Thursday, May 23, 2013

Injury Prevention

Injury prevention and rehabilitation is by no means my area of expertise. This is not because I do not have extensive experience with it. I've spent the last four years of my professional life in a managerial role at a high volume outpatient orthopedic rehab facility. I've actively participated in the rehabilitation of everyone from athletes and the elderly to a twelve year old child who was run over by a tractor. The purpose of telling you that I'm not an expert is not to undermine the advice I'm about to give you; it's to highlight the importance of a simple truth. Injury prevention and rehabilitation is an incredibly complex, multifaceted topic.

It's complicated for a number of reasons but the main one is fairly straightforward. Everyone's body is different. While there are established movement patterns that tend to be the best for certain exercises and tasks, ultimately every individual's ability to adhere to that strict pattern is going to be different and for some extreme cases, outright impossible. This principle applies to both rehabilitation and general fitness. While there are gold standard exercises, everyones tolerance to and individual benefits from each movement are going to be different and any proper program design should reflect this.

The way I see it there are two ends to the spectrum of human performance. On one side we have the rehabilitation and return to baseline. On the other side we have baseline into athletic performance enhancement and development. A confusing phenomenon is that on a very surface level the foundational principles of each side appear to contradict with one another. Rehab involves a huge amount of single joint, single muscle group isolation exercises where most athletic performance programs focus on training muscle groups and energy systems together. Of course, the more in depth your understanding becomes the more you realize that ultimately both modes of though can benefit from the other when applied in the appropriate situations. I'm going to do my best to synthesize my knowledge of both sides to provide you guys with some reasonable and easy to follow advice on how to avoid injuries and deal with minor setbacks along your path to becoming invincible.

Because Batman and rings. 
Guidelines for Injury Prevention 
 Keepin' it Proper

1) Proper Technique: I think I've gone over this multiple times but it absolutely bears mentioning here. Practicing and using proper technique is quite literally the most important aspect of injury prevention. If you are sacrificing proper form for increased weight or duration of an exercise, you're f*cking up. In training terms muscular failure is not meant to be considered the point where you can't move, it's the point where you can't complete another repetition with picture perfect form. This sh*t is not negotiable. Your form needs to be on point, always. If you aren't sure, find a professional who can help. In fact, if you send me a picture or video of your form on ANY exercise I would be happy to give you pointers, free of charge.

2)Proper warm up: This is probably another one that you've been told a thousand times but my guess is unless you're a competitive athlete you probably don't pay much attention to it either. Your body needs time to shift into gear before it can perform optimally. Fighters literally spend 30 minutes to an hour warming up before an actual bout. Now, if someone on their physical level still needs a warm up, don't you think you might too? It really doesn't matter if you are lifting weights, playing a sport or going bouldering blindfolded; your body needs to warm up. 
You need 5-7 minutes of a general warm up first, this is basically to raise your body's temperature and get your muscles moving. This could be anything: jumping rope, jogging in place, doing bear crawls or shooting a few hoops for example. The key is to start slowly and gradually increase until you're warm but not exhausted. After that you need 5-7 minutes of a specific warm up. If you're preparing for a sport, this portion of the warm up should involve sport specific movements and drills. If you're running, you should run. If you're going to be lifting weights, the best warm up is to do a couple of sets or even a circuit of the exercises you'll be doing with a lighter weight than your work weight. This will prep both your muscles and your nervous system for oncoming activity. When your muscles and connective tissue are warm they're more pliable and resistant to tear. When your nervous system has been activated it fires more efficiently and provides more consistent control of your body.
Sometimes selling people on a warm up to prevent injury is difficult so I'll tell you why I do it: it makes you stronger and better at whatever you're doing. If you warm up properly, you should be able to run faster, lift more and perform at a higher level in every way. A good warm up really is that effective.

It's important to note that what constitutes a good warm up is incredibly individual. What is a light warm up to some may be a moderate to intense work out for others. Proper care should always be used when selecting appropriate warm-up activities.

I'm starting to sound like a textbook. F*ck.

3) Proper training progression and periodization: Some of the most common injuries in sports are not related to a specific incident. They're overuse injuries; the result of too much training or repetition in a certain movement without enough recovery or cross training. Shin splints, tendonitis and recurring irritation or inflammations of that nature are some of the most common examples. There is a more sinister side to overuse injuries, however. 
When your body is injured or inflamed, you will typically have some type of concurrent performance loss (when your sh*ts fucked up, you don't do things quite so good as you used to). Our bodies are performance machines so they like to help us cheat. The result of these two things is that when you begin to have trouble with a certain movement, your body will attempt to cheat by altering the pattern in such a way that the task becomes easier and therefore doable. There's all sorts of biomechanics and complex physics having to do with moment arms and levers and sh*t but on a primal level you guys should all know what I'm talking about. Inflammation can lead to creation of unhealthy movement patterns that lead to further complications. They may even lead to a real, now-you-f*cked-up kind of injury where you need to have someone cut your sh*t open and sew it back together. The point is overuse injuries are very bad. They are also incredibly frustrating for us professionals because they are fairly easily prevented with proper training programs. 
Periodization is yet another complex topic to which many people have already dedicated gigantic, cryptically worded tomes and therefore something I can't do any real justice here. What follows is what I think are the most important considerations in terms of programming for preventing injuries:

-Focus on form FIRST- If you are doing any new exercise or a new routine, your ONLY focus should be on hitting the movements with absolute mechanical perfection (to the best of your ability). Increasing weight and intensity will come soon enough. First things first. 

-Increase weights/intensities at a steady but REASONABLE rate- Once you've got your form down you can focus on upping your intensity but this is the most common place where people lose focus. We all want to go harder and faster (...) and our bodies are excellent at cheating our way to it. Don't do that.   While your muscles may be getting bigger and stronger the support structures don't grow at the same rate (your tendons grow at about 1/10th the speed of your muscle fibers). You need to give your body time to catch up and maintain its structural integrity. The most common recommendation I've heard is the 10% rule. You should not increase your total workload by more than 10% a week. That means if you run three miles this week you shouldn't try to run more than 3.3 next week. It's important to note that this increase is per WEEK, not workout. With lifting I would be a bit more conservative, sometimes as low as 5% per week. Think about it; if you are benching 150, should you really try to go up to 165 next week? Maybe more importantly, if you're already a beast and way up at 300, do you think it's reasonable to shoot for 330 when you were struggling with 300 only a week ago? Starting Strength which is a really popular and well regarded strength training program recommends adding 5lbs a week to each major lift in their program. I am a big fan of this approach for as long as it remains effective. It may not sound like a lot, but if you are consistent you can go from squatting 185 to 315 in about sixth months. That's really not so bad. 

-Variety- This is where true periodization really comes into play. If you are doing the same rep scheme and the same exercises day in day out for several months you are putting your body under basically the same stress in the same patterns. Not only will this hinder your progress as your body becomes more efficient and you hit a plateau, but it is basically the exact formula for an overuse injury. You're doing the exactly the same sh*t over and over. Stop it, now. This doesn't mean you can't hit the same exercises with a high frequency, they just can't be exactly the same. I squat 2-3 times a week, but I rotate between front, back and overhead squats so I almost never hit the same variation twice in the same week. Most core lifts have similar variations (think rows, presses, lunges, deadlifts, etc.)
In terms of training for a specific sport, you may not have as much freedom with this particular rule. There may be movements that are prioritized in your training as a result of the sport you're training for. This is understandable and can still be done safely but extra care should be paid to the athlete during the lifts. Pain, inflammation or discomfort that may be insignificant in other scenarios should be given priority because the athlete is not getting as much time to recover.
This is also where cross training is really important. Spending too much time with a single set of movement patterns makes you strong in all of the related muscle groups. If those are the only groups you focus on you can end up with muscular imbalances. Guess what those do? It's probably got something to do with improper movement patterns and injury. Just..guessing...

-Proper Recovery- Take some time off now and then. If you are in the gym every single day you are f*cking up, unless two or three of those days are very light, active recovery days. Don't do more than one max per week, regardless of the body parts. This can lead to nervous system fatigue - your muscles may be recovered but your nervous system is harder to gauge. When your nervous system isn't firing efficiently it can lead to -yep, you guessed it- improper movement and injury. 
There's a couple of different ways you can monitor nervous system fatigue but one of the simplest, cheapest and best guidelines I've come across is using your resting heart rate. Start taking it in the morning at around the same time when you wake up. Keep a record so you can establish an average value. If you wake up and your heart rate is significantly higher than normal (eliminating all confounding factors such as medication, alcohol, sleep deprivation etc.) then it is likely your nervous system still has not recovered completely. 
Once you are a fairly well trained individual you might be able to max more than once a week without significant CNS fatigue, but unless you're a competitive powerlifter or olympic lifter there really isn't much reason to. 

-Movement Selection- I touched on this a little bit when I mentioned cross training above. Movement selection is important for a number of reasons, sport specificity and functionality being two of the biggest. It is also incredibly important in terms of injury prevention. Unfortunately it's also something that I can give nothing other than a broad overview of in this post. If you are a healthy individual with no outstanding injuries or anatomical curiosities then most movements are acceptable. You may need to work on your flexibility and mobility in certain joints in order to hit the movement properly, but that's no big deal. I had quite a bit of work in hip flexibility and thoracic extension in order to squat properly and honestly most people do. It's ok. What I'm talking about here is modifying exercises for people who are injured or the structure of their body is different in some way. Some stuff is simple, if you have hardcore scoliosis you probably shouldn't do heavy deadlifts, but that's not what I'm talking about. More than anything the main point of this is that you should be cleared for all movements by a qualified professional before attempting them. I know that's annoying, but I guarantee you it's nowhere near as annoying as having to swap your workouts for physical therapy sessions 3 times a week. 

-Don't do stupid sh*t- This is one that I think a lot of people straight up miss out on. I don't give a sh*t what your trainer told you and I couldn't care less what your bootcamp instructor said. It's not that there aren't qualified professionals out there it's that if you are doing these things and your defense is someone told you it's ok then that person is an idiot and you should be smacked for swallowing their bullshit. So, how do you know if you're doing stupid shit? It's pretty simple. I'm gonna get Jeff Foxworthy on this b*tch.

Does your exercise have a name that's more than two words? Then you're probably doing some stupid shit.

Example: Single leg kettle bell deadlift to press on a bosu. Individually a lot of this stuff is good. Single leg- good, kettle bell - good, deadliest-awesome, press-fantastic! Now why the f*ck do you need to do them all at once? You're not being efficient. You're not creating or emulating a beneficial pattern. You are too unstable to get the maximum benefits of any individual exercise and you're wasting everyones time. Stop. Now.

Does your exercise involve more than a single piece of equipment? Then you're definitely doing some stupid shit.

You can get sick fit with just your own bodyweight, doubly so with just a barbell and a squat rack. If you are holding one kind of weight in one hand, a different in the other while standing on something, you're f*cking up. Badly. 

Does your exercise have a straightforward purpose that can be explained in a sentence or two? If not, you're doing some stupid shit.

Take the single leg kettle bell deadlift to press. What the f*ck is the purpose of that? "well single leg improves balance" Sure, but you can just stand on one leg. In fact there's a growing body of evidence that standing on destabilized surfaces only increases your ability to stabilize yourself on an UNSTABLE SURFACE. In other words, unless you plan on living your life standing on a boss, it's probably not doing much for your functional fitness level. Why do you have to do all that other stuff with it? You don't and you shouldn't. Exercises should be specific to their goals and they should not, in most cases, be blended. 

Did you get your workout routine from a magazine with a glossy cover? Then you, my friend, have f*cked up and you are the current king of stupid sh*t. I used to read a lot of Men's Health back in the day and the reality is that from time to time they did have some solid information. The problem is that their main motivation is not your health, it's selling articles. They have a monetary incentive to keep providing you with new, interesting, exciting information and workouts pretty much irrespective of their level of bullsh*t. It's not so much that these magazines have nothing to offer, but you should understand their place in the hierarchy of things. Basing your entire workout around an article you read in Muscle & Fiction magazine is like basing your entire financial life around an article you read in Entrepreneur. Would you do that? Please say no.

4) Understand Pain - I think these days too many of us have the attitude that we should work through pain. In the interest of embracing the suck, I would frequently agree. In the realm of injury prevention, however, there are certain types of pain that are glaring red flags and should signal the end of a workout or at the very least the end of a particular exercise if the pain does not go away. They are:
-Sharp, Stabbing Pain- I'm not talking about the kind of deep burn you get in your muscles when you're Anchorman-ing your way through your 1000th rep. I'm talking about feeling like someone just stuck a f*cking knife into you. If you feel pain this intense, stop what you're doing.
-Numbness - If you feel some type of pain followed by persistent numbness, stop. This could be an indicator of some type of nerve damage or nervous system malfunction.
-Burning - Again, I'm not talking about that deep burn. If you have a sensation that feels like someone just put a soldering iron up to your skin, stop. This is also typically an indicator of some type of nervous system damage/involvement. The same goes for tingling or a cold/wet feeling that has nothing to do with the presence of something cold or wet. 

When i set out to write this post about six hours ago I was originally going to include some stuff on proper recovery because recovery and injury prevention are pretty inescapably intertwined. Recovery is going to have to wait until tomorrow because it's almost 9:30 and I still need to hit the gym myself. The reason I dropped this picture of my buddy Maximus here is this: The truth is that injury prevention is incredibly simple. Warm up properly, progress in a measured, intelligent manner and don't do anything really f*cking stupid. It really is that simple. The problem is that no one f*cking does it. Warming up and progressing slowly isn't exciting and in your face. It's tedious and so most people just skip it altogether because who gives a f*ck if you can walk when you're fifty if you're pretty at 30? Am I right guys? Guys...?

If you're looking for a magical set of exercises that will make your body bulletproof there isn't one, well, not exactly. All of my talk about movement patterns? That's how you become invincible. Developing healthy, proper movement patterns will improve performance and prevent injury. Obviously some of us need help with those patterns. Without doing an in person evaluation it's really difficult and frankly unprofessional to prescribe corrective exercises. 
That being said, if you're anything like the average American you probably have tight hips, tight shoulders and sh*tty posture. It's cool. Happens to the best of us. If I get enough responses I'll try to do a work up of some basic exercises to combat those really common problems. Check back tomorrow for an equally intense post on proper recovery and how recovery can help prevent injury. Until then, do yourself a favor and check out You can use the search function there to find mobilization and rehabilitation exercises for pretty much every joint in your body. I will warn you, a lot of them are pretty painful but all the ones I've tried (particularly the thoracic vertebrae mobilization with lacrosse balls) are very effective.

Until next time guys and dolls. Good luck and good lifting.


Todays Workout:

Dynamic Warm-Up 10-15min

Met Con Circuit

400m run
3 Pull Ups
6 Burpees 
9 Dips
12 Kettlebell Swings (24kg)
15 Squats

 4 rounds for time

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