You Can & Should Train Around Any Injury
Let's face it, injuries happen. You can be pushing yourself to the limit in the gym, breaking records on the field, or roll your ankle putting your shopping cart away. Whatever the cause and whatever your prior activity level, you can and should train around this injury.
One of the things I focus on primarily with clients and patients is what they can do, not what they can't. Almost everyone will tell you something they can't do well anymore or at all because of an injury or a bad experience, and that's fine. But I'd bet there are more exercises you can do, albeit with some modification, than there are limitations you think you have.
Oftentimes with proper coaching, load management, and thoughtful exercise prescription, the thing the client couldn't do is added to the list of cans.
Before this article continues, I want to clarify what I mean by training "around an injury."
Scenario 1
Your shoulder is absolutely killing you. It hurts all the time now and every time you do barbell bench press it lights up and you spring for the Advil and TigerBalm. So what do you do? You go to the gym Monday and barbell bench anyway because it's written in your program.
This is training through pain or an injury.
Scenario 2
Your shoulder is absolutely killing you. You first try to change your grip, change the angle of the press, or use dumbbells with some relief but not full relief. So you call up your local sports chiropractor and make an appointment. In the meantime, you do some troubleshooting.
You remember some dude's blog a while back that suggested some modifications for dealing with shoulder pain in training. You run through your inventory of trainable movements that you can still push.
Your legs are fine and goblet squats, split squats, and deadlifts feel great.
Training back feels great.
Doing band flyes actually feel good and you get a good chest pump without pain.
Single-arm landmine presses feel strong! Yes, you can press without pain.
Focusing on these tasks is training around the injury, not through it. Be scenario 2 guy or gal.
Here's why you should always train around an injury and a few examples of how I've done this in the past with myself and one of my significant injuries.
Train to Prevent Deconditioning
If you got one flat tire on your car would your first thought be to slash the other 3? That's what total rest is like after an injury. One of the biggest challenges athletes, and normal people like me, face after an injury is aerobic and muscular deconditioning from prolonged rest. This deconditioning happens quickly. The decline is much more rapid than the time it took to acquire your fitness. All of the good stuff we get with training starts to go away. Muscle fiber cross-sectional area that was built through months and years of heavy resistance training starts to decrease (atrophy). Mitochondrial density and capillary density earned from aerobic training start to dissipate. Adaptations made to the energy systems that you train begin to reverse back towards baseline or that of a sedentary person (1). You get it, you go from a hardened piece of stone to a marshmallow. Don't worry, this won't happen in a day, or 2, or even a week or two. Laying in bed for a month because of an Achilles injury, however, will get you there.
Once you have the acute injury under control and you are seeking the proper professional medical help to manage it, find out what you can do without interrupting the healing process of the acute injury. Using myself as an example, I suffered a severe shoulder dislocation back in 2015 (see image). For those without a radiology background... the round thing is few inches below where it should be. This shoulder had to be immobilized for a period of time before any intro level, passive range of motion rehab could begin. So what did I do? I was at the gym the next day in my sling doing bodyweight walking lunges, sled drags with the straps around my waist, riding a stationary bike, and then some more walking lunges. I did lots of walking lunges. Once I got my arm out of the sling my training choices expanded somewhat, but I never stopped.
Most injuries can be trained around in some way or another. Some guidance (and sometimes a lot of creativity) can make this happen. Don't be a marshmallow.
At the early stages, I didn't have enough shoulder external rotation to back squat with a straight bar. So, I used a cambered bar and attached a strap so I could hold my left hand lower (around nipple height) so I could still squat heavy. My squat was actually the strongest it ever was after this shoulder injury.
Foot or leg injury? Do seated, supine, or prone exercises. Shoulder injury? Do bodyweight movements, load with a weighted vest, pull a sled, do some cardio, or anything that doesn't require holding weights. Back injury? Relatively unload the spine, reduce axial loading, experiment, see what feels good, and crush it.
Train to Create a Cross-Education Effect
There is evidence that shows you can make gains in an immobilized or injured limb when training the uninjured limb. This is called the cross-education effect and is largely a result of neurological adaptations that occur with strength training. As said by folks smarter than me...
Hendy and Lamon (2017) proposed mechanisms for the cross-education effect that include primarily neurological mechanisms via an increased neural drive to the untrained limb from the trained limb.
Lee and Carroll (2007) gave two neurologically-based hypotheses to explain the cross-education effect. The first suggests that neural circuits in the trained limb improve coordination and firing of circuits in the untrained limb leading to increased strength via neural drive. The second suggests unilateral training makes changes in the brain, in motor areas that control the opposite limbs, garnering better control and strength in the untrained limb.
Cirer-Sastre, Beltrán-Garrido, and Corbi (2017) found the training parameters that might determine the greatest cross-education are 3-5 sets of 8-15 reps of eccentric contractions with rest times of 1-2 minutes between sets. In addition, there seems to be a direct relationship between the training load applied and the effect achieved, albeit statistically, not significantly.
Full references at end of the article.
Using myself as an example again, while I was still in a sling I would press, row, curl, and do anything I could with my uninjured limb. This was partly because I love working out and wanted to minimize any deconditioning and muscle loss but also to use some of this cross-education effect to help start the rehab process while my shoulder was still immobilized. There is a point, of course, that you would start to develop imbalances in muscle mass and strength so it is crucial the injured limb is reintroduced to load as soon as possible in accordance with your healthcare professional's guidelines.
Mental Considerations
Not doing something you enjoy doing sucks. Apart from the physiological changes that occur with exercise that serve to improve mood and mental status, taking away something you really enjoy doing (lifting, training, practicing a sport, etc) sucks. Do as much as you can without interfering with the healing of the injured tissues.
Treat any injury as an opportunity to learn more about yourself, your body, and your development as an athlete. Spend time on some aspects of fitness that maybe you've been neglecting. If you can't train for maximal strength (right now) work on aerobic capacity. If you can't squat heavy (right now) work on your strength to weight ratio and get really good at calisthenics. Adaptability is what gives people longevity.
The injury will heal & the pain will subside. Now you don't have to go back to square one. Just need to get that ankle, shoulder, hip, or knee back up to speed.
Have questions about how to train around injuries and come back stronger? Contact me.
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Thank you for reading.
References
Bogdanis G. C. (2012). Effects of physical activity and inactivity on muscle fatigue. Frontiers in physiology, 3, 142. https://doi.org/10.3389/fphys.2012.00142
Cirer-Sastre R, Beltrán-Garrido JV, Corbi F. Contralateral Effects After Unilateral Strength Training: A Meta-Analysis Comparing Training Loads. J Sports Sci Med. 2017;16(2):180-186. Published 2017 Jun 1.
Hendy AM, Lamon S. The Cross-Education Phenomenon: Brain and Beyond. Front Physiol. 2017;8:297. Published 2017 May 10. doi:10.3389/fphys.2017.00297
Lee, M., & Carroll, T. J. (2007). Cross education: possible mechanisms for the contralateral effects of unilateral resistance training. Sports medicine (Auckland, N.Z.), 37(1), 1–14. https://doi.org/10.2165/00007256-200737010-00001