Brian Minogue, ‘Injury Recovery,’ Hard Gainer, 61 (1999), 18-21.

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The reality of physical injury is omnipresent to all human beings. Whether it comes in the form of broken bones, muscle tears, strains or sprains of connective tissue, damage to our all-too-fragile form is a cost of doing business on earth. While a proper strength training program can do much to decrease our risk of injury from outside forces, it can’t make our bodies impervious. Not only that, but improper exercise can do much to inflict the injuries that we try to avoid. But even with the safest training practitioners and environments, sometimes people still get hurt.

Once an injury occurs, the body must be allowed to heal. But the process is

rarely as simple as just bed rest. The damage which our muscles, bones and connective tissues can incur while exercising can be drastic, and often difficult to discern from the naked eye. To promote full recovery from an injury, the sufferer must ensure proper steps are taken. Put generally, these are: (1) diagnosis, (2) rehabilitation and (3) recovery. Each of these steps needs to be explored in the event of an injury, so that future damage to the same areas can be avoided, and long-term pain and loss of mobility do not result.

Diagnosis

The first step to be taken whenever an individual suffers a training-related injury, is proper diagnosis. It’s imperative that we, as exercise enthusiasts, don’t attempt self diagnosis. Unfortunately, this is one of the steps in injury recovery which is most often forgotten. Strength trainees can often become a hodge podge of varied anatomical, kineseological and biological information. This lay person’s level of knowledge can’t replace the expertise of a medical professional. Don’t self diagnose.

As an example, allow me to relate the recovery process of one of my training partners. This individual suffered numerous shoulder dislocations, following the initial injury that resulted from a nasty fall. In response he and I, with only a limited understanding of the function and anatomy of the rotator cuff, decided that the injury was the result of an excessive mobility in the shoulder joint, which had been caused by overstretching of the rotator cuff muscles in the initial fall.

To a degree, our attempt at self diagnosis was correct. The rotator cuff muscles had been stretched. To correct this problem, my training partner began using an array of dumbbell rotation movements to strengthen, and thereby stabilize his rotator cuff. Once he had strengthened the area considerably, he returned to a normal strength training program. After a month or so, his shoulder dislocated once again, while performing a overhead press, causing even greater damage.

What our diagnosis could not determine was that, along with the overstretching of the rotator cuff muscles, my training partner had suffered damage to the bony prominences on the head of the humerus. These raised points had been considerably reduced in size, and could no longer function to prevent the humeral head from moving too far out

of the shoulder joint. Only with the medical expertise of a professional could such a determination be made.

If an injury is harsh enough to cause you to stop training, either by sharp pain or prolonged discomfort, it’s severe enough to seek proper diagnosis. You’ve nothing to lose by seeking a medical opinion. If the injury proves to be a minor strain, then a few days of rest will be all that’s necessary to return to your previous best. But if you’ve caused excessive damage to your body, you will need to know that. Any attempt to ignore or “work through” physical harm will only cause greater pain and injury.

As a trainee seeking a medical opinion, you must attempt to find a professional with some level of training experience or understanding. Obviously, in cases of an injury causing great pain, emergency medical assistance is required, and the need for a training- knowledgeable provider will have to wait for follow-up care. But, in any case, to provide you with a full understanding of your injury and its repercussions, the medical professional must possess a moderate appreciation of strength- training practices and methods. If you’re in any doubt as to the ability of your care provider to understand your needs as a training practitioner, don’t be afraid to voice these concerns, or seek further medical advice.

It’s vital that you, as a patient, be an active participant in your diagnosis and injury recovery. This requires what I refer to as “full disclosure” with your doctor or rehabilitation specialist. You must do your utmost to explain to him or her the level of activity you participate in, what movement you were performing when the injury occurred, its relative difficulty for you, etc. If you were using poor form, cheating a dangerous rep, then your doctor needs to know. If, on the other

hand, you were using strict form, using a weight that was fully under your control, and something totally unexpected happened, this also has a direct bearing on a full diagnosis.

Anything that you hold back, or fail to explain fully, can affect the quality of your diagnosis. Remember, most people don’t participate in serious strength training; so express your previous training experience to assist your care provider in determining if any long- term injury abuse has occurred.

Rehabilitation

Following a full diagnosis of your injury, the second step is rehabilitation. This is the healing step on your road back to strength training. Dependent on the severity of your injury, this process can be extensive or a minor concern. Whatever the result, you need to exercise patience more now than ever. As a strength trainee, it’s very probable that you have an almost addictive need or desire to train. You must curtail your internal drive to rush back to peak training, as such an action would only cause more damage.

Your doctor and/or recovery specialist will provide you with a program and time line to follow. You need to be an informed consumer of the care being provided to you. Be equally concerned with how you perform your rehabilitation program properly, and why this program is formatted as it is. If you’re not satisfied with the information provided, be more persistent. If the practices of your diagnosis and/or rehabilitation seem counter to what you know of safe and proper training, or your symptoms, ask questions. While it’s very dangerous for a non-trained person to attempt self treatment, it’s equally dangerous for an injured person to be treated by a poorly trained professional.

Not all medical care providers are created equal. Unfortunately, the realities of insurance programs often demand that we as patients take what we can get, regardless of the quality of the care provided. Do the best you can with the care you can afford. Hopefully, if you’re dealing with a caring medical recovery facility, and broach your concerns in a considerate manner, together you can find an acceptable path to recovery.

Once again, full disclosure is very important at this stage. What a typical person considers full recovery may vary considerably from what you consider it to be. Remember, the average person has no interest in pressing several hundred pounds overhead in a few months. Your desire to get back to a 400-pound squat may be beyond the goals of your rehab specialist. Explain your long-term desires for your recovery. What do you want out of your body in the future? How possible are your goals given your injury? These are questions you need to work with your care provider to address.

Whatever restrictions are placed on you during the rehab stage, if they are explained in a reasonable fashion to you, stick to them. If you allow your passion for strength training to get ahead of your rational mind, you may quickly return to the pain and suffering you experienced not long ago. As frustrating as it is to watch hard earned strength and muscle atrophy, you must be patient.

In the meantime, apply the same zeal and perfectionism which you give to your normal training, to your rehab. If you rest assiduously for your squat, do so for the strain in your lumbar. If you never miss a scheduled workout, don’t ever miss a rehab session. In the meantime, you should discuss your long-term training realities with your medical professional. What can you do now? Which movements are out on a temporary basis? What movements are out for good?

Recovery

Following a full rehabilitation, the third step in injury recovery is recovery itself. This is the point at which you return to the gym, ready to reapply yourself to your passion for muscle and strength. Now you will have to come to grips with the long-term training restrictions which your injury may place on you. You may need to find suitable exercise replacements, which address the same muscle areas, but which don’t re-injure you.

Returning to the example of my training partner, his rehab specialist told him that the overhead press was out, for good. As good a movement as the overhead press is, for him it was an unacceptable risk. Instead, he performed a high-incline bench press. His pushing musculature was being worked without risking re-injury.

In the recovery phase, you must still temper your training passion, at least temporarily. Returning to previous weights too soon is not good for your training future. Start slowly, and with lighter weights. It will be hard to reduce the poundages and gradually work back, but you will work back without re- injuring yourself.

Any new movements which you’ve added in place of unacceptable exercises will need to be mastered for form and speed. And old lifts will also have to be re-learned in some cases. A deadlift before major back surgery may not feel the same as after. You may find new limitations in your pre-injury range of motion. Adapt.

Don’t force your body to act as it did prior to your injury. In many ways, your body may no longer be the same. A shoulder which has been surgically

tightened and altered, for example, is not the same one it was before. Bone and muscle structures have changed. Treat these new joints as training neophytes, by working back slowly.

Now that you’ve returned to your training, take the time to consider the practices which may have led up to your injury previously. If you used shoddy form in the past, or accelerated through your reps, take a different tact now. Take the time to reconsider your training methods so as to do your best to injury- proof your routine and body. Slow down the reps, use strict form on sound movements, move through the range of motion which is appropriate for you. Remember, training is intended to be a life-time activity. What you do with your “trick” elbow now may cause twenty to thirty years of pain and suffering down the road.

Don’t be afraid to use your rehabilitation specialist as a resource in redesigning your training regimen. You may not completely see eye to eye regarding proper training, but an educated opinion can only benefit you. Considering the value of an outside opinion, even if you choose not to take the advice, will expand your training knowledge.

Whatever your history of injury, don’t forget, human bodies can live healthy, pain-free lives for many years, or they can suffer with aches and limitations for the same period of time. If you suffer pain, it’s a signal that some kind of damage has occurred. This, by definition, is an injury. Taking the proper action now—by way of (1) diagnosis, (2) rehabilitation and (3) recovery—can, in most cases, make great strides in reducing or completely removing the pain. Such action is definitely to your benefit. Remember it’s your body to save or destroy.