How to Train Around An Injury by Tina Jo Orban

You’re a fitness savvy person. You read and learn about nutrition, training and all things fitness. And best of all you apply what you know to yourself and perhaps others if you are a trainer/fitness instructor.

You are a walking model of health. Until you get injured that is. Injury is actually the opposite of health. Injury means you have damaged and or impaired some natural healthy structure and tissue function. For lifters it typically is ligamentous, tendinous, or muscle itself. (If you broke a bone you will know). Bone takes quite some time to heal and has three stages of healing: inflammation, reparation, (this is where osteoblasts and and chondroblasts lay down new proteins to recreate model bone). Then finally remodeling occurs and new bone hardens. This all takes upwards of six to twelve weeks. Bone injury is not something you want to train with.

That said, there are some injuries you can work around in the gym. In the gym especially! There exists a myriad of ways to keep on training even with an injury!

The main types of injury are acute and chronic. Acute simply means sudden onset of an injury. For example, maybe you lifted a heavy object with poor form and you feel a strain in your low back. There is also chronic injury. This you can figure out by the name is a long term injury that has recurring inflammatory phases. Perhaps you have scar tissue from previous damage.  Chronic may also be caused by perpetual poor posture, compromised gait, joint misalignment, ill-fitting shoes and so on. This type of injury is sometimes referred to as sub-acute. What you should know is that it slowly wears and grades away at a joint or bone (bone will grow in response to stress this is why some people develop spurs) or tissue[1] . If this is your issue you should to figure out what in your lifestyle is creating chronic pain. Perhaps you sit slouched over your computer. Perhaps you carry a heavy work bag that slowly stretches ligaments in the shoulder joint. Perhaps you need better form and lifting technique. Some gait issues or post traumatic injury are best assessed by a physical therapist to address such pathologies.

Chronic may be dealt with anti-inflammatory meds such as NSAIDS (non-steroidal anti-inflammatory) and or if you are a pro or competitive athlete and you need to push through your program you might seek a doctor’s prescription for steroidal (corticosteroid) intervention. This is to reduce severe inflammation and subsequently chronic pain. People with a variety of inflammatory issues such as rotator cuff syndrome, rotator cuff impingement, knee pain, tennis elbow (lateral epicondylitis) I could go on here, basically any where you have joints, ligaments and tendons and inflammation a doctor may treat inflammation with steroids.  Corticosteroids are administered (injected) by a licensed practitioner and may be indicated for chronic inflammatory issues. But be warned they too have pitfalls. Current research suggests that long term outcomes for cortisone injections have inconsistent results and over the long run, pain diminishment is not as effective as the first eight weeks of treatment[2] . And as with almost all medicines there are those pesky side-effects: Here are just a few of the potential side effects: Weight gain (bloat) elevated BP (blood pressure) compromised immunity which can lead to a whole host of problems, namely fungal skin infections… Gross!

Sprain versus Strain

Sprain is a stretching or tearing of ligaments. While a strain involves a muscle or the musculo-tendinous unit. This is where the muscles belly ties into the tendon. Sprains take longer to heal simply because they are not as well vascularized as muscle. Muscle is uber-vascularized and and depending on the severity of the strain you can get back to weights within days.

The foremost consideration to deal with injury is decreasing inflammation. Inflammation means pain. You can deal with pain by use of the aforementioned over the counter medications. You may have heard of the RICE method (rest, ice, compression, elevation). To ice simply  crush ice, put in a plastic bag and apply it to the swelling or injury. Ice for about ten minutes. And never apply heat to swelling!

Nutrition.
Nutrition is a key factor in healing. Avoid foods that exacerbate inflammation such as: sugar, trans fats (those found in fast foods and food with processed fats) white flour and its products, and MSG (yep skip the soy sauce with your sushi). Some people with gluten allergies (who also happen to weight train) should be vigilant of their gluten intake while injured as gluten is shown to cause systemic inflammation.[3]

Go for foods that contain nutrients that promote healing such as zinc (a mineral). Zinc functions in the healing process and has an immunity function. You can find zinc in beef, and spinach and shellfish. Vitamin C is not just for helping you skin look great and staving off colds, it is imperative for collagen formation and is critical post injury. Your body will produce collagen fibers post trauma assuming you have all the right nutrients to mend tissue. Don’t forget the C. You know where to find vitamin C: citrus fruits, strawberries and grapefruit. But did you know Kale is a good source. So now you can don the Kale University t-shirts with pride as you hobble in for a workout. You will need your essential aminos (those you cannot manufacture) of course to mend torn muscle. Eggs and meat chicken and fish are all great sources.

Lastly I would like to suggests chondroitin sulfate and glucosamine therapy for ligament and tendon healing. I use the brand Osteo Bi-Flex.  Osteoarthritic patients use these protein sugar chains called glycosaminoglycans. Big words, but just keep in mind cartilage is made partly of chondroitin sulfate.  Glucosamine sulfate, specifically is also used to treat osteoarthritis. However, it should be cautioned that high doses of GS can lead to rashes and stomach upset and more in some individuals. More importantly many manufactures source their GS from shellfish: therefore, if you have a shellfish allergy steer clear of this supplement!

So again don’t overlook the function of diet in healing quickly. That said, plenty of water is necessary for a speedy recoup. Hydration is necessary for good circulation. It is simple. Low volume of blood equals diminished circulation equals slower healing. What needs to occur is swift delivery of hormones and nutrients to repair the damage. So you have to take in the nutrients and you have to have a good delivery system. This is the bloods job to circulate and deliver.
That brings us to the actual training! Training is what you don’t want to miss. There is a dovetail to training and staying fit and training to promote circulation and healing: Training as you know from experience increases circulation immensely! Below is how to approach injury in the gym. This is why you read this far!
First I’d like to enlighten you with some ancient wisdom:
 There’s this old joke about a gal goes in to see her doctor:

Doc says: What can I do for you today?
Woman: It hurts when I do this (woman demonstrates).
Doc: Here’s my expert opinion, Don’t do that.

It basic wisdom. If you have a screaming pain signal while you lift. Stop immediately. And do not try to mask the pain with drugs or try to push through that kind of pain. You should know the difference between the type of pain that is going to create a worse pathology.
If you feel like it’s a warm up achy pain and after a few reps, it improves push on! Yes, I said it. You will have aches and pains sometimes it takes a little movement to get the synovial fluid flowing to a joint. You will know.

Higher and Lighter.  No. this has nothing to do with the recent legalization of marijuana across the country. Its about higher reps and lighter weight for the injured area. This is an easy practical thing you can do to train with an injury.  It is important that you protect the injured area as you train. Be smart! Do exercises that don’t aggravate your wound.

Circuit weight.

You may want to slip in total body workouts. This way you get excellent blood flow and can avoid a focus on the injured area. For example, if it’s your shoulder injured, you could employ jump squats, lunges, and light compound multi-articular muscle movements for the glen-humeral joint to work your upper-body. That means stay away form isolated (especially heavy) movements that you would otherwise engage in to hypertrophy the tissue. The goal here is keeping neuromuscular activity which has been shown to minimize atrophy. Other goals are A) keep you working out and B) as mentioned previously keeping up circulation for quicker recovery.

Lastly, while this article addresses post trauma issues I should add the old adage “An ounce of prevention is worth a pound of cure”.
So I leave you with some preventative advice....
You should always warm up before you hit it heavy, make sure your eating optimally to fuel your workouts, stretch after work-outs or at least during and only once you have warmed up.

Get sleep. I have read many studies on (and you are probably aware that) sleep deprivation is linked to accidents[4] . You don't want to be in the gym moving heavy iron or steel objects sleep deprived! Last but not least at all... proper lifting form and technique is critical to preventing a future injury! This may just save you the time having to read an article titled “How to train around an injury!"

By Tina Jo Orban Dec 20, 2016

[1]   http://www.healthhype.com/what-is-acute.html  19 Dec. 2016.

[2] Resourced from Web MD report by Kathleen Doheny “Are Cortisone Shots for Tendon Injuries Worth It?”

Study: Shots Provide Short-Term Relief but Inferior in Long Term. WebMD.com 2010.

[3] Sourced from The Arthritis Foundation. http://www.arthritis.org Dec 18 2016.

[4] Sourced from a 2012 report and study done at Harvard of injured persons on the job. “Lack of sleep linked to 274,000 workplace accidents a year” http://www.ishn.com/articles/94247-lack-of-sleep-linked-to-274000-workplace-accidents-a-year>October 8, 2012

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