Training Without a System
I recently saw a patient, a young former college soccer player who came to me complaining of knee pain. Lee was a good athlete, and though she had some postural and biomechanical issues that contributed to her symptoms that needed to be addressed, the primary problems required more education and coaching rather than therapeutic activities or manual intervention. Part of what she needed is immortalized in a joke:
Patient: “Hey doc, my knee hurts when I do this.”
Doctor: “Don’t do that.”
Clinicians and patients hear this punchline differently. The clinician hears himself giving good advice not to worry about pain caused by tapping on the right hip with a rubber mallet while standing on one leg, touching the toes and trying to look up at the ceiling. Stop doing that, and boom! the pain goes away!
Yep, every Doctor you go see is going to tell you that there's little they can do for your back if you keep insisting on doing this.
Patients hear a clinician who fails to grasp the fact that the reason they’re sitting in a medical office in the first place is that they do worry, or they do want their photo to end up in a Ripley’s Believe it or Not exhibit. Clinicians do well when they remember that they are paid to find a way to allow the patient to do what the patient wants to do safely and without pain. That said, patients may need to listen to clinicians when they are told that some activities are excessively stressful at a given time and weigh the risks and benefits of modifying the activity.
Instead of jumping off this roof, try using a ladder.
In Lee’s case, she had bursitis in her knees. She wasn’t the one jumping off roofs, but her recovery would be hastened by taking a full break from running and knee-dominant exercises for 1-2 weeks and then reintroducing them progressively and systematically. Without minimizing the importance of wise progression, a long-term key for Lee was to train systematically. She worked out 1-2 times per week with a personal trainer, and because she had stated that her goals were to lose size in her glutes and thighs, the trainer gave her what she wanted: multiple variations of squats and lunges and jumps to exhaustion: a blast of volume for the legs to underline that the trainer understood the importance Lee placed on addressing her lower body, high-intensity work to give Lee her money’s worth, and enormous variety to keep it all from getting stale. On top of this, she trained independently on her off days (except the days she was playing soccer) using exercises found via a smart phone app. Even if the exercises as demonstrated on the app were good (by good I mean safe AND effective, and most were not), they still were not part of a system. What was the natural result? Lee ended up doing a program, every day, consisting almost entirely of lower body exercises. It was no wonder she ended up in pain. Had she trained using a system, rather than simply picking exercises on the fly, it’s likely that she would have never ended up injured. If she or her trainer really sat down and looked on paper at the program she was doing, it would have been much more clear how imbalanced the program was.
(Tip: I thought that this was common knowledge, but what we used to call spot reduction--losing fat in one area of the body like the stomach or the legs by simply training that area more, does not work effectively. In general, good training is balanced training using full body exercises)
In the spirit of having systems, here is a very simple and very effective 3 day per week system:
Start with a Postural Stability Exercise for the front of your trunk (ie, a core exercise), then one for the back of your trunk. Hold each one for 10-20 seconds, rest briefly, and work to 3-6 in a row before switching to the next exercise. Spend 2-3 minutes of total ‘hold’ time for each exercise.
Perform a squatting, lunging or step up type movement, catch your breath, then do a pullup or rowing-type movement. 3 moderately hard or hard sets each. Alternate each pair of exercises, resting long enough to catch your breath after each set.
Perform a hip hinge type movement or pick something up from the ground, then do a pushing movement for your upper body. 3 moderately hard or hard sets each. Alternate each pair of exercises, resting long enough to catch your breath after each set.
Finish with fast runs, or for people used to running, sprints, up a hill for 10 seconds and then walk briskly down. Repeat for 3-5 minutes.
Choose a new exercise that fits into this framework or change the repetitions from 10-12 per set to 5-8 per set every three or four weeks and you have all the variety you need. Below is a sample workout that can be done with minimal equipment.
Plank: hold for 10 seconds; repeat 3-6 times
Quadruped Lift: hold for 10 seconds; repeat 3-6 times
Repeat cycle 3 times, then
Single Leg Squat to Box: Repeat 5-8 times
Towel doorknob Row: Repeat 5-8 times
Repeat Cycle of Squats and Rows 3 times, then
Single Leg Stiff-Leg Deadlift: Repeat 5-8 times
Pushup Variation (yes, you can use 2 hands): Repeat 5-8 times
Repeat Cycle of deadlifts and pushups 3 times, then
Hill Repeats: 10 seconds sprinting up, then jogging or walking down. Repeat for 3-5 minutes.
Boom! You're done in less than 30 minutes. This framework is excellent for improving one’s general health, appearance, work tolerance and injury resistance. Volume can be added if desired (for example, Lee might have a hard time limiting herself to 30 minutes three times weekly) but for general wellness and aesthetics, this is the system that should be used. For more specialized goals, such as sports performance, there is another framework better suited to those goals under"Session Structure" here:
For those with an injury history, I recommend seeing a Physical Therapist or a Chiropractor that emphasizes exercise as a treatment modality. For those with balance issues, an adjunctive set of exercises is on the way for you.
Good luck, and remember to train smart!