Friday, April 8, 2011

Training with an Injury Q & A, Part 2

In Part 1, I briefly discussed when you should and should not train through an injury, and also a few strategies for receiving a training effect in spite of a shoulder or back injury.  Let's get right to the next couple:

(**Interjection: Originally I was going to cover the knees AND ankles, but I ran out of time, so you'll just have to be happy with the "knee advice" for the time being!)

3.  Your Knee Hurts.

Quad Dominant vs. Hip Dominant Exercises
The first thing that comes to mind is to scale back on "quad dominant" exercises (think: front squats, back squats, lunges, etc.) and stick to more "hip dominant" exercises such as deadlifts, box squats, glute bridges, pullthroughs etc.

Single-leg Variations
Also, understand that not all lunge variations are created equal.  Exercises such as forward lunges and walking lunges are going to place much more eccentric (or decelerative) stress on the knee joint than a stepback lunge, split squat, or single-leg RDL.  So, consider (temporarily) omitting the single-leg work that places more decelerative stress on your cranky knees. 

Single-leg RDL
Sled Work
As noted in Part 1 (with regards to back pain), sled work is very joint friendly.  Typically, those with knee pain can push the sled - on the high handles, as there's less knee flexion involved than the low handles - or drag the sled, such as our client Kaleigh in the video below:

Take a "Warm-Up" exercise and make it a staple in your lifting routine
One thing I've found while working with a lot of injured clients, is that an exercise I normally use in my warm-up can quickly become a very appropriate strength exercise for an injured person.

For example, take the Bowler squat.  The bowler squat is an exercise I'll use in a warm-up, to help prime my hips for the workout ahead.  The bowler squat is great, as it trains the glutes to produce (and resist) motion in all three planes of motion:

You can make it more challenging by stacking cones right to the outside of the ground leg, and pick one up with each rep. 

Not to mention, many people with knee pain have very poor glute function, which the bowler squat improves.  This leads me to my next point:

You may just have sucky gluteals
As I've noted before, we live in a society plagued by gluteal amnesia.  With the increase of desk jobs (and also, pure laziness) in our culture, people forget how to use their glutes properly.

Anyway, something that those of you reading this may not realize is that weak glutes can frequently lead to knee pain.  The hips/glutes play a HUGE role in proper knee tracking during sport (be it running, playing soccer, lifting weights, etc.) and if they're not doing their job, then your knee is going to want to give you the middle finger eventually.  Employing plenty of weighted glute bridges (once you've progressed appropriately), hip thrusts, side-lying wallslides, etc. will help your knees line up where they're supposed to during activity.

Also, be sure to include plenty of glute stabilizer work during your warm-up before a run or lifting session.  Whenever I go to the field to sprint, I always take a band with me so I can do some X-Band Walks before running:

Employ conditioning tools without lower body involvement

If running aggravates your knees, then stop!  This isn't rocket science.  You can still condition via means other than running.  For example, using the battling ropes:

Or, you can run through a medicine ball circuit.  Here is Eric Cressey's wife getting after it during a conditioning session six days before her wedding:

Both of those options (battling ropes and med ball work) will give you plenty of conditioning, while sparing your knees to boot. There are countless other options we've used at SAPT with our clientele, but for the sake of brevity I'll stick with those two for now.

Of course, specificity is going to play a roll.  You can't train for a marathon using only upper body conditioning tools, but it will at least help to reduce a loss in cardiovascular fitness while helping your knees heal up. 

Then again, I don't think most people should take part in the idiocy of running a marathon, but I digress :)

It could be a TECHNIQUE flaw

Let's not neglect the fact that your knee may be bothering you because of a technique flaw.  It could be your running technique (if you're a runner with knee pain) or your technique in the weight room during lower body exercises.

As Chris McDougall mentions in Born to Run, almost anyone will take diving lessons if they want to learn to...go diving.  Or, hire a martial arts instructor if they want to become a better fighter.  However, rarely anyone even thinks twice about hiring a running instructor before going on a run.  They just go out and do it, assuming that "any idiot can just go run," failing to understand the implications (i.e. injury) if they don't know how to properly absorb 2-4x their bodyweight in ground reaction force on each and every step of a 3 mile run.   

It's the same thing with resistance training.  Many people just head to the gym assuming that they know how to do everything.  Of course they do!  (note sarcasm).  Honestly, whenever I head into commercial gyms and take a look around, I'm surprised there aren't more people with injured knees due to atrocious technique I see during squat and lunge variations.  

So, take a look at your technique. 

Hope these tips prove useful.  Have a great weekend!


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