7 Essential Injury Management Tips for Lifters

Chapters:

00:00 Intro

01:05 #1 Exercise selection

03:35 #2 Warm up

04:04 #3 Reps

06:16 My Online PT Course

07:11 #4 Tempo

07:49 #5 Volume & #6 RIR

08:49 #7 Blood flow restriction / KAATSU

09:48 Conclusion

Transcript:

Getting injured sucks. Fortunately, a new scientific review has just outlined 7 strategies you can use at home to manage most injuries to make them suck a little bit less.

There is widespread consensus in evidence based physiotherapy that most injuries can be managed quite well at home, if you know what you’re doing. For the purpose of this video I’m going to assume that whatever injury you have is a true biomechanical injury. Some injuries are actually just pain and they are psychogenic, or have a very strong psychosomatic component. Generally, for serious trainees that are lifting very intensely, doing relatively heavy training and doing high volume training, my experience and the literature indicates that the injuries have a true biomechanical component, in that there is actually damage in a certain tissue. Even if that is not the case and the injury is just neural or hypersensitivity, there’s pain, but not actually damage in a tissue present, most of the advice is actually the same. But I will note that if the advice in this video is not enough to get rid of an injury, then you should look up on psychogenic and psychosomatic pain. And of course, seek out a professional to look into the specifics of your injury, because this is all general advice.

Strategy #1: Modify your exercise selection to make it pain free and reduce the stress on the damaged tissues. For example, if squats hurt your knees and you are doing high bar squats or front squats, then you can switch to very hip dominant low bar squats, in which you sit way back and the knee does not come forward. Biomechanically, this significantly reduces stress on the knees and most people experience less pain this way.

For shoulder pain that hurts during pressing exercises, which is very, very common in lifters, it often helps to perform the exercises with the elbows tucked a little bit more, less shoulder abduction and the shoulder in a less internally rotated position. So for, for example, your lateral raises, you want to bend over a little bit more and rotate the pinky up. You can even do what’s called a full cup lateral raise, which means that you perform exercise like this in the scapular plane instead of straight out to the side. You come a little bit forward and instead of the pinky going down, you have your thumb pointing up. So you would have the dumbbell, you would hold it like this. And instead of performing the exercise like this, you would do it more like this. Generally, this helps reduce pain, but again, look at the specifics of your injury to see if that is true and if this makes sense. For bench pressing and shoulder pressing, generally a closer grip reduces shoulder pain. But again, try it out, see if that is the case for your injury.

And as a very broad tip for elbow pain: Generally, if you get elbow pain from pressing or pulling exercises, a wider grip reduces that without reducing the stimulus for the arms all that much. Generally, modifying your exercise selection, even if you have to make the exercise a little bit less optimal or ideal for the target musculature, has a very good risk reward.

Reduction in training stress for that muscle group is not that much if you look at the scientific research, and it does often make the difference between an exercise being sustainable and completely pain free, or still hurting a lot, and making the injury worse. Because, generally, the worst thing you can do is to keep training through the pain. That’s how most people turn a nuisance that can be resolved in 1 or 2 sessions of modified exercise selection into pain, or an injury that lasts months. The researchers even note that you should reduce the range of motion if needed to reduce pain. However, generally, I’m more of a fan of trying other exercises first because if an exercise is so painful that there’s no way you can do it with a full range of motion. My view, generally, is that it’s better to do a different exercise for certain types of injuries, though it can be beneficial, especially when the injuries are very sensitive to a specific range of motion.

Strategy #2 is to warm up extra thoroughly. Theoretically, warm ups increase tissue elasticity, making them less susceptible to tearing. However, there’s almost no empirical hard data showing that warm ups actually reduce injury risk. The researchers note this, but generally, if it doesn’t hurt and it might help, it is a good idea to do when you’re injured. Anecdotally, at least, a lot of people experience less pain when they are fully warmed up, as opposed to when they just walk into the gym in their jeans and try to squat a 1RM.

Strategy #3 is probably my favorite of all of them. Higher repetitions. Reducing the load, especially if your primary goal is muscle hypertrophy, and not strength development, is an excellent way to increase the risk reward of exercise. Higher repetitions are generally a lot less painful than lower repetitions. In fact, there are a lot of exercises, like lateral raises or triceps exercises for people with sensitive elbows, that are almost always painful if you do them very heavy. So when a tissue is injured, it makes a lot of sense to go higher in repetitions.

The reason for this is that connective tissue generally has a higher threshold that it needs, to get robust training adaptations, and research indicates that this is more around 70% of 1RM, whereas for muscle growth it’s more around 30% of 1RM. That means that if you go close to failure, weights with just 30% of your 1RM, which for most people is like 30 repetitions or sometimes even more, you will get equivalent muscle growth on a set by set basis as going heavier. So you can do sets of 30 repetitions instead of sets of 8 repetitions, and for most people, that causes a whole lot less pain, instead of your usual sets of, say 8. And this will not reduce muscle growth at all while significantly reducing the stress on the connective tissues. Because generally, if the training intensity is below 70% of 1RM, it is quite well tolerated by connective tissues like tendons and joints.

As a very rough analogy to understand an injured tissue, you can look at a tendon as if it’s a piece of paper, and you put stress on it by pulling on the piece of paper. When the tissue is in good health you can put quite a lot of tension on it and it will not tear. However, when the tendon or other type of tissue is damaged it is like there is a hole in the middle, and when there is already a hole in the tissue, it is much easier to tear out that hole further when you put more stress on the tissue. This analogy is a little bit simplistic, but it drives the point home that you don’t want this. That’s why essentially, most of the advice in this video comes down to reducing the total training stress for the damaged tissue, while ideally still preserving the training stress for the muscles. You want to train around the injury to stay as active as possible while still stimulating your muscles.

Strategy #4 also highly effective – using a slower tempo. Tempo doesn’t have a big influence on muscle growth. So by slowing down your tempo, especially the eccentric or the negative or the lowering phase, you can significantly reduce the amount of weight you need while still getting maximum muscle growth. It also helps to pause in both the top and the bottom position of most exercises. Generally when you’re injured, the goal is to make the lowest possible weights still effective for muscle growth. So when you combine high repetitions and a slower tempo, you can use very, very light weights, often just half the weights you use when you’re already doing what is normally high rep training, like sets of 15.

Strategies #5 and #6 from the review are generally best left as a last resort. They are: reducing the training volume and increasing the reps in reserve. So basically training less hard. If you do less volume or you train further away from failure, of course it reduces the total training stress, making it easier for the tissue. However, it also proportionately reduces muscle growth and strength development. So these strategies don’t have a great risk reward ratio. They’re just a way to make the total training program less effective, but also less injurious. Generally my experience for motivated lifters is that when you cannot do an exercise, even with high repetitions in a controlled tempo, good technique, then it is probably not a good idea to do the exercise at all. If you also have to stay, say, five repetitions away from failure; my experience is that many people think they get a good compromise, but in reality they get the worst of both worlds where they’re still kind of aggravating the tissue just enough to prevent healing, and they’re also not getting a great training stimulus.

Strategy #7 is highly effective, but a little bit beyond the scope of this video. It is blood flow restriction training, also called Kaatsu by the Japanese. As a very, very quick summary, generally if you use 30% of your 1RM, and you wrap your limbs with something that is not painful but does reduce how much weight you can lift, or how many reps you can do, and it doesn’t cause any bruising or tingling or anything like that, so the occlusion is sensible, but not very strong, that is called blood flow restriction training, and it is a very effective way to further reduce the weights that you need to stimulate a robust training adaptation, because you get a lot more metabolic stress and hypoxia and increased muscle activity as a result of that. But this is again a little bit beyond the scope of this video.

If you know how to implement blood flow restriction training, it is an excellent way to reduce the weights you need to still get robust training adaptations. So if you have a device to implement blood flow restriction training which can just be powerlifting knee wraps, then definitely look into that. But I’m not going to go into that in this video because most people won’t actually do it. And most people also don’t really need to, because if you implement all the other advice in this video, especially changing your exercise selection, listening to your pain signals, using a very controlled tempo with pauses and a very slowed down eccentric phase, and doing higher repetitions…

Most injuries can be managed super well at home, so I hope that if you are injured or you ever get injured, this advice helps you with that. And if you like this type of evidence based fitness content, I’d be honored if you like and subscribe.