Injury Prevention & Management

10 Steps For Training Pain-Free

Shoulder_pain_dyn All significant injuries should immediate medical attention, but oftentimes we find ourselves dealing with chronic orthopedic issues that don't readily respond to "medical" treatment. "Itises" (E.g., tendonitis, bursitis) are an example of what I'm talking about. My suggestions below are in no way meant to supercede proven therapies such as iceing and bodywork. Instead, these 10 tips are meant to help you safely get back into a productive training program.

1. Use the widest possible variety of exercises, stressing varied positions, contraction modes, and joint angles. Especially stress positions that you don’t tend to use for fear of injury.

2.  At the beginning, use loads that you’re SURE will not provoke your injury. This might in some
cases mean doing stuff like curling no weight for 5 sets of 5 (yes, I’m serious).

3. Progress VERY gradually. In the case of the empty curls, work up to 5x6, then 5x7, etc. When
you hit 5x10, start curling a 2.5 pound plate for 5x5. Then 5x6, etc., etc.

4. Because the loads are so light, you won’t really need to rest between sets much at all.

5. Because the loads are (initially) so light, you should be able to train frequently— probably every day. The body’s most unique feature is it’s ability to adapt— more frequent training “teaches” the body
to accept constant challenge.

6. If at any time you re-injure yourself, wait until your symptoms subside and drop the previous
workout’s volume by 1/2. In other words, if 4x6 caused re-injury, wait for it to heal and then do
4x3. If that goes OK, start climbing your way back up.

7. Be flexible and creative. If something on your schedule hurts right at the outset, make a pain-free
substitution right then, on the fly.

8. Understanding pain symptomology: Sometimes you’ll know if you’re hurting yourself right
when you’re performing the offending exercise. Sometimes you won’t know until the next day.
Pay attention and become sensitive to these issues.

9. Despite my earlier advice about stretching, don’t stretch a sore, torn or “tweaked” muscle—
Even though stretching often "feels" like the right thing to do, typically you’ll only injure it further.

10. Start right, finish right: Light aerobic activity before and after the workout will make tissues
warm and more pliable (pre-workout), and will enhance circulatory oxygenation and cellular
nutrition (post-workout). Don’t cut corners, EVER.

The slow but steady approach must be your constant mantra if you want to keep training in the wake of chronic injuries. The guy squatting 800 on the rack across the gym might be mere moments from an injury anyway. Seek slow, continuous, steady challenge every day— your injured tissues don’t like big surprises, they like predictability. Treat your body with a velvet glove instead of an iron fist, and you’ll be rewarded for your efforts.

Orthopedic Profiling

In political terms, “profiling” is a hot-button topic. For example, at airport security checkpoints around the US, we’re supposed to pretend that a wheelchair-bound 80-year old woman of Norwegian ancestry is as much a threat as a 30-year old Middle-eastern man shouting “Allah Akbar, Allah Akbar!” prior to boarding his flight. After all, if airport security guards paid more attention to individuals who posed a greater security risk than those who posed a lesser risk (based on historical evidence), that’d be profiling.

Politics notwithstanding, the concept of profiling actually has some interesting applications for those of us who deal with orthopedic issues. Last week I had my left shoulder tested on a Biodex machine (I’ve had some longstanding impingement issues in that shoulder). Now, if you’re like me, your first thought might be to dismiss the Biodex altogether. After all, while the machine does accurately measure strength/speed/endurance profiles, all test movements are decidedly “non-functional.” In my case for example, we were testing internal and external rotation of the left humerus. During the test, the patient is locked into the machine, which totally controls the plane of movement as well as the range of motion.

Obviously, you might wonder how the results of this test correlate to real World, multi-planar, self-stabilizing movement. And that’s a fair question. The real value of Biodex testing is that you first test the non-involved joint (in this case, my right shoulder), which illustrates what the strength/speed/endurance profile of a pain-free joint looks like. Then, after testing the involved side, you compare the two and see what type of discrepancies you’ve got between the pain-free joint and the painful joint. My results were surprising, because my external rotation on the involved shoulder was slightly stronger than the right (non-involved) side. My internal rotation capabilities however, were significantly weaker on the left side as compared to the right.

Now, again, it’s easy to think “OK, that’s all well and good, but the Biodex machine forces you into completely unnatural movement patterns that simply don’t relate to normal joint functioning.” But you’d be missing the point here, because this test showed me what a pain-free shoulder looks, tastes, smells, and feels like. It further demonstrated that my painful shoulder has a completely different strength profile (on this particular test battery) than my pain-free shoulder. This realization prompts me to modify my training in the direction of minimizing this discrepancy.

Now let’s take this discussion back into an admittedly more functional milieu. For the sake of discussion, we’ll assume you’ve got a painful right Achilles tendon. And we’ll further assume that your left Achilles is pain-free. Now you’re got a control that you can profile for the purposes of comparing it to the painful side. And even if you know very little about anatomy or kinesiology, it’s still a fairly simple matter to develop some tests to create a profile for that joint.

The first thing that comes to mind might be to perform single leg calf raises. Do 10 reps and take notes on how difficult is was, and whether or not there was any type of pain or discomfort. Next, perform 10 reps in the involved side. Was it more difficult? Look at both Achilles tendons, as well as your calf musculature on both sides. Do you see any differences? While you’re at it, feel both tendons. Is one side warmer than the other (this suggests an active inflammation)? Also, look at the soles of your most commonly worn shoes- any differences between left and right sides? Another self-test (and this is tricky because it’s tough not to bias the results by knowing the desired outcome, but it’s worth doing anyway): walk in a straight line and see if you hear a difference between your right and left steps. Further, when you walk, do your foot mechanics appear to be the same or somewhat different?

Once you’re done these comparisons, you’ll have a profile of a healthy Achilles tendon, and a comparative profile of a painful Achilles. And that’s very useful information to have. After all, even though pain often causes dysfunction, the reverse is often true is well.