This post gives some practical tips on training around injury.
Disclaimer: I’m not a doctor or a physio, so this article is written from the point of view of an athlete and a coach of other athletes.
Many people, especially those new to training, are worried about injury.
They can overreact when they get a minor injury. People will avoid training altogether or stuff themselves with ibuprofen.
Experienced strength athletes get used to training around injury. They learn how to identify and handle different types of pain.
This is not a ‘suck it up, buttercup’ approach to injury. It’s just that if we stopped training every time something went ‘ow’, we’d never make progress.
In addition, we can learn and come back stronger from injury.
Training around injury can be an opportunity
In strength sports and fitness, training around injury is possible the vast majority of the time. This is because strength training is a full body thing. If one area is hurt, we can focus productively on other areas.
In running, for example, if you have a leg injury, it’s pretty difficult to do any running! However, in strength training if you have an injury to a leg muscle, you can work on your upper body instead.
(By the way, if you are an injured runner, now is the perfect time to work on your strength!)
Here is an even more specific example. If you are getting knee pain at the front of your knee, usually it is possible to do glute-ham dominant exercises without any pain – such as deadlifts, romanian deadlifts, good mornings etc.
Ironically, the underlying cause of the knee pain may well be weakness in the glute-ham muscles. So you are actually fixing the underlying problem as well as training around the injury.
If you have an injury to core muscles such as the lower back, you can support the back while training the limbs, so that the forces going through the back are diminished.
Your coach or trainer can find ingenious ways to make sure you get a productive workout while protecting the injured area.
I once had a client with a broken foot, but we still managed to train the leg muscles by doing exercises from a kneeling position.
Out of date advice is everywhere
Doctors and physios used to treat most soft tissue injuries by advising the patient to rest and not train at all. You will still hear GPs telling people to do this.
This is old and out-of-date advice. Immobilisation for the majority of soft tissue injuries is not ideal and sometimes downright detrimental.
These days you are more often advised to keep training, in order to promote blood flow to the area and to allow the body’s natural healing process to kick in.
Sometimes you will need to take a few days off, to allow the initial inflammation of the injury to die down. But after this initial period, you want to start getting movement in the area.
If too much scar tissue forms due to an injury, you will be left with a shorter, stiffer and weaker muscle. Training helps to avoid this process.
No Ice, Baby
The popular RICE method for treating injuries – Rest, Ice, Compression, Elevation – has also now been revised. Icing an injury is now NOT recommended for healing, although it can be a short-term analgesic (pain reliever).
Even the author of the original acronym RICE has now changed his mind. As Dr Mirkin explains in his article, inflammation is an important part of the body’s healing response, and ice delays that healing process.
What happens when you get injured
Some injuries seem to appear out of nowhere; you didn’t feel them happen at the time but you feel it the next time you train. Others can be a sudden pain during an exercise.
When this happens, the injured muscle and surrounding muscles can go into spasm: they get very tight in order to immobilise and protect the area.
This has the effect of making the injury seem worse than it really is, and can really worry the athlete. If your whole back seizes up, it can be scary.
If you get a sudden muscle tweak and your muscles go into spasm, the best thing to do is to lie down and take tension off the area, gently stretch or massage and try to get the muscles to relax again.
Two types of pain
In my experience there are two types of injury pain. One gets worse when you train, the other appears to improve or temporarily disappear when you train.
Pain that improves when you train
This type of injury is often a minor muscle strain or tweak, which goes away when the muscle is warm and working, but comes back when cold.
In this case, I have found it is fine to keep training, and it can help the healing process to promote blood flow to the area.
At the same time, consider what the underlying cause of the injury was and address it (see below). Often it is a muscular weakness that can be addressed by muscular conditioning.
Pain that gets worse when you train
Where training increases the pain, you should avoid training that particular area or muscle to the point of pain.
However if it is possible to train the same area with a light weight, without pain, this is a good idea. You will be getting blood flow to the area and speeding up the healing process.
An example of injuries that fall into this category are golfer’s elbow and tennis elbow – injuries to the tendon. Tendon injuries can hang around for a long time. Ultimately you need to strengthen the muscles and tendons, but you can’t train hard on them otherwise they won’t get better. You have to take it slowly. Do exercises and stretches recommended by a physio.
Don’t ignore injury
When I advise people to train through or around an injury, I’m not saying that they should ignore it. The first question should be, what is the reason this injury occurred in the first place?
Often there is an underlying cause, such as:
– weakness in another muscle causing the injured muscle to overwork or to do a job it shouldn’t be doing
– poor movement/technique
– poor posture
– lack of recovery
– lack of proper nutrition and hydration, weakening the connective tissue (training while dieting hard can do this)
– lack of general self-care (sleep, eating properly, stress)
– too much too soon: a previously sedentary person jumping into high intensity training without a foundation of strength and movement competency
Injury is an alert that something needs to change. It is very common for people to be prone to injure the same body part over and over again. This is a sign that there is an underlying issue that needs to be addressed.
Getting a diagnosis and a rehabilitation program from a physio is a good start. However, depending on how good your physio is, you may get a diagnosis of the injury itself but not necessarily an explanation of why it occurred (e.g. the technique or execution aspect that led to the weakness that led to the injury).
Discuss injuries with your coach and work on what might have caused them.
Some of the treatments that people recommend for injuries are little more than analgesics: they might take away the pain temporarily but they are not ‘cures’ for the injury itself. Taking an anti-inflammatory is a prime example.
Tune in to your body
The best way to anticipate injuries and cut them off at the pass, is to tune in to how your body is feeling on a daily basis.
Can you distinguish between normal soreness and injury?
What action will you take if something is hurting at the end of a training session?
Are you sleeping, eating and hydrating adequately?
Are you being slack with your technique, or using more weight than you can safely handle?
Do you need an extra rest day?
In conclusion, make injury management a part of your training process. Just because something hurts, doesn’t mean you should immediately stop all training – in fact, this could be detrimental.
See the situation in the round: many factors contribute to an eventual injury – are you managing those factors?
If you get injured, what have you learned and what are you going to do differently next time you train?