Rehab Is Just the Training You Skipped
Before we begin
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In light of a recent post I made on how people neglect rehabilitation, my friend Chris Masterjohn made an insightful commentary and observation
“Rehab” for life. -By Chris Masterjohn, PhD (go follow him and subscribe)
And fix your training program.
If the injury was substantial enough to permanently remodel tissue (stretching ligaments or tearing something that needs to be reattached) the need to rehab is quasi-permanent.
But “rehabbing” is often just doing exercises you should do anyway with greater and more intentional focus.
For example my left shoulder dislocated four times and had one operation when I was in my teens and early 20s.
If it ever hurts it’s because I wasn’t doing enough to strengthen it’s ability to bear load in various positions and directions while being kept flush to my body.
Every few years I’ve developed pain in my shoulder that occurs during irregular protraction and it disappears after a few days or a week or two of banded protraction exercises.
Recently I was doing some exercises that were very heavy on external rotation and lateral pulling without proportional counterbalancing of internal rotation and lateral squeezing, and it destabilized my shoulder allowing me to feel pain in a wide variety of positions.
I experimented with exercises and the simplest way to correct it was to do cable or banded internal rotation.
None of these problems ever happen to my right shoulder.
They only happen to my left shoulder, which is not held in place effectively by my stretched ligaments, requiring more work of my muscles to coordinate it, especially in keeping it close to my body.
This also manifests as a defective frontal lat display, even when I have zero pain.
Pictures had made me think my left lat is smaller than my right. But I disproved this taking a picture of my lat spread from the back with a measuring tape. In fact it is just that my protraction on my left side is not strong enough to compensate for my stretched ligaments which manifests as a weaker frontal lat display.
The work I need to do to rehab, though, is a result of an imbalanced program.
Protraction should be abundant. An easy way to get it in is to do gymnastic pushups instead of regular pushups.
If you do the full range of things you should be able to do with your shoulder, you will get plenty of work of the internal rotators that keep it flush to the body. That means having them not just push weight in front of you or on top of you but also be moving loads where the resistance is outside your body and moving into or across it.
If you introduce an exercise that moves your body in one way you should counterbalance it with an exercise that moves it the opposite way, unless you are introducing a temporary and strategic asymmetry.
So, on the one hand, your need to rehab could be forever.
On the other hand, rehabbing it is just compensating for the deficiencies of your program.
In fact, you probably got injured because of the deficiencies of your training in the first place.
For example, I had biases in my falling that made me spiral forward from left to right, plunging my left shoulder into the ground.
I should have trained how to fall, and I should have found and corrected that asymmetry.
I do both now, but I can still subtly feel that same asymmetry:
When I was 14 it made me spiral forward across my body to the right, plunging my left shoulder into the ground.
Now what I feel is that when I do forward and backward rolls, the backward roll over my left shoulder, which takes my right side backwards across my body, feels hard to coordinate compared to the other three rolls.
The asymmetry formerly forced me forward to the right. Now it subtly restrains me from gracefully rolling backward to the left.
I was injured in the first place because I didn’t find and train out my asymmetries.
The injuries have created a lifelong vulnerability of shoulder pain in response to far less glaring deficiencies in my training program.
But if I train right, I have no pain. And I don’t need to rehab because proper training is always rehabbing everything.
Damn, well Said
Chris, knowingly or unknowingly, lays out a number of physiological lessons and training principles that are rarely talked about.
1. Injury can creates permanent structural change
When we talk about making a 100% recovery from injury, that “100%” is usually defined in the context of performance and being pain free. The tissue and joints though are NEVER going to be exactly the same as they were post injury. They’ve had to rebuild themselves. Hopefully this rebuild got you back to moving how you want, but that healing process is now part of physiological record and changes can still be present. In many cases if the ligaments are stretched, scar tissue is present, and/or tissue is remodeled, the joint loses some of its passive stability. This means the muscles must permanently work harder to keep the joint stable and flush. This means you MUST always keep those muscles stronger and train them directly. This could apply to the your knee, your hips, your spine, your glutes, your shoulders, etc. You cannot neglect this life long strength practice.
2. “Rehab” is usually just proper training done with more intention
Bodybuilding often gets called dumb. Yet its one of the most intelligent ways to train; build muscle and strength through training your body through its natural ranges of motion. Most of what gets labeled as rehab is simply exercises you should already be doing; training your shoulder girdle, training your glutes, having a strong back, having strong quads, etc. The difference is you train with greater focus, volume, or specificity because the joint is now less forgiving.
3. Training must be permanently “imbalanced”
The idea of training “balanced” sounds nice, but it has no real defintion. And in the case of rehab and staying painfree, you will likely ALWAYS need to do that extra strengthening work. Your training is going to “imbalanced” on purpose to make sure that old injury never regresses into a weakness. That might mean lifelong focus on overhead stability and the rotator cuff, or the glutes, or ankles and achilles and calves, etc.
4. Post Injury, training lines of movement and opposing movements become essential
One of the peculiarities of injury is that you if dont train a line of movement, you not only lose strength in that line of movement, but theres a negative effect on overall joint function. You need to get a muscle strong on both sides of the joint, in both directions. If you introduce an exercise that moves the body or joint in one direction, you should generally include work in the opposite direction.
Do you leg curls and leg extensions? Do you do an equal amount of pulling as you do pressing? When was the last time you did single leg exercises? Or did a wide stance squat? Do you performing pulling movements with a wide and narrow grip? Can your shoulders both internally and externally rotate?
These are rhetorical questions; the major point is that you need a holistic bodybuilding approach moving forward.
5. Asymmetries that caused the original injury still exist
If you injured yourself with bad technique, you must address that. The same subtle movement biases (how you fall, how you roll, how you load one side) often remain years later and continue to stress the vulnerable joint. These need to be identified and trained out.
6. Good training is Continuous Rehab
Bodybuilding is the process of building your body, and well designed program achieves across multiple context. There process of muscle and strength and prehab and rehab all cross over with one another. The customization of this process and yoiur workouts will be unique to yourself. What you need is dynamic to yourself at any given time.
Fin.