Training whilst injured, yes or now?
As an osteopath I am working with clients on a daily basis who are often presenting with pain or limitation in their function or capacity. Often many of these clients are either avid exercises in the gym or with another active hobby i.e. cycling, running or a team sport. Many of these people have worked hard to create a healthy active habit of exercising and fear stopping and want to know, can I keep exercising. For others, they stop and are fearful of doing any activity as they are not sure if they should train or not.
Now the reason I am writing this blog post is that I recently aggravated my right knee following a run 1 week ago. I have never really had any issues with the right knee, but I do carry a history of musculoskeletal issues (achilles tendinopathies, previous knee pain on the left, some lower back stiffness). There was no specific trauma at the time and on reflection it was a short simple run that I had done many times before i.e. 4km. I guess it could have been a combination of factors i.e. that day I had already trained in the gym and also did a 30 min easy to moderate indoor bike session, so fatigue could have played a role. The other factor that I suspect probably played a role is that i hadn’t ran in 4 weeks and the conditions that I ran in were not optimal i.e. wet ground and in some areas, heavily covered in water. The next day I woke and had a very sore knee. It wasnt overly swollen, but it didnt tolerate mid to end range flexion with loading or any side to side or rotational movement. Now at 42 years of age, I am likely to have some wear and tear in my knee, I am likely to have some meniscus wear as well as chondral wear. I dont have any clicking, locking or giving way, so my plan is to let it settle and then re introduce activities again.
So my plan was and still is the following:
First week
-I backed off any specific lower body leg work that involved stressing the knee i.e. I took away squats, split squats, single leg work, multiplane work from my program.
-I continued with upper body program as normal and trunk focus. I simplified and modified some of the exercises to minimise stressing the knee i.e. instead of performing a KLT full integrated movement with say a posterior pull + squat, I modified this to a seated row with no or minimal lower body loading.
-I continued with indoor cycling as this was not irritating it, however i dropped the resistance 1-2 levels and kept the cadence at around 80-90 RPM
-I took some anti inflams for a couple of days
-With regards to work and ADLs, I backed off and made deliberate choices where possible to minimise loading too much i.e. stairs etc.
Second week
-I have just clicked into day 8 since the aggravation of my knee and I did a lower body session today. Todays program involved modifying what I normally do with a focus on more hip dominant patters, bilateral patterns instead of single leg and also reduced load or range within the exercise. I listened to my body with regards to how it was feeling so that I could continue training. For those interested in the program, watch the videos below that I posted on my instragram.
View this post on Instagram
The plan now is to see how it reacts and continue to adapt the program and re introduce movements as tolerated. Now for many of you out there who have had similar experiences with regards to injuries in the past, I would highly recommend you consult a practitioner to review your injury and also seek advice on how to continue being active as much as possible. In the vast majority of cases with simple musculoskeletal complaints, we can continue to be active through modification of training. In some circumstances i.e. broken bones, post surgery, in the acute stages of recovery following major trauma or injury with swelling, we will need to rest for a period of time to let things settle. If however you have had a strain or sprain, please book into see a practitioner for specific advice.
This blog post was written by osteopath Heath Williams of Principle Four Osteopathy, your Collins St osteopath in the heart of the Melbourne city cbd.