Awhile back a member of my Jiu Jitsu team approached me after practice looking for some help with an injured shoulder. He was due to compete in the IBJFF World Championships in Long Beach, CA a few weeks later, and was having some problems with his shoulder. After a quick evaluation I realized that he had a rotator cuff injury of the type that was relatively straightforward to treat. He was searching for a stretch to ‘open up my chest’. As I tried to nail down exactly what he meant by that so that I could tailor my advice to his language and expectations I realized that what he really wanted was one exercise that could eliminate his pain long enough to allow him to continue all of his training unabated until after the Worlds.

So I gave him the X-Wing Stretch, and it worked, and he’s now a World Champion.

Everything above is true, except for the part about the Hot Dog stretch turning him into a world champion. One of the things about injuries is that they typically come at the worst time (or at least, we always think it’s the worst time), and even when the answers are simple, they are far from convenient. I broke my toe in January just as the competition season was starting and missed the first two tournaments of the year. It would have been nice had Tight End/Party Animal Rob Gronkowski been 100% at Super Bowl XLVI with my beloved Patriots (or around at two Sunday's ago) Etc. Etc. Etc. There are two rehab-related questions to ask for an athlete who is injured: how we address the injury, and how we optimize the training and maximize performance while working around it.

For the first question, it should go without saying that licensed professional attention should be sought, typically a Physical Therapist in states with direct access, a sports medicine physician if you don’t, or a Chiropractor with a strong foundation in functional movement and exercise. From there, it's extremely important that the medical professionals communicate with one another and the injured athlete's coach, as well as the patient himself.

For the second part of the question, here are some suggestions that when explored, will help athletes realize that you can still train, and train hard, in the presence of injury. It is obvious, but it goes against most athlete’s mindsets, so I’ll say it anyway: if we’re dealing with an acute or inflammatory injury, activities that increase the pain (“It hurts when I do this”) are activities to avoid.

Train opposites: if someone can’t bench press, they can perform a single arm DB or kettlebell press. Often, they may need some sort of stabilization. If tolerated, they can hold a weight in the other hand as a counterbalance and not press it. You can set yourself up alongside something fixed to the ground that you can grab. You can switch to a cable press on a functional trainer or cable. This can be done unilaterally, or The injured side can pull while the healthy side can push to facilitate stability. If someone can’t squat because of their lower extremity, try a single leg squat, with assistance if necessary, or even step ups. Switching to unilateral exercises is especially beneficial for those athletes not tolerating axial loading. I always remind folks that a single leg squat is akin to a bodyweight back squat, and any external weight counts for twice as much. Remember too that strengthening one extremity elicits a training effect that actually strengthens the opposite side, reducing detraining effects bilaterally.

Opposites Attract.  This was a pretty dope video in 1988, and yes, Paula Abdul looks the same now as she did then. — Opposites Attract. This was a pretty dope video in 1988, and yes, Paula Abdul looks the same now as she did then.

If someone can't tolerate knee-dominant movements at all, or is under post-surgical restrictions, try emphasizing the posterior chain with hinging movements like Kettlebell Swings or Stiff-Leg Deadlifts. Maybe you can’t do any overhead work. Rows can substitute for pulldowns and bench or decline pressing is a very good alternative for overhead pressing (though less likely tolerated). Is it ideal? No, but if someone performs heavy rows for even 12-16 weeks while avoiding overhead activity, any loss in an ability to perform vertical pulls will be minimal, with a quick return to form once normal training resumes.

Use different weights: I almost didn’t include this, because of the slippery slope that it invites, but in a disciplined athlete with supervision, a significant reduction in resistance used during exercise (clearly and definitively below the pain threshold and usually to less than 30% of normal RM for a given number of reps) can continue to groove motor patterns and reduce strength loss.

Cut in a different direction, practice planting off a non-involved leg, or at a lower speed: Another one I almost didn’t include, again, because of the risks involved with certain injuries. That said, the ideal rehab program involves progressively increased force, velocity, variability and reactive components--just make sure, especially in the case of ligamentous injuries or surgery--that your physician’s protocol is not violated in terms of returning to sports-specific drills. It may also be good opportunity to reach out and have a constructive conversation if you happen to disagree with said protocol.

Try isometrics. I couldn't help but mention Charles Atlas here--I don’t think that anyone in fitness has been so associated with a technique in the history of resistance training, especially among laypeople. His Dynamic Tension Method was simply a form of isometrics. Find a position that allows for pain-free pushing or pulling against an immobile object and push or pull for 6-10 seconds. Look for 60-120 seconds of total time under tension. It’s not glamorous, and it may not have kept that many 98 pound weaklings from getting sand kicked in their faces, but it is an effective tool. Additionally, there is no ego involved, and precise variations in tension can be made both quickly, in response to any discomfort, and at different angles, allowing someone to maximize force in a specific joint position without increasing pain. Still unconvinced? Keep in mind that many normal training phases incorporate isometric pauses; look to Mel Siff, Cal Dietz and NASM for suggestions. Remember that appropriate core work primarily involves isometrics, and people can obviously get a workout from a few sets of hard planks. Additionally, Gray Cook suggests isometric holds at the top of pull-ups in tandem with hanging as a way to improve pull-up performance; finally, Frans Bosch, Craig Ronson and David Joyce point out that during high speed activities with rapid turnover such as running that the muscles themselves are acting isometrically: Instead of following an eccentric action with a concentric contraction, they simply maintain length in order to keep the the tendons and fascia fixed, allowing the non-contractile tissue to stretch and rebound, generating elastic energy to create force.

Avoid full contact and focus on drilling and conditioning: Breakdown simple movement skills such as the shuffle or the crossover at slow speed. Make sure that you are stepping exactly where you want to step, that your arm movement is efficient, etc. It’s difficult to make precise changes like this when training at full speed; take the opportunity to build effective movement patterns. The idea of drilling is especially effective in combat sports, which tend to be technical, until that technique breaks down under the pressure of fighting or grappling and the competitor defaults to habit. Spending time drilling removes the ego from practice, allowing new skills to be developed and building the neural pathways that lead to automaticity of correct movement.

You can rest assured that your strength is not going to go down all that fast! One of my teammate’s big concerns was that he would lose strength. A 350+ pound bench presser, he found that he had pain with even 135lbs. My first point was that if his strength had decreased that much in a few months, his pain was limiting him a lot more than any detraining effect was. My second point to him was that even without pain, detraining effects do not occur that quickly. My favorite example: A few years ago I had a patient with a rotator cuff tear that was on the cusp of needing surgery. He chose to avoid it, but had to stop doing any overhead or bench pressing. Before his injury, he reported that was Flat DB pressing 105 lbs for 5 reps. It took about 2 months of therapy to get his shoulder feeling better again, but after that he was able to press 80 lbs for 10, and the next week, pressed 100 for 2 without pain. The kicker here was that his injury had been about one year prior. He had spent a year without doing any kind of pressing and his strength had been reduced only marginally--certainly not reduced enough to be noticed in any non-lifting sport.

It is natural to be frustrated when an injury limits an athlete's ability to compete and train, but with appropriate guidance, communication, education and psychological support, and by utilizing the strategies involved above, a setback can be turned into not only a minor impediment, but an opportunity for long-term progress.

Finding Ways to Train Around Injury