Training with an Injury, Part 1

Q.  I have been interested in and really trying to read more information about training with an injury. As a competitive athlete I feel like we are training a lot of times with little aches and pains. How do we know when to back it off and what is some advice on how to continue to train let's say if you have knee pain or elbow pain? I know a lot of us athletes are scared about losing something when we are injured and training is such a part of our lives that we like to work on something i.e. upper body work if our lower body is injured or vice versa.

A.  It's always daunting for me to even begin an answer to a question like this, because I'm constantly playing "What if?" scenarios in my head:

What if the athlete has knee pain but is also diagnosed with spondylolisthesis (vertebral slippage)?

What if the person has elbow pain but also has a partially torn labrum that's asymptomatic?

What if the person is going to unknowingly become run over by a giant cable roll because of an epic fail by the repair guy?

But I digress.

Anyway, great question.  I think one of the most unnerving thoughts for an athlete (or someone who loves exercise, in general) is the idea that he or she may not be able to train because of an injury.  It's obviously beyond the scope of this post to go into every "What if?" scenario, but I'll cover the basics.

If you take anything home from this post, let it be this:  You can almost always elicit a training effect, even while injured.  

HOWEVER, if something hurts, don't do it!  This isn't an excuse to train like a wimp, though.  As Dan John says: "There's pain and there's injury.  Learn the difference."

When it comes to injuries, people often fall into two camps:

1. They won't stop, even when their training only aggravates the problem.  They'll literally try to run through a brick wall before taking a break to heal. 
2. At the first sign of discomfort, they stop exercising.  

The former will never reach their full potential because they're way too impatient to let the injury heal, and continue to impose an (improper) training stimulus on their body without allowing sufficient time to recover.  The latter will never return to full function because they're way too much of a wimp to push their body to get stronger and drive through the adaptation process.  

The key is to train with the proper modifications in place, while not being an idiot.  If bench pressing hurts your shoulder, then find a substitute for a while.  If running hurts your knee, then give it a rest and cross train via other means.  It's not going to kill your mile time.  Remember: you're training for something greater than today.  Always have the big picture in mind.

You should train to enhance the quality of your life.  Let your training serve you, don't serve your workout program. 

Okay, let's go over some common issues and some ways to train around them.

1.  Your Shoulder Hurts

Bench pressing less than three times per week would be a good place to start.  Most people (primarily, males) press wayy too much and it's a no brainer that such a high percentage of guys end up with shoulder problems.  You'll be much better served working on row variations, on top of other exercises that develop the scapular retractors/depressors,  and well the external rotators and horizontal abductors of the arm.

Try a press variation that you can do in a pain-free range of motion.  Floor and board presses tend to be a bit more shoulder friendly as there is less humeral extension involved.




However, if your shoulder is pretty jacked up, then I would avoid the barbell altogether as it locks your humerus into internal rotation.  A healthy dose of neutral-grip (palms facing each other) dumbbell presses, or pushups (even better) will allow you to maintain a training effect in spite of a shoulder injury.

Here is Eric Cressey with 150lbs of added weight during a pushup.  The total system weight (bodyweight + external resistance) for this pushup is over 250lbs.  As he mentions: who says you can't load a pushup!

Pushups tend to be the most shoulder friendly, as they're a closed-chain movement, and also allow freedom of the scapulae to glide about the thoracic spine.  Pushup variations are awesome, whether you have shoulder problem or not.  They have to be one of my top 10 favorite exercises.

If your shoulder is really messed up, then you may need to drop pressing altogether a focus on horizontal pulling (row variations) which people can always use more of, anyway.

2.  Your Back Hurts.

Again, you'll have to see what causes pain and what does not.  In general, it will probably be best to avoid any direct axial loading (direct compression acting along the spine) for a while, and take a break from some of the bilateral lifts ex. squats, deadlifts, etc.

You'll still be able to receive a great training effect through hammering some unilateral variations for the lower body.  Stepback lunges,  split squats, and single-leg RDL's will keep your leg strength in tact while giving your spine a break.

It will do you good to hammer the glutes.  Weak glutes is a very common problem amongst people with back pain, and the good news is that one can generally strengthen the glutes even in the presence of back pain.

Here is my fiancee, Kelsey, performing the barbell glute bridge.  Kelsey has more than one herniated disc in her low back, and she's able to get in some solid glute training, pain free:



Sled pushing/dragging is another clear winner.  It's basically a form of unilateral work (as you have one leg at a time producing force independent of the other leg), and is generally pretty back friendly.

I've been toying around with the sled with increasing frequency, and have been loving it:




The prowler has been a fantastic tool for some of our clientele (especially the adults), that have a history of back pain.  It's a great way for them to increase their lower body strength (not to mention, enhance their overall work capacity), even with a testy back.

That's it for now, I'll be back next time to go over some other common injuries (knee pain, ankle pain, etc.)