by Mike Robertson T-Nation
In 5 Strategies to Train Around Upper Body Pain, I outlined some tips to make sure you're not getting soft and lazy when dealing with an injury.
How often have you seen someone suffer an injury, and the next two months of their life revolves around extended periods of time sitting on the couch, a diet that would make anyone cringe, and just being a total slack-ass?
Eric Cressey is someone I respect the hell out of, and if a kid comes to him with a torn ACL he tells him he's still got one healthy leg, a core, and two arms he can train, so it's time to get in the gym!
Quite simply, an injury isn't an excuse to get lazy and soft – it's a reason to learn a thing or two about your body and hopefully get a bit smarter and stronger in the process.
That said, let's look at some common issues from the core/low back down, and how you can train around them to keep you in the best shape possible.
Low Back Pain
I can't tell you how many times I've worked with clients in lower back pain. For three years, 80+% of the patients I dealt with in a chiropractic clinic were there for low back issues.
One of the worst cases was a client we dealt with at IFAST. When I met him he hadn't done a bilateral lift in over a year, and had resigned himself to single-leg work for the rest of this life.
The kicker? He was only 23 years old!
Here are some tips from the pros that you can use if you're suffering from lower back pain. Keep in mind that every kind of "pain" is unique, and some of these tips may work better than others for your specific condition.
1. Keep the Spine Vertical
Regardless of what you've heard, the spine is incredibly resilient at dealing with compressive forces.
Have you ever seen how big a lumbar vertebrae is? Tell me that sucker isn't built to deal with compression!
What most people struggle with, however, is shear forces. The more bent-over or inclined your spine is, the more your body is forced to deal with and control shear.
As a result, staying more vertical/upright is key. Watch how Joe Schmoe with back pain picks something up off the floor – he squats down (on his toes, no less), but his spine is bolt upright.
I'm not saying you should lift like that, but it's a lesson in how your body naturally responds to avoid low back stress.
Regarding the gym, taking back squats out and replacing them with goblet or front squats is a great option. Anterior loading not only encourages t-spine extension (something most of us sorely need), but also reduces shear forces on the spine.
2. Get Down with Single-Leg Work
I'm not ready to throw my powerlifting card out just yet, but someone with back pain can often benefit from incorporating more single-leg work into their program.
Single-leg work can be beneficial for several reasons:
It keeps the spine relatively vertical
It develops hip stability
It develops hip mobility
Watch people that suffer from back pain and chances are, their hip mobility is similar to that of a stone golem.
Single-leg work, and specifically split-stance work, can be wonderful. To do it correctly, focus on staying tall through the torso and squeezing the glute on the back leg butt-cheek.
This facilitates both pelvic control and hip extension. If your hip flexors are locked down, they're going to drive you into anterior tilt and an increased lumbar lordosis.
Along similar lines, let me answer a question I get all the time – I do not think Bulgarian split-squats are a good idea for people in back pain.
Let's use the example of someone who suffers from compression-based low back pain – they're in anterior tilt, with an increased lumbar lordosis.
Quality split-stance work for this client is hard enough. The hip flexors are short/stiff, and dominate the external obliques and gluteals.
Now, imagine elevating the back leg so that the rectus femoris is in an incredibly stretched position. Do you really think you're going to be able to maintain control of your pelvis and keep your hip actively extended?
Good luck, my friend.
3. Learn to Move From Your Hips and Thoracic Spine
Another thing I've learned over the years is that clients have no clue what movement from their hips and thoracic spine actually feels like.
They have these preconceived notions of how much "motion" they should have, even if it's not quality movement.
When going through your warm-ups and strength training exercises, focus on keeping the lumbar spine in neutral at all times. If you're doing hip focused exercises like squats, you may have to cut your range of motion for the time being to make sure you're not substituting hip motion for lumbar spine motion.
If you're trying to rotate from the spine, think about getting as tall as possible so that you rotate from your upper back versus your lower back.
Quality of movement is critical if you want to lift heavy long-term. Improve the quality of your movement, and often you'll see an increase in your lifting quantity as well.
As a "corrective exercise" guy, I'm known for my success in dealing with knee pain.
That said, here are some tips for those suffering from general anterior knee pain.
4. Keep the Tibia Vertical
Dan John is known for telling a funny story. A young man says, "Squats hurt my knees!" Dan then asks him to squat.
After reviewing his technique, Dan says, "Son, squats don't hurt your knees – how you're squatting is hurting your knees!"
There are at least a million articles describing how to squat, so I'm not going to bore you with the specifics.
If you suffer from knee pain when squatting, try squatting with a vertical tibia. Box squats are great because they force you to sit back and load the glutes/hamstrings.
But it's not just squatting – virtually anyone with anterior knee pain can perform exercises with a vertical tibia (pull-throughs, RDL's, rack pulls, etc.) and have absolutely no knee pain whatsoever.
5. SMR (Self Myofascial Release) your TFL, IT Band, and Quads
I'd guess that at least 100 times in the past five years someone has complained to me of knee pain. I promptly have them foam roll one of the offending areas (TFL, IT band, and/or quads), they stand up, and notice an immediate reduction in knee pain.
This also makes me look incredibly smart, and let's be honest, I'll take this whenever I can get it.
6. Address your Ankle Mobility
Ever notice how so many football, basketball, and soccer players suffer from knee pain?
It's not just the incessant amount of running they do.
It's the fact that they use high-top shoes, ankle braces, and/or ankle tape to create external ankle stability so they don't get injured.
I get that. Nothing sucks worse than rolling up an ankle and missing a couple weeks of action.
But this artificial stability at the ankle can wreak havoc on overall ankle mobility. And that loss of ankle mobility often ends up in excessive motion at the knee joint.
In my experience, almost everyone can benefit from some self-myofascial release to the gastroc, soleus, and plantar fascia. Combine that with some dedicated ankle mobility and tibialis anterior strengthening work and you begin to regain some structural balance at the ankle joint.
7. Improve Your Hip Flexor Length
Hip flexor stiffness/shortness is incredibly common in clients and athletes with anterior knee pain.
If you want to reduce said stiffness, you need to get your external obliques and gluteals stronger. One of the best ways to do that is to incorporate half-kneeling and tall-kneeling exercises into your programming.
Similar to the aforementioned split-stance work, half and tall-kneeling exercises force you to create stability using your muscles versus passive structures like your lumbar spine.
The key to these exercises is to focus on getting tall and actively squeezing your glutes. Don't focus on how much weight you're using. Instead, I often tell my athletes to think of it as a game – the goal is for your core, spine, pelvis, and hips to move as little as possible.
In fact, the only thing that should be moving is your arm and the implement you're holding.
8. Split-Stance Work
When dealing with knee pain, I like a combination of tall and half-kneeling exercises combined with split-stance unilateral exercises.
The tall and half-kneeling work gets the obliques and glutes into the game in a static environment, whereas split-stance work forces you to control the hips and pelvis while moving through an active range of motion.
I don't care if you're a bodybuilder, powerlifter, Olympic lifter, strongman, or just someone who wants to stay strong – single-leg and split-stance work should play a role in everyone's programming.
I love how exercises can burst onto the scene and then disappear just as fast.
Many have been quick to dismiss the step-up, saying it has no intrinsic value.
I feel step-ups are beneficial in a program, but for different reasons than split-stance work.
When performing a step-up, there's a point where your working leg is the only body part in contact with the ground. As a result, your body is forced to create an incredible amount of stability. You have a very small base of support, which hits the small stabilizing muscles around the hips, knees, and ankles hard.
Furthermore, if you focus on actively extending the hips and knees at the top, you drive both hip and knee extension simultaneously. I'm a firm believer that the more "stacked" your joints are on top of each other, the better they'll feel.
As I outlined in a recent blog post, I live by the following equation:
Hip extension + Knee extension = Happy knees
Every time you step-up, actively think about squeezing the glutes at the top (hip extension) and flexing the quads (knee extension).
Put away your tissue and stop feeling sorry for yourself. Injuries are as much a part of the iron game as barbells and dumbbells. While sitting on the couch and watching reality TV may sound tempting, you can still continue to train while working around and addressing an injury or "tweak."
This article, however, wasn't meant to be all encompassing. I can't outline every strategy I use, or address every possible injury. So here's where I lean on you guys.
What are some of your best tips and tricks to work around an injury?
I'd love to hear your feedback in the Live Spill section below.