Training with chronic injury: Kintelary, Coach

Kintelary's post opens up an important can of worms for many of us,

A lot of people, especially the older set who have been around the block a few times may already have chronic injuries. I am not sure how to advise in this situation, but I have witnessed what happens to those who stop training altogether; joints freeze and muscles calcify, thus multiplying the original injury manifold. My rule of thumb has been, if an exercise causes pain, don’t do that exercise, but still keep that area of the body moving. If possible, do other exercises that don’t exacerbate the problem because blood circulation to a body part is essential for recovery and repair. Sometimes a previously injured area just isn’t ready for a new exercise: if that’s the case, one may be able work up to the desired exercise without pain, by creating more intermediary steps between the starting point and the end goal (as Coach Sommer and others have advised). Sometimes an athlete feels fine – maybe even great during a workout, but then notices irritation or pain several hours after the fact. This to me is a sign to back off and reduce load or reduce intensity of the exercise. In fact, I have recently had problems with one exercise that seems to cause inflammation after doing it, so I take that as my cue to rethink my approach on that progression. My understanding is that if anyone ever feels like something is going to give during an exercise – scratch that exercise – at least for the moment because it means structural integrity is not up to the task.

I suppose one of the drawbacks to training for people with chronic injury is that they tend to become specialists and their training may become lopsided, favoring only some planes of movement within the full ROM. When they do work on strengthening the compromised area, gains may not be as quick as for other areas. Over time, this can lead to muscle imbalances, which then can lead to impingements and other injuries. As Coach Sommer has noted, it happens to bench pressers all the time, as well as swimmers who specialize in freestyle and a variety of other athletes who focus too tightly on one movement or form. Training becomes a catch-22 for those who have chronic injury and don’t want quality of life to be diminished by it because on the one hand, to make something stronger, you have to stress it. That’s the signal to the body to start construction on reinforcing the region to withstand similar loads in the future. On the other hand, overstressing something tears it down to the point it is functionally compromised, thus causing an injury and making it weaker. While pain is an immediate indicator that something isn't right, irritation from inflammation is a little more subtle. It is a signal to the body that means “send all your rebuilding forces here right now.†Training is finding that optimal point between exercise and recovery that produces the best results, not just in terms of strength gains but structural fortification as well, which includes strengthening the tendons, ligaments, bones, and osseous junctions where connective tissue and bone meet. For people with chronic injury, finding the balance becomes even trickier. People in chronic pain later in life often had a chronic injury that made them stop using the injured area altogether until the point that it got so weak that even the most basic tasks become painful and taxing. This problem is the number one thing to avoid!

Nutritional changes may also be important when considering injury: As discussed elsewhere, Vitamin C and copper are both essential for building connective tissue, as are omega 3-6-9 fatty acids in the correct proportion, magnesium, and vitamin B. I am not a nutritionist, so I don’t know how to advise in this (I take all of them). Experts have differing opinions on vitamin C, as to what is the safe maximum intake per day. The general consensus seems to be to take no more than 2 grams per day but this is a generalization that doesn’t take into account differing body masses within the population. I do know that most animals can make vitamin C in their bodies, and that after injury, vitamin C production rises dramatically. Humans must get this from food or supplements. Also, some foods, such as too much sugar, are known to interfere with collagen production. As a general rule, it is best to avoid refined sugars and flours. Unrefined wheat or spelt flours and natural sugars from fruits are better. Black coffee and dark chocolate are actually good for you so long as you don’t mix them with milk or sugar. The “Dutch†method of processing chocolate diminishes the antioxidant benefit. In any case, coffee and chocolate must be taken in moderation because too much caffeine can also interfere with healing. Most dark chocolates contain a fairly high amount of saturated fat (except for pure, unsweetened cocoa powder), another thing you don’t want too much of. In otherwords, navigating the nutrition minefield is an art unto itself - especially when dealing with injury.

Anyway, sorry for the ramble and repetition of much information that can be found in different places all over the forum. However, I think Kintelary and those who replied to his post address a hugely important topic because many athletes are in the same quandry.

Excellent post.

One of my primary concerns with my National Team athletes over the years has always been that there might be a hole in our physical preparation & joint prehab work that would make them physically vulnerable later in their careers; wrists, achilles, knees, rotator cuff, rear delts, hip, lower back etc. Notice from the preceding list that it is rarely the prime movers which become vulnerable, but rather their essential support structures which atrophy though insufficient preparation or over-use. This is especially an issue for very strong athletes. As a consequence, I have found it essential for my athletes to consistently cycle through many prehab movements on a weekly basis.

A case in point; too great an emphasis on only straight body maltese/planche/lever work for long periods does not allow all of the veterbrae to work through a sufficiently large enough ROM to prevent muscle and ligament imbalances between the vetebrae. This results in some vetebrae becoming relatively immobile with the vetebrae above and below attempting to over-compensate for the "frozen" vetebrae. The result is a painful restriction in the ROM. The solution, however, is simple - merely add elements which do require ALL of the spinal vetebrae to articulate fully; e.g. curl-ups, windshield wiper variations, limber work etc.

Please note that in such a situation rest, ice, heat, vit C, fish oil, massage, stim etc. will temporarily help to relieve the symptoms of the problem; but can ultimately do nothing to resolve the issue. The only long-term solution is to strengthen/stretch/align the structure back into physiological balance.

Yours in Fitness,

Coach Sommer

What is amazing to me is what I find influences people to make choices about health and wellness.

Quickly, cheaply, will it help me make a profit, will I look like "them", will people finally accept me, will I be able to do 'that', now, now, now.

There are no quick fixes and no easy answers. There is self discipline and for health and fitness, the only motivation can be to know oneself. I cannot compare myself to someone else, because we are different. I cannot expect the same results as someone else (not exactly). And I have to consider how I want to feel in 5 years. 10 years. I remember the last 10 years quite well, they flew by :roll: . So, as the next 10 years fly by :roll: , one day at a time, at my own pace, with my own needs, hoping to find what works for me.

Well, I feel inspired. Thanks for this Thread 8)

Interesting.

A guy at my kung fu school has muscular dystrophy in his left arm. His wrist is always curled in and arm bent about 45 degrees. He can move his shoulder however he likes though. He trains most things with one arm. The same things we do, except with one. Basically, less work load However, some things we do are harder with one arm. Push ups, obviously.

Thinking of one arm push ups, I don't know why, but my left arm is capable of them (before my injuries) and my right never was. I'm not talking about those crappy rocky style ones either; I mean a push up the same way with one arm.

Even more, my right leg and right arm are faster/harder hitters for punches and kicks, blocks, etc. However, my left arm and left leg are stronger in ability to handle more weight. I jump from my left leg in one legged skills, and use my left arm for strength elements (except for one arm chins, my right is better for an unknown reason).

I hope I don't become too imbalanced through recovery.

Hmm, I totally missed this thread.

As for punch, kick, block...train more with your left.