As lockdown continues, and we face another few months of life without access to our traditional gym settings, I have been inundated with questions regarding training strategies that can be implemented at home.
After spending some time firmly in the trenches of the fitness industry, it becomes clear that clients tend to fit into one of a handful of categories. The obvious ones are of course those wishing to lose some body fat, those looking to add some muscle, and then those who are looking for performance, usually the competitive athlete or weekend warrior type. While these categories do a fairly good job of encompassing most that a coach or personal trainer might encounter, there is another group. The pain group. This group is comprised of those who are in pain, and want to do something about it. Most often, these clients are people who are recovering from a known injury, or perhaps in some cases have sustained an injury sometime prior they aren't even really connecting to, that has led to a pain-state. Lately this has become an area of focus for me personally, as my previous careers in American Football, and service in the Royal Marines, have left my body functioning more like an old rusty door hinge than a well-oiled machine.
Let it be said first off that the stronger and fitter someone is, to a point, the more resistant to injury they are. So, for those of you who aren't injured, know that smart strength training is one of the best ways to keep the body strong, robust, and injury free. Now, should you be unlucky and become injured, whether that be a bone break, a joint injury, or soft tissue, we do know that recovery outcomes for those engaged in strength training and/or fitness programmes are significantly better. The other day I was discussing this very topic with a good friend of mine, who happens to be an NHS physiotherapist. She explained to me that for sedentary individuals who sustain injury, often the first line treatment is to enrol them in a program to get them stronger, before allowing any surgical procedure to take place. They find outcomes to be markedly better for those going into surgery who have a minimum level of muscle mass and strength.
So undoubtedly there are those out there thinking, well that's all fine and good buddy, but I'm currently injured, so preventative measures do me no good! Well, I hear you, and that's what we will focus on.
Before we get into the nuts and bolts of rehab and training, this is something that must be discussed. Getting injured sucks. It breaks your routine, it hurts, and it can undo months and years of hard work in the gym, or on the field. Outlook matters here. I have seen this many times, and I have come to realise the psychological side of getting injured can be huge. I have seen more than a few times teammates suffer devastating knee injuries, and the psychological impact that can have can sometimes in the long run be greater than the physical trauma.
It often unfolds in this way. An injury is sustained. The individual in question then assumes, or allows, for the possibility that this injury will define them going forward, they believe the narrative that the injury will always give them problems, and limit the activities they can participate in. The fall out is they do the rehab required, but all that does it restore them to a pain free state in the context of daily function. A pain free state, however, is not the same as returning to the state that they were in before the injury. That requires training beyond low intensity physio. The individual slips into a state of learned helplessness, where they believe they cannot change their circumstances, so they do not even try. I have personally seen this. The end result was a friend and teammate who has since lived a sedentary lifestyle, based on the belief that their injury limits them, and fear that they might aggravate the injury.
The take away here is that you cannot let the injury beat you. Do not simply accept a pain free state at the conclusion of prescribed rehab. Fight and work for full function, so you can enjoy all the things you did before your injury.
Rehab vs Strength Training
As touched on above, rehab is generally low intensity exercise that by design is meant to achieve day to day functioning in a pain free state. This is not the same as returning to a pre injury state. Let's indulge in a simple thought experiment: a 20-year-old female netball player, who plays competitively 2-3 times a week, suffers a knee injury and requires surgery. Post-op she does her physiotherapists prescribed rehab. After months of rehab, she has full range of motion, and is walking around day to day pain free. Success! Is she ready to get back on the court? Most certainly not. Months of low-level rehab, and being otherwise sedentary, will have left her strength levels far below what they were pre injury, and will have possibly left her with some muscular imbalances. She is most certainly not ready to get back on the court, and subject her joints to forces generated by sprinting, jumping, and explosive lateral movement. If she were to do so, she would be at serious risk of re-injuring her knee, or worse, sustaining a new injury.
The loss of strength and muscle mass around the previously injured knee are very likely to have left the joint less stable. It should also be said that due to limited blood supply, it takes months of loading for ligaments and tendons to make positive adaptations, like growing stronger and thicker. It is these ligaments and tendons that contribute directly to joint stability. It must be said that there is no way of fast tracking this process. Diligent adherence to physio, followed by the slow progression of loading and ranges of movement, are the way forward. Acceptance of the process is what will be required...full recovery does exist; it just requires patience and consistency.
What we can conclude is that while physio is an absolutely necessary part of the rehab process, it is only part of the puzzle. Physio, combined with properly programmed strength training and expert coaching, is your best route to full recovery. This will help facilitate a level of recovery that can help one build confidence in their movement and the affected area again, and get them back to enjoying all the things they loved to do pre injury.
Another scenario worth mentioning are implications when it comes to injuries sustained that are perhaps less serious, and don't require surgical intervention, or perhaps don't even garner enough attention to seek rehab from a physio; an ankle sprain being a prime example here. Often in these cases, months or even years down the line, we can see clients who are having a pain experience, but with no structural issues to joints or tissue. This is because while the injury itself has healed, the brain now associates certain ranges of motion as unsafe due to the past injury, and delivers the experience of pain. Pain may also come from compensatory mechanisms...the brain in order to protect certain joints or tissues, may stop the firing of certain muscles after an injury, and imbalances can result. As you can imagine, there is a deep rabbit hole to go down here regarding current pain models, which is beyond the scope of this article! Either way, a good coach can use principles such as progressive loading, and progressive ranges of motion, to restore neurological connections to the effected muscles, thereby fixing underlying issues that can cause a pain experience.
If you have made it this far, congratulations, you deserve a gold star. In summary, and thus making the previous one thousand words or so fairly redundant, there are a few key points worth taking way. If you are currently engaged in, or wanting to get into, strength training, you are well on your way to becoming physically more resilient and less prone to injury. Should some bad luck strike and you do sustain an injury, rest assured that you are at least better off than you otherwise would be, and you can expect faster recovery and better outcomes when it comes to rehab. Lastly, while we know that physiotherapy and rehab are vital to achieving a minimum level of function and recovery, strength training is imperative for regaining full pre injury function, and aiding in preventing the chances of re-injury.
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