Staying active is integral to maintaining human health and performance. Without regular exercise, our physical, mental, and social health all suffer. Exercise is one of the few things we can do for ourselves that has such a large positive impact on our wellbeing. This is why when injuries come up, they can carry quite a burden. Knowing what to do when an injury arises is key.
Let’s start with a broad perspective on the question at hand: Can I still work out while injured? The overwhelming answer is absolutely. The largest factors at play here are severity and location. What is injured, and how much is it impacting you? Training is extremely modifiable around circumstances. For example, a mild calf strain has no impact on your ability to train your movements that don’t stress the calf. As long as you can tolerate walking and other movements that are required in your workout, there is no concern.
When evaluating how bad an injury actually is, a few simple characteristics to consider are:
Nature of pain - how does it feel? Is it dull, achy, throbbing, sharp, or stabbing? I often encourage people to avoid anything that recreates sharp or stabbing pain. These sensations are indicators of high sensitivity that may be correlated with more substantial tissue damage.
Intensity of pain - how bad is it? This can often be quantified using the numeric pain rating scale of 0-10, where 0 = none and 10 = the worst you’ve ever experienced. Again, to keep things simple, I often implement a traffic light system where:
0-3/10 = green light. All clear to proceed.
4-6/10 = yellow light. Consider modifying and proceed with caution.
7-10/10 = red light. Stop.
Using this method can be a way to self-assess your own tolerance and make decisions on what you should do next.
24-hour response - how is your recovery 24-hours after training? Ideally, symptoms should return to baseline in a 24-hour period. By doing so, we are reassured that training did not exceed your current capacity and no major modifications are required from you. Note that this does not apply to delayed onset muscle soreness (DOMS), which can last for several days.
Below are a few examples of common injuries and how I might suggest you train around them.
Overhead pressing with a degenerative rotator cuff partial tear
What needs modification? Upper body pushing and pulling patterns, vertical more than horizontal.
Original Movement > Modified Movement
Barbell strict press/Military press > Landmine Press
DB snatch > Bottoms Up KB press
Wide grip pull up > Neutral grip lat pulldown
The goal of any modification is to reduce the stress from loading enough to normalize pain levels while keeping training intensity as high as possible. Specific to the shoulder, oftentimes we can modify the range of motion or the position of the joint and keep training loads relatively high. Training load does not always mean heavy weight. It could also indicate high volume, time under tension, overloading one contraction phase, etc.
Squatting and deadlifting with a bulging disc
What needs modification? Hinge and squat patterning.
Original Movement > Modified Movement
Conventional deadlift > Trap bar deadlift
Low bar back squat > Front squat/Goblet squat
1st pull during power clean > Elevated clean pull
By changing the way that the body is being stressed during the painful movement, we can reverse-engineer and change where loads are being directed. Moving from a conventional deadlift to a trap bar brings the load closer to our center of mass, reducing the lever arm on the low back. A low-bar back squat requires a significant hinge to occur at the hips during the squat pattern, increasing the stress on the low back. By modifying to a front squat, we can shift more of the load from the low back to the quads and upper mid-back. Lastly, the first pull during a power clean requires a forceful effort in a hip-hinged position. To maintain the focus on triple extension rate of force development, clean pulls can be performed from an elevated position. This reduces the total range of motion being utilized and brings the trunk into a much more upright posture.
Squatting and lunging on a sprained ankle.
What needs modification? Axial loading and ankle dorsiflexion range of motion.
Orginal Movement > Modified Movement
Front squat > Heels elevated goblet squat
Walking lunge > Bulgarian split squat
Squat jumps > Medicine ball slam
The primary goal in this scenario is to limit the ankle dorsiflexion range of motion (how far the shin moves forward over the ankle). With a sprained ankle, the motion tends to be limited and painful early on. By elevating the heels, the ankle starts in a position that is further away from the painful range of motion. Lunge patterning requires a significant amount of ankle dorsiflexion as well; therefore, by elevating the rear leg and maintaining a vertical front shin, the pattern can remain similar without pain. Lastly, squat jumps involved both high amounts of dorsiflexion and axial loading. To train a ballistic effort without these adverse effects, choose a medball slam instead.
The main take-home message here is that there’s almost always a route for you to modify your training plan around an injury. This does two really important things: 1) maintains your body in an optimal healing environment with plentiful blood flow, helpful hormones, well-managed inflammation, and a good supply of neurotransmitters to aid in pain management. 2) keeps you active and engaged in life! The best way to get past an injury is through it. If this speaks to you or someone you know, we would love to help you create a game plan. Call us today at 404-548-8263 or complete a contact form, and we will reach out to you!
Best,
Dr. Mike Jones, PT, DPT
Board Certified Orthopedic Clinical Specialist
Certified Strength and Conditioning Specialist
Owner/Founder - Stamina Performance Physical Therapy
Dr. Mike Jones
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