak accidents happen. A soccer player who just recovered from a knee injury could get slide tackled and tear her ACL. A baseball player recovering from elbow surgery could sit on the couch at a weird angle while playing video games and set himself back several weeks. Or a powerlifter could fall down the stairs chasing her kids and hurt her shoulder. These are all actual things that have happened to athletes I’ve coached. Nothing we do in the weight room can account for stuff like this.

We can, however, make intelligent training decisions, like picking the right exercises for the athlete, knowing when to push hard, and knowing when to pull back. We can build resilience through the right blend of heavy lifting, aerobic conditioning, and maintaining adequate joint range of motion for the athlete’s sport. “Injury resistance” may be a better term here, but there are still no guarantees that injuries won’t happen.

Strength coaches could just as easily be called “stress management coaches” because we purposefully apply a stress (exercise) to the athlete in what we believe is the proper amount to get that athlete bigger, stronger, faster, etc. The dose of that stress is ideally enough to force the athlete to adapt without causing unnecessary fatigue. Apply too little stress and the athlete doesn’t get better. Apply too MUCH stress and the athlete can’t recover, and sometimes gets injured. Couple that with outside-the-gym stressors like work, family, school, etc., and you can see how designing a strength training program is like shooting at a moving target.

There are two main factors I like to consider when evaluating why someone got injured: systemic stress and localized stress. Systemic stress refers to all the stressors an athlete is experiencing, both in and out of the gym, that compete for recovery resources. Localized stress refers to the direct stress a muscle and/or joint experiences from training, competition and daily activities (work and posture).

SYSTEMIC STRESS

General adaption syndrome (GAS) is one of the classic ways to explain stress and our response to it. Researcher Hans Selye used studies on rats and their response to stressful situations to conclude that our response to stress falls into three stages:

1. Alarm: We realize we’re in a stressful situation and our body’s fight-or-flight response kicks in via increased heart rate, adrenaline, and other useful physiological responses to help us survive. In our case, the Alarm phase occurs when we perform stressful training.
2. Resistance: After surviving the situation that triggered the alarm, our body realizes it would be good to adapt in case that situation happens again. The relevant example is increased strength and muscle size in response to hard training. This is exactly what we want.
3. Exhaustion: If stress continues to increase and/or we don’t recover between bouts of stress (through insufficient nutrition and/or sleep), or body can no longer adapt in a positive way. This leads to increased fatigue, decreased performance and increased chance of injury.

While we now realize that GAS is an oversimplified way to explain the impact of stress, it illustrates this simple fact: some stress is good, but too much stress is bad.

Even mental and emotional stress increase our chance of injury. Dr. Bryan Mann, a strength and conditioning coach at the University of Missouri, published a landmark study that looked at illness and injury rates among college football players during times of high academic and physical stress. The study found that athletes were twice as likely to get injured during periods of high academic stress (i.e., midterms and finals) than they were during times of low academic stress, and about as likely to get injured during stressful academic periods as they were during training camp (two-a-day practices plus lifting).

Bottom line: if you’re really stressed out, your chance of injury goes up. So if you’ve got a huge project due at work or school, or if you’re fighting non-stop with a family member, or some other life event has you tweaking out, it’s a good idea to back off the throttle in the gym.

LOCALIZED STRESS

Taking it one step further, muscles and joints can experience high levels of stress based on the exercises, sets, reps and weight that you throw at them. So even if you’re cool as a cucumber and cope well with mental and emotional stress, if you beat the living crap out of your body, there’s still a chance you’ll get hurt.

This seems like a no-brainer, yet some people still insist on squatting every day, maxing out on the bench every Monday, and calling a couple toe touches and half-assed arm circles a “warm-up”.

The Law of Repetitive Motion illustrates how the mismanagement of training can lead to injury.

Basically, injuries (I) occur when you perform too many reps (N) with a weight that’s too heavy (F), using too little/too much range of motion (A) with poor technique (R). So if you lift heavy weights with bad form all the time, you’re gonna get hurt? I told you it was a no-brainer.

But even if your technique is textbook, you still might do more weight or more volume than what body can recover from. And unfortunately, most people don’t realize they’re doing too much until it’s too late.

I’d argue that the reason most people get re-injured when returning to training is a mismanagement of this equation. Coaches often prescribe to much “N” and “F” or allow the athlete to use an “A” they’re not ready for. The rest of this article is about how to manage that part of the equation to reduce the chances of “I” occurring again.

I’M FEELING BETTER… NOW WHAT?

OK, let’s say you got hurt, but now you’re better. You shut it down for a bit, didn’t push through the pain, and maybe even saw a physical therapist or got some manual therapy to help you feel better. What now?

Rather than jumping right back into training where you left off (that’s what got you hurt in the first place, remember?), it’s best to take things slow to prevent getting injured again. Patience is a virtue. There are certain precautions and specific steps I’ve found that have helped athletes regain strength AND avoid re-injury.

I’m not a doctor or a physical therapist, so don’t take my advice and ignore what a medical professional says. However, through experience and trial-and-error, these steps have yielded positive results for my athletes returning from an injury.

1. ISOMETRICS

I’ve found few things to be as effective as isometrics for testing the waters on a previously-injured body part. Yielding isometrics, or paused reps, for long durations and light-to-moderate loads are a safe way to determine if a muscle or joint is ready to get back in the game.

I’ll typically start with a moderate joint angle for sets of 15-20 seconds, gradually adding duration and weight each workout. Once that joint angle is cleared and completely pain free, we’ll progress to a more aggressive joint angle.

For example, if someone is returning from a knee or quad injury, we might do split squat iso-holds with the back knee a certain distance from the ground. When first starting out, the athlete might hold the knee a good distance from the ground, so the loaded front knee/quad isn’t overly stressed. Once they can hold that position pain-free for 30 seconds at a time with dumbbells in each hand, then we’ll get the back knee closer to the floor.

Occasionally, we’ll use overcoming isometrics (pushing against an immovable object) to reintroduce higher levels of force as specific joint angles. This is a more intense option because you can generate a ton of force. There’s an inverse relationship between force and velocity, and the velocity during an isometric is zero.

What I like about overcoming isometrics is that you can isolate a specific joint angle. For example, if a lifter is recovering from a pec strain, you can target a specific range of the bench press and build up tissue tolerance at that range. Also, by using an empty bar and safety rails, you can ramp up the intensity of the movement by gradually pushing with a higher level of effort as you feel comfortable. You don’t have to blast the bar against the pins as hard as possible right from the get-go.

2. REDUCED RANGE OF MOTION

Often when returning from an injury, a muscle or joint will only hurt in certain positions. The entire range of motion isn’t painful, so simply train in the non-painful range and skip the rest.

There are tons of options here for the big lifts, such as:

• Box Squats or Pin Squats
• Board Presses or Pin Presses
• Block Pulls or Rack Pulls

Use a box, pins or blocks to reduce the range of motion as needed to avoid pain. As the athlete continues to heal and improve, gradually introduce a larger range of motion over time as tolerated.

3. CONCENTRIC-ONLY MOVEMENTS

Sometimes concentric-only movements are tolerated best early on in the healing process. By skipping the eccentric (i.e., lowering or lengthening) part of a movement, you reduce the overall force generated and tissue damage endured.

Sleds are incredibly versatile in this scenario. Clients have often heard me say, “Well, you can always drag the sled.” For some reason that never really cheers them up… But seriously, sled drags (forward and backward) and pushes/marches are an excellent way to load the lower body while working around a lower back, knee or hamstring injury. Plus, if done continuously and with lighter weight, they provide a solid aerobic stimulus to promote recovery.

For upper body ailments, band exercises like triceps pushdowns, presses, flyes and rows are basically concentric-only and work best when done for ultra-high reps with the sole intention of getting a huge pump. This floods muscles and joints with blood and healing nutrients without muscle damage and joint stress.

4. ONE EXERCISE AT A TIME

One of the biggest mistakes I used to make when reintroducing loading to a previously-injured athlete was throwing multiple movements at them that target the same muscle or joint. However, that’s often too much, too soon. Now, I often opt to introduce one exercise at a time to let the athlete adapt and assess their own readiness to return to training.

For example, if an athlete hurts their lower back, we’ll often remove axial loading like squats and deadlifts and switch to lunges, split squats and 1-leg RDLs. When their back is recovered, rather than going back to squatting AND deadlifting at the same time, I’ll often add one back for a week or two before reintroducing the other. This slow-drips the stress rather than turning it back on like a fire hose.

I see this far too often in a “rehab” setting too. An athlete is injured and in an attempt to expedite the healing process, a coach throws every rehab and prehab exercise under the sun at the athlete. But remember, rehab exercises are just low-level strength training movements, and if you do a ton of them, you can overtax the injured muscle or joint just as you would with too much heavy lifting.

For example, it may be tempting to take a baseball player experiencing shoulder pain and give them 10 different rotator cuff exercises. However, if it was overuse that caused the injury in the first place, more stress isn’t better. Start with the minimum effective dose, which could be just one exercise, and slowly add from there.

5. AEROBIC TRAINING

As alluded to with sled work, increasing an athlete’s low-impact aerobic work will improve their ability to recover while also shifting their focus toward what they CAN do instead of what they can’t, especially if heavy lifting is still off the table.

There’s a saying that all recovery is aerobic because processes like restoring ATP (the body’s energy currency), reducing inflammation and regenerating damaged tissue all rely upon the ability to pump blood and move oxygen throughout the body. Even if you’re insanely strong, if you can’t climb a set of stairs or tie your shoes without hyperventilating, your recovery is going to suck.

Even if you can’t lift heavy yet, you can probably go for a brisk walk, ride a bike or drag a sled. At The Strength House, we often assign our athletes to go for a brisk 20-minute walk every single day. This proactive approach ensures that we’re always training the aerobic system without adding more high-impact training.

THE TRIUMPHANT RETURN

Just like you can’t prevent injuries entirely, there are no guarantees that these methods will “fix” an injury. However, using prudence and common sense can help an athlete continue to train productively and recover faster. Be patient, do what you can with what you have, and incorporate these methods to avoid doing too much, too soon.