Injuries happen, but they shouldn’t stop you from completely working out. Now, that doesn’t mean go running on a sprained ankle! However, with the help of Andrew Johnston, author of “Holistic Strength Training for Triathlon” and twice voted “one of the top trainers in America” by Men’s Health, we have picked the top exercises for knee, shoulder and back injuries.
As a professional cyclist and leukemia survivor, Johnston knows both endurance and smart training. There’s a fine balance between pushing yourself to recover and further straining an injury — however, there is also a fine line between excuses and legitimate reasons for rest. Injuries in these main muscle groups are actually signs of dysfunction in other areas, typically revolving around the core. Targeting these areas with specific exercises will facilitate healing and help prevent future problems. One of the rules of rehab: if you can’t, you must.
Before attempting these exercises, note these signs to gauge your level of fitness:
- Strength Curves: Created both 15 degrees before/at the end of range of motion (i.e. holding the arm at 90 degrees of elbow flexion strengthens the elbow flexors at 75 degrees through 105 degrees range of motion). Thus, working within whatever pain-free arc you have will allow for the benefits of movement (circulation, nutrient delivery, lymphatic drainage, etc.) while reversing any neurological inhibition/atrophy secondary to pain.
- Pain: You’re either doing the exercise wrong or you’re not ready for the exercise. Descend the exercise to a point where you can perform it without pain either during or 24-48 hours after.
These are the most mobile joints in the body, so therefore they are the least stable. You should start with small movements and even more basic everyday motions to begin.
Best type of exercise: Closed chain exercises. These refer to movements where the “distal end” (the point of attachment, so the hand in this case) of the limb doesn’t move. For example, do a push up rather than a bench press. Your body pushes off your hands that are planted on the ground in a push up, but in the bench press, your wrists attain most of the pressure.
- Crawling. Simply crawling works the shoulder very effectively, as it works on proper timing/sequencing of the joint in a closed chain, very stable environment — just how Nature intended. Fun fact: that is why crawling is so crucial for human development.
- Shoulder clocks performed from a side lying position would also be a good place to start. Careful attention should be paid to working the shoulder muscles, which often get neglected — the external shoulder rotators. An imbalance at this joint will only perpetuate any dysfunction.
Unless the wrist directly suffers a trauma or straight break, it is likely injured due to faulty posture or overuse. An uppercross syndrome where the shoulders are pulled forward due to short/tight internal shoulder rotators and long/weak external shoulder rotators can close down the thoracic outlet and compress the nerves/vascular structures feeding the wrist, often resulting in pain.
Common cause of wrist injury: Upper cross syndrome where the shoulders are pulled forward due to short/tight internal shoulder rotators and long/weak external shoulder rotators can close down the thoracic outlet and compress the nerves/vascular structures feeding the wrist, often resulting in pain.
- Prone Cobra: Similar to Supermans, you will lay on your stomach with your arms at your sides. Raise your legs, trying to get your thighs off the floor and raise your chest simultaneously.
- Modified use of wrist: If you’re a tennis player and your wrist hurts while holding a racket, simply changing the diameter of the handle (new racket or more/less tape on the handle) will recruit the muscles responsible for grip differently, allowing the inflamed/overworked muscles/tendons to rest.
Getting the proprioceptors to work is key; these are the sensory receptors that detect motion and transfer the motion to the central nervous system.
Best form of exercise: One-legged movements with the “good” foot up and the affected foot on the floor (either standing or seated on a ball) are the basis for restoring function. Try closing your eyes or turning your head to make these movements more challenging. Progressions should aim for functional movements common to daily living.
- Unilateral squats: squat on one leg, keeping the other slightly raised for the whole set.
- Step ups
Since pain inhibits function, a key member of the inner unit, the multifidus, gets turned off. The multifidus is the smallest but most powerful muscle that gives support to the spine. Most muscles have a main nerve and an auxiliary nerve, but the multifidus doesn’t. So when it’s in pain, it atrophies as much as 25% in 24 hours.
- Horse Stance Vertical
Horse Stance Vertical:
- On your hands and knees, lift one hand up just enough to slip a piece of paper underneath it. Do the same thing for the opposite knee.
- Hold for 5-10 seconds while minimizing any lateral deviations or change in spinal curvatures (basically stay still).
- Switch and repeat for 5-10 reps on each side.
- At the same time, activating the pelvic floor muscles (the muscles you use to stop the flow of urine) along with the transverse abdominal muscles will help turn on the multifidus, as they are all on the same neurological loop. Therefore, turning one muscle on helps to activate the other muscles.
Of course, if the body is healthy, the idea behind exercise should be to keep it that way. Think movements (rather than muscles) and always integrate unless there’s a specific reason to isolate. Proper training can be a lot more complex than people often realize. But that’s one of the reasons we keep hurting ourselves!