Every halfway decent coach has, at least, a basic understanding of how to train their clients to prevent pain and injury. But what if your client is already in pain? What if your client wants to get in the gym and work hard, but they have some nagging aches keeping them from getting after it?
Most coaches would say refer out, and I agree, But that’s not enough. Barring severe injuries, there’s no reason why we as coaches shouldn’t understand how to train clients around common aches and pains.
Not every “boo boo” needs a physical therapist. And just because one movement hurts doesn’t mean you can’t do something else pain free.
Training around injuries is something every coach needs to understand. It’s not a recommendation; it’s a requirement. In today’s article I’m going to discuss 4 of the most common aches and pains I see in my clients, and how I evaluate, assess, and program accordingly for each.
Finding a Solution
I recently had the opportunity to work with a baseball player, Neal, who had chronic pain in his throwing shoulder. He went to a doctor and was told he had no serious damage; he just needed to take a break from throwing and rest his arm.
His mom contacted me because she was worried he wasn’t getting any better and she wanted to figure out a solution ASAP.
So I started working with Neal and, at first, he was tentative because he was so concerned about his arm. We started with the basics and took things slowly to get him feeling more comfortable in the gym and using his arm again. As we began making progress, his arm felt better and he was getting stronger.
Once he started making progress, noticing his shoulder was feeling better he got so excited. His confidence immediately shot up and, as I’m sure you know with your clients, more confidence leads to more motivation to train.
To Train or Not To Train?
When an athlete is injured I’ve usually found they either go way too hard in the gym trying to push through the pain or, on the other side of the spectrum, they’re so scared of getting re-injured they stay out of the forgo working out altogether.
I’ll discuss each of these below. First, let’s talk about the athletes who are too scared to get in the gym at all.
In my experience, getting athletes initially to trust that they can train around pain has been tough because they’re afraid of causing more harm. They have been told that they need to rest and often times that leads to bad advice like “don’t work out” and “stay away from the gym.”
Obviously, that couldn’t be further from the truth. There’s no reason why with smart training and a well-designed program a client can’t train around an injury pain-free. In fact, I’d even argue it’s irresponsible NOT to try and train around the injury – doing something is always better than nothing.
I had this situation happen recently with one of my football players, Ryan. Ryan is a great running back and all around athlete but was frustrated because he was having groin pain. When he came to train, he would tell me that he couldn’t train legs because he was afraid to make his groin worse.
As we talked, I wanted him to understand that training the muscles surrounding his pain would actually help, because getting stronger and more stable he would start to feel better. I made sure that he knew we would not do anything that caused pain what so ever.
Most of his pain was coming form his anterior pelvic tilt and sitting in a classroom for six hours a day wasn’t helping.
The Healing Process
When I was putting his program together, I knew from the beginning that squats were out because they were causing him pain.
His program needed to be posterior chain dominant because this would help get his hips to a more neutral position and help reverse what sitting was doing to him all day at school.
His programming consisted of deadlifts, hip thrusters and other hip extension exercises but the biggest difference came from bands. X-band walks, hip thrusters and glute bridges with a band around his knees, making him use his hip external rotators made a huge difference.
He had great success with these exercises because they helped him reverse the process of sitting all day but he was also starting to learn to use his glutes. As he started to learn to use his glutes, he was now having his bigger muscles be the catalyst for his movements.
The other exercise that made a difference was lateral lunges. Doing these helped open up his adductors because he was very tight.
Before we did any of theses exercises, Ryan tested them without any weight to make sure that they didn’t cause pain.
Building Confidence
As Ryan started to feel better, he started to get excited about coming in. He was very motivated to get back to feeling himself. He would come in wanting to deadlift and hip thrust because he knew that it was making a difference.
Then there was one day I will never forget, he came in all excited and just said, “ Matt, I can squat.” As he says this he demonstrates an air squat and says, “see, no pain.”
Unfortunately, I had to ruin his excitement because I wasn’t going to let him squat just yet. For the time being, we were sticking to unilateral, quad dominant exercises.
Once he realized that he could get stronger and start to feel better, he wanted to push himself harder because his confidence had grown. He wanted to start doing exercises that before were causing him pain.
Creating Positivity
When the client is coming back from an injury, they’re looking for anything that results in a positive outcome. Once they find an exercise that results in a positive outcome, they want to continue to do more. Since they are starting to feel good, they want to continue to build on that feeling.
During this time it is important to keep pushing the client, showing them that they can continue to train and rebuild the muscles surrounding the pain. The more they see they can do, the more their confidence continues to grow.
Getting Athletes Out Of Their Own Way
Then, on the other side of the spectrum you have the athlete who wants to be the gym hero. They want to push through the pain and show that they can work through it.
Minor aches are one thing but when dealing with real pain, that’s not the time to over push.
When working with athletes that have pain, I have found that they want to prove their toughness. They want to show that they can push through the pain at any cost but sometimes they push too far.
As coaches, our job is to coach but sometimes the most important thing we can do is mentor and advise. Getting them to understand that pushing through something might not be best thing and could even leave them on the side lines for an extended period of time.
For me, I do the programming and the coaching so I am able to make sure the athlete does what’s appropriate. That does mean I don’t have kids who try to push it or ask me to up the weights.
I always tell them that I appreciate their determination and effort but it’s better to be smart.
When, I have watched athletes try to push through the pain, I usually see compensation to the non-injured side.
The athletes will try to push through it by favoring the side that hurts. I always try to get them to understand that they’re going to do more harm then good and there is no need to push through it.
If I were using Ryan, as an example, it would be having him do squats even though they caused him pain. If he were to do squats, he would just favor the side that hurt.
The first time he came in saying he was hurt, he went to demonstrate that air squats hurt. When he did the exercise he shifted his weight to his good side to compensate for his pain.
When doing the programming for athletes that want to push it, I am very careful. I am not going to give them anything that will cause them to compensate or cause pain.
What To Look For
When putting their programs together, I go through a mini checklist to pick each exercise
These are a few things that I look at when I am looking for modifications:
- Will it cause the athlete pain?
- Will it have a strength transfer?
- Will it keep the athlete motivated?
- Is the athlete compensating in anyway?
- Is the movement pattern correct?
Lets go over these.
First, we have to find exercises that are not going to cause our athletes pain.
Once I have chosen the exercises that I am going to use with my athletes, I always start with bodyweight, unloaded movements. Then, from there I will shorten the range of motion of the specific exercise as we start to add weight.
As we are doing these exercises, I am always asking for feedback. I want my athletes to tell what and how they’re feeling throughout the movement.
Second, finding modifications that will still result in gaining strength. We want to continue to get our athletes strong while they are healing from their injury.
Strength doesn’t only mean pounds on the bar; it is also gaining stability in the surrounding area.
As I said in number one, it’s great to shorten the range of motion. For example, rack pulls are a great alternative to deadlifts.
The injury will determine the exercises selection. If the athlete is having back pain then you will want to be more knee dominant or if they’re having knee pain you will want to be more hip dominate.
Third, it’s important to find exercises that are going to keep the athlete interested.
Doing nothing but corrective exercises will leave the athlete uninterested and unmotivated.
Giving the athlete ten minutes at the end of the training session to do bicep curls or extra abs has worked great.
Fourth, I have to make sure the athlete isn’t compensating or favoring a certain side to do the exercise.
A lot of the time the athlete won’t feel himself or herself compensate, so it’s important for us to watch closely.
When Ryan went to squat he favored his groin. The feeling of driving his knees out hurt, so when he squatted he would shift his weight to his good leg and then he would drive up.
Fifth, I make sure the athlete is keeping the movement pattern correct.
We have to make sure the athlete is doing the movement pattern correctly and is staying in the same position. We don’t want the movement pattern altered because they can’t do it or it hurts.
Common Injuries
In the following section I am going to go over the most common injuries I encounter. I am going to talk about the problems I see, why these problems happen, how I fix these problems, why I like a particular exercise and how you can implement them.
- Low Back Pain
One of the common reasons I see athletes with back pain is because they don’t use their glutes. They compensate by using their lower back and hyperextending.
My favorite exercise(s) to fix a lower back problem is to start by using glute/hip thrust variations. Starting with basic weightless movements and then progressing to more difficult movements. Making sure that the athlete and/or client understands the movements and can execute them properly before we add any weight.
I really like to start with glute/hip thrust variations because it isolates the glutes. Your athlete really has to focus on feeling the glute muscle and that’s all they have to worry about.
These exercises also give you feedback, because when done properly you will only feel it in the glutes. As the athlete continues they will definitely start to burn when done correctly.
As the athlete starts to become efficient, they can then start adding resistance. It’s important not to add resistance to early because you don’t want to ingrain improper movement especially with weight.
- Shoulder Pain.
I see people with shoulder pain from non-mobile thoracic spine issues. This comes from sitting and developing rounded shoulders.
I fix the problem with bench thoracic spine mobilizations.
This drill is one of my favorites for opening up the thoracic spine. Getting the thoracic spine to open up while hinging the hips and maintaining proper neutral posture is very important.
I like to use this in my warm-ups or as a filler in-between exercise. This is a great way to get extra mobilization work while resting in-between sets.
- Ankle Injuries.
The problem usually comes from the ankles being unstable and weakened due to past injuries. They may have hurt their ankles in the past and never spent anytime training to rebuild their strength and stability.
I fix the problem with single leg balance drills on an airex pad. Once the athlete has shown to be able to balance on one leg, then we can start adding in medicine ball throws.
I like this exercise because it really challenges the athlete to remain balanced with the soft pad. To do so it teaches the athlete how to use a tripod foot, which puts them in the most stable position.
You can use this exercise in the beginning of the training session when the athlete is the freshest. I want the athlete to be fresh so that he/she can get the most out of the exercise.
- Hip Pain.
The most common reason people get hip pain is from sitting. Sitting in a classroom or office all day, locking up their hips causes a lot of pain.
When clients/athletes have pain like this, squats are out of the question. I like to use single leg exercises. Movements like split-squats, lunges, and step-ups are a great option to help to take the pain away.
I like single-leg work because you are able to build great strength and stability in each leg without putting pain on the hip. Another great perk is the added mobility element that comes with it.
Use these exercises as the first or second exercise in a session. Doing this when the client/athlete is fresh is going to let the athlete push the weight.
When the clients/athletes are training with an injury, the first thing I like to do is make them comfortable. I am not going to be putting them in a lot of extremely stressful positions.
Once they start to get more comfortable I will start to push it more. The more uncomfortable they are, the more likely their form will start to break down.
Although, we want our athletes to get stronger, we don’t want them to be compromising their form.
Getting our athletes to trust that they can execute an exercise without pain helps to put them in positions that feel good and build their confidence.
Putting It Together
Build the trust in your athletes, show them the keys to success, and let them reap the benefits.
All our athletes want is to be back to 100%, or as close as possible, and we are just a piece of the puzzle in getting them closer to where they want to be.
No longer should they believe they need to sit on the sidelines until the pain is gone.
It’s our job to show them that they can train and that it will help them improve.
With the right guidance and plan, build the confidence in your athlete and watch them succeed, and blast through the pain.
Because, at the end of the day all that matters is their success.
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