Tuesday, March 5, 2019

Do’s and Don’ts for Recovering from Injury

Have you ever wanted to be able to do one thing so badly, yet it was the only thing you couldn't do?

There I was, a little over a month ago, standing underneath my pull-up bar. Like any other morning, I was planning to hammer out a few reps before starting my schoolwork. Only this day turned out not to be like any other morning. As I started my first rep, pain seared through my back and arm muscles. Thinking I was just sore from rock climbing the day before, I tried again. The result was the same: shooting pain.

I had never felt this type of pain before. It took me a few moments to wrap my mind around the reality of the situation: I was injured.

The strange thing is that I don't remember suffering the injury. It must have happened while rock climbing, but I couldn't recall an acute episode where the injury occurred. I just woke up that morning and had intense pain when I tried the pull-up.

Assuming the injury was minor, I rested up for a few days and tried a pull-up again. Searing pain just like the previous go round. The severity of the injury was beginning to dawn on me. It was going to be a hot minute until I’d be back to doing any pull-ups or climbing.

As a calisthenics junkie, I was majorly bummed. Just a few weeks before, I'd set a new personal best time for 100 pull-ups. Now I couldn't do a single one.

Thinking back, there were some yellow flags that an injury was brewing. In the days leading up, I was more sore than normal and had a harder time loosening up when I climbed. I didn't think anything of it at the time, and I obviously should have.

My eternal optimism wouldn’t allow me to wallow for long, though. I decided to take my own advice. I reframed the situation as an opportunity for self-growth rather than a setback, and I set to work on rehab.

DISCLAIMER: Although I’m studying for my PhD in Rehabilitation Sciences, I’m neither a medical doctor nor a physical therapist. Please do NOT take any of the information below as medical advice. If you have a nagging injury (e.g. pain that persists, worsens, affects sleep, causes numbness/tingling or shortness of breath, etc.), seek out attention from a trained medical professional immediately. Don’t take the chance that you miss something that turns out to be serious.

Practical wisdom would suggest that the first step to recovering from an injury is rest. While this can be true for some injuries, it wasn’t the case here; my pain hadn’t improved after a few days of rest. Instead of catastrophizing about any potential long-term damage I’d done, this was my signal to get back to business in the gym.

I started by identifying the movements that caused pain and avoiding them in the short term to prevent re-injury. Of course, one of those movements was the pull-up. The other turned out to be scratching my lower back (shoulder extension and internal rotation for the anatomy nerds). Because the back scratch is an unloaded movement, I could also use that periodically to reassess for pain (as a way to measure my progress).

Given that only two things caused pain, that left me with a huge menu of trainable movements. And train them I did. All my favorite lower body exercises were on the table. And for the upper body, I could still bench press, overhead press, and curl heavy without pain. I could even hang from the pull-up bar pain-free (so long as I didn’t pull up). For the next several weeks, I continued to train these exercises hard. I even established a new 10-rep max in the barbell overhead press along the way.

Meanwhile, I kept training my unaffected arm with heavy unilateral pull-downs to maintain strength. There’s a common misconception that you shouldn’t train the uninjured side because you’ll develop an asymmetry in strength and size. As a matter of fact, that asymmetry is exactly what you want.

Injury will necessarily lead to decreased strength on the affected side. But it doesn’t mean both sides have to get weak. Moreover, it turns out that continuing to train the unaffected side keeps the neural drive to the affected side strong, too. So when you do get back to heavy training on the affected side, the strength returns faster. Isn’t the human body weird?!

In conjunction with my heavy strength training, I also included targeted exercises for my injured arm in each session. My goal was to expose myself to pain-free stimuli only. I was okay with a little bit of discomfort, but no pain outright. Each session, I would go slightly harder and heavier. This process of gradually reacclimating to producing force without pain is called graded exposure.

Here’s what my exercise progression looked like for my affected side over the span of about a month:

  • Isometric stiff-arm pull-downs at multiple angles
  • Easy horizontal pulling (suspension trainer rows)
  • More challenging suspension trainer rows (at a more reclined body angle) 
  • Light eccentric single-arm lat pull-downs
  • Very light partial-rep* Gravitron pull-ups (e.g. 100 pounds of assistance for 135 pounds of bodyweight)
  • Band-assisted and leg-assisted pull-ups
  • Less and less assistance on the pull-ups until, finally, a single neutral grip bodyweight pull-up
  • Sets of multiple bodyweight pull-ups with varied grips and bent- and straight-leg positions
(*At first, my pull-ups were only partial reps. Because the very top of the movement caused some pain, I limited the range of motion during the first couple of sessions to what I could do without pain. I gradually added range of motion as tolerated.)

The morning after my training sessions, I carefully re-checked my back scratch motion. The pain was decreasing, which was my signal that I was on the right track.

Once I was back to doing unassisted bodyweight pull-ups, I returned to rock climbing. To start I did a very short (20-minute) session of beginner routes without pain. The injured area was sore the next day, so I waited an entire week before climbing again. During that week, I backtracked a bit in my exercises and focused on pain-free assisted pull-ups.

The next climbing session was almost two hours long, completely pain-free, and included a couple of more challenging routes. To my delight, I wasn’t sore at all the following day.

It’s been a little over a month since my injury. I’m still not 100%, but I’m getting there. My next step will be to string climbing sessions together with fewer days in between. From a strength training standpoint, over the next few weeks I’ll continue to progress my pull-ups in overall volume (lots of low-rep sets); build to more consecutive reps within each set; and lastly, add external load (e.g. weighted vest).

If I’m being perfectly honest, this ordeal has been long and frustrating. At the same time, though, by focusing on all the things I can do, I haven’t actually been that limited. I’ve been able to maintain my fitness, and even improve it in some areas, despite the injury. It just so happened that the thing I’ve wanted to do most (pull-ups/rock climb) was the one thing I couldn’t, at least not for a few weeks.

While every injury is different, and the above is just what worked for me, my purpose in sharing this story is to shed light on some of the do’s and don’ts of recovery. To reiterate:
  • Focus on what you can do, not what you can’t.
  • Keep training the uninjured side.
  • Keep training bilateral movements that are pain-free.
  • Progress gradually in volume, load, and frequency.
  • DON’T push through pain.
  • DON’T think you’re never going to get better, even if it’s taking longer than you expected.

And remember, the above recommendations are not medical advice. If you need help finding a good medical professional in your area, feel free to reach out to me. I know people!

Photo credits to MingYuan Low. Thanks, Ming!

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