Trust me when I say, I’ve been there. I understand the frustration that comes with being injured and not being able to train to your full potential. Being a high level athlete and a physical therapist gives me a unique view, and has allowed me to come up with strategies to overcome injuries in a way that won’t only get you back in the game, but will get you there stronger than ever. So here are my five cents:
1. STOP DOING WHAT HURTS, NO PAIN= MORE GAINS: If you have pain when you squat/deadlift/snatch/press- don’t do that! Just as important as what you DO is what you DON’T DO. We hear this from healthcare professionals all the time, yet we almost always chose to ignore this simple advice. It doesn’t mean don’t do it forever, it just means avoid it for now.
2. TISSUE ADAPTATION TAKES TIME: Injury occurs when LOAD> TISSUE TOLERANCE. Between load and tolerance there’s a margin of safety. If you’re coming back from an injury, that margin of safety is smaller. You need to give your tissues time to adapt by progressively loading them so they are strong enough to withstand the load.
3. HABITUATION: Turn off the pain alarm. Whatever movement is causing you pain, expose yourself progressively to it. For example, if you have back pain when you bend forward, begin with OTHER movements that involve spine flexion like cat/cows, segmental flexion, sitting down in a chair with your head down. The second portion of this point is to begin loading under your CURRENT pain threshold, never above and increase volume and intensity slowly.
4. ISOMETRICS and high rep, low load: There is a big body of evidence that suggests that isometric contractions have an analgesic effect. Stuff like bird dogs, dead bugs, side planks, wall squats, etc. These exercises also increase muscular endurance, which improve stability. I’m talking about 8-10 reps 30-60second hold multiple times per day.
5. MOVEMENT CORRECTION: Sometimes it isn’t as clear cut as simply avoiding a movement. We can do that for a short period of time, but if that doesn’t take care of the issue we need to identify the biomechanical fault and target it with corrective exercises.
-By Dr. Stefanie Cohen, DPT
Body proportions can affect torso positioning in the squat, stance width and angling of the toes, this is why there is no “one size fits all squat”. Textbooks are great at teaching us proper technique, but what they don’t take into account is the role our anatomy can take in the way we move. Hopefully the images above and this explanation will help further clarify these points. Dr. Ryan DeBell of The Movement Fix (@themovementfix) wrote a great article discussing how hip anatomy changes squat mechanics and inspired me to make this follow up post.
Besides mobility, anatomy differences can explain why some people can easily squat deeper than others, why some point their toes out and some don’t, why some have a harder time keeping their chest up, why some squat wide and some squat narrow. Anatomical differences will dictate form and comfort of the athlete. Pic 1- the orientation of the acetabulum (hip socket) varies greatly
Pic 2- the angle between the shaft and the ball is greater in one femur than the other
Trying to force a movement pattern upon someone who’s anatomy isn’t conductive for it will lead to less than optimal movements . If the athlete is uncomfortable in their stance despite how much mobility work they do, take a step back and look at their anatomy. As long as their technique follows basic rules and they aren’t putting themselves in a compromised position, their form should be dictated by comfort rather than the textbook. Here we see the perfect example of two very different- yet very effective squatting techniques by @hulksmassh and @phdeadlift; depth is good, movements is coordinated and controlled, no major knee caving and spine remains neutral.
-By Dr. Stefanie Cohen, DPT
The lockout in the deadlift can become problematic to a lot of lifters. In this post I’ll explore some faults that may lead to issues in the lockout and recommend a few exercises that might help you with it. Struggling with lockout makes people think that what they need is to isolate this particular portion of the lift by practicing supra maximal rack pulls. While this is not a bad idea, it’s important to identify some other areas that may be contributing to this.
EARLY KNEE LOCKOUT puts the bar too far away from your center of gravity, in order to counter act the weight of a heavy deadlift you need to keep the bar as close to you as possible. Ideally you want to lock out the knees when the bar is at the mid thigh to ensure your leverage is optimal. STANCE WIDTH too narrow or too wide will result in suboptimal length tension relationship of the hip extensor muscles. Avoid RUSHING when the bar is at the hip because you’re desperate to lock out. If the bar made it all the way to the top of the thigh, squeeze your glutes, lean back and relax. Don’t rush.
Finally, weak hip extension or over-reliance on the back to complete the movement. As you know after the bar passes the knees its up to the glutes to complete the job. Above are my favorite exercises to build explosive hip extension strength that will undoubtedly lead to a strong lockout in the deadlift.
By: Dr. Stefanie Cohen, DPT