Recovering from long term injury

[Fryk]

I am seeking advice on how to get back in to gymnastics training. My goal is to do the WODs. I have not been able to train consistently and with out having to avoid certain types of exercises since December 2009.

My Case

Because of a major shoulder injury coupled with a injured sternum, I am currently at less than 100%.

The shoulder injury itself has by now healed somewhat. The underlying mechanisms that caused the injury is still present. A major part of my injuries has to do with a underlying muscular imbalances. At least that makes sense given other problems with my physique.

This week I had my first visit at a PT specializing in sports injuries. He seems to know what he is doing, and so I am confident that by working with him, it is indeed possible to get back in working condition.

I have been told a realistic time frame before I start seeing real progress is about 3-4 months, given the length of my problems and the underlying issues that does not seem unreasonable.

I have been given a green light to train, except exercises where I might "loose" control over the shoulders. I guess this means that I should stay away from most pushing work, where as pulling work probably is a better idea. Leg work is no problem. Where as some core work, might be problematic due to shoulder involvement.

The Questions:

- Which statics is a good idea in my case? For a FSP warm up.

- Which exercises should I be doing in particular and which to avoid?

- How to integrate my case with the WODs? Or should I disregard the WOD since I cannot to them all?

Anyway, what I am trying to achieve with this thread is to get advice that can ease the transition from injured / less than optimal state to a optimal state. Hit the ground running so to speak. I feel there is no reason to neglect areas which could have been worked during the physical therapy. 3-4 months + is a long time. Advice from anyone who has been injured long term and how they got back, would also be much appreciated.

I reckon it would help with morale to do some decent work outs, rather than just being in a chronic injured state. Like getting the feeling that I am already "back". I realize that I got injured because of I failed to show proper caution and patience. So I know that there are limitations, and that it is better and safer to take it slow. Still I want to get on the right track.

[Fryk]

I have given the original post some thought. I have come to realize that it probably wasn't entirely on to the subject, also the name of the thread is probably some what mis-leading: Yes, it is about recovery, but the questions are not specific to this. Anyway I thought I would try to be more clear.

1. I am not seeking answers about specific treatment of my injuries. I am seeing a PT, and he is in charge of that part.

2. I have been given the green light to train. I thought I might as well do the WODs as a general template.

3. This is where I need a bit of help. Doing the leg WODs is easy, no problem there. Everything else is bit of a blur however. I have come to realize that there is alot I cannot do. This is not important for me right now. It is however important to do what I can.

4. My PT has said that I can do what-ever as long as I keep the shoulders under control.

5. From what I can understand this would translate into not protracting / and kick out the shoulder blades. Looking at my form in old training footage specifically of the FL and PL, I notice: Shoulders moving forward in the FL. Shoulder blades kicking some-what out in the PL. I have received comments before

6. Apart from the two above mentioned exercises, I am a bit at a loss about the nature of the various gymnastic exercises is in regards to the shoulders.

7. I might take BtGB by my PT and ask him what he thinks is realistic and what is not. That being said I do not expect him to be in charge of the implementation of my training not beyond the scope of injury treatment anyhow.

What I was thinking is that the statics is the following, in form of a FSP warm up:

- Front lever: Might be possible. Starting over from the first progression, tuck with a emphasis on retraction of the shoulders.

- Back lever: Might be possible, in the form of German hangs.

- Planche: Probably a bad idea.

- L-sit: I am on the fence about this one. It is a good basic exercise, not sure what the shoulders role is in particular.

- Straddle L: Not sure, probably not realistic.

- Manna: I have seen Slizzardman doing some sort of reverse push-up hold.

FBE:

- handstands: No go currently, I reckon. Though I think it will be a milestone in getting back to 100%.

- Pushing: I fear this is where I would probably easily loose control and re-inforce the problem. Though I would like to hear which pushing exercises might be "easy" in terms of scapular control.

- Pulling: This is where I am hoping to put in some effort, also in order to strengthen the posterior chain over the anterior.

What came to mind after reviewing the situation is that it possibly could be a good idea to record an attempt at the various exercises, for some imput at to what I should / should not be doing.

[Cole Dano]

It sounds like you are beginning to answer your own questions which is excellent.

Since you know you have a shoulder issue, and have only been with your current PT a week, i'd say to give it more time, and refer your questions to him since he will have a much better idea of your exact injury and current capability.

If there is an underlying problem that he is working on getting that cleared is important, and then learning to integrate that into your basic GB work. This will most likely mean reducing the load so that the shoulders are able to perform correctly. Teach them how to work first and then add load.

One thing that can help with this on the rings is getting a couple of the loop style bands that you can hang with the rings to support some of your body weight. Lifeline has also recently come out with a pull up assistance system that looks useful.

Once you have more details as to whats going on check back in and maybe we can be of more assistance, but understandably a forum can never equal work with an actual person so let your PT be the final authority for now.

[Fryk]

I had another talk with my PT. I showed him the book, and asked about a few of the exercises. Most of it is out of the question at this point. Especially the stuff with huge stability requirements on the shoulders, I think this translates into open end kinetic chain movements. Ring work is therefore suspended for the time being.

I did get the green light for the FL. So I have started a SSC with the FL as the only "real" element. In the FBE department I think I will do Front lever pulling variations, as well as ordinary pull up variations.

About the recovery work:

I am doing stretches and exercises on two to three times a day, every day, specifically for recovery .

About "ordinary" work:

On the basis of the advice I have been given, it is not feasible to do anything remotely like the WODs. Everything but the leg WODs is basically out of the question. I have looked through the WOD archives lately, and tried some of the leg WODs. It has been some great workouts!

I was thinking that I could use the general GB template, and do two leg WODs a week followed by a pulling:

M: Leg WOD (dynamic / sprinting)

T: Pulling

W: Rest

Th: Leg WOD (strength)

F: Pulling

Sa: Rest

Su: Rest

The pulling day being:

3-5 x 3-5 FL row - variation.

3-5 x ?? Pull up variation. / Front Lever pull variation.

Even though I have been fairly dormant for a time, my strength is still beyond 5 reps of the more basic pull up variations. I am a little unsure whether wide grip is a brilliant idea still at this moment.

Any thought on this lay-out?

[Joshua Naterman]

You can get yourself into trouble with pull ups if you have shoulder stability issues. To me, it sounds like your best bet for recovery is specific scapular work every workout day, regardless of what else you work out. Retractions, elevations, protractions, depressions are your 4 basic scapular movements; depression + retraction => elevation + protraction, depression + protraction => elevation + retraction are the two diagonal movements you can do, which tend to be called the X pattern. The basic directions alone, and then when you feel up to it (or EOD) the "x pattern" I described. I wouldn't suggest working on elevated protraction to retraction or depressed protraction to retraction yet, but it may be ok. I wouldn't try to do all of those together. Do your basic 4 movements, ad then later in the day do the X stuff, and then the next day maybe the basics and later the elevated or depressed pro to retraction if you are able to do them correctly. I would be careful to make sure that your retraction work comes last and that you do more of that than protraction.

I'm doing this and it is working wonders. Like you, I am still correcting the foundational problems that led to my symptoms. It will still be at least until the end of the year, but I am expecting more like next May to actually have fully corrected the problems. When THAT is actually accomplished my progress should really start taking off!

I am just now starting to put in pull up work, and it is very low volume, because my right scapula still doesn't quite move how it is supposed to. I have trouble retracting all the way up for reps so I stick to chin variations for the most part, but the scapular work is making it better each week. You may want to start with assisted pull/chin ups and standing Bulgarian rows so that the resistance is low enough for you to move correctly, and I would approach it with a GTG mentality: super low intensity and fairly low volume each training session, but don't try and hit it like 5 times a day. 1-2 times will probably be enough at first. I think that adding a rep to each of the 1-2 daily training sessions is better for recovery purposes than adding extra sessions but that may not be true. I think you will find that concentrating on chin ups, both parallel grip and palms facing you, will do the most good for your recovery because it is much easier to control your shoulder blades and retract them as you go up in these two positions. Palms away pull ups are much more difficult, the tendency is to protract the shoulder blades and hollow the chest/shoulders. This is necessary for a muscle up but terrible for rehab. Later on you will need to put that in, but unless you are consistently able to perform proper scapular retraction pull ups for reps without concentrating too hard it's probably not a good time for that right now. You'll need the rings for Bulgarian rows, chins can be on whatever. Remember, perfect movement is what matters! Not resistance!

I would definitely do a bunch of higher rep cable and dumbbell stuff for triceps extensions and biceps/reverse curls to keep your joints well-conditioned and pre-habbed. That should cause no problems when done light enough, and for this purpose the sets should never be a physical challenge outside of some initial burning from the lactic acid build up.

As you say, for the most part this is a great time to concentrate on your legs and core, as well as the more basic joint prehab so that when you get back into things your joints are prepared and you won't have to spend all the extra time for conditioning them.

You may not agree with this, and that's ok too. Just sharing what I'm doing.

[Cole Dano]

Slizz what are your thoughts on using bands or a chest expander for this kind of work? It been one of my go to tools of late.

[Coach Sommer]

... I had another talk with my PT. I showed him the book, and asked about a few of the exercises. Most of it is out of the question at this point. Especially the stuff with huge stability requirements on the shoulders, I think this translates into open end kinetic chain movements. Ring work is therefore suspended for the time being ...

This problem is easily avoided by simply following the progressions as listed in BtGB. This is a point which is missed by many beginners. The exercises as presented in BtGB are not like a buffet where you simply get to choose which ever one suits your fancy for that particular day; rather you need to begin with the easier exercise families/exercise variations and gradually build up your strength over time.

For example, if pull-ups are too demanding for you, drop down to focusing on rows. If dips are too demanding drop down to ring pushups. If ring pushups are too demanding, drop down to floor pushups etc.

Yours in Fitness,

Coach Sommer

[Joshua Naterman]

Exactly. I mean, I'm not even doing all that much advanced stuff and I'm fairly well along with my recovery. If you are doing an honest job of selecting the appropriate exercises you should have no trouble. I am still not messing with Bulgarian dips, because my shoulder stability isn't quite good enough for that. For a long time I wasn't doing anything but static holds of very easy positions like the bottom of a dip and the bottom of an elevated push up, just to teach my body how to hold that position, because I was getting improper shoulder movement with even basic exercises. There will almost ALWAYS be SOMETHING you can do for each plane or vector of movement, but you may have to scale way, way , way back. In some areas you may not even be at the first progression in BtGB yet, simply due to the stability problems. As Coach said, you just scale back as far as you need to.

Mr Brady: I think that chest expanders and any other band-type devices are really good once you have established some basic scapular control. As long as you are able to get low enough resistance to move properly they are a great tool! I haven't used mine much lately because I have been using the free-motion machines at school for a good bit of my band-style warm up. It's not quite the same, but very similar in many ways. As I slowly catch up in school and fix up my GF's basement as an exercise room again I will be able to run a more complete program. But yes, I think they are great. Like Coach showed us, there are many different tools to use for shoulder pre-hab/rehab and they all have value. Cycling them from one day to another is a really good idea.

[Cole Dano]

Like Coach showed us, there are many different tools to use for shoulder pre-hab/rehab and they all have value. Cycling them from one day to another is a really good idea.

Yes that has been working fantastically, my shoulder is the best it has been in ages.

[Fryk]

... I had another talk with my PT. I showed him the book, and asked about a few of the exercises. Most of it is out of the question at this point. Especially the stuff with huge stability requirements on the shoulders, I think this translates into open end kinetic chain movements. Ring work is therefore suspended for the time being ...

This problem is easily avoided by simply following the progressions as listed in BtGB. This is a point which is missed by many beginners. The exercises as presented in BtGB are not like a buffet where you simply get to choose which ever one suits your fancy for that particular day; rather you need to begin with the easier exercise families/exercise variations and gradually build up your strength over time.

For example, if pull-ups are too demanding for you, drop down to focusing on rows. If dips are too demanding drop down to ring pushups. If ring pushups are too demanding, drop down to floor pushups etc.

Yours in Fitness,

Coach Sommer

Coach, I very much appreciate the answer and I do see your point. However given previous problems and injuries, I am/was hesitant to do stuff with out having "clearance" - which is why I was looking to the stuff in BtGB that seemed "problem free". But I do see that by scaling way back, I could be doing more. Granted I will take this issue to my PT ... yet again.

Saying that I do scale back to what-ever my level may be for each movement family. What does that mean in practical terms? If what you are proposing is to stick with the WODs, and scale them. How is it then even possible to scale handstand or ring strength wods? Should I look to other types of WOD on these days?

[Coach Sommer]

... How is it then even possible to scale handstand or ring strength wods? Should I look to other types of WOD on these days? ...

Good question. In your situation, I would recommend that Handstand WODs could be scaled with headstand focus work and that Ring strength WODs be scaled with appropriate FSP focus work.

Yours in Fitness,

Coach Sommer

[Longshanks]

This problem is easily avoided by simply following the progressions as listed in BtGB. This is a point which is missed by many beginners. The exercises as presented in BtGB are not like a buffet where you simply get to choose which ever one suits your fancy for that particular day; rather you need to begin with the easier exercise families/exercise variations and gradually build up your strength over time.

For example, if pull-ups are too demanding for you, drop down to focusing on rows. If dips are too demanding drop down to ring pushups. If ring pushups are too demanding, drop down to floor pushups etc.

Yours in Fitness,

Coach Sommer

This very good advice. I used to do quite moderate lifts before a string of injuries, including both shoulders, both elbows, both Achilles' and my left knee. For quite a while statics of very easy variations were all I could do (Wall chair squat holds, headstand, bottom of pushup-knees on floor). Its took me a year to build up to negative push-ups, Pull-ups and pistols, but then my joints were really knackered, and I'm quite a big bloke. I've found doing half your max for static holds and reps works well. You need to be conservative with training injuries. Heat treatment on a daily basis works great as well, a hot water bottle is worth its weight in gold. Even after a year of it I still realise I need to scale stuff back every now and then.

Best of luck

Longshanks

[Fryk]

So just to re-capture.

I should revisit the FSPs and FBEs and evaluate what progressions I can do, scaling it as much as needed.

- Doing the FSPs as part of the warm up

- Scale the WODs with appropriate substitutions.

- Take it slow

@Longshanks: When you say half of max hold and rep: Are you suggesting that working sets should be 50% of max rep?

@Slizz: About the pull ups, I think I will show caution and see if chin ups aren't a better progression for me.

[Joshua Naterman]

I think Longshanks is talking about specifically concerning recovery work, and while that is a good guideline even 50% may be far too many at first. Your sole focus should be on perfect movement. That's the only way to properly retrain your body once it is injured. Your strength and endurance will come back with time. If that means that you're only doing 2-3 reps each day that's ok!

That's how I am starting with pull ups, despite being able to easily pull my body plus 30-50% BW attached. I can, for sure, do at least 12 good pull ups, and that is reaaaaally lowballing, but I'm working on 3-4 pull ups per day, one set, in my warm up. When those feel perfect AND easy with little concentration, I'll add a rep and see how that feels, and so on.

[Longshanks]

So just to re-capture.

I should revisit the FSPs and FBEs and evaluate what progressions I can do, scaling it as much as needed.

- Doing the FSPs as part of the warm up

- Scale the WODs with appropriate substitutions.

- Take it slow

@Longshanks: When you say half of max hold and rep: Are you suggesting that working sets should be 50% of max rep?

@Slizz: About the pull ups, I think I will show caution and see if chin ups aren't a better progression for me.

As an example I can do about 9 negative pull-ups before I feel a bit of pressure in my elbows, so I do a few sets of 4 for as long as it feels comfortable (about 5-6 sets). This is just me however and what I've found from my experience, everyone's different. Plus I've been doing physio for nearly a year now and I've found firsthand that different things seem to work better at different stages of recovery. Statics are by far the best when you've just recently started physio. Just make sure you do full SSC's before to try to progress, and 50% of or max hold time (or less if that isn't comfortable or causes any flare ups). Just ones to start would be just be L-sit, headstand, push-ups and pull-ups. You can hold the push-ups and pull-ups at various angles Isometrically when you start out. I did this for quite a few months before moving onto negatives.