Do you want to get back to exercise but keep on getting hurt?
The merry-go-round misery of a repeatedly injured exerciser is a common complaint at Smith Performance Center. When someone shows up, our physical therapists listen to a series of injuries that seem to occur every time they get into a workout routine. The exerciser finishes rehab and heads back to their respective sport. The first few days go well, but inevitably the same problem comes back.
In our clients’ minds, their body has lost the ability to stay healthy. They believe age is driving the problem, or the joints are shot. They think the activity they choose to do is too vigorous and must be replaced.
These are not the problem.
The cycle of repetitive injury is a strategic mistake.
Returning to activity with a strategy
We believe in a process called the SPC Phases. A phase at SPC focuses on the specific problem a client experiences at different points in their rehab journey from diagnosis to developing one’s ability to manage a flare-up.
A phase that is commonly skipped is activity progression.
The problem is so common, that the Activity Progression Phase is where most people quit and fail rehab.
This does not need to be you.
The 10 strategy mistakes individuals suffering from repetitive injury make when exercising
There are 10 mistakes the repeatedly injured exerciser makes:
- Your tissue capacity is lower than you think
- The feedback loop from your tissue issue is lousy
- You select an exercise intensity that matches your exercise capacity when tissue capacity is the limiting factor
- Impatience to return to normal training leads to poor choices in workouts and programming
- You do not manage normal flare-ups and misinterpret them as a full setback
- Programming does not support changes if you are having a flare-up and you stop activity
- You skip certain exercises families and movements because they hurt or make you nervous because of the injury
- Volume of activity over a longer period of time overloads the recovery ability of the tissue
- Motivation to perform the home plan and management strategies impedes tissue healing
- Contributing factors need to be systematically addressed and monitored while activity increases
Your tissue capacity is lower than you think
After an injury, your tissue needs time to heal.
As someone who keeps having injuries over and over, you are likely overloading your tissues on a consistent basis. The goal of activity progression is to get you to a point where you do not have to think about your tissue. But just because you are returning to a more normal exercise routine, this does not mean your tissue capacity has returned to normal.
Your tissue that was injured needs to heal and these have different requirements based on what tissue was involved (you can read more about this in our article “The 7 Tissues to Consider When Progressing Activity After Physical Therapy”).
If you have an injury that comes back over and over, the tissue never healed and gained resilience.
In this situation, you need to stress the tissue and monitor for healthy feedback loops.
The feedback loop from your tissue issue is lousy
If you are going to be stressing the tissue capacity and monitoring to make sure you do not do too much, then you need a good feedback loop.
Unfortunately, not all injuries provide good feedback. And some individuals completely ignore bad tissue responses.
You may be doing this.
Here is a common example. Imagine you are returning to exercise following a bout of low back pain that you seem to get every 3 to 4 months. You ran the day before and now when waking up, your hamstrings feel very tight. You can barely bend forward without severe pulling in your hamstrings.
These are not ‘tight hamstrings.’ You have irritated your low back again but the feedback loop is not pain, but something called neural tension. If you stretch this, you are starting the cycle of low back pain over, and eventually, you will have pain again.
If you struggle with knowing what a symptom is, do not make an assumption it’s coming from a tight muscle that needs to be stretched.
You select an exercise intensity that matches your exercise capacity when tissue capacity is the limiting factor
We call this a violation of the rehab standard.
And it is a really big problem.
If you choose your exercise intensity based on what feels physically hard, you will likely blow past your tissue capacity. This mistake is very easy to make if you have been consistently exercising with your injury. You need to realize that certain exercises will put more load on the injured tissue and it may feel like you are barely exercising.
We want a good tissue response based on the feedback loop you established above.
You can read more about the rehab standard and tools for activity progression in our article “The 5 Most Useful Tools for Progressing Your Workouts After an Injury”.
Impatience to return to normal training leads to poor choices in workouts and programming
Impatience to return to normal life only grows as you move into the activity progression phase.
You start getting back to the lifestyle you want to lead. You no longer have pain all of the time. Your body feels better. This leads you to think that you are farther along the rehab journey than you actually are.
You get impatient for it all to be over. We see two large issues with impatience:
- You want to get back to a normal training routine
- You to get back to group exercise
A normal training routine, if performed by yourself, is easy to create and update as you progress as long as you monitor your tissue response. It may take 3 months for you to tolerate a heavy back squat or it may take 9 months.
Your body will give you feedback as long as you do not ignore it.
The danger in group-organized exercise is that you make bad choices and ignore what you need to do in order to be successful.
Group formats include Crossfit, F45, Orange Theory, body pump, indoor cycling, and rowing. We also include single, repetitive exercises such as running, biking, swimming, and triathlon training groups that primarily work outside. The same problem happens, you do not want to be the person missing the workout or doing an activity different from the group.
So you quit making adjustments that let your tissue handle the load and get blown up by your workouts.
To be successful with group exercise during activity progression requires you to think about adjustments before the workout session. Once you are at the workout session, do not deviate. Social pressure and camaraderie are often large drivers in individuals who successfully develop an exercise habit, but they are also huge issues in those who keep hurting themselves.
You do not manage normal flare-ups and misinterpret them as a full setback
Flare-ups happen.
A flare-up is when your symptoms return after a period of complete or partial resolution. This can be the same symptoms or slightly different but testing confirms the same structural diagnosis for the cause.
When you start to progress, it is difficult to avoid flare-ups.
You overshoot your tissue capacity with a new exercise or you do more without even realizing it because you no longer have pain limiting you.
Flare-ups need to be managed immediately with your home plan. (You can read more about your home plan in our article “7 Key Reasons Why the Home Plan Is Vital for Success in Physical Therapy”). This is the entire focus of Symptom Stabilization. If you cannot manage a flare-up independently, your home plan has not been well developed with your physical therapist.
But remember a flare-up is normal. This does not mean you have had a full setback and are starting back over. You have a diagnosis, a feedback loop, tools to manage symptoms, and improved tissue capacity. This does not go away just because of a flare-up. We should see you manage the pain quickly and get right back to where you were prior to the flare-up.
Programming does not support changes if you are having a flare-up and you stop activity
Our team obsesses on keeping you active.
Because of this obsession, we use home plans, artificial stabilization, PT Additions, and programming that keeps you moving. This obsession is not shared by other places, which we completely understand. However this means that if you keep getting hurt and you do not have programming that allows you to use alternative exercises to work around the problem, then you will often be forced into exercises that make the problem worse, or do not actually provide a training effect.
The worst thing to do during a flare-up is to stop all activity. This does nothing beyond making you less fit.
A flare-up is the perfect time to take control of your injury. Your entire focus needs to be on reducing how long it hurts and how long it impedes your ability to be active. (There could be an issue with your trigger management that needs to be addressed as well. We have a series of articles that may be helpful if you struggle to understand what is flaring up your symptoms.
The 5 Components of Invisible Triggers That Cause Your Rehab Progress to Stall
7 Tools to Overcome Invisible Triggers Stalling Your Rehab Progress
Trigger management: Why physical therapy exercises are not enough to get you better?
If these resonate with your issues, you may need more in-depth testing.)
You skip certain exercises families and movements because they hurt or make you nervous because of the injury
There are 6 functional movements you need to own for normal physical activity.
If you do not have the ability to perform these exercises, you will be compromised in your normal day-to-day activities. However, following an injury, we often self-select out of exercises because they cause pain or because the movement is the one that hurt us.
A common movement that individuals avoid is the deadlift. This deadlift is a loaded hip hinge movement. You cannot go through the day without performing a hip hinge. If you completely remove it from all of your exercises, you are simply making sure this movement will hurt you during a daily activity.
The problem is not the movement itself. The problem is that you are doing it poorly and most likely doing it with too high of an intensity.
Do less load.
Do an alternative exercise from the same exercise family.
Focus on the tissue having a great response.
This will allow you to master the movement, gain confidence, and prevent recurrence due to poor functional patterns.
Volume of activity over a longer period of time overloads the recovery ability of the tissue
Volume creep happens when you feel better.
We already discussed the issue of too much intensity with a single exercise or workout and we reviewed how programming can help with managing a flare-up. We did not discuss how too much over the course of a week or even longer can leave you vulnerable to flare-ups and regression.
Symptom exacerbation of symptoms can be cumulative over the course of a week and related to activity progression that is not recognized.
In this situation, we recommend that you build in deloads to your programming even if you feel great. This allows your body to recover and not miss warning signs that you are doing too much.
(You can read more about how to deload in our article “Optimizing Your Strength Training: Understanding the Importance of Deload Weeks At Smith Performance Center”.)
Motivation to perform the home plan and management strategies impedes tissue healing
Pain is a fantastic motivator.
When you hurt and your home plan makes it feel better, the pain prompts you to do it. During the Activity Progression Phase, pain is not there to motivate you. If you did not build your home plan into your daily routine, you likely stop doing it.
If you have a repetitive injury, you should not stop the home plan EVEN when your pain resolves.
This can vary from patient to patient, but make sure to have a conversation with your physical therapist about when to stop doing the home plan.
Contributing factors need to be systematically addressed and monitored while activity increases
Contributing factors are things that lead to your injury, limit tissue healing, and increase the likelihood of recurrence.
There are several contributing factors we see over and over:
- Muscle Strength
- Neuromuscular Inhibition
- Abnormal Neuromuscular Overactivation
- Balance and Proprioception
- Relative Stiffness
- Gross Motor Control
- Fundamental movements
Contributing factors cause radical changes in exercise performance (ex. motor control changes in the low back may show a client is unable to engage the core despite demonstrating competence previously).
If you notice that there are large changes in your ability to perform an activity and it seems to become painful overnight, you are likely dealing with a contributing factor. During the Phase Activity Progression, you have the opportunity to improve these and prevent recurrence.
Our physical therapists will test for them during our second phase, Symptom Stabilization and our coaches will address common contributing factors such as strength, muscle inhibition, and balance with programming.
