Modifying Exercise Around Injury: A Guide for Safe and Effective Training and Rehabilitation
Injuries can be a significant setback in anyone’s fitness journey, but they don't have to mean the end of your exercise routine. With the right modifications and adjustments, you can continue to stay active and even promote recovery. Here, we’ll explore various ways to modify your exercise regimen when facing an injury.
The Problem
The current healthcare provided in the United States is subpar at best. It is a reactive creature that does very little to help itself from a preventative standpoint. A vast majority of medical schools (80-90%) fail to cover basic nutrition and exercise physiology. So, it shouldn’t be any surprise that your doc just tells you “Well just don’t do it if it hurts” when confiding in him/her at your appointment. Which is a wildly lazy answer that a 6-year-old could give you. It's difficult and skilled to adapt training to an injury. It requires an in-depth evaluation/examination with equally in-depth questions sprinkled throughout. But more on that later.
What does that look like in the Physical Therapy World?
While Physical Therapists do have more training in these areas, they often fail to practice what they preach from a health and fitness standpoint. This leads to some PTs being incompetent in realms of people that often get overlooked. These groups involve CrossFitters, Olympic Weightlifters, Powerlifters, Body Builders, Hyroxers, and other fitness athletes from different backgrounds. Many healthcare providers, PTs included, will take one look at these individuals and assume they don’t need PT. Or, if they do magically get referred to PT, will be grossly under-dosed from an exercise standpoint. The guy who deadlifts 500+ pounds doesn’t need side-lying clamshells with a red theraband… he needs exercise modifications to the movements he loves and wants to do.
Modify Strength Training
Strength and conditioning is essential for maintaining muscle mass and overall fitness, but it may need to be adapted around an injury. How we adapt however is of the utmost importance. As a general rule we have 3 ways to modify. Volume. Intensity. Range of Motion. The one we choose depends largely on what we find in asking crucial questions. We likely wouldn’t modify the volume with a client who reports increased pain with deeper ranges of motion or increased weight/resistance. Nor would we modify intensity in a patient with complaints of increase pain with more repetitions. If adjusting those is not in the cards or ineffective, that's when we look to substitute in another movement that still challenges the area of pain in a tolerable way.
Exercise parameters
Volume refers to the amount of repetitions one does in a training program. Intensity refers to the amount of resistance one uses for a given movement. Range of motion refers to how much joints move when performing an exercise. We discover which is the culprit by establishing the “mountain of irritability.” Which is a fancy way of saying “how long does it take for the tissue to get mad” and “how long does it take for the tissue to return to baseline.” So if a client/patient comes through the door and reports that pain reaches its peak by the 4th set of a movement… this likely isn’t a range or intensity issue. It is likely a volume issue. This can be extrapolated out to include the other variables, but I think you get the point. As mentioned above, if adjusting said variables proves to be ineffective at allowing a movement to be tolerable, that is when we substitute in another movement that hopefully still challenges the involved area. The last thing we want to do is not move or challenge the tissue in question as this leads to further atrophy and increased instability.
Pain should be tolerable in the moment and 24 hours after
In conclusion, it is important to listen to your body. If the movement is tolerable in the moment, but the tissue is flared up in the 24 hours after, then further modification is required. We need both in the moment and the 24 hours after to be tolerable to know that we are hitting the intended stimulus. As long as one sticks to this, risk of further injury is unlikely. That is of course as long as one is getting quality sleep, nutrient dense food, and managing their stress in healthy ways. If those are out of whack, then odds of full recovery in a reasonable timeframe are slim. More on that for a later blog post.
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