In this post we’ll look at how to recover from chronic injury using resistance training.
I’ll use a particular case study to show you what’s possible when you apply the principles we’re about to discuss.
First a little background.
I’m very fortunate to work with people I enjoy spending time with. I have no idea how it worked out this way but it has.
Lee is no exception.
A former boxer with more than one chronic injury, Lee had been searching the rehab world for a solution for over a decade.
In that 10 year period he’d tried everything from physiotherapy to cortisone injections, shockwave therapy and A.R.T.
Eventually he felt like he had no option but to opt for surgery.
Whilst this had improved certain aspects of his function, he was still no closer to his goal of punching people in the head without pain in his elbow.
That’s when he came to see me.
Through his own hard work and diligent application of the principles that follow, Lee achieved that particular milestone a few weeks back.
My apologies go out to the other chap concerned.
Note that it took 12 months to improve a situation that had been noticeable to Lee for 10 years. The root causes probably go back further still.
In my mind that’s an outstanding result but what do you think?
It’s important to recognise that a situation which has been in place for a long time won’t change quickly.
That’s not to say you won’t notice improvements along the way. It’s more that you should take a long term perspective.
Lee understood this from the start and set himself up for success with this mindset.
He didn’t focus on the inevitable ups and downs, but rather the overall trend.
Tightness is secondary to weakness.
Everything I’m going to talk about relates back to this principle.
It’s how you find your weaknesses.
It’s how you set up exercises so they’re safe and don’t cause you issues.
And it’s the reason you stop doing the things that aren’t taking you any closer to your goal such as stretching and foam rolling.
All you need to understand about muscle tightness or restrictions in range of movement is what governs those restrictions..
In other words tightness is not a mistake but rather a solution to a problem.
Think of it as an internal splint, or the barriers around a hole in the road. It’s there to prevent you going into a position you don’t currently control.
Taking the splint away or removing the barriers with stretching for example doesn’t solve the issue.
In order to achieve a long term solution you need to find the source of the problem, weak muscles.
How to find muscle weakness.
Locating weak muscles is the holy grail in injury rehabilitation. Sure there are other factors involved in successfully returning you to your activities, but get this right and you are well on your way.
Weak muscles leave clues as to their whereabouts. These will be seen as restrictions in range of motion. Things you can do on one side of your body that you can’t on the other.
Let’s take a look at how you can assess motion at your knee to demonstrate this approach.
Anatomy of the knee.
The knee is formed of two joints, the tibiofemoral joint, where the femur (thigh bone) meets the tibia (shine bone) and the patellofemoral joint, the articulation between the patella (knee cap) and the femur.
Whilst the tibia is able to rotate under the femur, the primary motions available at the knee are flexion and extension.
This makes it a relatively simple joint to assess motion at. Note however the position of the hip and the tibia may alter how much flexion and extension is possible.
How to assess knee extension.
Lay down on the floor and place a foam roller or rolled up towel in the back of one knee.
Without lifting your knee away from the roller, squeeze your quadriceps and straighten your knee as far as you can. Note the distance your foot travels from the floor.
Now do the same on the other one.
How to assess knee flexion.
Lay on your back again and this time slide one foot towards your butt. Note the distance between your heel and your backside.
Now do the same on the other one.
Did you find a limit?
Were these motions harder to do on one side compared to the other?
If so, congratulations! You have found a group of muscles that need your attention.
If not, congratulations! You have eliminated an area from your search for the time being.
How to improve range of motion limits.
A limit in range of motion represents a muscle or group of muscles that may not be operating at their best.
The first course of action is to see if you can make an immediate change.
As I’ve discussed before isometrics (muscle contractions without movement) are a great way to restore motion.
The test that showed the limitation then becomes the exercise.
Perform gentle contractions at the end range of motion in the direction that you can’t currently go to improve that particular range.
For example, if your limit is in knee extension, straighten your knee as far as you can and hold it there for around 5 seconds before resting and repeating a further 5 times.
This should provide immediate gains in range.
Resistance training targeted at muscle weakness.
Whilst isometrics can be of enormous value in improving range of motion, they alone won’t necessarily get you back to your activities.
When a muscle hasn’t been contracting particularly well for some time, it will inevitably lose strength.
Resistance training is the most effective method to restore this function.
I’ve previously explained in detail why the best way to apply this is with strength training machines. They allow you to isolate weaker muscles and reduce the confounding impact of muscle compensation.
Strengthening the knee extensors.
To continue with the knee extension example, once you’ve sought to improve range of motion, what’s now required is to challenge those muscles further by adding resistance.
For the quadriceps that’s best done using a leg extension machine pictured below.
This enables isolation of the target muscles and allows you to gain a true picture of any strength deficits that may be present.
Use slow repetition speeds to begin with and ensure the exercise takes place within your active range of motion.
This video will show you precisely how to do this.
You can read more about this crucial concept here.
Improving long term chronic injuries is possible if you apply this thought process.
1) Assess your body for asymmetries by comparing motion on one side to the other.
2) Improve these deficits with gentle muscle contractions in the direction you can’t presently go.
3) Seek to load these areas in as much isolation as possible with appropriate resistance training.
It is both as simple and as complicated as that.
Remember that in some way you trained yourself into this situation. By the same token you can train your way out of it.
Be patient and keep looking for areas you can improve. Like Lee, you’ll be back doing the things you love soon enough.