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.