To Train or not Train? That is the question....

Let’s cut straight to the chase.

The answer is…MOST LIKELY. I don’t live in absolutes and neither should you. When you sustain an injury, life doesn’t end. You still have to get up and go to work, you are still part of your team, you still identify as an athlete, you still have family to take care of, and most importantly (in this context) you will eventually return to competition/function. How will doing the bare minimum help you do that? The answer to that question is…..it won’t! However, there are some things to be mindful of following an injury when it comes to training.

Reasons to avoid training during injury recovery:

Reproduction of pain
Unhealed surgical wounds
Threat of further injury
If Doc says no training (maybe see go see another doc)
An injury is good excuse to stop training if a person wants to avoid, but it is an inappropriate choice

Pain: If everything you do hurts, training probably isn’t the best choice for you, until you can get yourself out pain. See a good health care professional for this. However, there is most likely some movements you can do.

Surgical Wounds: Having deep wounds that reach your joints and bones that are unhealed and being held close with string, is generally a good reason to go hard in training. The risk of infection is pretty high and is not worth it. Rehab with a medical professional, of course, should be started and keeping the wound clean is very important during this time. Your big focus during the time is rehab and keeping an optimal healing environment for the wound. The sutures are generally removed after 10-14 days. If you have done your part your wounds are most likely closed. If you negate creating an optimal healing environment then you wound and skin may still be damaged and it is a good idea that you continue to hold off training until everything is cleared up. Poor wound management=lossed training time, keep it clean people!

Further Injury: If you have an injury in which training has a high chance of making things worse, then don’t train. These injuries are generally brain, spine, or pelvis related involving heavy trauma and/or instability. Be smart! The goal is to return to function not lose it.

The Wrong Reason: Now….if you are excited about being hurt because you feel that it gives you a good excuse to stop training, then you may bigger problems than your injury. Look, if you don’t like training then don’t train. If this is you, during this injury management time and take a deep look inside and ask why are you training, and dig deep, maybe as yourself why a couple times. If training helps to fulfill a goal you have and isn’t making your life better, then ask yourself if it’s something you should be doing? You don’t need to train to be healthy, but you should continue to be physically active.

Let’s cut straight to the chase.

Reasons to avoid training during injury recovery:

Reproduction of pain
Unhealed surgical wounds
Threat of further injury
If Doc says no training (maybe see go see another doc)
An injury is good excuse to stop training if a person wants to avoid, but it is an inappropriate choice

Following an injury one should not stop training but should modify how they train.

Modification Principles (I don’t live in absolutes so these are not laws or rules):

First things first, listen to the doc.
Remove exercises that cause pain and replace with exercises that are pain free yet stimulate the same/similar muscles.
Focus on weak spots and imbalances
Lower intensity and increase volume
Increase Sleep
Decrease rest time
Cardiac Output/Aerobic Conditioning
Lock in nutrition

Doctors orders: If the doctor says not to do something don’t do it. Quick story: One time when I was working with a team I was working with a prominent athlete who was recovering from an injury (there was a surgery) and an interview on him showed up in the paper and the news that stated he was “ahead of schedule”. The next, the doctor shows up and pulls me aside. He says, “Greg, what are you doing? There is a schedule for a reason”. He proceeded to lecture me on healing tissue, rate of repair, re-injury rates, a bunch of other stuff. I then showed him the performance/rehab programming athlete was doing and we discussed the principals involved. He saw that we stayed within his parameters in regards to the recovering tissues and he was very pleased. So why did the media report he was ahead of schedule, #fakenews? The most likely answer is because within his injury management programming we had him continue to train, thus the “Return to activity” phase of traditional rehab protocols was almost non-existent.

As an allied healthcare professional it is my ethical duty to respect and follow the doctor’s orders. The first question I ask the a physician in regards to a recovering athlete is “What can’t they do?” I ask this because I want to make sure I “do no harm”. Next, the referring physician is the King when it comes to performance in regards to the law, what he says is law. This also builds rapport with the physician, letting him know I respect and recognize his knowledge. Building this healthy relationship is important for the athlete in many ways during their recovery. But most importantly, I ask what the athlete can’t do because most likely it will be a limited list, which leaves what they can do wide open. This question allows me to think outside of the box and utilize the knowledge and skills that that have to determine the things that the athlete can do. So, if an article comes out that states the athlete is ahead of schedule, I can show the physician that we are following is parameters.

There is a caveat to this. If a physician says something along the lines of “That you can’t do anything other than rest, ice, compression, and elevation”, then I advise you get a second opinion from a different doctor. If your injury is a surgical case, you should ask this question as soon as you know that surgery is a possibility.

Pain, No Gain: I know, I know….you must be thinking “but Greg if I’m doing Smolov, Murph, or threshold training then it’s going to be painful”. Yes performing intense training protocol will lead to what many would call feeling “pain”, but I challenge you to change your mindset and switch that feeling from “pain” to “discomfort”.

Let us take a look at the Oxford Dictionary definition of these 2 words.

Pain: Highly unpleasant physical sensation caused by illness or injury; Mental suffering or distress

Discomfort: Slight pain; worry or embarrassment.

After reading the definitions do you get where I am coming from in regards to the use of these words?

Post-surgical this obvious very important because we do not want to ruin the integrity of the repair. However, it is also important on non-surgical cases, such as tendonitis, impingements, and strains. The continuing to stress the injured tissue in a painful manner will generally slow or even set back your recovery, check with you rehab health care professional on any activities that cause pain to the injured area.

Strengthen the links: “You are only as strong as your weakest link”-Somebody. During the recovery from injury phase training should shift more towards addressing the functional issues that led to the injury. If it was a contact injury, as in direct blow to the area (think Willis McGahee https://www.youtube.com/watch?v=r_wPOfTGegA), then focusing in improving whatever aspect the athlete and sport coach agree upon should be worked in with the rehab. I specify direct below because conditioning/work capacity can play a role in, what I refer to as, in-direct contact injuries. An example of this is when someone his hit in the shoulder late in the game and leads to a lower body injury due to fatigue. The direct blow and in-direct contact injury should be addressed differently.

Rep it out!: The body cannot learn while in pain. Pain disrupts the neural signally to the muscles, an example of this is when you have been walking after a knee injury and your knee buckles, essentially this occurs because the mind shut down the muscle to protect itself, this also occurs when you have bad patella tendonitis and you can’t make your quad muscle very good (I know bad English). I bring this up because high intensity exercises (max strength and power) are neural driven and if you are in the early stages of the recovery phase your body will have a hard time making the neural connections needed to efficiently increase strength/power. You may be thinking, “If my knee is hurt why can’t I max bench” as performance athlete all lifts are total body lifts, it’s all connected. If you are a physique athlete then max lifts are not your focus anyway.

Another reason to lower intensity is safety. Max effort lifts require good technique to be accomplished and if you are recovering from an injury something is going to be off.

Now let’s talk about volume. All the hormone changes mentioned previously, well they are optimized through volume work. Research has shown that Growth Hormone as well as IGF-1 better stimulated with volume rather than max effort. These hormones help repair injured tissue and released systemically and go where needed! Guess what, that means the injured area.

ZZZZ: Sleep is where you recharge your batteries. The majority of your healing occurs when you sleep. It is the time in which your body has nothing to do but keep you alive so it has the energy during this time to rebuild injured tissues. Sleep is a very very important part of the recovery process (look for a future post to go more in depth on this), but during this time is when you anabolic hormone release is the highest. However this works best when you get an adequate amount of the right type of sleep. You want to average at least 5-6 sleep cycles per night. A sleep cycle is approximately 90 minutes so we are looking at 7.5-9 hours a night, this the average so if you miss a bad night don’t panic.

Superset: Decreasing the rest time between sets goes hand in hand with dropping the intensity. Performing supersets and giant sets towards the end of the session is a great way to decrease rest time and to spark some of the benefits mentioned above as well as to increase the cardiovascular effect of your training has.

Cardio: Do you know how your joints and muscles get nutrients? It is largely through the blood. The blood transports the nutrients that your injured tissues need to heal. This makes it important that the engine of your cardio system (the heart) has good output. Increasing your cardiac output training during the recovery phase helps prevent over training, this occurs only if you replace some of the other conditioning you are doing with cardiac output and not add to it. CO also helps increase the blood flow systemically by focusing on the heart rather than placing focus on a local area, as your recovery progresses a good rehab program will address the conditioning of the recovering tissue. Lastly, have an increased focus on cardiac output will benefit the injury in the long run. The increased aerobic capacity gained provides improved long term nutrient deliver not just during training but all the time. Furthermore, the aerobic system fuels the other energy systems increasing the potential speed in which the recovering tissue can build the proper work capacity needed for return to play!!!

Eat Right: The nutrients that your blood delivers to the recovering tissue largely comes from what you eat. If you are not eating the proper nutrients then it will be difficult for your body to heal. If you are eating processed foods that contain substances that the body does not know how to you use, you can potential hinder the healing process. During the recovery process focus on eating whole foods (no more than 4 ingredients listed), I also recommend a muli-vitamin (I know technically its processed but as I said earlier I don’t live in absolutes), try to eat at least 4 times a day with each feeding containing a protein (lean meat), smart carb (wild rice or fruit), at least a fistful of veggies (spinach), and healthy fat (fish oil). Something to consider is also making sure your fat intake is balanced by increasing fish, olive, and nut oils and decreasing vegetable oils. The goal is get more omega-3s than omega-6s, but don’t skew too far in one direction.

The Wrap Up

When recovering from an injury it is generally not in your best interest to stop training.
However certain injuries may Require one to stop training
There are many benefits to training during the injury recovery process
Some of the benefits directly affect the healing process
While other benefits are important for long term and returning to competition
Training should be modified during the injury recovery process maximize and not hinder the body’s ability to heal it self

There is a lot going on here and I understand that it may be difficult to make the above actionable, so I will list my top three actionable steps:

Stop doing what causes the injury
Get 5-6 sleep cycles, some may benefit from 7
Improve the quality of your nutrition, even its by just a little bit

To Train or not Train? That is the question….