If you haven’t checked out part 1 of this article series then please do prior to reading this. You can find the link to part 1 HERE. It’s about to go down!
Now, with any pain situation one of the very first things to do from a rehabilitation perspective is to get out of pain. This is where a licensed healthcare practitioner will come in handy. I recommend seeing a therapist, physician or other qualified healthcare specialist prior to starting any rehabilitation protocol, including anything you read here. Everyone is an individual and a rehabilitation protocol should reflect that.
My general recommendations to help get out of pain (After seeing a qualified health care professional):
Keep in mind that pain is a defense mechanism designed to keep you safe from harm. It is also a very valuable teaching tool. Be sure to listen to your body and what it tells you. It will help guide you to success.
Some things that we can work on concurrently while getting out of pain that were discussed in the last article series are:
Part of getting out of pain and back to training are removing the root causes of your pain. As described in the prior article, overhead mobility restrictions can lead to lumbar overextension. We definitely want to get rid of this to prevent future problems and optimize performance. Here’s how I screen athletes and improve overhead mobility:
First we need to figure out if you have a hip extension limitation. Remember our hip extension assessment called the thomas test? If you forgot it, I’ve included it below:
If you’re missing hip extension we’ll have to work on it. Keep in mind not everyone with extension based low back pain has this issue going on. Here are a few of my favorite mobilizations below with a few exercises to strengthen and reinforce that new range of motion after mobilizing:
After we’ve improved both hip and overhead mobility we’ll want to learn how to move appropriately and build strength and endurance in these positions. What we’re shooting for is the ability to move from the hips and shoulders while keeping a neutral spine. We’ll want to start with easy, unloaded movements and progress to movements that are loaded and more specific to what we want to get back to (eg: overhead press, kipping and olympic lifts). Here are a few drills I like to get started with this process:
Learning to extend from the hip fully while maintaining a neutral spine:
Core stability – Moving from the hips while maintaining a neutral spine
Learning How to Press Overhead with a Neutral Spine
So we’ve gotten the pain to die down some with time, modification and exercise. We’ve ironed out our mobility restrictions, gotten stronger and we’re moving better and better. Generally this takes several weeks to months. Now it’s time to slowly introduce back in our offending exercises gradually and progressively and fix any technical problems we used to have.
Now we have to start introducing and loading the movements that bugged as previously slowly over time. If split jerks were previously the offending exercise, I wouldn’t start by introducing push jerks. Start with simpler movements and if you’re pain free when loading, progress to the next level, all of the while with correct form as you go. Here’s an example:
An example for returning to olympic lifts
Just keep in mind that rehabilitating from an injury is like riding a roller coaster. Some days feel good, some don’t. That’s just the name of the game. Try not to get frustrated. On days where you feel good, push a bit. On days where you don’t feel as good pull back some.
I like to think of pain as the boss of your body. If I come to work every day late, don’t finish my work and do a poor job then my boss is going to be on my ass big time. If I start showing up early, get my work done on time and make my patients happy then my boss leaves me alone. Do what you should and your boss lays off of you over time after you’ve built his/her trust. Pain is pretty similar. With pain, do what you should over time and slowly the pain will die down as well.
Remember the discussion on load from the last article. Too much weight can throw off your technique and potentially flair up your symptoms again. Make sure to keep your weights manageable moving forward. I often tell my athletes to use percentages based off on your 1 rep max with good technique. Sure you may be able to snatch 225lbs 1 out of 10 times and do it with god awful technique but 210 can be done cleanly, consistently and with good technique. Use that as your true max to determine lifting percentages moving forward
The other piece of the puzzle is a smart training program. Now this is a complex topic to delve into because everyone is an individual with different goals, injury history, tissue tolerance etc. 3 things that are universally important are:
Well that’s it! Sorry for the length of the whole series but I really wanted to be thorough. This is a glimpse into how I treat individuals in pain on a regular basis and how I help them get back to what they love, training. If you know someone who could benefit from this series then please share.
That’s enough lower back talk for today,
Keys to Fix and Prevent Shoulder Pain
How to Work Pain Science Into Treatment for Athletes
5 Common Causes of Extension Based Lower Back Pain (Part 1)
Shoulder Impingement: Part 5 – How Posture and Breathing Effects Shoulder Impingement
Shoulder Impingement: Part 4 – The Thoracic Spine and Ribcage’s Role in Impingement
Shoulder Impingement: Part 3 – The Shoulder Blade’s Role in Impingement
Shoulder Impingement: Part 1 – What It Is and Why It’s Important
The Largest Factor that Leads to Injury that No One Addresses