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Injuries are a particularly hard topic to address since there is really no one-size-fits-all prescription to nurse someone back to health from an injury. Everyone responds different to treatments and has different recovery factors to take into account (differing diets, sleep schedule, training schedule, etc.).
As such, please note that the content of this chapter is general. Things that may be effective for some people may be marginally effective for someone else. It could be essentially useless to others and even detrimental to certain populations still
This is why it is extremely important to get individualized care for your specific injury. This means going to see your orthopedic doctor and potentially a physical therapist for certain issues. These people can examine you and take a look at your case and specifically prescribe rehabilitative or prehabilitative work that will help you back to full health,
However, this chapter and the subsequent one focuses on specific things we can be aware of and do to help stave off injuries and promote healing processes. Do not take anything I say here as absolute truth; if you or your professional medical care providers find something that works better for getting you back to 100% then by all means that should be chosen over the general advice of this chapter.
Any information located in this chapter should be read for general information purposes only. None of this
information should be misconstrued as medical advice. You should always consult your physician or physical therapist before accepting or using any information located herein.
I would expect that everyone reading this has heard of the saying, "No pain, no gain." This ubiquitous in the athletic world as is pushing through pain. Some coaches, usually at the high school level and below, actually believe this saying. Let us discuss why this is incorrect.
Pain is your body telling you something is wrong or adversely affecting your body.
There are different types of "pain" you could say. Some are acceptable and some are not.
The pain you get when you exercise extensively and during the exercise your muscles start to "burn" is not a pain that is adversely affecting your body (except for rare situations where this becomes excessive and continues to be pushed through). This is a metabolic type of "burn" in the muscles where there is muscular acidic build up. Metabolically, this stress on the muscles helps to force anacrobic adaptations in the muscles which may be the goal of that particular training.
On the other hand, delayed onset muscle soreness generally occurs approximately 24 hours after exercise and can last up to 48-72 hours. In some pretty extreme cases, usually a trained athlete coming back from a layoff, it can last up to a week.
Generally, you only get it when you (1) try new exercises, (2) increase volume or frequency, or (3) perform excessive amounts of eccentric exercises.
However, when examining soreness and its relation to progress, it is actually not necessary. The body is able to progress both in strength and hypertrophy or any other aspect without having to go through the pain (or pleasure) of soreness. As long as you are increasing your strength, gaining muscle mass, or meeting any of your goals do not worry about soreness. If, however, you are not progressing, the time to modify your routine, or make a strategic change of some sort. Soreness need not be involved with any of these events as it’s not an accurate indicator of an effective workout.
Laying out some guidelines for training with soreness is a good idea because people new to training often do not realize the difference between pain and soreness and when or when not to exercise because of . Here are the guidelines that I use effectively:
Whether you se it as positive or negative, soreness really is not something to worry about. Generally, itwill be more of a hindrance 1o training than anything so if you plan to do a workout hat is higher in volume than you usually do or has a lot of eccentric movements, plan on being sore. But do not make it a priority. Stay in line with your goals and aiming for progres: soreness.
There are many types of different symptoms of detrimental pain that may be from a variety of Sources: burning, scaring, piercing, sharp, dull, aching, throbbing, pins and needles, tingling, numbness, tightness, pressure and pulling
Different issues may be present depending on the source of tissue, but no mater the source we need to remember one important rule about these types of pain:
Never exercise through pain!
Remember, pain is your body telling you that there is something wrong. You should never work through pain because it is likely that you will be further damaging tissues which may significantly prolong recovery. One more workout or exercise pushing through pain can mean one more week or one more. month of rehabilitation from injury. It is just not worth it.
Chronic pain is a different story though, and that needs to be addressed differently.
Now, let us step back for a second and examine why we get injured. There are multiple ways these things occur. Knowing how injuries develop will allow us to look back at our own training and our bodies to possibly figure out why such problems are cropping up. Unfortunately, this type of analysis does not allow us to all instantly become medical professionals, but it can give us a direction of what may help alleviate and correct our injuries. Additionally, it may allow us to explain to a medical professional things we notice in our training that may have caused potential injury scenarios which can help significantly in diagnosis and treatment,
There are two major things we need to consider when we evaluate injury conditions.
That probably seems to be the most repeated and overused phrase in regards to training, nutrition, and life in general. It is repeated often because it is true, especially in regards to injuries.
This is a big problem I have seen online when people are discussing how to rehabilitate from certain injuries. People with "similar" experiences often like to chime in on what their injury was and how they were able to resolve the issue. They are not you. Different injuries may present the same symptoms on a
person, and what may help one injury may not help another. To explain this further we are going to look at a few examples.
Say we have six different people perform the same exercise such as a planche. Even though everyone is doing the same isometric hold, the sites of potential injury differ by a wide margin.
For example, one person may start to get some wrist pain issues that could potentially be tendonitis. Another may develop elbow overuse complications. Still another of those five people could run into pain in the front/anterior of the shoulder and another could run into pain in the back/posterior of the shoulder. Another person may get a muscle strain in the biceps, while the fifth and final person may have a problem with middle of the back pain.
Knowing how and why an injury develops in a person before the injury happens is nearly impossible to tell. The one factor that shows the most significant promise to predict injuries is imbalances. This main factor that we need to keep an eye on. We can look at the factors involved with exccuting a routine — intelligent volume, intensity, and frequency, proper technique, and balance between pushing and pulling — and they still may not tell us what has a high potential for injury. However, knowing these factors can blunt some of the potential for injury to aceur or depending on some of these factors we may be able to predict where someone is injured. For instance, someone may get back a back injury if they perform deadlifts with improper form.
This is precisely why stretching before or after workouts does not prevent injuries according to the scientific lterature. This is why I do not prescribe stretching for injury prevention. However, stretching post injuries is an effective intervention if there are imbalances.
Out of these many factors, there are some that we can control and others we cannot.
Some of the factors we can control to an extent are rooted in recovery like sleep, nutrition, habits, and activities oflife. Muscle imbalances can be fixed through the addition of appropriate exercises. We need to take into account activities that may cause overuse or imbalance when we train.
One such instance would be those who are in manual labor occupations being predisposed to overuse injuries expecially if they use se their bodies for a lot of heavy lifting. A carpenter who relies on his arms for his job may not want to train excessively with a lot of the tough upper bodyweight strength skills. He has increased propensity for injury just due to overall volume of his work. Getting injured may severely affect job performance.
The other factors are out of our reach to be able to control. Some people have poor genetics which predispose them to certain injuries within the tissue. For example, those with a lot of ligamental laxity have greatly increased injury risk because they are more prone to have a joint sublux or dislocate even at Tower forces on the joint. These are the most dangerous cases. While these may people need to be cautious, strength training is actually indicated for these people because strength and muscle mass will help stabilize the joints structures more. They just may need to be more careful performing exercises.
Other people may have certain anthropometry — length of body segments — which may predispose them to be good at some exercises. For example, short arms allow one to perform iron cross easier due to ess torque at the shoulders. The less fortunate have anthropometries that predispose them to be more likely injured with some exercises. For example, longer arms putting a lot more torque on the joints in iron cross. Increased torque puts a lot more strain on the connective tissues of the wrist and shoulder, especially when the muscles start to fatigue at the end of sets. Thus, we need to be aware that if something is off or does not feel right we may need to stop a set before an injury happens.
If someone is starting to get pain or become injured at a certain spot we can take an integrated look back over their nutrition, daily activities, sleep, anthropometry, genetics / family history, etc. and see if we can see any patterns that may have induced that injury.
In addition, now that we know where certain injuries tend to manifest we can be more proactive with our prehabilitation or rehabilitation work to make sure that this spot stays injury free. Indeed, the very fact that an injury has occurred means it is already predisposed to injury in the future. This is because of the weakening of the tissues via formation of scar tissue. Sear tissue is weaker than healthy tissue because it is more haphazardly structured and sometimes may be less like the actual tissue that it is replacing.
We will reexamine the shoulder since it is the lynchpin for upper body strength and is one of the more complex joints in the body. We can easily show that the place of pain in the shoulder is not always the cause of pain. This is why in some cases we get injuries that reoccur frequently even though we have. rehabilitated the area of the perceived injury.
For example, not all shoulder injuries are rotator cuff problems, and rotator cuff problems do not fix all shoulder injuries. This is one of the common fallacies I see when people are trying to "fix" injuries with the shoulders or help keep the shoulders healthy.
The "shoulder" has the most range of motion in the body and has many separate articulations and joint movements: the (sternoclavicular (SC) joint, the acromioclavicular (AC) joint, the glenohumeral (GH) joint, and scapulothoracic movement. In addition, it has muscles connecting to it from all over the body often crossing multiple joints.
For instance, the triceps brachii, biceps brachii, coracobrachialis all cross the arm (forearm in the case of the biceps) and have different connections to portions of the scapula. Pectoralis major, pectoralis minor, and subclavius, have connections from the frontanterior ribs to the humerus, seapula, and clavicle respectively. The serratus anterior has lateral thoracic rib connections to the scapula.
In the posterior (back) we have a latissimus dorsi attachment that crosses from the lumbar (low back) and mid-thoracic area across the whole seapular complex to the humerus. We have levator scapula, upper, mid, and lower trapezius connections to various parts of the scapula, and thomboid major and thomboid minor that also attach near the spine of the scapula.
We even have the inferior omohyoid (a throat muscle) which has an attachment on the scapula. We have our teres major muscle that cross from the seapula to the humerus, and finally we have our rotator cuff muscles (teres minor, infraspinatus, supraspinatus, and subscapularis) which cross the glenohumeral joint from scapula to humerus as well. This is not to mention the various ligaments, joint capsule structures, and cartilage involved with proper movement of the shoulder joint, and the blood vessels and nerves that criss-cross and interweave between, through, and under the muscles, ligaments, tendons, and joints.
So we have many of muscles and tendons coming from all different places that interweave with the network of blood vessels, nerves, ligaments, connective tissues, and joint capsules that are all involved in proper movement of the multiple joint articulations that make up shoulder movement. This is why "rotator cuff rehab" is not the answer to most shoulder problems. In some cases, exercise is even a contraindication — will actually negatively affect rehabilitation. For a shoulder injury, a medical professional will perform a variety of tests on structures and muscle function in the shoulder before prescribing anything, much less exercise in most cases.
The major piece of information to be taken from this section is that the site of the pain is not always the site of the injury.
Unfortunately, muscle and joint mechanics cannot be extensively discussed here because there are volumes of books on how all of these types of things relate to injuries. Instead, here are a few general rules.
There are four main factors that contribute to the integrity of the sues of the human body:
These four factors can be broken down into two separate categoris: neurological factors and musculoskeletal factors (much like strength training).
Posture and biomechanics represent the neural control of the central nervous system in its interaction with the environment. Posture itself is primarily a static element and biomechanics are the dynamic clement of movement. We receive feedback from our somatosensory system from these pathways in two
ways. Proprioceptive feedback is from static elements, and kinesthetic feedback is from moving elements. Each of these neural elements exerts influence on musculoskeletal structures
Because biomechanics require constant recalculations of the nervous system as the environment changes, using exercises are often the best way to reteach the body how to move and work correctly. Indeed, resistance exercise is an effective way to strengthen the muscles too.
This is not to say that posture is irrelevant; rather, proper posture provides a platform for optimal ability of the musculoskeletal structures to apply and dissipate force when called on during movement. For instance, hunched forward shoulders or "caveman posture" which is prevalent with desk jobs and computers puts the shoulder in an unstable position by changing the length and tension relationships of the muscles. With this come all kinds of problems: increased propensity for impingement (due to decreased space under the acromion), anterior instability (due to posterior shoulder weakness), increased stress on the AC joint, and many other potential injury conditions. Not only that, but posture also affects your thoughts and decision making.
To correct these possible problems, prehabilitation and rehabilitative protocol must focus on both re- teaching proper posture and biomechanics. These are things that must constantly be focused on.
Our bodies are trained to become efficient in things we do constantly. If we teach it to do wrong things which lead to injuries, poor posture, and poor movements, then we become efficient at those wrong things. Subsequently, re-teaching our bodies may require more than simply a few weeks or months of constant diligence to correct.
Do not think of this as a chore, but something else you can do to improve your health and performance. This is just like we do when we instill good habits to train well, eat well, and sleep well.
The two musculoskeletal elements each have their different properties as well.
Mobility is comprised of the musculotendinous relationship to the bones and connective tissue. Through various receptors kinesthetic feedback is provided to the central nervous system via muscle spindles which regulate muscle length, and control system for the muscle spindles via gamma motor neurons. Muscle spindles are located in the muscles themselves
Muscle length-tension relationships are also comprised of the musculotendinous relationship to the bones and connective tissue. However, it has its own set of kinesthetic feedback to the central nervous system via the golgi tendon organs which regulate muscle tension/force. Golgi tendon organs are located at the muscle-tendon junction.
Both of these feedback systems are essential for helping to regulate our posture and biomechanics from the forces/torques of gravity, the environment, and our actions. There are receptors in our skin and joints that provide feedback as well.
If we distill an injury condition down to its basic constituents we can say that:
As stated there are two conditions upon which this occurs:
Obviously, the first scenario is the worst because these people tend to have major imbalances or instabilities within their body. The aforementioned people with ligament laxity who are double jointed or who dislocate their shoulders doing normal everyday tasks.
As previously discussed, overreaching and overtraining syndromes occur when training volume exceeds capacity of recovery factors of the body.
Muscle strains are the most common examples of acute injuries from exercise.
Muscle strains usually occur when the muscles are fatigued, typically at or near the end of workout. More specifically, strains occur when a muscle is eccentrically loaded (Iengthening) under fatigue because it requires energy to slow down the muscle lengthening. If the energy is not there, the muscle lengthens beyond its ability to contract against the force against it and the muscle strain occurs.
Other types of acute injuries on tissue structures are rarer. Such things would be ligament or tendon tears and muscle cramping can sometimes fall into this category, though it depends on the type.
Generally, when these types of injuries are catastrophic enough — tendon and ligament tears — you will want to see a medical professional about them to check out the extent of the damage and review your ns are as far as recovery goes.
For strains and other muscle injuries your mileage may vary. The general best bet is to rest, RICE, and do mobility work if you are not going to see a medical professional. Avoid anything painful
For those where normal forces are enough to overcome your body's tissues and cause injury you should definitely talk to a medical professional about this. Strengthening or surgery are the most common options. Since your body is like it is you will likely have to be strengthening your entire life to avoid anything significant injuries from occurring. Think of this not a curse but motivation to become strong.
The most common chronic injury we will run into is tendonitis. When tendonitis becomes "acute" this simply means most medical professionals are recognizing that pain and dysfunction have become significant enough to diagnose,
A typical case of tendonitis commonly happens with the flexor tendons which connect at the medial epicondyle of the humerus. This condition is known as golfer's elbow or medial epicondylitis and has a high frequency among golfers (go figure) as well as those who do a lot of pulling movements such as in rock climbing. More relevant to us, medial epicondylitis rears its ugly head in a lot of pulling-type bodyweight movements, especially when training for the one-arm chin-up and iron cross.
Chronic tendonitis/tendinosis typically results from overworking through the pain of tendonitis for more than a couple months. There are numerous degenerative physiological changes that occur within the tendon itself and the surrounding tissue when you continually work through the pain.
There are three main phases in healing which are inflammatory phase, proliferation phase, and remodeling phase. The body initiates an inflammatory phase when tissue is damaged. This is normal; it occurs when there is microtrauma in muscles and that is how we get hypertrophy. However, when there is too much stress the body cannot get out of the inflammatory phase and therefore cannot initiate a healing response where the tissues can proliferate and remodel to heal the damage.
Inflammation in and of itsel is not negative; in fact, we need a certain amount of inflammation to facilitate the healing process. When we get chronic suppression of immune response to inflammation, the tissues start to degrade and weaken further because they cannot get repaired correctly.
To compound on this, the body also senses (via the somatosensory system) that the area is in pain and thus starts to shut down muscular involvement in the area in an attempt to discourage us from using that area. That is why all of the muscles in the area, most notably the forearm flexors, start to get extremely tight, lose strength, and as it progresses they atrophy.
So here we have suppression of healing along with muscles in the area tightening and locking up. This combination exerts constant tension on the tendon and becomes a huge problem.
When muscles are relaxed, blood flow is able to work itself into the area for healing; however, when there is constant tension on the muscles and tendons they start to get hypoxic and will not heal correctly. In some cases they will even cramp up.
This may lead to the development of tender spots (localized aras of tenderness in the muscles) or trigger points (points in the muscle which produce radiating pain in certain distributions). Hypoxic conditions are often associated with stiffness especially after periods of immobility such as getting up in the morning, so this is why chronic tendonitis exhibits this type of pattern.
Overall, the area loses quality and becomes painful, tight, and stff, especially in the tendon. You start 10 lose range of motion because of the tight muscles which may start pinching nerves causing numbness and your ability to exhibit strength decreases.
Looking back over the four areas discussed earlier (posture, biomechanics, mobility, and muscle length-tension relationships), we can see how this disrupts multiple aspects of the neuromuscular system and the musculoskeletal system.
Rehabilitation for chronic injuries is therefore focused on multiple angles of attack and can be often not as straight forward as rehabilitation from acute injuries. The best case scenario is to never let it get that far if possible. However, once it is that far many things need to be addressed.
Typical rehabilitation depends highly on the quality of the tissues. For instance, remember back to the example of Olympic swimmers warming up for their events. They shake their muscles which are loose and pretty pliable. That is how your muscle tissue should be at all times if not being contracted.
If you palpate your muscle tissue and it is tight, painful, and it does not move well when you massage it then that is what you want to focus on correcting. Stretching will help through lengthening the muscle and help reduce the tension (which can be one of the causes of tendonitis), but using other types of work such as massage will help regain that desired looseness and pliability.
To be considered "fully healed", you must (1) feel no pain through full range of motion, (2) be able to exercise like you want to without limitation, and (3) have tissue that’s loose and pliable.
In this chapter we looked at the distinction between pain and soreness and how to identify between each. We also concluded that we should never under any circumstances be working through pain unless supervised under a medical professional.
Additionally, we learned about the four factors that affeet injuries which are posture, biomechanics, mobility, and muscle tension relationships. All of these play a role as risk factors in injuries and improving many of these factors will help us to stave off injuries in general.
Likewise, we also looked at the factors that make up how acute and chronic injuries develop, and some general solutions to each of those.
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