To train, or not?
We’ve all had it happen.
Goals in sight.
A solid training plan laid out, ready for that client to rock.
Progressions, regressions, lateralizations all lined up on deck.
Then…the dreaded words come out of their mouth.
- “I tweaked my back”.
- “I pulled something”.
- “The old joints are aching today”.
There goes that plan.
…or does it?
Now I’m not going to sit here and tell you whether or not it’s cool to work through it or not. I don’t know you or your client.
As an athletic therapist, I’m always going to suggest an assessment for a clearer understanding of what’s happening (so get a good clinician on your team if you don’t have one yet!)
I’m just often asked how I make these clinical decisions when I send someone back to the gym with some suggestions, or inform the client they don’t actually need me for rehab.
Here’s (some) of the thought process:
1. Most of the time, a diagnosis doesn’t change the technicalities of rehab. In fact, upwards of 80% of back pain is non-specific anyways, and is rehabbing a cuff strain that different than if it’s called subacromial impingement? (the answer is no.)
So like with anything.
- Respect pathology (ie. don’t hammer into inflammation, or repeatedly flex something flexion intolerant).
- Be smart (use tolerable ranges, train the uninjured areas, condition the rest of the body, and progressively load).
- Use the regressions and lateralizations you had ready.
- And be a team player (with the client and anyone else involved…therapeutic alliance is the real deal for success)
2. New injuries with a biomechanical mechanism that makes sense, do deserve a bit of rest. Active rest, that is. Use braces, tape, therapy, modalities, or whatever you need to provide some protection. Then, train everything else. Use isometrics. Use graded activity to help lay down good quality tissue and mobilize scar tissue. Optimizing recovery and minimizing atrophy is a key to success.
3. Persistent pain, that is pain lasting or recurring for 3 months, or beyond expected tissue healing times, doesn’t always make sense. It’s why it’s often called “unexplained pain”. And truthfully, it probably doesn’t deserve rest.
The literature shows us that fear avoidance and kinesiophobia are common, and predictors of poor prognosis. So let’s keep people moving.
We also know that exercising into pain (again, be smart) rather than avoiding it leads to significant benefit in the short term, and there are no differences between pain free vs. painful exercise in the medium to long term. This is where graded exposure and graded activity come into play, along with being smart with the rest of training (as outlined above).
If you want to dive deeper into this one, I did recently publish a related article in the Journal of Athletic Training.
See how it’s not all gloom and doom?
And how much better will your clients feel when they realize they don’t have to completely shut’er down?
This will forever be a reason I loved learning the CFSC programming so early on in my career, outside of even being an athletic therapist.
It makes things make sense. Especially when you combine it with understanding of injuries and physiology.
Now go crush it in the gym, and let me know how it goes!
Megan Pomarensky is a Certified Athletic Therapist, a Certified Functional Strength Coach and a Certified Vinyasa Yoga Instructor with a Master’s Degree in Rehabilitation Science.
Over the past 8 years, Megan has built a successful private clinical practice working with clients from professional athletes looking to improve performance to older adults with chronic pain, and everyone in between. Her mission is to empower every client to better understand their body and make informed decisions about their care.
She also helps athletic therapists, trainers and physiotherapists get out of the textbooks, protocols and checklists for better client results.
IG/Twitter @meganpomarensky www.meganpomarensky.com