Dr. Chase Christy is a physical therapist and owner of Amarillo Physical Therapy. He specializes in working with fitness athletes and the geriatric population.
Injuries can be a significant setback in anyone’s fitness journey, but they don't have to mean the end of your exercise routine. With the proper modifications and adjustments, you can stay active and promote recovery. Here, we’ll explore various ways to modify your exercise regimen when facing an injury.
The problem
The current healthcare system in the United States is subpar at best. It is a reactive creature that does very little to help itself from a preventative standpoint. Most medical schools (80–90%) fail to cover essential nutrition and exercise physiology. So, it shouldn’t be surprising when your doctor tells you, “Well, just don’t do it if it hurts,” during your appointment, a wildly lazy answer that a 6-year-old could give you. Adapting training to an injury is complex and skilled work. It requires an in-depth evaluation and examination, with equally in-depth questions sprinkled throughout. But more on that later.
What does that look like in the physical therapy world?
While physical therapists have more training in these areas, they often fail to practice what they preach from a health and fitness standpoint. This leads some PTs to be incompetent in treating frequently overlooked groups, including CrossFitters, Olympic weightlifters, powerlifters, bodybuilders, Hyroxers, and other fitness athletes from diverse backgrounds. Many healthcare providers, including PTs, assume these individuals don't need physical therapy. Or, if referred to PT, they receive grossly inadequate exercise prescriptions. A person who deadlifts 500+ pounds doesn't need side-lying clamshells with a red theraband; they need exercise modifications to the movements they enjoy and want to perform.
Modify strength training
Strength and conditioning are essential for maintaining muscle mass and overall fitness but may need adaptation around an injury. However, how we adapt is crucial. Generally, we have three modification options: volume, intensity, and range of motion. The choice depends on answers to crucial questions. We wouldn't adjust the volume for a client reporting increased pain with deeper ranges of motion or increased weight/resistance. Nor would we modify intensity for a patient experiencing increased pain with more repetitions. If adjusting these parameters is ineffective, we substitute a movement that still challenges the painful area tolerably.
Exercise parameters
Volume refers to the number of repetitions in a training program. Intensity refers to the amount of resistance used for a given movement. Range of motion refers to the extent of joint movement during exercise. We identify the problem by establishing the "mountain of irritability," that is, how long it takes for the tissue to become painful and how long it takes to return to baseline. So, if a client reports that pain peaks by the fourth set of a movement, this is likely a volume issue, not a range-of-motion or intensity issue. This principle can be applied to the other variables. As mentioned, if adjusting these variables proves ineffective in making a movement tolerable, we substitute another movement that hopefully still challenges the affected area. Failing to move or challenge the tissue leads to further atrophy and instability.
Pain should be tolerable in the moment and 24 hours after
In conclusion, it's essential to listen to your body. If a movement is tolerable at the moment, but the tissue is inflamed 24 hours later, further modification is required. Both immediate and 24-hour post-exercise pain must be tolerable to ensure the intended stimulus is achieved. As long as this guideline is followed, the risk of further injury is unlikely. This assumes, of course, that one is getting quality sleep, nutrient-dense food, and managing stress effectively. If these factors are not addressed, the chances of full recovery within a reasonable timeframe are slim. More on that in a later blog post.
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Dr. Chase Christy, Physical Therapist, Owner, Coach
Dr. Chase Christy is a physical therapist and clinic owner. He is an ICE (Institute of Clinical Excellence) certified specialist in treating fitness athletes and orthopedic patients. He is also trained trhough ICE in dry needling. To cap it all off obtained his CF-L1 (CrossFit Level 1) and occassionally coaches CrossFit classes.
