Unfortunately, most of us at some point or another have experienced some musculoskeletal pain. Whether it affects the muscles, tendons, ligaments, or joints, it can impact our daily functioning. Our natural reaction to musculoskeletal pain is often to avoid movement altogether for fear of aggravating the injury; however, movement is beneficial and safe at any age. Exercise not only accelerates healing but also greatly reduces the risk of re-injury, supporting rehabilitation and longevity after injury. Musculoskeletal injuries can arise in many ways: lack of movement, extended periods in certain positions (such as sitting at a desk all day), and high physical and/or mental stress can all lead to different musculoskeletal issues. This is not to say that when you are injured, you need to function at the same level as before the pain, but rather to adjust movement and volume to support what your body currently needs to maintain function and feel better. We know regular exercise, especially strength training, has many benefits, and injury prevention is one of them; however, how do we integrate strength training safely and effectively when we are dealing with pain from an injury?
Maintaining an exercise routine while injured helps for several reasons. Exercise while injured helps maintain strength in the muscles surrounding the injury, supporting stability and reducing the likelihood of re-injury. In addition, exercise promotes mobility to prevent excessive stiffness at the injury site. Exercise is also crucial because it promotes blood flow to the injury site, aiding the healing process. That said, recovery is also crucial when dealing with an injury; however, it should be controlled and appropriate to the injury at hand rather than avoiding movement completely. When we refer to recovery, we do not mean stopping movement altogether, but adjusting activity to match the body’s current state and what it can handle.
When returning to exercise after an injury, we can modify the program in different ways to suit the current state of injury and pain. We can modify the activity completely. For example, if pain is caused primarily by running, it may help to switch to cycling to allow rest and recovery while still maintaining cardiovascular fitness. For some injuries, modifying the exercise variation may help avoid excessive strain while still stimulating the surrounding muscles similarly. For example, if a barbell back squat consistently causes flare-ups, we may need to adapt to a modified squat variation such as a goblet squat or a leg press. Lastly, make sure the return to exercise is gradual to allow the body to adapt and become stronger over time, avoiding setbacks. Depending on the injury, we may need a mix of these adaptations to find a reasonable balance of intensity without pain flare-ups. When working out around an injury, it is common to feel some discomfort around the injury. This does not mean exercise is causing harm as long as we stay at 2-4/10 on the pain scale. When we start feeling more intense pain, such as 5+/10 on the pain scale, we know the approach may be too intense for the injury at hand.
Completely avoiding exercise following an injury tends to be detrimental to the healing process. This is not to say that complete rest is never necessary; in some cases, it is, and following the guidance of your physiotherapist and other healthcare professionals is key. However, if you have the green light to reintroduce exercise slowly, it is okay to feel a small amount of discomfort. If you feel intense pain during certain exercises or movements, the intensity is likely too high and may do more harm than good, prolonging healing. Isometric exercises are a great place to start when rehabbing an injury because you focus on holding a position, allowing the muscles to contract around the injury without much movement. As time passes and the injury heals, gradual progressions can further strengthen the muscles around the injury while also improving mobility.
At the end of the day, most people, regardless of age, deal with some musculoskeletal pain or injury, and as tempting as it may be to avoid movement completely because of pain, this often makes the problem worse and leads to a vicious cycle of sedentary activity. We know that, in addition to an injury, being sedentary weakens muscles, stiffens joints, and often worsens injury, leading to prolonged or chronic pain associated with the initial injury. We often hear the saying that motion is lotion, and it couldn’t be more true, especially during musculoskeletal rehabilitation. To avoid further injury, a well-tailored program and a gradual return to exercise can support and speed healing, allowing you to keep doing the activities you love as well as your activities of daily living.
