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Training with Pain: Are you Injured or Are You Dead?

If you’ve spent any amount of time in the iron game, then you have probably had some type of ache and pain.  Whether it be a tweak or a twinge from attempting to max PR your squat or from doing a cycle of heavy volume work, the iron can eventually catch up with you. Injuries can range from small areas of discomfort to needing surgical intervention.

This article will apply to most people who are having pain and injuries when they are training or pain or injuries throughout their day.

Just because you may be experiencing an injury, doesn’t mean you need to stop training. Remember, you are injured, not dead!

There are many mechanisms for injury in the training environment. They include:

  • Poor Technique (Form on Exercise)
  • Too Much Axial Loading (Force Pushed Down Through The Spine)
  • Too Much Volume (Total Work Done In Training)
  • Too Much Load (Weights Are Too Damn Heavy)

But here’s the deal. When you are flared up or even injured, there’s no excuse not to continue to train. You just have to make sure your programming is locked in and your execution is near perfect on your lifts. Here are the most effective exercises to train straight through lower back pain, shoulder pain and knee pain.

Training Through Lower Back Pain

This is one of the most common injuries people who train and just the general population will experience at least once in their lifetime.  Actually, 80% of people will experience low back pain in their lifetime.  Many different aspects of training can contribute to low back pain as well as other injuries. If you are experiencing low back while training, here are the most effective movements that can help to spare your low back.

Goblet Squat To A Box

Key Points:

  • Maintain a neutral spine, not flexed or extended.
  • Push hips backwards.
  • Tap box and return to standing.  Finish with glutes.

Goblet Box Squat

The benefits of performing a goblet squat is that you can make the exercise exponentially harder without having to use an increase in weight.  For example, if you can back squat 315 lbs, you will definitely not be able to goblet squat 315 lbs.

Therefore, by changing the exercise, it can decrease the amount of stress on the spine and use a significantly lower load, but still be challenging for the participant.

Key Points:

  • Maintain a neutral spine, not flexed or extended.
  • Push hips backwards.
  • Sit back onto box while maintaining a neutral spine. Finish with glutes.

Front Squat

The benefits of using a front squat as compared to a back squat is similar to the goblet squat in that the load will have to be lower. Most people will not be able to front squat what they can back squat.  By using a lower load, this can help to spare the spine. Also, by placing the load anteriorly as compared to behind the neck in a back squat, this will place an increased challenge on the anterior core and decrease strain on the back.

If neither of those suggestions work, performing single leg work can contribute to increased strength gains in barbell work, but decrease the strain and load on the lumbar spine.

For example, any type of lunging or step-up variations can significantly challenge the individual without placing an increased load on the spine. Movements like the following.

Reverse Lunges

Key Points:

  • Have a slight trunk lean forward, but a neutral spine.
  • Move slowly under control with a step behind and drive back through.
  • Keep tension in the hamstrings and glutes throughout.

Anterior Step-Ups

Key Points:

  • Maintain a neutral spine with a slight trunk lean.
  • Drive through your heel.
  • Maintain a vertical tibia.

By placing the load at the sides of the body and in turn, decreasing the amount of axial load of a barbell on the top of the spine, can pay huge dividends when trying to train when dealing with low back pain.

Training Through Knee Pain

Knee pain is another common area that most lifters will deal with. Here are some movements that can still create a training effect without placing increased strain on the knees.

Squats to a Box

Key Points:

  • Maintain a neutral spine.
  • Push hips backwards and maintain a vertical tibia.
  • Tap box and finish with your glutes.

The benefit of using a box squat is that it forces the lifter to have to sit back and use the gluteals and hamstring musculature.  It will also decrease the demand of the quads as well as decrease anterior shear force at the knees.

This can be a quick fix to people looking to train their legs when having knee pain.

If any type of squatting variations bother your knees, performing more posterior chain dominant movements can help such as:

Sumo Deadlift

Key Points:

  • Neutral spine.
  • Push hips backwards and maintain a vertical tibia.
  • Find the outside of your heels.
  • Finish with the glutes at the top.

Trap Bar Deadlift

Key Points:

  • Neutral spine.
  • Push hips backwards and maintain a vertical tibia.
  • Find the outside of your heels.
  • Finish with the glutes at the top.
  • Make sure not to “squat” the deadlift.

Glute Ham Raise

Key Points:

  • Maintain a neutral spine.
  • Slowly lower yourself until you are parallel to the ground.
  • Maintain a neutral spine and use your glutes and hamstrings
  • Drive and pull yourself back to the starting position.
  • Finish with your glutes.

If your knees have pain with any type of lunging variations, try these movements to decrease strain on the knees:

Reverse Lunges

Key Points:

  • Maintain a vertical tibia.
  • Keep your knee in line with your 2nd to 3rd toe.  Avoid valgus collapse.
  • Drive through your heel and finish with the glute.

Rear Foot Elevated Lunges

Key Points:

  • Slight forward trunk lean.
  • Vertical tibia aka shin.
  • Sit back towards the bench.
  • Finish with the stance leg glute.

Also, by adjusting the angle of your trunk to a more anterior tilted position and maintaining a more vertical shin when performing lunging variations can make a world of difference when it comes to knee pain.

Training Through Shoulder Pain

The shoulder is another area of the body that is often hurt or injured through training. Any time someone experiences pain, pinching, or localized discomfort in the shoulder, we don’t want to have them work through this.

Movements such as bench pressing and overhead pressing can be problematic for people who are experiencing shoulder pain.  Here are various movements that can be done if your shoulder bothers you when training:

Dumbbell Bench Press

Key Points:

  • Retract your scapulae aka “Put your shoulder blades in your back pockets.”
  • Maintain the retracted position throughout the movement.
  • Stay within a pain-free range of motion.
  • Don’t go into excessive anterior humeral glide.

Dumbbell Floor Press

Key Points:

  • Retract your scapulae.
  • Slowly lower dumbbells to the floor.
  • When elbows touch floor, drive dumbbells towards the ceiling.

Barbell Floor Press

Key Points:

  • Retract your scapulae.
  • Slowly lower the barbell to the floor.
  • When elbows touch floor, drive the barbell towards the ceiling.

Close Grip Barbell Bench

Key Points:

  • Use a slightly narrower grip as compared to the Barbell Floor Press
  • Retract your scapulae.
  • Slowly lower the barbell to the floor.
  • When elbows touch floor, drive the barbell towards the ceiling.

Half Kneeling Kettlebell Overhead Press

Key Points:

  • Can be performed bottoms up or down.
  • Perform in sagittal or scapular plane depending on which is painful.

Chain Push-Ups

Key Points:

  • Use a number of chains that will be challenging but that you can still maintain proper technique with.
  • Maintain a neutral spine.
  • Retract your scapulae as you descend to the floor.
  • Allow your scapulae to protract or separate as you push away from the floor.

Train Smarter, Make Gains & Heal Up In The Process

If you are dealing with low back, knee, or shoulder pain, give these variations a try.  By adjusting your programming with variations in different movement, this can help to alleviate pain in certain areas.

If you are still experiencing pain with training after trying these variations, make sure to see a licensed healthcare practitioner.


About The Author

andrew millett
Andrew Millett is a practicing physical therapist in the field of orthopedic and sports medicine physical therapy.  He helps to bridge the gap between physical therapy and strength and conditioning.  By evaluating and treating his clients using multiple lenses, such as the Selective Functional Movement Assessment (SFMA), Postural Restoration Institute (PRI), the main goal for all of his clients are for them to move and feel better and to keep their body functioning at high levels.

Learn more from Andrew on his website AndrewMillettPT.com, and be sure to follow him on Facebook , Twitter and Instagram.

6 PHASES OF THE PERFECT DYNAMIC WARM UP

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