Monday, December 31, 2012

Reconditioning Part I

My last post covered injury prevention techniques and can be read here.

Let's say it's too late for prevention and you've already hurt yourself in some way.  Whether the injury is severe or mild,  a proper rehabilitation protocol needs to be implemented immediately in order to prevent further regression and inhibition.  You'd be surprised how many people have "life changing injuries" that could have been just "injuries."  Immediate effort to restore function and mobility can be the difference between complete restoration or lasting disability.  Here are some basic rehab techniques for common problem areas.

Shoulders are notoriously complex, and highly individual, so there are no two shoulder problems quite the same.  Most shoulder issues are caused by a number of factors, all of which contribute to the injury as a whole: imbalances, weakness, tendonitis, tendonosis, bursitis, labrum problems--the list goes on.  Even if you're willing to shell out for an MRI, pinpointing the exact cause is practically impossible, so implementing a wide variety of exercises will always grant the best outcome.

Once I detect impingement in either of my shoulders, I start adding "rehab" exercises to shoulder day right away.  But hold on, what does impingement feel like anyways??  Well, it feels exactly like what it sounds like, an inhibiting sensation, usually accompanied by pulling in the front of the shoulder and even upper chest, often radiating down the arm as well.  It can even present itself as perceived instability or weakness during key upper body movements, or as a reduced non-resisted range of motion.  Immediately adding a combination of pendulums, rotator cuff exercises, and additional stretching usually clears up impingement right away.  More severe cases will need a little more attention, but sufficient rest and rehab will do the trick in the end.

Bend at the waist with a light weight (or nothing) held in the hand of the problem shoulder.  Allow the shoulder and arm to hang neutrally and gently, GENTLY! swing the arm in circular motions.  You can experiment with swinging patterns, i.e. back and forth, side to side, clockwise, and counter-clockwise; you can even experiment with hanging angles, I like to rotate my torso, first with the working shoulder up, then down, creating a comfortable stretch in both directions.  Most of all, go slow and be gentle!  NEVER use more than 10 lbs on this exercise, it's not necessary!  A 5 lb dumbbell is plenty!

Rotator Cuff Exercises:
"Rotator cuff" is actually a colloquial term used to refer to four separate muscles which help stabilize the shoulder: the subscapularis , the teres minor, the infraspinatus, and the supraspinatus.  These are very small, very weak muscles that work together in order to function, and therefore must be trained very conservatively and VERY lightly.

Using a cable or a resistance band set or secured at waist height, start with the elbow pinned to the body and bent at 90 degrees.  Rotate your body so that your lower arm can rotate in a smooth arc in both directions.  Perform using both adducting and abducting movements.  Use EXTRA light weight (resistance bands are often preferred for this reason), and make sure that your upper arm is ONLY rotating, not raising laterally--your shoulder and elbow should both be static!  This exercise can be varied by using either a high or low fixture for your resistance, and positioning the humerus horizontally out to the side (if you are using a high setting, start with your lower arm pointed up, if using a low setting, start with your lower arm pointed down).  Start with the elbow bent at 90 degrees and smoothly pull up or push down, rotating the humerus and shoulder, but once again keeping both in a fixed position.  Keep your movement range limited to what is comfortable without form breakdown.

Knees and Hips
Now to be fair, if you lift weights, you should have fairly few hip and knee problems--we all train legs every week, right??  Hitting hamstrings and quads hard once a week should be plenty to solve most knee imbalances, and should sufficiently strengthen and stabilize the hips as well.  Like I mentioned in my last post, strengthening the quadriceps and especially the hamstrings should be sufficient prevention against further injury, but if you are recovering from an injury and can't fully utilize some of the more demanding lower body exercises, or if you need to even things out a bit, a good place to start is hamstring curls.

A fantastic injury-friendly variation of the hamstring curl is the ball curl.  Begin in a lying position and place a large physio ball under your ankles.  Depending on the severity of your injury, adjust your position as necessary to minimize injury aggravation or pain.  Ideally, you want to be able to lock your hips and lower torso in a fixed position held slightly above the floor while keeping your shoulders and upper back on the floor, forming a straight line to your feet on the ball.  From there, curl your heels towards your glutes, lifting your lower torso further as necessary to maintain your original straight-line body position.  Lower, maintaining a straight body position, and repeat.  Perform slower to increase difficulty.  This exercise can be varied to include only one leg, and can be performed with the entire back in contact with the floor--a version  often used in knee repair patients to help regain strength and range of motion.

If performed with light weight and good form, knee extensions can also be great knee strengtheners even for those recovering from an injury.  For my explanation of how to perform this exercise properly, check this out.  Remember to use extremely LIGHT weight and extra smooth movement speed when recovering from an injury!

If you're experiencing hip problems and you already lift weights, you might want to consider some of the exercises you are already performing.  If you're doing leg press, that may very well be the culprit.  Most plate-loaded leg presses feature a counter-balanced sled and a fixed seat, while most selectorized models feature fixed platforms and sliding seats.  Both, however, feature slight angles in the plane of movement, creating unnatural forces on your hip.  Squatting keeps all the force directed down through the hip into the femur, but when the subject is in a fixed seated position, the femur tends to push back in to the hip, rather than up into the hip as it should.  Try skipping leg press altogether or significantly altering the angle by using lower foot placement and seat settings.  Don't hesitate to substitute another leg movement for fear of losing size, I haven't done leg press with heavy weight for YEARS and my legs are bigger than ever.

Hip adduction and abduction, preferably performed with ankle straps and floor cables so that a more functional straight-leg position can be utilized, should be an integral part of warm-up and stretching on leg days, and can be added regularly as necessary to alleviate hip and groin tightness or to simply help add stability.  Maintain an otherwise neutral body position, allowing only the working leg to push outward or pull inward.  Avoid twisting and rotating with the hips, as this only destabilizes the spine and reduces stress on the target muscles.

I'll cover the back, plus a few other tidbits to consider, like shoes and chairs, in my next post.  Stay tuned!

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