"In health there is freedom. Health is the first of all liberties."
- Henri Frederic Amiel
When I started as a personal trainer, I was super excited to help people become extremely strong and capable, I wanted to turn everyone into a real action hero. I noticed very quickly that almost everyone I worked with, even my strongest and most athletic clients, were quite often limited by injuries, pains, niggles, and “bad ____’s”. For some it was bad knees, others bad backs, or bad elbows. Knowing the goals I was aiming for, for them, I knew I had to resolve their bad ____’s before the real fun work could begin. That was how I began my 10+ year journey of learning how to help people heal themselves so they can express their full badass potential.
I have to acknowledge the many people who helped me learn. I received many treatments from many professional therapists, and they were all gracious enough to allow me to pick their brains. Thank you to all the physiotherapists, sports therapists, massage therapists, manual osteopathic therapists, chiropractors, and rehab specialists that have helped me learn over the years. I still have coffee with many of them, just to discuss some of the ideas I’m going to share with you.
Understand the Problem
One of the first things I do when meeting a new client is to ask about any injuries or limitations they have in any of their joints. First we identify the area that’s bugging you (is it your knee, or your shoulder?), then we get into further specifics (if it’s the knee, is the problem located medially, or laterally? Proximally, or Distally?). Then we try to identify the specific tissue (is the problem in the rectus femoris? Or the patellar tendon? Is it due to an issue in your anterior cruciate ligament? Or do you have arthritis due to degradation of your cartilage?). Roughly speaking, the major issues are often in muscles, myofascia, tendons, ligaments, or cartilage.
The order I wrote those in closely resembles two things. First, that’s usually the order of likelihood that a problem is located in. Most people injure and/or have deficiencies in their muscles more often than they injure their cartilage. Second, this is the order of their rate of healing. Muscles have a lot of access to blood supply, and are highly responsive to stimulus. They can change their form extremely quickly. Collagen-based tissues work a bit slower, tendons take longer to adapt. Some people even argue that cartilage doesn’t adapt at all. I don’t personally believe this is true at all, but I do concede that the rate and extent at which they adapt is significantly lower than the other tissues I have mentioned.
Address the Problem
Once we have an idea of where the problems lie, we begin by reducing the likelihood of making things worse. This may be done with a modification to a program, where we either reduce load/volume of exercise, we may selected a modified variation of an exercise the reduces pain, or if the problem is quite serious, we may opt to not exercise the area directly with major exercises. That’s not to say we won’t stimulate the tissue someone, but perhaps we’ll avoid heavy compounds lifts for a few weeks if we need to.
Once we’ve modified training to reduce likelihood of making things worse, we see if modifications in form solve the problem. Many, many problems are solved simply via changing neurological engagement. That could mean changing your technique in a particular exercise to put less strain on a tendon and put that strain into the muscle (sending hips back a bit can place less strain on the knee when squatting). Or perhaps changing form to engage a muscle that is underactive (many people neglect to depress their scapulae when doing a pushup or bench press, resulting in shoulder pain)
For more chronic problems, we place stimulus for adaptation onto the tissue itself.
For muscles, that often simply means doing the right exercises. We use compound movements when we can, and switch to isolation if we have to. If a muscle remains particularly underactive, I’ve had incredible success getting clients to pre-activate their muscle via electric stimulation with a TENS unit before their regular exercise. I’ve used that various times with clients who lose temporary voluntary muscle contraction due to nerve damage from spinal surgery; but it also is useful for people who simply can’t engage their mid traps and rhomboids.
For myofascia, I encourage every single client of mine to engage in self-massage techniques using massage guns, lacrosse balls, and foam rollers. I will write an article about this topic soon, but for now let me just say that this is an incredibly powerful practice that yields significant reductions in referred pain, much greater ranges of motion in all your joints, and can create environments that are much more conducive to healing for larger injuries.
For tendons, I’m a huge believer in placing stress on to the tendon in a lengthened state in both isometric and eccentric fashions. The next trick to make this even more effective is to take collagen supplements! There are not many supplements I recommend to all my clients, but collagen certainly is one. It is my belief that many tendinopathy issues aren’t due to excessive strain on the tendon, but rather due to insufficient healing - often due to not having the aminoacids to facilitate that healing.
For ligaments, it begins to venture near the end of my scope of practice. Depending on the severity of a ligament issue, I may recommend working with a physiotherapist to oversee the initial stages of healing. If you’re cleared for exercise, and wish to undergo a proper rehab that restores full athletic function, then we can work together to do that! First, I recommend we maintain tension in the joint low by engaging in self massage. Then we do a lot of exercises for the muscles around the area, particularly any stabilizing muscles, to minimize any over-straining of the ligament itself.
For cartilage issues, I will implement a combination of every method I’ve mentioned so far. In addition to that, I recommend you consider and research the benefits of: anti-inflammatory diets, collagen supplements, and glucosamine. That said, a physiotherapist friend of mine explained his philosophy towards cartilage issues, which I think is a very practical approach as well. We may be able to help the tissue heal, we might not; but by strengthening all the tissues around it, we can almost always improve functionality.