As Strength and Conditioning coaches our role is to provide effective programming to meet the athlete’s goals and ensure that the programming is executed properly. We make adjustments to exercise technique, volume, frequency, and intensity to ensure the desired adaptations occur and the athlete stays healthy.
In the weight room the Coach is the subject matter experts so it is natural that athletes would come to us when something goes wrong but it’s important to understand that we are neither qualified nor formally educated on diagnosing musculoskeletal injuries.
At best, we can reference our own previous injuries and what worked / didn’t work for us.
The below protocol is how we suggest dealing with those aches, pains, and sometimes, injuries that will inevitably pop up in your training career.
If this is a first time injury and any of the following is present we suggest stopping immediately.
Sharp or Shooting Pain
Instability of Joint
Tingly sensation or numbness
Load Audible Pop in a joint
If in the muscle belly work around it, not on the actual spot
Apply Ice and take anti-inflammatory to reduce inflammation to alleviate pain
Where pain is present is not always where the injury is.
The first step is not really a step at all. It’s a realization that something in your body is not functioning the way it should. Sometimes this is a very sudden recognition (you did a squat, felt a pop, and now have pain) or it can be a gradual recognition that takes days or weeks (your shoulder feels off, you kept training, it slowly but surely got worse, now you are unable to do the prescribed exercises).
At this point it is very likely that your training session, and possibly others, will have to be modified.
If the level of pain is severe and limits movement (low back goes out for example) then we suggest stopping the session completely.
Whether you stop the session or move to onto step 2 in the protocol we suggest icing the area and taking an anti-inflammatory to reduce inflammation (which causes pain). Note that neither of these “fixes” the problem, they simply mitigate how much it hurts.
The first step after recognizing something is wrong is to modify either the exercises or the programming to accommodate for the potential injury. I hesitate to use the term “injury” as that is very different from “pain.” Typically injuries have pain, but pain is not always indicative of an injury.
Start by making small changes to the prescribed exercise. Types of changes include:
- Reduced loading (Drop 50lbs in the Back Squat) – this is often times done with an increase in volume (3x to 8x)
- Reduced range of motion (Do quarter Squats)
- Different variations of the exercise (Shift from high bar to low bar Back Squat)
- Changing the tool (Switch from Barbells to Dumbbells)
If you’ve run through those options and still have pain then your next step is to change the exercise completely.
Initially we try to stay with the same muscle group. If Bench press hurts then try dumbbell flies, If Back squat hurts try lunges.
If pain is still present then we try staying with the hemisphere of the body but change the primary muscle group. If Bench Press causes pain try Military Press or Barbell Rows. If the Back Squat hurts then move to Romanian Deadlifts.
Another option is to continue to do the prescribed exercises but with only the uninjured side. Going from Bench Press to a single arm Dumbbell Press is a very quick and easy solution to something hurting.
Note that when these modifications are being made that you are essentially halting the “improvement” process and starting a “maintenance” process for the hemisphere of the injured areas. For the uninjured hemisphere training can continue as planned. If your shoulder gets injured 2 weeks into a strength cycle then the upper body work pauses, but your lower body work continues as planned.
Following these guidelines should get you through the session, and a cycle if needed, until the affected area heals up.
Moving onto your next training session requires a little more preparation on your part. We suggest doing a few things:
- Assess how the injured / painful area feels. Is it gone? Is it better? Is it the same?
- Regardless of how it feels we suggest spending additional time warming up. This includes not only lighter initial loads but more soft tissue and mobility work. Soft tissue work should be done around the injured area, not directly on it.
- If it is better or gone then shoot for a pain free session. Follow the guidelines from the modification section. Stay light, be cautious.
- If it is the same then you need to work around the injury through a modification. This can be the same mods we used earlier or it can be switching to a single extremity version of the primary programmed exercise.
- Come into the gym with a plan on how to work around your injury. If unsure check out our Injury Substitution Guide here.
A little twinge can go away in a session or two. A muscle strain may take a week. Ligaments, tendons, disc, and joint issues will take longer as they do not receive the blood flow that muscles do and simply don’t mend themselves in the same way. We suggest following the Modification – Preparation portions of this article for 2-4 weeks before moving to step 4.
If the problem area does start to get better it’s extremely important to be patient with it’s progress. Typically when pain subsides you are on the road to recovery, but not yet recovered. At this point it is very easy to re-injure yourself. Be patient and move back into regular training very gradually.
Seek Professional Advice
If you’re 3-4 weeks in and still have pain you have an injury. It’s time to take the next step which unfortunately will cost you money. Seeing a specialist that does manual therapy on sports injuries is usually our first stop. Oftentimes these are Chiro’s that have cross-trained in Active Release Technique or Arrosti practitioners. Some experienced massage or sports therapists may also be an option.
Typically these practitioners will perform a series of tests to help diagnose the injury, do manual therapy, and suggest exercises to assist in recovery. Treatment may require multiple visits.
Unfortunately they can only see / diagnose so much without the aid of an MRI. Getting a scan of the injured area is the final and most expensive phase of this process. Although costly, an MRI provides the practitioner with a very clear image of what is wrong with the injured area.
MRI’s will either confirm what the therapist suspects or provide new insight into what is causing the problem. If there is severe structural damage then surgery could be recommended. At this point you’ll need to see an orthopedic specialist to get informed on the pros and cons of surgery and whether it is a good option for you or not.
Training is good for the body but there is a good chance at some point you will do something that will piss it off.
The protocol is to recognize – modify – prepare – then be patient. If it doesn’t go away spend the money and get someone to look at it.
Seeking professional advice is usually limited by discretionary income. How long you wait oftentimes depends on your financial resources.
Train hard, stay safe!