You’re pretty good at this…”
Edit: I would like to point out that this post is not comprehensive. It only scratches the surface. Hopefully it helps you understand that tissues adapt to the forces that they encounter. In order to heal, tissues will need an adaptive stress in normal movement patterns, so this is how rehab is most effectively done.
I will ironically do my best to detail the common types of injuries in lifting and how we typically will treat them. It is kind of hard to sit in one spot because of my back, but I will press on for you, the reader. Justin Lascek; Man of the People.
Muscle Belly Injuries
The most likely injury to happen is a muscle belly tear. Which muscle belly is dependent on the exercise being done, length of the warm-up, relative weight lifted, technique, and for some times for seemingly no god damn reason.
The standard protocol for muscle belly injuries is to wait till the initial bleeding process occurs, then make that muscle contract to get blood and lactate to it so that healing is promoted. This technique will also prevent any scar tissue forming as a result of the ancient and asinine “let it heal on its own” advice. We refer to this method as the Starr Rehab Protocol/Method/Whatever and it was originally developed by Bill Starr and has been taught by Mark Rippetoe since he learned it from Starr. The best description can be found here. There is no sense in discussing this any further, because Rip has already done so more than adequately.
Back Injuries
Back injuries are less common than muscle belly injuries, and are almost always caused by a form fault. The most typical reason that the back would structurally come out of alignment in a properly performed squat, deadlift, power clean, etc. will be when the upper or lower back undergoes flexion. My experience (coaching and otherwise) has been that this will happen right off the floor in a pull and during the beginning of the “up” phase in a squat (as the bounce or rebound occurs). You can have an over-extension of the back as well, but flexion-type injuries will be more common in a less experienced lifter. Sometimes the back can be slightly out of alignment before lifting at all, and then the additional load causes the problem.
Back injuries usually involve a wonky alignment of the spine, and this typically irritates the surrounding tissue. An ideal rehab protocol will include both spinal adjustment or manipulation as well as soft tissue treatment. Assuming there isn’t anyone in your gym that can do this, you’ll have to find a good chiropractor. I don’t know much about the practice of chiropractic, but my understanding is that more of them are getting involved in treating the soft tissue along with spinal adjustments. Some are familiar with A.R.T. as well, so finding one that can treat muscle tissue will be more useful. The good news is that most back injuries will heal on their own over time, assuming you are delicate with the rehab process.
It’s important to note that a back injury will not be rehabbed in the same way that a muscle belly will be. A couple days after the initial injury back extensions can be done for high reps in order to help the muscles around the injury, and squats and/or deadlifts can follow the day after. It is not uncommon for the injury to be a little painful while under a compressive load (at the top of a squat or deadlift). Halting deadlifts can be done (from the floor to just above the knee) early on so that you can get the isometric back work off the floor while avoiding any compressive forces that would be associated with the lockout — just try a light deadlift and see first. You won’t squat or deadlift for reps since you aren’t trying to heal a muscle belly that is going to be contracting eccentrically or concentrically — the muscles of the back are postural and will only act isometrically. This means that you would just do sets of five, starting with the bar and working up SLOWLY to what you can handle that day. Nobody can decide this but you, and you ideally would have to decide if you will work up to a single set, or do some sets across. Your goals will include not pushing it too far, especially early on, and keeping your back in complete extension whether it is in your lumbar or thoracic spine. The injury should be fine in two weeks at the most with the average time around a week to a week and a half.
Until the injury is fully healed, you will have to have some extra warm-up on your back prior to squatting. This can be done with back extensions, reverse hypers, extra sets of squats, or even a heat pad. Mike Street at Eastside Strength and Conditioning has this “thing” that has pre-heated towels in it, and when we did a seminar there last I used it before training. It was delightfully useful.
Wrist and Elbow Injuries
If you are just doing the linear progression, and you are experiencing elbow or wrist pain, this is most likely due to a grip problem on the squat. You are supporting some percentage of the weight in one or both of those joints instead of solely supporting it on your back. Shoulder flexibility is more than likely the limiting factor in getting into a correct position. Consult Starting Strength if you are confused about how your hands and wrists should be aligned. If flexibility is, in fact, the problem, then you may want to get a releasing massage — this will be quicker than trying to improve your crappy flexibility over time on your own.
If you are a weightlifter, then you may run into wrist and elbow problems during the jerk or snatch. These injuries are rare, but more serious. Dislocated elbows and broken wrists are going to require some professional help. Since they are less likely to occur, they leave the scope of this post.
The worst thing you can do with any of these injuries is to leave it alone and expect it to heal on its own. We always rehab injuries using compound, systemic movements. We use the press and chin-ups to heal shoulders and the squat to heal any muscle belly injury in the hips or legs. Isolation movements are a waste of time since they do not allow the muscle to function in the same way that it will in normal daily activities or any athletic endeavor.
hi I have a question, I don”t really understand what a muscle belly tear is. This is because English is not my native language. Is it when a muscle is being teared off?
thanks
I think it””s worth mentioning disc problems in the back injury; as they will have different requirements to muscle issues.
After the initial acute injury, disc issues don’t really occur much in lifting. We have had many people over the last year that had at least one disc that was bulging, and they not only trained just fine, but got pretty damn strong. A large percentage of the population has a disc problem whether it is symptomatic or not.
Consult Rip’s Q&A forum to see if disc problems actually occur frequently in lifting, because it has been my experience that they have not (I would say Rip agrees with me, but I won’t officially speak for him until I ask him later today).
–Justin
In B4 “Chiropractors are quacks”
Some of them completely are, but some of them are really awesome. I know that there”s a huge argument that there”s “no scientific basis” for chiropractic, but it works, and honestly that”s all I care about.
Well, chiro CAN work. Chiropractors can be a valauble asset when they work as part of a team, but too many people see them as the “be all, end all” of sports med. Unfortunately, there are those chiro””s (like any other profession) who try to bilk people out of their money by unnecessary procedures and unending treatments. I know people that talk about having gone to their chiro steadily for years. I think, “wow, a Physical Therapist would probably be fired if they tried that.” If a PT can””t fix you in the specified time, they try something else instead of saying that you””ll need this treatment for the next eighteen months. I am, of course, biased, even though I””m not a PT, but as they are both expensive, and a PT can do everything a chiro can do and more, I know where I””d go.
All that being said, I””m not disputing Justin””s advice. Like everything else on the site, it””s sound and well-reasoned. I would simply caution people to be careful in the health care professionals they choose. And drink more milk.
Your advice is simply common sense. If someone doesn’t think like this, then they will learn through experience. Also understand that most “health care professionals” will not be able to help you much more than you can help yourself, with the exception of a good chiropractor. This is why I said “a good chiro” instead of “find a shitty one”. Obviously you would want to get one that is worth his salt…
–Justin
I just ordered my own belt from bestbelts.net. So far, the service has been awesome. I emailed them about sizing and got an email quickly stating that all belts can be custom for no extra cost. I took some measurements as a starting point for him and he punches to holes to allow for weight gain. I am very excited to get the belt and try it out.
“This can be done with back extensions, reverse hypers, extra sets of squats, or even a heat pad. Mike Street at Eastside Strength and Conditioning has this “thing” that has pre-heated towels in it, and when we did a seminar there last I used it before training. It was delightfully useful.”
I find that putting a wet washrag in the microwave for about 15-30 seconds works quite well as a temporary heating pad. It””s easy to just stick it back in there and reheat when needed, too.
BTW, I love my chiro/ART doc. I had a structural issue a little over year ago and he had me better than new in about 6 sessions (3 weeks going twice a week). I couldn””t squat without pain with 225 on my back before that and afterwards I was setting new PR””s regularly within weeks afterwards.
Nice tip on having a home remedy for warming tissues up.
–Justin
On chiropractors, one of the kids I””m teaching the barbell lifts to says he has a spine condition that his chiro diagnosed and told him because of it he should be doing dumbell bench instead of barbell… is that logical?
another one has had really bad headaches while squatting and has to stop, what would be the cause of it? he says he gets a weird pain at the top/back of his head and will hurt for 2-3 days…sounds scary, thoughts?
The spine isn’t loaded in a bench, so the point is moot.
And I can’t see the squat from here.
–Justin
Thanks for the post. My elbow has been sore. I””ll look into getting a releasing massage. I thought I could get my flex up by myself and by spending time under the bar. I guess 35 years of not using my shoulders is bound to be a problem.
Batman and Robin!
Robin: You””re pretty good at this, little girl.
Batgirl: Well watch and learn, little boy.
Favorite line:
Robin: She knows who we are, guess we””ll have to kill her.
Batman: Yep, we””ll kill her later, we””ve got work to do.
That is not the quote. Sorry.
Your elbow probably hurts because of how you rack the bar when squatting.
–Justin
caseydonovan….possibly blood pressure related? I”ve had that before, but only when trying 20 rep sets with squats.
Chiro is excellent, especially the ones that understand meridian therapy. This is old medicine, folks, not new age quackery. A lot of the problems with the profession came as a result of insurance allowances in the 80s and 90s. It was a heyday for chiros; some got very rich while doing nothing for patients. Things have changed, and there a lot of guys out there who can help you out. As a 35-year old judoka with a penchant for heavy lifting and an SI issue, I love my chiro visits.
The Starr method is good. I”ve used it a couple times, and it will get you right as rain.
The danger in recovery is more mental. Don”t worry about the training that you are going to miss. So what? You can”t lift heavy for three months. Three months of form work will do you good, and you”ll be back on the horse in no time. Take it from me, trying to come back too early will cost you in the long run in terms of lost function, extra scar tissue, and stuff that just doesn”t work right.
The last two posts have been really helpful. I”m actually going to see a chiropractor today.
I experience arm pain when squatting, which is due to flexibility. I will definitely look into a release massage.
Snyder, I just spoke to the man at best belts (I think his name was Dwayne). He said there”s a 100% return policy, and that they used to make belts for other companies. On the site there are ranges for the thickness, but you”re free to choose the thickness, just let him know.
I”m going to order a belt from them as soon as I get home and measure around my navel. The other vendors I investigated were lacking due to either price, selection, customer service, or shipping time.
In regards to back injuries, I””d be really interesting to hear more about fixing them via weights (even if they didn””t occur in the gym). My dad has been dealing with major L3-L5 issues (IIRC) for over a year (one surgery w/o success, another coming up soon). I really believe strength training has the potential to help him live an active lifestyle, but would appreciate input from others as well.
Also, not sure if this has been posted before, but I ran into a link describing some of Doug Young””s training from back in the day. Some interesting little twists. http://ditillo2.blogspot.com/2008/11/doug-youngs-training-jack-woodson.html
Someone with a disc injury should strengthen their back in order to stave off any potential shit that could happen to them otherwise. We have had plenty of people at the gym with bulging discs train very effectively — just keep the low back in extension (a coach will be beneficial for them).
–Justin
What is “releasing massage” and where do I get one. I need more flex in my shoulders to get a flat wrist in squats.
Jacob–
I have L4-5, L5-S1 Degenerative Disc Disease. My MRI showed that there is NO disc at the L5-S1 area and minimal at the other. I was running 5 days a week at that time with no strength training. I was in serious pain. I went to a Ortho Doc and he told me to get on a strength program or he would see me in 3 months for artificial disc insertion surgery. Well that was 2.5 years ago. I am now about 95% pain free. I squat 345x5x3 and dead 375x5x3. I”m 33 so that may have a benefit vs being older but pain free is nice. I would highly suggest training to him.
Hutch – that”s awesome, congrats. My Dad also has nerve injuries accompanying his back pain – something where his right leg muscles just don”t respond well to what he wants them to do. It”s very strange. Luckily, I”ll be back in his area soon and will start working with him asap.
Pingback: Top 5 Things to Ask about a Massage Therapy School
Anyone else have experience w/ groin pain? I get a slight strain every now and then when squatting.
Also, don””t you have to pay extra for a “releasing massage?”
This is not the same thing as a normal massage, and normal massage therapists will not be able to do it.
Repeated groin pain is probably due to form problems.
–Justin
Unrelated question, but have any of you found a 1 rep max calculator for squats that you thought was reasonably useful? The reason I ask is that I have my first powerlifting meet in March, and am trying to get a sense of what I might attempt to lift without actually taking time off from SS to test my 1RM. Alternatively, if you think such calculators are stupid, if you have any advice on how decide where to open at a meet, I””d really appreciate it.
Cheers!
They are never really useful.
First attempt — do something you know you can do for at triple.
Second attempt — match a gym PR
Third attempt — go for a PR
P.S., Jacob, thanks for the Doug Young link, which did actually have some useful information for deciding at what weight to open at a meet.
Filthy – most of my PL friends open with what they can do as a triple. If you are on strict SS, open with your latest 5RM for a single and bury it. If everything after that is a PR, no need to get greedy. 20-30 pound jumps or so. For my first meet I was doing a bunch of singles and stuff so I had an idea of where I”d be. I had done ~405 3×5 and 475 for 5 singles. I opened with 440 (though most of my buds told me to open with 405ish), then 485 for a PR, then 507 for what would have been a state record (but I got redlit and someone else squatted 560ish anyway). I was quite happy with these decisions. Just don”t rack the weight early. ;)
This is off topic. If anyone, or Justin, has a quick answer I””d appreciate it. This is usually my first stop in regards to questions of this nature. If nobody has the time for a quick answer, then maybe a link that would provide information. I will check Rip””s forum next.
When I exhaust the linear progression I am moving on to the Texas Method. My question, How do you choose what lifts you do? Instead of being able to alternate between the bench and press it seems its more specific through the 3 day a week process. Do I bench or press? Back squat or Front Squat? Clean or DL? Maybe I””m missing the point. I still have about 7 weeks before I jump into the Texas Method so I””m not terribly worried. Any answers would be appreciated. Sorry that it””s off topic.
This is discussed IN DETAIL in Practical Programming for Strength Training. Look for it on StartingStrength.com
–Justin
Would someone mind convincing me that meridians are not new agey quackery?
I really don’t want to hear this discussion. Take it somewhere else.
–Justin
Thanks, Jacob! That”s really helpful.
And 507 is beastly (loved the video). Sorry you got a red light, but at least you know it”s a mistake you only make once!
Justin, could you do a bit on Knee injuries?
I have some sort of problem with my knees, its not too serious but it is hampering my squats massively, and leaving my knees feeling a little unstable during deadlifts/PCs.
I feel alot of pressure close to the top of my knee each time I hit parallel on the squat.
No, because knees don’t get injured when we barbell train, assuming you are doing it correctly. Plus, it is dependent on what your specific issue is. It leaves the scope of the post.
E-mail me if you want to talk about it.
-_Justin
Any advice, would be much appreciated.
@Max
That”s difficult to diagnose with such a simple description of of the problem…
However, it sounds like it could be tight quads and/or hamstrings. Make sure you”re getting properly warmed up and stretching well after your workouts and on your off days.
@Jacob:
@Hutch:
I”ve had disc issues for about 5 years and have been training for almost 1 year. I had a bulging disc at L5/S1 which resulted in sciatic pains (starting in the left of my ass and radiating down my left leg to below the knee). I did nothing about it and it went away on its own after about 2-3 years.
About halfway through my strength training (about 5-6 months ago) I was training and forgot my belt. I didn”t have an injury as such, but I noticed that my sciatica pain came back, this time on the right side. X-ray says early disc degeneration at L5/S1.
I”m on NSAIDs and and have still been training heavy. Training hasn”t made it any worse, it”s sort of just there, in the back ground bothering me. I don”t think I”ve got any unilateral weakness. I”m squatting 285 for sets and deadlifting 308 for reps (I”m still progressing linearly and have had a few extended breaks).
I don”t know if any of that is of any use, but if you have any other questions, please ask.
i just came off a back injury, actually, its still there a bit. i found out that squatting had NOTHING to do with it, and i”m pretty sure my lower back relaxed in the bottom of the squats(i”m doing box squats now), but i deadlifted yesterday and my lower back started bugging me again, so defiantly deadlift technique. i”ll start pulling like mikhail koklyaev to ensure that my back will be straight.
box squats are fucking awesome
by the way, you mentioned soft tissue work, but not foam rolling
i HIGHLY recommend stretching, foam rolling and lax ball rolling.
These things may make you feel good, but typically are not useful for treating injuries, hence their exclusion.
–Justin
Pizza time after shoveling piles of snow.
Justin, I disagree. foam rolling has helped a TON with alleviating my stupid left lower back injury pain, and ultimately, i believe it helped with the injury itself, obviously that”s not the only thing i did, but i”m positive it helped. same thing for knee problems, i had a problem with knees caving in(my knees felt wierd afterward) a month ago, foam rolling helped alleviating the pain, and in conjunction with yelling at me to push those fuckers out, and terminal knee extensions, my knees are ok now.
besides, even when speaking outside of injuries, i think that foam rolling and rolling on a baseball ball DO make you feel better, and therefor you”ll have a better workout. obviously the effectiveness of these tools decreases over time, like everything.
by the way, for those who can”t get a releasing massage for their shoulders, this right here:
http://www.youtube.com/watch?v=xCp-YynBEvE
enabled me to grip the bar with the wrists inline with the elbows.
I might get off topic here, but i don”t think that riding the bike for 10 minutes, or going straight to squatting, is a smart idea.
@DaveG
Foam rolling/self-myofascial release is not going to actually heal an injury (which is the point of this article). However, self-myofascial release is excellent for loosening tight muscles and tissue, and can definitely alleviate pain and discomfort you may be feeling.
Thanks for the tip Justin.
It was the racking (no surprise to you). I have a free standing squat rack that has a u-shaped cup at the top to receive the bar. Not much play. When doing the warm up sets tonight I noticed that I would rack the right and then swing the left in. (And my left elbow started hurting right away). Paid more attention at racking it both sides at the same time. No pain.
Second kick at the movie quote: Snakes on a Plane
(I figured if I comment I should at least try to guess)
Seeing as how my two passions rarely intersect (strength training and music) I thought I”d take this opportunity to call attention to something.
I just got a single put up on iTunes. If you”re injured.. or having a bad day, take a listen and I guarantee you”ll feel a little better
http://itunes.apple.com/us/album/sublimation/id353432107
Edward – Thanks for the input, since the problems started I have made it a priority to warm up throughly for squats, usually with 10 mins on the bike and about a million warm-up sets. It helps on the day but still have the same feeling the day after.
Justin – email sent.
Crazy Cheap ReUseable Heating Pad:
1- Sew together 2 pieces of cotton fabric leaving a 1 inch gap in the seam
2- Turn inside out
3- Fill with uncooked rice
4- Sew the gap closed
5- Anytime you need a heating pad: microwave for between 30 seconds and 2 minutes
*Not wet, or weird, and free. Almost.
Also… I”ve been seeing a chiropractor intermittently for almost 25 year for scoliosis in the neck and upper spine. -If he tries to convince you that chiro will help your cold, he”s a quack; if she gives you a good crack and you can turn your chin past your shoulder again, she”s good.
Still more… My elbows have been increasingly causing me pain for the last 2-3 months (especially on Oly lifts, not so much on squats). The last 2 weeks I have been inflaming the hell out of my elbows with chin ups and curls– my elbows feel so crazy much better!
After a super gnarly motorcycle accident injury I went through 3 years of PT that may or may not have been of any use. -Training is way more productive, and way more useful. Which I think is what we all all about, yes?
PR Friday?
PR”s
Deadlift: 390×5
Bench: 239x3x5
I purchased “Defying Gravity” and it”s a good read.
A day late, but another guy giving credit to foam rolling. Developed nasty ITBS while climbing big mountains last year, and it wasn””t until I added foam rolling into my therapy that I finally started fixing it. It””s not magic, but it can be extremely helpful, and is much cheaper than repeated massages. So maybe it””s not perfect for pure gym fixes, but for those of us taking the strength outside and using it, it can be very helpful.
I like a non-foamed 3 inch PVC pipe for this kind of thing. Other lifters agree.
–Justin
“Letting the knees travel forward at the bottom of the squat is both inefficient for posterior chain
involvement and detrimental to the health of the hip flexor tendons.” (Rippetoe, Kilgore 2007) If you”ve agitated that tendon, can you still squat at lighter weight to work out the injury or should you quit all together for a couple weeks?
I had a desire to begin my own company, however I didn’t have got enough amount of cash to do that. Thank heaven my mate said to take the credit loans. Thus I took the bank loan and made real my desire.