People will perform stupid antics on social media (the latest being the Milk Crate Challenge)
Additionally, if you’re an active person, particularly if you lift weights, unless you’re name is Wolverine, it’s inevitable you’ll (probably) experience pain during exercise.
Maybe your knees will feel a little cranky after a serious squat session or your shoulders will be mad after prioritizing the bench press for several weeks.
What’s more, many people after a hiatus due to injury have to navigate the rehab process, which can be a painful experience and about as fun as sitting on a cactus.
However, if we’re discussing any of the aforementioned scenarios highlighted in the introduction my response is an emphatic “YES!”
Albeit, with some caveats.
If you want to elicit change, you need to move. When we move, we induce something called mechanotransduction, which is just nerd speak for “tissue begins to heal.”
Pain, when DOSED ACCORDINGLY, can be beneficial during exercise. When we push into a little pain there’s generally better short-term results than if not.
Whenever I’m working with a client/athlete experiencing pain during exercise (especially in a rehab setting) I like to use a “pain threshold” scale.
On a scale of 1-10 (1 = no biggie, I got this and a 10 = holy shit, a panther just latched onto my carotid), exercise should hover in the 2-3 realm.
Elaborating further, my friend and colleague, Tim Latham of Back Bay Health in Boston, uses a stoplight analogy when it comes to pain during exercise:
0-3 on the pain scale = green light. GO.
4-5 = yellow light. Proceed with caution and modify ROM, technique, sets/reps, etc
6-10 = red light – stop and revisit at a later time.
Let’s Put This Into Action
Let’s say I have a client who had ACL surgery a few months ago and has been cleared by their doctor and physical therapist to begin more aggressive strength training.
My expectation isn’t that (s)he is going to walk in on Day #1 and feel like a million bucks; there’s going to be some degree of discomfort. However, I am not going to shy away from it and attempt to avoid it at all costs.
Remember: A little pain is okay, if not preferred. It’s imperative to challenge the body. I’d make the argument that a lot of what inhibits or slows down the rehabbing process for many is the threat of UNDERloading.
I.e., doing so little that the body is never forced to adapt to anything.
Tendons, muscles, and bones NEED (appropriate) load in order to heal and come back stronger.
Taking my ACL client through the process I may have them start with a deadlift. So long as their pain stays within the 0-3 range, it’s all systems a go.
If that number jumps to a 4-5 it doesn’t mean we have to omit the exercise altogether. Instead we do the following:
Modify ROM – Elevate the barbell off the ground (less knee flexion)
Modify Tempo – When in doubt, slow down. It’s actually quite profound how effective this simple tweak can be.
Adjust Technique – Play around with foot position or stance to see if something feels more comfortable.
Adjust Volume – Sometimes we’re too overzealous with volume and need to ramp up more slowly.
If the pain threshold at any point falls in the 6-10 range then we know we’ve overstepped our coverage and we need to stop that exercise immediately and regress.
It’s not a perfect system and there’s no doubt an aspect of subjectivity to things, but I hope this helps encourage people to not be deterred if pain is present during exercise.
It can be an important cog in the healing process.
Speaking of entry points: I sat down with my four-year old this past weekend to watch Jurassic Park. Now, most coherent parents would start with something a little less scary.
You know, say, Dino Dana or, I don’t know, Care Bears.
Nope, I went with the ginormous, scary T-Rex.
In hindsight, it probably wasn’t the best “entry point” for someone who has no idea dinosaurs aren’t real. Again, maybe Toy Story or, hell, Mighty Morphin Power Rangers would have been a more germane choice?
I gotta say, though…
…Julian handled the T-Rex like a champ.
He didn’t blink once. He giggled when the guy sitting on the porto-potty met his demise.
I didn’t know whether to be proud or scared shitless.
Kid’s the next John Wick in the making.
Okay, Cute Story Tony. But WTF Are We Talking About Here?
Yeah, yeah, yeah…
Lifting heavy things.
Entry Points.
I’ve recently been making my way through Dr. Michael Mash’s excellent resource, Barbell Rehab, and giving credit where it’s due…he’s spends quite a bit if time throughout the course discussing the idea of entry points and how to use the concept to guide anyone’s return back to a specific lift after injury.
Let’s use the bench press as an example.
If someone has pain when he or she bench presses with a straight bar, finding their entry point is nothing more than altering the lift the minimal amount possible in order to gain the minimum desired training effect.
For the visual learners out there it may look something like this:
Adapted from Barbell Rehab
TO BE CLEAR: If pain exists in the shoulder the idea is NOT to automatically regress all the way back to a push-up.
I know some people who’d rather swallow a live grenade than do that.
Instead, the goal is to be as specific as possible in order to elicit a (relatively pain-free) training effect.
If someone has pain with a straight bar FLAT bench press, however it alleviates significantly when you switch them to a decline bench press.
Sha-ZAM.
You just found their entry point.
Maybe it’s DB Floor Presses for one person, and yes, maybe it’s a push-up (albeit loaded) for another. The idea is to TRAIN.
Moreover, it also could just come down to tweaking their grip slightly or adjusting some component of their technique.
Rehab doesn’t always have to result in sending someone to corrective exercise purgatory.
Likewise, using the squat as an example, sometimes the entry point is using a different bar (Duffalo or Safety-Squat Bar) if the shoulder is the issue, or maybe it’s having someone squat ABOVE parallel if it’s their knee(s) or hip(s) bothering them.
Sometimes, and hear me out, we may have to combine the two: Not a straight bar AND above parallel.
It’s not uncommon for people to seek out a coach or trainer because an exercise doesn’t feel right or because something – a shoulder, a knee, lower back, their soul perhaps – routinely hurts and they can’t seem to get out of their own way.
That’s where I come in to save the day.
Most of the time.
To fix someone’s squat technique and to maybe (probably) give him or her a reality check.
This is a term I stole from a friend of mine, Dan Pope of Champion Physical Therapy & Performance, and to a larger degree has its roots from a presentation I watched him do centered around the conversation of understanding shoulder pain.1
“Boom or Bust” refers to the person who handles their business as follows:
Train/Overload –> Do a lot –> To the point where it becomes painful –> Get pissed off, becomes upset, is inconsolable, and inevitably increase their volume of ice cream and Julia Roberts’ movies –> Feels better –> Repeat –> What an asshole.
I’m sure many of you reading – whether the above sequence of events describes you or some of your clients – can commiserate.
It can all be summarized using the following graph:
Again, props to Dan Pope. I essentially drew his graph, but added a little Tony LOLs.
What this depicts is a scenario and approach that keeps the alarm system sensitive as well as pain levels up. They train hard on Monday and hit their bench pretty aggressively, of course.
A day or two passes, the shoulder feels okay, and they decide to test the waters again and perform a bunch of high-rep push jerks. Another day or two passes, the shoulder starts to feel, normal again, and since they have zero fucks to give, decide it would be a swell idea to perform kipping pull-ups paired with handstand push-ups for AMRAP on broken glass.
All they do is perpetually plow through their pain threshold and the cycle continues over and over and over again like an episode of Russian Doll.
This, of course, is absurd, and makes zero sense.
Conversely, what also makes zero sense is the opposite approach…
…UNDER-loading, over corrective exercising people to death, or worse, doing nothing at all.
I’m not dissing the corrective component. Depending on how sensitive someone’s pain threshold is, we may very well have to resort to a myriad of side lying external rotations, arm-bars, and band work.
The key to improving pain, though, particularly with the long game in mind, is to elicit a smidge (key word: SMIDGE) of it during training. You want to tease it, buy it a drink, make out with it a little bit.
If you want to elicit change, you need to move. When we move, we induce something called mechanotransduction, which is just nerd speak for “tissue begins to heal.”
Pain, when DOSED ACCORDINGLY, can be beneficial during exercise. When we push into a little pain there’s generally better short-term results than if not. Think of it like this:
There’s a line in the graph above labeled “pain threshold.” On a scale of 1-10 (1 = no biggie, I got this and a 10 = holy shit, a panther just latched onto my carotid), exercise should hover in the 2-3 realm.
In this case, the person can tolerate things like push-up, landmine, and row variations.
When (s)he perform those exercises, the pain level never exceeds a “3.”
When (s)he’s done exercising, along with the hours after, the pain level never exceeds a “3.”
The following day, the pain never exceeds a “3,” and in an ideal situation is back down to baseline, which is a “1.”
That’s the sweet spot and what we’re after from a managing pain standpoint. We’re doing juuuust enough to elicit a training effect, playing footsie with the pain threshold, but avoiding any boom or bust scenario where we place commonsense ahead of our ego.
And then, over time, the graph looks like this:
I’m an idiot. That arrow pointing up should be labeled “Improvement in Pain.”
The pain threshold slowly creeps higher and higher, and before long, push-jerks, bench pressing, and fighting Jason Bourne ain’t no thang.
Training (with weights), when matched with someone’s current ability level, and when dosed effectively, can be corrective.
Today’s guest post comes from a former distance coaching of mine, Australian strength coach Shannan Maciejewski. Shannan started working with me when he was coming of a pretty serious ankle injury, and he hired me to help him sift through the program design process as he worked his way back to playing competitive rugby.
As a funny aside, speaking of contact sports, I had a very brief history playing football back in the day. I tried out for the football team in 7th grade and lasted a week.
After getting crushed for five straight days I handed in my helmet and pads and decided I’d rather collect baseball cards and play wiffleball in my backyard.
Nonetheless, Shannan offered to write a guest post and thought the theme he came up with was spot on to a lot of what I write about on this site. Which is: yeah, you’re hurt. But that doesn’t mean you still can’t train. Learn to make lemonade out of lemons!
Enjoy!
It’s 3.45pm and you receive a call.
Client
“I am just calling to let you know that I got crunched at training last night and am only just able to walk. I am going to have to cancel todays session at 4”
A few things go through your head…
-Is this just a cop out?
-Hmmmm, it is lower body day? I’ll go to hell if he doesn’t deadlift.
Your response
“That’s ok mate, come on in I will tweak the session for you”.
Being able to adjust on the fly or even plan in and around injuries is an extremely important aspect of a coach’s job. Tony has brought it up before on here, and I am going to shed some further light into creating a positive training response while recovering or dealing with the mud that life throws at you.
As with the above example, to have the session off and do nothing would rarely be the best option.
Life is going to get in your way.
I don’t have much energy today, My car broke down, My knee hurts, My nose is snuffly, I am still sore from Monday, My Doctor said to rest, my mum said I’m special, I think I’m coming down with something, I finished work at 5.10 instead of 5, I think I slept on my arm weird, my neck hurts……………And it goes on..
I think we all can relate to something above, I know I can. Mainly the special one!
Each and every individual is unique in what they present, and that is how programming should be approached.
Now just so you know upfront, I am not a physical therapist or a physio and therefore do not treat pain. I work with other professionals to get the best outcome for everyone we have contact with. It is always best to understand what the actual injury is, or what the limitation is before you start tinkering with exercises. So if in doubt seek professional advice initially and build from there.
What I can do is shed some light on is how to incorporate smart training and programming while you feel all busted up and helpless or just in need of some immediate action points that you can incorporate to keep progressing and moving forward.
Quick Story of a client of mine.
-Debilitating and season ending low back injury from over arching and sharp movement of throwing a football.
(Not quite the same throw in, but amusing anyway)
There wasn’t much initially that didn’t hurt. Bending, leaning, twisting, running all aggravated and stopped him from playing.
12 months later he is 10kg heavier, broad jump and vertical jump has increased, deadlifting and squatting is completely pain free and now a dominant figure sitting smack bam in the mid field. Cutting, turning, jumping, sprinting is all fair game.
Below I will outline some tips for you not just in how I approached the above client, but how you can do so with yourself and your injury/mishap.
Because, as Tony always says, you can ALWAYS train around an injury. Always
Whatever you do it must be pain free
I think this goes without saying, but it does warrant a mention. I have heard it time and time again, and I will also say it.
IF IT HURTS, DON’T DO IT…
It does not matter if it is the number 1 exercise that your specialist or favourite guru said you should be doing. If it causes you pain or discomfort, stop it….Now!
There is always an alternative.
It won’t put you right off track if you need to sub in some Barbell hip bridges instead of your beloved deadlifts. If it means pain free, and creates a positive effect, well I am all for it.
For example do lunges hurt your knee? First off: try doing them properly. That’s a novel idea, right?
A lot of the time this alleviates some issues. I won’t go into correct form in this post, but it’s safe to say that there is a ton of info on this site that you can go back through.
Note from TG: In fact, you can always perfect your RDL….(hint, hint).
If that’s still no good, go through a pain free range. Or as an example try these Low Co-Contraction Lunges with Anterior Pull. These allow you to feel more controlled and keep more of a vertical tibia therefore performing the exercise more effectively.
Start Point: With your right hand on Vastus Medialis (teardrop shaped muscle) and left hand on your glute and your right butt cheek squeezed hard, lift yourself off the ground a few cm.
Mid Point-End Point: Raise up stopping shy of lock out. This will keep tension throughout and reduce the range. Be prepared for the burns, and an intense stretch through your trail leg. This is fantastic to engrain 90/90 position and give instant feedback on what muscles should be working.
The point is even if it’s a magic exercise, it’s not magic for you if it hurts or aggravates an issue.
Focus on what can do, rather then what you can’t
This piggy backs on the above, but it definitely is worth mentioning.
Accept that you may not be able to perform your heavy squatting pattern for the time being, and focus on what movement you can do to create a training effect.
This is exactly the process that I went through when I broke my fibula and dislocated my ankle being tackled. Write down a list of movements that can be done pain free, and focus on these.
Can’t squat/deadlift/lunge due to injured/stiff/recovering ankle: Maybe it’s a time to hammer on your glutes and hamstrings through various supine based exercises. Lean on the cautious side and build up.
I recently just had a client who outstretched to catch a ball and his ankle blew up to balloon status. We had sumo deadlifts programmed, but ended up starting out with plenty of upper body as well as quadruped glute work, glute bridges, single leg glute work, strap leg curls and went up from there.
After a few weeks we worked up to barbell glute bridges, and now as ankle mobility has nearly been regained I am confident, as he is to slowly incorporate some standing work.
Here he is with some warm up sets on the BB glute bridge.
Try incorporating some DB pressing variations and a lot of pushup progressions, while hammering and bringing up your back strength. There is hyuuuggeee variety to use.
For example we have successfully regressed back to single arm fat grip floor presses with a neutral grip (mouthful I know) pain free. This still lends itself to some heavy lifting, while respecting the body.
It never hurts to incorporate more back/upper back work into the mix all year round too. A 2:1, sometimes a 3:1 ratio of pulling to pushing can help regain some normality in your posture and any strength deficits you may have.
Some pressing variations that tend to give the shoulders a bit more room to breathe and be a bit more joint friendly are DB floor pressing variations, Tucked neutral grip pressing exercises, ½ kneeling cable/band presses, standing split stance cable/band presses, ½ or tall kneeling corner presses. There’s more this just gets you to think outside the norm.
This variation is great as the resistance is low on the shoulder, and it is an angled press. So therefore we get a fatter grip, neutral hand position and varying resistance all while the glute is on and we get a bit of anti-extension throughout. Perfecto!
Don’t forget the other limb
There are times when being couch or bed ridden is unavoidable. Although when you are able to be up and moving around, there is then also the chance to begin to start the process in moving forward.
When we injure ourselves, or something doesn’t go quite as planned we can feel quite defeated and mentally drained.
With my ankle injury I wasn’t going to let both my legs turn to jelly and lose everything I had gained. Having 3 surgerys over a 12 month period I needed some avenues to keep me mentally and physically on top of things.
The results of the carry over were positive. Training the other limb has a slight carry over in strength and muscle control.
Choose exercises you can do, and do so with a slowly progressing volume. Most exercises can be done single side loaded or off set loaded.
On a note on stretching here is a hip flexor stretch I had to use when I couldn’t put pressure on my left foot. It worked a treat, and I used it frequently.
(All the pressure is taken off the front foot).
Hit the other half of your body hard
If you are someone who trains 4-6 times per week and can’t bare the thought of missing scheduled training sessions, then don’t.
What we can forget is that although we are injured, and recovery is number one at times, we still have 80-90% of our body to train. That’s a big chunk to me. Don’t let 10-20% get you right off track with everything.
Get your meathead on and add in a varying upper body session. Alter the rep ranges, and go for it. Maybe even add some arms in there. I won’t judge.
If it’s your upper body, add in a lower body conditioning session, or some extra lower bodyweight exercises.
If your ankle/knee is playing up and you can’t join in team training sessions, try incorporating some battle rope conditioning sessions to jack the heart rate, and minimise joint stress.
Try these battle rope variations to keep it interesting and challenging. Not all will be able to used if you can’t walk forward or backwards but you get the idea.
Check List to kick A#*when injured and recovering
I wanted to provide you with a list to go over and sift through, and take note of what you are doing/can do/and will do to make the transition from where you currently are, to where you want to be.
– When in doubt, seek professional advice and determine your injury/restriction
– Focus on what you can do, what you can’t is not important and irrelevant
-List movements you can do pain free. Think in terms of horizontal push/pull, vertical push/pull, squat, hinge, isolation.
-What would you like to achieve in the next 2,4,8,24,52 weeks that you may be recovering etc
-Do you have any weaknesses/imbalances that you can work on and bring up?
-How many days per week do you want to train/ or can train?
-Do you have some opposite limb exercises to perform to carry over to the injured side?
-Omit the days of your current program that you can’t do, or tweak the exercises so you can do them
-Add in some pain free conditioning/metabolic methods to utilise if this is what is needed
-Surround yourself with positive people, and a powerful network that can help you when necessary
-Remain positive and know that this is short term and you can get back to your normal regime when it’s time.
Being injured and recovering takes a new skill set and different approach to training and lifestyle. Some small tweaks to your current plan, and you can remain on track, keep some normality and sanity and in general feel good that you are doing something to benefit not hinder the process.
If you have any questions, pop them below.
About the Author
Shannan Maciejewski is a strength coach from Australia and the founder of Raw Fitness and Sports Training located in Ballina NSW.
He has a strong passion for developing on and off field performance for football(soccer)players, and his no-nonsense approach and methods produce long lasting results for many regular joes, individuals, athletes, and teams he works alongside.
He does not share the same passion for Star Wars as Tony though. Sorry!
There are times when being couch or bed ridden is unavoidable. Although when you are able to be up and moving around, there is then also the chance to begin to start the process in moving forward.
