Injury Management

How to deal with injuries.

Well, sooner or later, it happens to most of us: you will be injured. But let’s stay calm and manage that little misfortune like a rational human being. Even though some injuries happen during training, training per se is rarely the cause. Most likely there already was a problem brewing up and training just brought it to the light. So let’s take a look of what actually helps you recover and heal faster!

To be honest, most injuries that occur during training, are self-imposed. Remember that last overhead press rep that was grinded out over ten seconds? Now you have neck pain whenever you turn your neck. A classic for me, as I like overhead pressing a lot but suck at it at the same time. Not a very good combination, but I have to deal with it. So, as a first measure to make sure you won’t do the same mistake twice, analyze your training that got you injured. Look at exercise technique and make sure you learn from your mistakes. Luckily, most exercise-related injuries are quite harmless: little strains and sprains, nothing to worry about. But how to get rid of them?

What to do?

There are many useless, or at least not scientifically proven recovery methods out there, but there is one thing almost everybody in the evidence based fitness community agrees on: keep moving!

Active recovery actually speeds up recovery. It increases systemic hormone concentrations, particularly that of growth factors, activates the immune system and, perhaps most importantly, significantly increases blood flow to your connective tissue. This is particularly true in the case of connective tissue, because connective tissue has extremely little blood flow when the surrounding muscles are inactive. So the first rule of injury is: don’t stop training. Compromise, be creative, try something a little different.

Be mindful

Great, you have decided to not give up and keep training. But don’t overdo it! While staying active is important, making sure to not aggrevate your injury is of utter importance. How to do this? Listen to your body and avoid any pain.

In general, listening to your body and avoiding pain is a very good way to autoregulate your training when you’re injured. And any pain is generally bad: during exercise, your body is full of analgesics (your own pain-killers), making you very insensitive to pain as a result of being warmed up and ready for heavy exertion. It takes a significant amount of pain to cross your pain threshold and become noticeable. That means when you feel pain, at cellular level you may already have done significant damage.

‘Listen to your body’ without specification of when, ranks up there with ‘just be yourself’ on the useless advice list. However, you should listen to your pain. If everyone would do it, the vast majority of injuries would not occur and rehabilitation would often be rapid and uneventful. So take a step back and make sure to listen to any signals your body is giving you. It will be worth it in the long run.

Sustainable training

So, we want to keep moving and we want to avoid any pain during activity. Now we have to look at our training program and make adjustments for our injury to heal properly. We want to create an adapted program that is sustainable during our injury.

The use of fossil fuels is not a sustainable activity in economic terms, because we use fossil fuels at a faster rate than they are formed in nature. We can apply the same concept to the human body. A training program is sustainable if its damage tissues does not exceed their rate of recovery.

Keep your tendons healthy by balancing tissue damage and healing processes carefully.

Any exercise is “damaging” tissue, but we want to make sure the resulting damage is as small as possible and our body has plenty of time and ressources to heal. I suggest you implementing the following strategies:

  • Exercise selection: The number one way to create a sustainable program is to modify your exercise selection. Most injuries are very specific and often all it takes to prevent an ache or nagging pain from becoming an injury is to swap out the culprit exercise. Don’t clinge to an exercise, it is only a tool. Get a new tool with a similar purpose if the old one is broken.
  • Training intensity: Limiting your average training intensity is another way to make your program more sustainable. Unless you are so severely injured that you cannot move a body part at all, there is by definition an intensity of work that you can tolerate. Moving all the way up to 30 rep sets or a training intensity of 60% of your 1 rep max will greatly limit the damage to your connective tissues while preserving most of the stimulus for muscle growth.
  • Intensiveness: also known as proximity to momentary muscular failure. Going to failure almost always means a loss of good technique. The worse your technique is, the worse the tissue stress distribution. Staying a few reps further away from failure goes a long way towards controlling your movements well and reducing connective tissue stress.
  • Rest intervals: When injured, make sure you’re resting long enough to mentally focus on perfect technique. You can’t focus on controlling the injured body part if you’re still out of breath from your last set.
  • Repetition tempo: The last major variable to manipulate is tempo. Implementing very controlled eccentrics with correspondingly lower training weights will help you spare your joints while still reaching high levels of muscle activation compared to using a more explosive repetition tempo. Incorporating pauses in the top and bottom position of an exercise also helps. A more controlled tempo maintains high muscle activation levels while sparing your connective tissue from having to absorb the shocks of explosive training. As a result, emphasizing eccentric muscle contractions helps speed up the recovery of muscular injuries.

In conclusion, effective rehab exercise is generally performed with lesser loads, not taken to failure, with at least enough rest in between sets to catch your breath and with a very controlled tempo. If all the above still doesn’t make an exercise pain-free, you should almost certainly replace it.

Disclaimer

Some injuries are of course more severe and physical than others. The following symptoms warrant seeking urgent medical attention:
• Complete loss of range of motion.
• Internal damage to a muscle or joint that presents with skin discoloration.
• Any serious symptom that grows in severity for longer than 72 hours.

Post-pain rehabilitation

All right, so let’s say you’ve managed to make your exercise program sustainable. There’s no more pain during exercise. Hurray! Many people then conclude the injury has healed and they go back to their original program. This is a mistake! Just because you are no longer reaching your pain receptors’ threshold to actually feel the sensation of pain, does not mean your tissue is necessarily fully healed yet.

Gradually working back up towards your pre-injury training level of stress for the damaged tissue is key here, as injured body parts can remain extra susceptible to injury for a while even after the pain has subsided, as it can take longer for the connective tissue to be remodeled with full strength.

Only increase weights as needed and gradually let the repetition tempo increase in explosiveness to progress in strength. This will ensure the injured tissue has more time to heal and can gradually adapt to more stress again. The last thing you want is to injure yourself again!

Reduce Inflammation Levels

If you want to push all the buttons of optimal recovery, think about reducing overall inflammation levels in your body. Less inflammation allows your body to heal faster. There are several ways to achieve this:

  • Reduce gluten: altough I am not a fan of the “oh-my-god-it’s-gluten-free-so-it-must-be-healthy” craze, gluten really has the potential to increase inflammation levels in your body. Yes, in your whole body, particularly your joints, not only in your gastrointestinal system, as most people believe. This increase in inflammation seems to affects everybody,at least to a certain degree, not only people suffering from celiac disease.
  • Reduce dense carbohydrate sources: eating processed, carbohydrate rich foods can increase overall inflammation in your body. Fruits and veggies seem to have protective qualities against inflammation, but whole grain based foods are not helpful when reducing inflammation in your diet.
  • Eat your veggies: fruits and vegetables come with tons of vitamins that help your body healing. Eat them. Please!
  • Get your omega3s: omega3 fatty acids can help lower overall inflammation levels. Get a good supplement or, even better, eat lots of fatty fish.
  • Get enough sleep: sleep is incredibly important for your overall wellbeing and recovery. Make sure you get enough of it, it will help you in quite everything you could imagine. This isn’t fancy, but don’t overlook the importance of sleep.

I hope I could help you manage your existing injuries and/or developing a training program that keeps you healthy and able to train all year long. If you have any further questions, just comment below. And if you need a coach, just apply here for our online coaching service. Stay awesome, healthy and strong and have a nice day!

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