If you implement anything from this post, you do so at your own risk. Always consult with your physician before any kind of treatment.
The best way to avoid injury is to avoid inefficient technique and program effectively. Even subtle form issues can cause problem in the long-term, but especially so if the body is in a perpetual state of under-recovery. If the system and structures aren’t fully recovered, then they can exhibit issues like soreness and pain, but they can also be susceptible to an acute injury. If the structure isn’t 100% and is being used inefficiently, a sub-maximal repetition can cause damage; I talked about it in this post. In any case, do something wrong with a lack of recovery and it results in shit being jacked up. This post is just a brief review of how to deal with most injuries.
What Is Hurt?
First order of business is knowing what the hell is actually going on. If you don’t know the name of a structure, that’s okay, but you should at least be able to discern what that area does. Something on the front of your hip is probably a hip flexor. Something on your ass or hamstring is probably a hip extensor. What happened when it got hurt? Under what circumstances or during what movements does it hurt now? This is all information that allows it to be ‘diagnosed’.
Irregardless, Ice It
Last night I heard a guy on ESPN radio say irregardless. If you have any kind of pain after a workout, then ice it. Failure to do so will result in being dropped from the course. But seriously, the way Kelly Starrett goes about this is that if you have pain and you’re not icing it, you don’t have an issue. It isn’t worth addressing if you’re not utilizing the most basic recovery mechanism.
Icing removes heat from the body to decrease inflammation and pain and helps promote healing in the structures. This is especially important in the first 24 hours of an acute injury, but should also be implemented throughout the process of recovery. Any time you rehab structures, ice them after until full, pain-free ROM is achieved.
Heat Is Only Preparatory
I know a guy who has been treating his injured back with heat. This may feel better than icing, but heat promotes inflammation while cold reduces it. Instead, only use heat when preparing for movement. Ligaments don’t receive blood flow, so externally warming them up with a heating pad and then keeping them warm with joint sleeves, clothing, or sweats can help them function normally. Weightlifters and powerlifters will often wear knee sleeves and I’ve had to use heat sources for my shoulders (acromioclavicular joint) and back in order to train or compete in a meet. However, don’t consider heat as a treatment; stick to using ice.
Remember: The Muscle Belly Isn’t Inflexible
An injured muscle shouldn’t be actively stretched. You’ll often see guys who have a calf, hamstring, or quadriceps strain trying to stretch it. The injury itself may have occurred because of inflexibility, but trying to stretch — or elongate the fibers — of a muscle when it’s injured isn’t going to help it heal. Instead, use light, high repetition contractions. Once the initial acute inflammation process has been dealt with (via icing), then mobilize the area via the “mobility” methods we use from MWOD.
General Rehab Strategy
Structures require an adaptive stress to increase in strength, size, or density. Injured structures like muscles and tendons (and to a lesser extent, bones) will obviously not be able to handle their pre-injury stress. The general strategy is to provide a very light stress through a full ROM and see how it adapts over the course of a day. If it feels the same or better, then apply the same stress or a little bit more. Gradually apply more stress as the structure(s) improve, and that’s essentially rehab. Stay patient, don’t be Johnny Badass, and you’ll get back to normal. It can be frustrating being hurt (I’ve had periods of not squatting or pulling for several months at a time), but it’s not the end of the world. Yet.
A Word On Joints
If you’re dealing with internal joint issues in a knee, hip, shoulder, or elbow, then rehabbing it will be different than a mere muscle strain. Joints will typically be out of the scope of what you should try and work on by yourself. However, if it’s an overuse issue caused by lots of work in a program or by doing new movements (i.e. elbows hurting with an increase in snatches or jerks or knees hurt from hiking a mountain), then reduce the work load and slowly adapt over time. Ease into new activities even if they don’t hurt from a muscular perspective. This is why beginners shouldn’t jump into a six-day-a-week Oly program.
Preventing Future Instances
Why did this injury happen? How did it occur? Do your knees move forward throughout a low bar squat rep? That would explain anything from knee pain to hip flexors, TFL, sartorius, gluteus medias, and lower back pain. Your medial elbow hurts? Well, do you have inflexible shoulders? Cause that would explain how a shitty low bar squat grip, clean rack, or press grip could cause that. Good coaching just isn’t to make you stronger; it helps you do the movements with mechanical efficiency so that extraneous stress isn’t placed on the wrong structure. Efficacy is safety. So please, be safe out there.
If You’re Lost On What To Do
You can search MWOD and other popular forums or websites, but you can always ask me or the 70’s Big community in the comments or the Facebook page. Chances are someone has experienced the same injury before and most people will know if actual medical treatment is necessary. Just keep in mind that seeing a doctor supersedes anything else, even if it’s a shitty doctor.
33 thoughts on “Dealing With Injury”
You must log in to post a comment.
nice post. very helpful.
for the record, I use the word “irregardless” all the time…as a joke though. see link below.
Yeah, we do it to piss people off.
–Justin
Why does the body try to deal with an injury by inflaming it if inflammation makes it worse?
I’m wondering if it has to do with (I can’t recall the term), but the thing in evolution where something that was helpful at some point in the adaptation/evolution of the species can also be harmful or no longer helpful. Like how sinus congestion intended to rid the body of bacteria can cause sinus infections.
I ice injuries myself but I’ve wondered this for a long time, especially ever since a guy whose opinion I trust said that sometimes he wont ice an injury since he thinks the inflammation/more blood rushing to the area will help the healing process.
I needed to a bit clear: the initial inflammation process is good, but it can be debilitating several days after with respect to training. We didn’t evolve in a way where we try to rehab injuries, yet we know rehab can improve the adaptation of an injured structure more than doing nothing. The short, easy answer is that something being inflamed tells the body, “Hey, this is still fucked up and that’s why you feel pain.” The swelling and redness is just a result of the body’s response to heal it. I’ll get Hartman’s two cents on this too and I’ll look some stuff up.
–Justin
This is a great post that highlights that technical issues can lead to soreness and pain. Injury or resulting daily pain from training is very frustrating and can lead to unexpected plateaus. It is good we have this community to help us out.
For almost a half year I had pain in my TFL/Hip Flexor area in the bottom of my squat. I figured out that I was not leading with my knees pushed out during my descent into the hole. I believe not leading with knees pushed out and limited external rotation in the hips placed a large amount of the load, not peter north’s, directly onto my hip flexors(?) I believe this also placed a lot of strain on my quads, they were constantly tight, which made it very difficult to achieve proper flexibility during the squat. Issues such as forcing me to lean forward. I roll my quads 4/5 times per week and do the dreaded couch stretch daily, and I started working on my bottom position in the squat by sitting in the hole for a while why maintaining proper position. Usually in the bottom I add some weight and move around to find the tight spots. Kelly has a video on a bottom position fixer, but I do not have access to videos while at work.
I remember how you squat, and I can see this as the case. I always thought your lumbar could have been extended a little more (when I saw you the first time I came to Chicago), and that can occur with more external rotation (via the hip impingement thing).
–Justin
And do your Curls and RBEs!
@Maslow check out this article on T-Nation from yesterday… explains inflammation fairly in depth. http://www.t-nation.com/free_online_article/most_recent/managing_inflammation
@maslow
my understanding is that when tissues are damaged, blood is flooded to damaged tissues, hence redness, swelling, and inflammation. Ice (cold) constricts the blood vessels thus reducing the amount of blood flow hence reduction in swelling. The blood is good for healing tissues though, so it’s better to ice first and reduce swelling, heat after swelling is down to get blood flow back to normal to help heal tisses.
but i am not a doctor. and i don’t ice shit. because i’m a fool.
Thank you!
heat on and injury in general has always been bad news for me. ice elevation and a FUCK TON of NSAIDs for like 7 days works way better. Oh and establishing ROM asap.
How do I rehab a combat injury?
I used to squat quite a bit but then I took an arrow to the knee.
How long should you leave ice on the hurt area? Can you ice for too long?
@matt_15
I hear no more than 20 minutes on 20 minutes off.
thank you Justino this came at a perfect time. I just hurt my back 2ish weeks ago while doing a low bar back squat, short story long, i came out of the bottom and got too far forward, good morning’ed it some and then tried to counter it by ascending quickly and i felt something burn in my lower back. i took a few days off and felt better after the first night of pain, it progressively got better, then i got johnny badass and wanted to go back to the weight and re-injured. Now i’m taking it slow and seeing a chiropractor Monday for some muscle manipulation and overall health.
overall this article was great, this is my first injury setback in a few years away from sports so I felt pretty down cause i was doing well on my LP. I ended up figure out my lower back was rolling A LOT in the bottom of the squat, now working on hip flexibility and pushing the knees out. ALSO ordering some lifting shoes.
thanks again brosephius.
-Chris
this is a really helpful post.
the information helps alleviate the problem of ignoring injuries and hoping they get better.
side-note: I’ve recently been trying to lift without looking at a mirror (my gym has mirrors surrounding all platforms and squat racks) and it has been a huge help. Im realizing the some of my form imbalances come from always looking at myself in a mirror (and not having access to a good coach)
Would you mind sharing what you did when you couldn’t squat or pull?
I have an MRI of the knee scheduled for the first week of January to confirm my doctor’s diagnosis of a meniscus tear caused by O-lifting without an ACL (long story). It looks like I’m going under the knife again, but it’s going to be a little while before I can schedule it. While I’m waiting, I thought I could at least work on my upper body pressing/pulling, some stiff-legged deadlifts, plank variations, and kettlebell work for conditioning.
Would you mind giving me some ideas on how to organize these movements into a program in order to make the best of the situation? Thanks!
You forgot a line, Justin. “NSAIDs are the debbil.”
@kublaire: I’ve had the same issue. Mirror directly in front of the squat rack. I think this is what I was going too deep for awhile. Now I try and look at the corner of the wall or the bottom cross member of the rack and gauge my depth by feeling for the stretch reflex. When pressing I just stare myself in the face. For the platform lifts I just turn around – as a bonus it feels real cool to be able to look at everyone in the room while doing deadlifts.
@alecks: Good luck with that. ACL recovery prognosis is real good but can take forever. I haven’t dealt with it but my wife is still recovering and it gets frustrating. My advice would be to get your hams as jacked as possible. As I understand it (and I may be wrong here), the hamstring – when sufficiently strong – can act sort of like a second ACL.
@Justin: Can you do the 70’s Big female butt logo on some sort of underpants? The wife said she would like that on panties or hot pants or some sort of booty shorts.
P.S. Wrote this post while eating meatloaf and mashed potatoes.
@harveymushman: haha yeah I turn around when I clean and snatch. I’m usually staring down some dude standing right behind my platform doing delt raises right before I pull. I tried cleaning my presses so I could turn around and not look at a mirror (due to shoulder issues ive been working on) and my form was so fucked. huge loop around my head and it felt like one shoulder was higher than the other when i locked out. needa practice I guess.
@kublaire: I find giving myself a death stare really helps on the press. Also, there’s a large structural column two feet behind platform so I’m usually not staring some bro directly in the face.
@harveymushman Thanks. This will be reconstruction #2 for me. The other knee was done about 12 years ago. Hoping my increased strength now vs the last time will offset the aging induced reduction in recovery capacity.
The mirror bothers me too. So I hang sheets in front of it so i can’t look at myself. I can’t help but real-time-critique my form when I’m looking in a mirror and of course that is impossible…so it fucks everything up.
plus i look fucking good. it’s distracting.
@matt15 puke is right, no longer than 20 min, any longer and your body will fear frostbite and increase blood flow to the iced area, clearly something we try to avoid
I usually do mobility work on my hips and lower back around the middle of the day. Often times, the physio will apply heat after the session to keep me warm for the rest of the day. Should I ice afterwards instead? I ice at night, irregardless.
I can’t lift in front of a mirror because I get lost in my dreamy eyes.
You certainly do have dreamy eyes.
–Justin
@ Puke Lols
@J-Train Thanks for the write up!
I mobbed just about every part of my body this AM… took about an hour… its fine. I iced afterward. Got a script for some 345mg naproxen or something that I haven’t filled, but was considering it today. My pops recommended a chiro if things don’t get better soon… we’ll see. I think next week I’ll get back to the gym and start doing some light sets on squat and dead and see where that goes. Anyway, thanks again.
Hurt my back several months ago and I really am lost on how to fix it. I guess I haven’t been icing it as much as I should be so maybe that’s the next step here. I started lacrosse ball rolling it recently too.
Good post
Justin,
Off topic, but with winter coming I thought this might be a decent question for everyone. How do you treat a cold to get rid of it ASAP, and how long before you start training again?
@wallymoccasins
As far as a cold, I usually just train through. But for treating it, make sure you get enough calories for the day (as much as you normally would) even if your appetite is down. Also taking vitamin’s (vitamin C, or drink OJ). I’ve also had success with gargling with listerine for 30 seconds a couple times a day. Supposedly kills the germs in the back of your throat (for cold, sore throat etc).
Also make sure you get enough sleep, lack of sleep will make you worse.
All the above works for me, but I haven’t gotten sick in a really long time because when I feel it coming on (sniffles, etc.)I react immediately and its gone by the following day.
1) Maslow, is “vestigile” the word you’re looking for? Regarding swelling, I believe I’ve seen before that in addition to being part of the healing process, swelling is the body’s way of immobilizing a joing so that you’re unable to do more damage.
2) I’ve had a lingering elbow injury for a few years. Doctor told me then that I had bursitis, tendonitis, and tennis elbow in both elbows (from lifting like an idiot). The tendonitis and tennis elbow have gone away with time, but the bursitis hasn’t gotten any better. X-rays look like there’s hooks coming off my elbows from the scar tissue where the bursa is folded over and if you feel them it’s jagged as if the bone is chipped. When I re-aggrivate it by bumping or over-stressing (eg. benching the other week w/out warming up) it hurts for a few weeks. Has anyone else had similar issues or have suggestions on how to deal with this?
I apologize for the overly long comment.
i’ve had two colds in like 3+ years. The most recent was worse and I couldn’t train. I think I trained monday and then took wed and fri off. Didn’t deload or anything when I got back on Monday. But you really gotta feel it out. Like Michael Loucas said (you should trust him his name rhymes with Mucus), essential to get the same sleep and calories you’d usually get. And it’s better to make them REALLY CLEAN calories. Overdose on Vitamin C. Wash your hands constantly. Still shower every day even though the tendency is to want to stay in bed all day for days.
Pingback: » Q&A – 10
@criedthefox
Mucus… suddenly traumatizing memories from childhood come rushing back. Lol.
Justin,
I had a workout last week consisting solely of clean and jerks and since then when I move my left arm in a certain way I feel a sharp, searing pain in the center of my tricep. It is not bruised and I have been icing it. Should I see a doctor?
thanks
dco
Pingback: SMRT Reads 11/18/12 | Move Synthesizing Massage and Resistance Training