So you’re injured, now what? (Part 2)
Diagnosing injuries is the task of a medical professional. But it doesn’t take a weatherman to tell which way the wind blows. So, if you’re experiencing pain at a joint, then your next meaningful, actionable strategy to resume training should be as follows:
- Try to identify what factors (mobility, technique, programming) are contributing to pain at this joint. With weight training, the muscular dysfunction causing pain is most likely not in the same spot where you feel the pain.
- Make a list of exercises that aggravate the pain and a list of exercises that are pain free. These may give valuable data in determining the source of pain while also giving you some suggestions on what your short-term programming should look like.
As mentioned in our previous blog, our goal is to identify truly pain-free options for exercise. Slight or tolerable pain performed at low loads will not be productive. In strength and conditioning, we look at movement dysfunction and the occurrence of pain through what we call the “joint-by-joint” approach.
This methodology is based on the idea that pain experienced at a given joint is usually the result of dysfunction at the next joint(s) upstream. For example, if someone is experiencing knee pain, the site of dysfunction will often be at the hip or at the ankle/feet.
By identifying the origin of the problem, we can begin the process of redeveloping pain-free movement while allowing the injured joint to heal. Let’s look at an example:
A strength athlete comes in complaining of pain at the knee. Their first step is to make a list of pain-inducing exercises, as seen below. Then, the athlete can begin to introduce corrective exercises that are pain-free as substitutes.
| Pain | Pain Free |
| Back Squat | RDL |
| Front Squat | Goblet Squat |
| Split Squat | 45 Deg. Extension |
| Leg Extension | GHD Extension |
| Conventional Deadlift | Single-Leg Glute Bridge |
| Sumo Deadlift | SLDL |
As is consistent with our findings in many of these case studies, this trainee is clearly able to perform hip-dominant movement (even in unstable patterns) if there’s minimal bend of the knee. So, instead of programming back squats and conventional deadlifts for heavy, bilateral compound strength training, we might modify the program to include RDLs and SLDLs.
This allows athletes to maintain their current level of weight training conditioning and progress in movement patterns that aid squats and deadlifts, all while fostering healing with a 2-12 week deload. During this time, they’ll integrate the aforementioned corrective exercises to begin strengthening their mobility/motor control and force growth of the originally dysfunctional muscles around the joint in question.
- Lastly and least importantly, we will begin to reintegrate variations of the pain-inducing patterns, but only up to weights and with frequencies that are completely pain free. We will choose strategic modifications of these exercises (for example, a tempo low bar back squat with minimal forward knee tracking or a posterior chain dominant belt squat) to strengthen the previous pain-inducing pattern and maintain/redevelop muscular conditioning.
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