Pain
At some point in time, we all experience some sort of road block. This could be an injury or general pain.
A diagnosis does not have to be a death sentence. The beauty of the body is that it will adapt the best it can. The right mind set is imperative to view this bump in the road as an opportunity to work on our weak areas; physical and mental.
Getting muscles stronger around painful joint is proven to decrease pain and improves the function of the joint. This blog post is not a cure for pain. If you have pain or restrictions seek a competent professional in the medical and rehabilitation fields helping you clarify the limits at which you should train in. Whether you decide to do it on your own or work with a coach, you must proceed with bodily awareness and open mind.
If you are working with a coach an open communication loop between the lifter and the client is essential. The process can help the lifter create more awareness of their pain triggers allowing desensitizing the affected area. This in turn will help reduce inflammation promoting healing of the affected tissues.
The top goals for the strength coach are: to create a non-threating environment for the lifter, do not exacerbate the pain, strengthen muscles around the joint by retaining as much as the main lifts as possible.
The following is an example of squat progressions with a lifter who has knee pain.
Scenario 1 – Knee pain squatting at 100lbs but not at 85lb
Example 1 - Working up to 100lbs after two weeks
Week 1 – 3x5 @ 85lb
Week 2 – 3x5 @ 90lbs
Week 3 – 3x5 @ 95lbs
Week 4 – 3x5 @ 100lbs
Example 2 Starting at 5 reps and building to 15 total reps then adding weight
Week 1 – 1x5 @ 85lbs
Week 2 – 2x5 @ 85lbs
Week 3 – 3x5 @ 85lbs
Week 4 – 1x5 @ 90lbs or 3x5 @ 90lbs
Scenario 2 – Knee pain squatting at the bottom of the squat
Exercise variation - Pin squat
Example 1: Increase Range of motion
Training Block 1 - Pin height 5
Week1 – 3x5 @ 85
Week 2 – 3x5 @ 90
Week 3 – 3x5 @ 95
Training Block 2 Height 4 (1” lower)
Week1 – 3x5 @ 85
Week 2 – 3x5 @ 90
Week 3 – 3x5 @ 95
Training Block 3 Pin height 3 (this is depth)
Week1 – 3x5 @ 85
Week 2 – 3x5 @ 90
Week 3 – 3x5 @ 95
Training Block 4 no pins, full range squats.
Week1 – 3x5 @ 85
Week 2 – 3x5 @ 90
Week 3 – 3x5 @ 95
Example 2: Increasing Intensity and wave loading volume
Training Block 1 Pin height 5
Week1 – 3x5 @ 85
Week 2 – 4x5 @ 85
Week 3 – 5x5 @ 85
Training Block 2 Height 5
Week1 – 3x5 @ 90
Week 2 – 4x5 @ 90
Week 3 – 5x5 @ 90
Training Block 3 Pin height 5
Week1 – 3x5 @ 95
Week 2 – 4x5 @ 95
Week 3 – 5x5 @ 95
Training Block 4 Pin height 5
Week1 – 3x5 @ 100
Week 2 – 4x5 @ 100
Week 3 – 5x5 @ 100
In both cases we can retest the full range squat to see if the pain is still present.
Scenario 3 - Any sort of squatting with regular stance hurts and the client cringing just thinking about the lift.
Here’s a limited list with exercise substitutions for the squat. The goal is to find a pain free squat variation.
1. Wide stance Squat
2. Box squat
3. High bar squat
4. Front squat
5. Cambered bar squat
6. Safety bar squat
7. Hex bar deadlift
8. Belt Squat
9. Leg press
10. Deadlift
11. Good morning
12. RDL
Once you find a variation that can work. Keep it in the program and progress it. Slowly testing the waters on the regular squat after 4-8 weeks.
Variables to keep in mind:
Speed of the repetition - Slowing the lift down allows for micro adjustments inherently increasing joint stability. This is because it increases time under tension and allows you to be more aware of your balance and joint positions during the lift.
Volume – You may find that you can only tolerate squatting 1 x per week. If that’s that case that where you start. In my strength and coaching journey, I’ve had plenty of success performing a lift 1x per week.
Intensity - Be okay with doing a lot less weight than you typically do. Changing the mindset from “I need to lift X amount of weight because otherwise I’m getting weaker” to “the goal is to lift as pain free possible” makes the process of healing a lot more achievable.
Final thoughts
Be conservatively and frequently check in with your body before trying to follow a plan. Keep a journal to help you become more aware of your pain triggers during exercise. Keep note of pain during daily movements like walking, cooking, sleeping, picking things up and working and look to build strategies to reduce pain during them. Work with professionals who specialize in these fields. There may be things that may always cause pain like fathom pain (from a previous injury), arthritis, joint problems, fibromyalgia, nerve damage, this is just to name a few, so have the right expectations and keep positive mindset towards what progress looks like.
The more you can build your awareness the better able you’ll be to learn the boundaries that you can safely thrive in. throughout this process hopefully you will find variations and strategies that help. Use a conservative approach. Inflammation takes longer to subside and will exceed the length of time it takes muscles to adapt to an overloading stimulus.
If keep your expectations realistic and you’ll always succeeD