The pragmatic approach to injury management.

As I have outlined in previous blogs, a general mechanism for injury is that when load on a given structure exceeds the tolerance of that structure, either at any one time or over a period of days or weeks, the end result is usually pain, injury, or overtraining. Simply put, training builds a tolerance within bones, ligaments, tendons, and muscles that over time makes them stronger and more robust. By gradually increasing the amount of training we do over time, we become stronger and stronger and capable of more and more.

With this being said, I have always thought myself very optimistic when a client comes to me and states categorically that they cannot, or do not, squat, they don’t deadlift, or that they don’t overhead press. These are just examples as generally speaking, as far as training tools go they have the ability to irritate certain joints, tighten up certain muscles, and are associated, in many cases, with pain of some sort.

The old thought process that squats are bad for your knees, deadlifts bad for your back, and that pressing ruins your shoulders, is in many cases a question of consistent mismanagement of training volume and intensity. With this considered, in many cases the process to go through is to dial back the volume, drop the load, start at a point that doesn’t cause issue and gradually progress at a rate that keeps any problems at bay.

In essence, someone who has chronic knee pain, is probably just someone who has a history of poorly applied training volume, and doesn’t have a body suited to squatting (or whatever exercise it is causing their knee pain).

Early on in my career I would always approach these situations with as much of an idealists mindset as possible, modifying training programmes and dialling things up or down as needed, always trying to make sure that every one of my clients could use any and all training tools under the sun if they wanted to. And as I say above, most of the time this is ok and holds true for most people. You should never cut off a training tool and label it as inaccessible until you have gone through the proper processes and put the necessary interventions in place to really rule them in or out.

This being said, the real question I have started to ask myself more and more is:
Is it really worth it?
When I say this, I don’t mean that you should grin and bare it and suck it up, deal with your issues and ignore aches and pains like they aren’t there. In reality you don’t always need to correct everything, and shouldn’t try to. If we see all training exercises, gym based or otherwise, as tools, and always refer back to the question of why we are using them, you start to question whether you really need to spend the time correcting everything.

If you are looking for changes in body composition, a reduction in fat and some additional muscle mass, then a sound strategy would be to start a well thought out resistance training plan, build an aerobic base, and begin to control portion sizes. If you hit the speed bump of knee pain during squatting, or back pain during deadlifts, does this mean the process of correcting imbalances and restrictions is essential to your goal of improving body composition? In short… No.
In this particular scenario, ask the question of why these exercises are in your training programme (because having muscle in your legs is good, and the process of building these muscles burns calories, amongst other reasons). That being said, if squats or deadlifts are out, then why not simply change course and use a split squat, a leg press, hamstring curls, or any one of the 500 other exercises that, in your case, does exactly the same job.

This lets you sink your teeth into training from day 1, keeps the ball rolling, and allows you to load the system without hesitation, as opposed to waiting 4 weeks to get any sort of meaningful training stimulus whilst you work on your bracing technique or loosen off your hips enough to squat pain free.
Whilst I like to try and stay optimistic with all of my clients and maintain the idealists approach, a career coaching athletes who put their bodies through car crash collisions and gruelling training regimes on a daily basis will really open up your eyes to the pragmatic perspective and show you 2 things very quickly:
Every person that trains are looking for certain adaptations, whether it is extra muscle mass, increased power and jump height, or a leaner physique.
Everyone has, on some level, some limitations in training. Whether it is due to their bone structure or postural issues, an injury they picked up in a tackle 5 years ago, or a poor awareness of movement and positioning.

Boiling down this thought process to its base, and coming back to the question I posed earlier, in many cases, it really isn’t worth it trying to perfect your technique on every lift and become master of all disciplines. A world beating super total isn’t necessary to become a great athlete or super lean.
People can get very strong using very few exercises, and you can get incredibly lean on almost nutritional interventions alone, so don’t let what you perceive as a chronic inflammatory issue or postural shortcomings derail your training, when actually it might be something as simple as poor programme design and poor exercise selection causing issue.

I can’t stress enough how important it will be to make sure you know exactly why you are in the gym, know what your goal is and what sort of processes are going to get you there.
Once you know what you want and what you need to do, I would suggest that for the first month at the very least, that you take the approach that less is more. Very basic and very common lifts performed with uncommon quality and consistency will take you a long way. If and when aches and pains crop up, as they will for many of you, use the pragmatic approach and take another route to get there. Getting bogged down in corrective exercise and a rehab process too early on will just stagnate your training at a time when your motivation is likely to be at an all time high.

Get the ball rolling, and keep it there! Don’t get caught up trying to work through your limitations and having them become the focus of your training when you can simply circumvent them and make progress the main theme of your time in the gym.

Max Hartman

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