If you didn’t read Part 1 of this 2-Part series, click here to do so prior to reading this post.
Now that you know continuing to lift in the presence of joint discomfort is a no-go, we can move along to actionable steps you can take to continue training hard while dealing with an inflamed joint. First, let me state that when it comes to healing joint pain or any actual “fixing” of injuries, I’m not your guy. I like to stay in my lane and defer to an orthopedist or physical therapist when my clients/readers approach me about injuries. If you have something that isn’t getting better, go see one of these professionals.
What I’ve had success with over the years is guiding trainees in choosing exercises that allow them to lift around nagging joint issues so they can allow those issues to properly heal.
My first word of advice is no matter what, you can still train. An issue in one of your joints should not put you on the injured list, it’s no excuse. There are 360 joints in the human body. If one joint is inflamed, that leaves you 359 healthy joints to play with. Get to work and stop using it as a cop out.
If she can lift without an arm, I think you can manage showing up with a shoulder ache.
“Use Pain as Your Guide”
I can’t recall when I initially heard this phrase and sure; it’s generic, but it makes total sense here. If something hurts, that’s your signal to make a change. There are a variety of tweaks or changes you can make to your program to account for a pissed off joint, it only requires a bit of trial and error. It’s simple: if it hurts, implement a change so that it doesn’t hurt and proceed getting stronger using the pain free option. Read on to learn options.
Exercise Selection
Let us assume the next exercise on your program is an overhead press. When you grab the dumbbells and press overhead however, you feel a nagging “something” in your shoulder. It only gets worse as you continue through the set. You have already read Part 1 of this blog post, so you know better than to continue this exercise.
What to do now?
The overhead press primarily trains the anterior and medial deltoids and to a lesser extent, the triceps. The best-case scenario is that you can get away with finding another exercise that hits the same muscles.
Moving to a machine version of the same exercise with a fixed range of motion is a great place to start. Give that a shot and see how it feels. If it doesn’t ding the shoulder, problem solved. Make progress on this exercise and check back on the overhead press after a few weeks to see if whatever you had going on has healed.
If the new machine-based exercise still bugs the issue in your shoulder, it’s time for a more drastic change. The employment of isolation exercises for the targeted muscles is now your best bet. Your shoulder doesn’t like something about pressing overhead so it’s time to keep things below the neck to avoid the discomfort.
This movement is a great way to train achey shoulders. You can use a light load and still induce tons of fatigue for the anterior and medial deltoids.
There are infinite variations of lateral raises that train the medial delts and an equal number of front raise variations that train the anterior delts. Google them and tinker with different variations until you find one that works for you using “pain as your guide”.
The same concept can be applied to most exercises that are causing pain. Barbell back squats hurting your knee? Try a different squat variation or exercise that trains the same targeted muscles (goblet squat, Bulgarian split squat, leg press) or change your squat stance (narrow, wide, toes out) to see if that takes pressure off the knee. If these are still causing knee pain, start focusing on isolation movements like hamstring curls, leg extensions, and glute isolation exercises to train the targeted muscles until the knee issue either heals or is addressed by a professional.
Decreasing the Resistance
Another way to tweak an exercise would be to decrease the load. Simply dropping the weight on an exercise will decrease the pressure on the joint and may allow you to execute the movement pain free. If it doesn’t, you need to change the movement. If this works, now your goal is to figure out how to provide a growth producing stimulus to the targeted muscle with the lower resistance.
There are a few different routes you can go here:
1) Increasing number of reps
2) Changing tempo to increase time under tension (TUT): Perform the lift slower, specifically on the eccentric or lowering portion of the movement. For example, on a bench press, you would take the bar off the rack and lower the bar to your chest slowly, pause with the weight an inch off your chest at the bottom for a split second and then lift the weight with a controlled tempo back to the starting position.
3) Using isometric holds to increase TUT: Holding a specific portion of the range of motion for a given amount of time. This is a popular way to perform exercises in a physical therapy setting as it eliminates joint motion during the exercise. This could be getting to the bottom of a squat or the top of a lateral raise and holding it for as long as you can tolerate. You want to hold the exercise where the targeted muscles are under tension and experiencing fatigue without joint discomfort.
4) Blood flow restriction: This is a more advanced technique that mimics the benefits of heavy training with low loads. I’m currently writing an article on this topic that will be published in the coming weeks. Stay tuned.
A joint friendly bench press. I combined 3 joint sparing techniques in one video.
1) Using the Smith machine: Due to the fixed ROM, some of the smaller, stabilizing muscles around the shoulder are removed from the lift.
2) Limited ROM: The yellow stoppers next to my elbow limit how deep I can go.
3) Low load: Using a 5 second descent and a 1 second pause directly above my chest, I am increasing TUT and making the exercise more intense even with the lower resistance.
Consult Your Trainer
There are bajillion other ways to trouble shoot when you are lifting with joint pain but some of them aren’t appropriate to discuss via blog post. Some require more personal attention specific to the individual and could potentially cause more problems if done incorrectly. Hire a quality coach/trainer you trust to help you.
To work with me in person you can contact me here.
To train with me remotely, go here.
With more detailed information from the trainee, a quality trainer can
· Manipulate ROM to eliminate a specific portion of an exercise that causes pain.
· Vary angles of a lift to find pain free options.
· Vary grips or stances that promote pain free movement.
· Strengthen specific muscles to take pressure off inflamed joints (especially with regards to back pain).
Using a wide stance and tossing a versa loop around the knees is a great way to make a leg press more hip dominant. This is particularly helpful if trying to avoid pressure at the knee joint.
Random Unorganized Thoughts That Came to Me After I Wrote the Article
Compression: Compression sleeves have gotten many a lifter through some tough times and can be a viable option when lifting with an inflamed joint. The increased blood flow and warmth provided by the sleeve can make an intolerable exercise tolerable. Check out these studies on sleeves. (Bryk FF. 2011) (Mazuka SA. 2004)
Low Back Pain: When dealing with chronic low back pain, strengthening the glutes and abs with isolation movements is typically going to take pressure off the back. In the meantime, choose exercises that have back/chest supports to train the targeted muscles so that your back doesn’t become the limiting factor of the exercise.
Joint Flossing: This practice was made popular in CrossFit circles by Dr. Kelly Starrett (click for demo). There is plenty of anecdotal evidence (including me and a few of my clients) but research is lacking. It hurts like a bitch but feels AMAZING when you take the bands off. This has been one of the only ways that I have been able to accelerate the healing of an inflamed joint. Use with caution and under supervision of someone who has experience and knows what they are doing.
I hope these posts have been helpful, now go to the weight room and lift something. Remember:
When performing a strength exercise, if the limiting factor is anything other than fatigue in the targeted muscle(s), stop said exercise.
If after reading both posts in this series you learn only this, I feel like I’ve done my job!!!