“Training Around Injuries” By Jonathan Pope
Just as nature takes every obstacle, every impediment, and works around it — turns it to its purposes, incorporates it into itself — so, too, a rational being can turn each setback into raw material and use it to achieve its goal.
– Marcus Aurelius
Injuries happen. Even if your training program is well thought out, sometimes you’ll run into small issues or you’ll injure yourself playing your sport or doing your job. These inevitable setbacks, while annoying, don’t have to crush your fitness and lead to long periods of doing nothing followed by the long slog just to get back to your baseline.
Before we talk about what to do, some context.
Over the past twenty years I’ve had five major surgeries, broken my elbow and foot, ruptured my spleen, and had multiple dislocations, sprains, and concussions.
Some from being stupid. Well, most of them from being stupid. I can’t help you on that front, but you can learn from my mistakes and harness the lessons in this podcast to more effectively work through your own injuries.
Before we talk about what to do with your training, we have to discuss your mindset.
Recovery is Your Responsibility.
Don’t assume that the medical practitioners you’re working with will be instructing you on everything you can do to recover as quickly as possible. They have an extremely limited amount of time with patients and can hardly get most of them to do anything to help themselves.
When a doc says to ‘rest’ something, they are basically saying, ‘don’t be an idiot’. Unless you have a serious medical condition, there is no reason to ever do nothing. You have to take responsibility for your recovery and navigate the balance between too much and not enough stress to allow for a quick healing process. No one but you can do this. This doesn’t mean you don’t seek out advice or listen to it when you get it, but ultimately you have to take ownership of your own decisions and the path that you choose.
So, don’t be an idiot and run on a bad knee or deadlift when your back is wrecked.
You are the only one that lives in your body and knows when you’re using your injury as an excuse to do nothing, and when you’re stupidly trying to push through a nagging problem instead of addressing it.
It’s not easy to navigate subtle situations like how much to stress your knee 8-weeks post ACL surgery – this is where medical advice should guide you.
But, if you’re the least bit honest with yourself, you know when you’re doing nothing or dumbly ignoring your body’s signals because you can’t set your ego aside for the sake of long-term health and capability.
Focus on What You Can Control
You can always eat well. You can always manage your mindset and response to emotions.
You can do your best to manage your systemic stress levels. You can always improve your sleep hygiene and get as much sleep as possible.
You can always do something.
The more energy you put into what you CAN do, the less time you’ll spend fixating on what is outside of your control. Practicing this approach strengthens what is called an internal locus of control, or believing that you can influence the path of your life and have the ability to respond to events within it.
The opposite, an external locus of control, is someone who believes that life’s events are outside their ability to control .
Having an internal locus of control is one of the strongest predictors of stress resilience and has an immense effect on the difference between actively or passively coping with the challenges inevitable in any life worth living.
Typically injuries mean less training demands. This is an opportunity to work on yourself in other areas – mindset, emotional regulation, nutrition, or other general life skills like communication or leadership.
Pain is a Signal
Pain is a predictive emotion that only very loosely correlates with tissue damage. It’s more a matter of attention and opinion than a direct connection to trauma or danger. For example, many people with chronic back pain have no observable damage in their spines when viewed through an MRI, while many people with no symptoms of back pain whatsoever can have things like bulging spinal discs, stress fractures or other damage that is visible on MRI’s.
Pain and fatigue are fluid strategies, not gauges on a dashboard. Thus, pain and fatigue are largely an emotional response created by the strategies your mind uses to get through them. Your beliefs about the perceived difficulty of something color how you feel during an activity.
Fortunately, your perceptions of pain and fatigue can be trained and controlled in much the same way that your strength can be developed in the weight room.
When training around an injury it’s important not to neglect or ignore pain signals. However, fixating on it or imagining that every ounce of discomfort is equivalent to that amount of physical damage is extremely limiting.
- We can probably ignore or compartmentalize pain when it relates to and continuing only results in temporary discomfort that doesn’t cause long-term harm (or slow the healing process). Think of this as the “hurt without harm” category.
- We do not want to ignore pain when there is an obvious issue that can be resolved with immediate attention or you’re causing serious physical harm or slowing down recovery. This is the hurt *with* harm category.
Training, Stress, & Recovery
Before we talk about specific strategies for different types of injuries, we first have to discuss training, stress, and recovery.
Your immune system is intricately tied into your body’s response to exercise. When you lift a heavy weight or smoke a conditioning workout, cellular damage occurs. This causes a cascade of other responses that end with you becoming bigger, faster, or stronger. This dynamic interaction means that your body’s response to the same stimulus is constantly changing.
Any injury that causes a large systemic immune response will disrupt your body’s response to training and ability to tolerate stress. Acting like your body is at full capacity and plowing ahead with your normal training volume is a bad idea.
Depending on the severity of the injury, you need to reduce your training volume to account for how stressed your immune system is throughout the recovery process. Exercise beyond your body’s ability to recover is a “pathogenic” stressor and slows recovery instead of stimulating it.
There are some good rules of thumb to follow here:
- First, you should not be ‘beat up’ from training when you’re recovering from an injury. Some soreness or stiffness is OK, but you should not be trying to achieve the normal ‘overreaching’ types of fatigue you experience during the end of a normal training block.
- Secondly, you should feel fresh, or close to fully recovered for every workout.
Principle 1 – Aerobic Work Enhances Recovery
All recovery is aerobic in nature. Blood flowing around an injured site as well as throughout the body promotes exchange of waste and the rebuilding of cells and speeds recovery.
Aerobic conditioning also develops the fat oxidation capacity of your liver, which allows it to clear out immune system waste products more quickly. In addition, aerobic conditioning helps enhance the balance between the sympathetic and parasympathetic nervous systems, which helps you to manage your systemic stress responses so that you can actively engage and focus when needed, and disengage, relax, and recover in the spaces in between.
We can hear the excuses now for avoiding aerobic work.
“I’m trying to gain muscle.” “I don’t want to get weak.” These rationalizations are the plaintive battle cries of mediocrity. Unless you’re an elite-level power lifter, Olympic lifter, or bodybuilder, you have no excuse to be deconditioned.
Do your aerobic conditioning. Work up to 2-3 times per week for 45-60 minutes in zone 2. If you aren’t familiar with heart rate zones, during zone 2 work you should be able to breathe through your nose, it feels ‘easy’,and you can hold a light conversation.
Circuits of various low threshold movements like mobility work can be a substitute for steady state aerobic work. Also, get outside if possible and go for a hike, bike ride, or some other outdoor activity. There are some important benefits to moving outside in a 3D environment compared to slogging away on an indoor hamster wheel.
Principle 2 – Movement is Nutrition
Whenever you injure a soft tissue such as a muscle, ligament, or tendon, movement is your best friend. As long as you use common sense and stay within the range of motion and loads your medical practitioners outline, you’ll be doing your body a favor. Movement stimulates increased circulation around the injured area, which feeds nutrients and gets rid of waste byproducts.
Movement is also a stress (a positive one when you listen to your body) and it stimulates scar tissue formation. This is important because scar tissue develops in specific formations to handle the stress that it’s placed under.
If you don’t stress the injured site during recovery, you won’t develop scar tissue that can handle the movements and types of stress that it’ll be under when you’re healthy and return to full speed. Known movements, performed at a low intensity for reasonable volume, speed up recovery.
Within the context of your specific limitations, move every day, even the injured area, when possible. You want enough movement to provide some adaptive stimulus and circulation, but not so much that you worsen the injury or reinforce a pain response. It’ll be up to you and your individual context to find that balance.
Training Around Upper-Body Injuries
These are the easiest type of injury to train around. You still have your lower body, core and one unaffected arm to train.
Train the non-injured arm. Just because one of your arms is injured doesn’t mean the other one can’t be trained. Many studies have shown that maintaining fitness on the non-injured limb significantly improves recovery time on injured limbs. We won’t talk about the mechanisms here, just trust us that it’s a good idea.
Effective single arm exercises are things like
- Single Arm Dumbbell Row variations
- Single Arm Dumbbell Bench Press Variations
- Single Arm landmine and Overhead Press variations
- Single Arm cable pull-down, press, and rowing variations
Obviously, that’s not an exhaustive list. It’s a starting point, and you’ll be able to find other options depending on your creativity and training environment.
As far as training the lower body goes, you can give your spine a break. Taking a month or two off from bilateral squats and deadlifts is a good idea even when you’re not injured. Thus, an upper body injury is an opportunity to focus on single leg exercises.
Some of our favorite options include:
- Rear-Foot Elevated Split Squat variations
- Lunge Variations
- Barbell Hip Thrusts (barbell on hips)
- And, Belt Squats
Safety squat bars can be good for loading a movement while dealing with an upper-body injury. Holding a weight in one hand or using a weight vest are also good ways to add load. Slowing down tempo and adding in isometrics are also effective ways to increase difficulty without just using more weight.
Working Around Lower-Body Injuries
Lower body injuries can be difficult to work around, but with a few good strategies you can continue to train and retain most of your strength throughout your recovery period.
Train the upper body. This may seem obvious, but most people think any injury means no training. You can still train the upper body with very few modifications and a good training partner to help hand you weights. Ideally, don’t do this by just sitting on machines. Use your communication skills and ask someone to hand you heavier weights you can’t move or ask them to at least move them to your general area.
Just like the upper body, always train the uninjured limb. Some options for the lower body include:
- Single Leg Squats
- Single Leg Hip Lifts
- Single Leg Deadlifts
- Single leg, leg press
A lot of core training involves the lower extremity and without one leg, finding core exercises to do can be difficult. Some of our favorite core exercises for clients with a lower body injury include:
- Dead Bugs
- Leg Lowering Exercises
- Straight Leg Sit Ups
- Hanging Unilateral Leg Raises
Training Around Lower Back, Rib, & Abdomen Injuries
Injuries around the middle of the body are the hardest to train around. However, that doesn’t mean that you should do nothing.
When we have clients with lower back and abdominal injuries we start with a lot of low intensity upper-body work that doesn’t stress the injured area. This usually means simple exercises such as floor presses and chest supported rows. Experiment with supported variations that require less core involvement until you find something that works for you.
If your lower back is an issue, you may find that anterior-chain movements that traction the spine can be helpful and productive, as long as you have the ability to get into the right position for them. In other words, think like a gymnast and do a lot of work that involves hanging from things while using your abs to control your spine and pelvis. Things like hanging marches, ab levers, or even pull ups can be useful here, alongside just about anything that you could come up with off of gymnast rings.
While you’re training around these injuries, replace intensity with volume and density. It’s unlikely you can lift heavy while recovering from this type of injury, so instead focus on doing a lot of high quality, low intensity work in short periods of time. This formula stimulates blood flow and parasympathetic (or, rest and recovery-type) activation.
This means things like movement work such as lightweight lunges, squats, deadlifts, as well as breathing exercises between sets.
Here’s an example of a circuit combining these different principles:
- Kettlebell Romanian Deadlifts (done with light weight, with a slow lowering phase)
- Dumbbell Single-Arm Bench Presses
- Half-Kneeling Cable Rows (hold at top for 3 seconds)
- Hanging marches, emphasizing a posterior pelvic tilt and a ribs-down position
- Deep Breathing Squats
Repeat this for as many sets of 5 reps that you can do in 15 minutes with no rest between exercises or sets.
Drivable Terrain – How to think about training around injuries
We’ll leave you with an analogy.
During a lot of the driving schools that Craig went through during his time in the special operations community, he was introduced to the concept of “drivable terrain.”
In high-stakes tactical settings, we learned to no longer see the world in terms of roads and things that are not roads. Instead, we learned to see things as either terrain that can be driven on, or not.
Drivable terrain might mean sidewalks, ditches, going the wrong way down a one-way street, or taking a path straight through a car that’s lightweight enough to ram through and push off the road.
We would train this in scenarios. We’d be behind the wheel, and our instructor would put a big piece of cardboard over the windshield while telling us how fast to go and steering us toward a destination from the passenger side.
Completely blind to what was coming in front of us, we’d follow our instructions. “Faster, faster, ease off a little… Ok, you have the wheel.”
We’d take the wheel and a moment later the instructor would pull the cardboard away and we’d be speeding toward some scenario with only a split-second to understand what was happening and respond to it.
Sometimes the only way to successfully handle the scenario was to launch off the road and take a new route in order to avoid an ambush or slamming into a barricade.
We’d often face barricades that were too close by the time the cardboard was pulled down for us to simply slam on the brakes. Staying on the road would mean a high-speed, head-on collision followed by an ambush and a failed mission. The only safe path was to find the drivable terrain off the road. There was always a way forward, as long as we didn’t get mentally fixated on our original no-longer-possible plan and adapted quickly to the new conditions.
You can think of training with an injury in the same way. One day you were cruising along and everything was going to plan. And then suddenly you were faced with an obstacle blocking your path – an injury.
If, at that point, you just give up and use that injury as an excuse to stop training, you will fail. If you fixate on the obstacle and stay on your original path by trying to keep doing what you were already doing ( in other words, the equivalent of locking up the brakes and sliding headfirst into a barricade instead of going around it) then you will also fail.
But, there is always a way. There is always drivable terrain or a contingency plan somewhere. You probably just have to deviate from your previous path and find a new way. Then, continue on, undeterred.
When it comes to an injury, you could use three quick questions to break down how to adapt your training:
- First, what can I keep doing, start doing, or do more of? In other words, where are the opportunities?
- Second, what can I continue, but with modification? For instance, maybe you can’t run for a while due to a knee injury, but your aerobic training can still be done in the pool. Or, maybe you can still train your lower body, but that’s going to mean single-leg variations instead of bilateral barbell lifts for a while.
- And third, what do I need to stop, at least for now? For instance, if you just had shoulder surgery, you’re not going to have a lot of barbell bench pressing in your future for a while. But, never confuse the means with the end.
There is rarely a single exercise that matters all that much in the interest of your long-term goals, unless your job is doing that specific exercise professionally. So, if you make a living as a professional barbell bench presser, then maybe you can be sad about that surgery for a minute. For the rest of us, it doesn’t really go on the big deal chart.
Further, if you’re good at this adaptability thing, you don’t have to see being injured and thus training around an injury as a compromise or a setback. You can view it as an opportunity to develop something that you would not have been forced to focus on otherwise.
As the Stoic philosopher Epictetus wrote, “on the occasion of any accident that befalls you, remember to turn to yourself and inquire what power you have for turning it to use.”
Perhaps this is an opportunity to give your spine a break from putting heavy barbells on your neck, and to get better at some single-leg movements. Maybe now you can finally get better at pull-ups. Perhaps this injury is what will finally force you to learn to move better or work on better breathing mechanics.
If you spend some time around a Brazilian Jiu Jitsu school, you’ll probably find a few black belts with stories like this, about how an arm injury forced them to develop their impossibly good hip movement, or a foot injury forced them to learn to develop an inescapable insane closed guard.
Fixating on your limitations is the same thing as surrendering to them. Don’t do that. Every path has obstacles. The most successful of us are simply better at finding our way past or through them.