Injuries suck; I see the impact or nursing the pain and limitations of an injury, every day in my clinical practice. What’s even more devastating are the weeks and months lost due to poor management of those injuries in the early stages and the failure to sensibly scale back the weights and volume when it counts most. I see role as a clinician as not just rehabbing athletes back to full functional fitness; but also modifying their training to allow sensitive and fragile tissues to heal and adapt to increasing load while maintaining fitness and condition. I guess in many ways, I also become a coach, because without modifications to training programmes, the pain and injury will continue to plague you as an athlete.
I understand the pain and discomfort associated with an injury, I’ve been there. The overwhelming feeling of defeat is tangible when a client enters my clinic door. Having to change your current training is understandably one of the hardest things you’ll do, because most people develop an emotional attachment t0 either training style or capacity of training. But, if you’re compliant and resourceful and ready to pledge your allegiance to nailing this injury as quickly as possible, your comeback story will be sweet.
Training like a savage makes you feel more accomplished, I get it, but scaling back at the gym to avoid overloading your fragile tissues will get you closer to your goals even sooner than you think.
Our bodies are incredibly efficient at healing from an injury. Depending on the severity and location of your injury, tissues take about 6-12 weeks to fully recover their tensile strength. Let’s take a closer look at the various phases of injury and what training techniques you can use throughout this recovery process.
Understanding the 3 Phases of Tissue Injury Repair
Following any injury, whether it’s a strained hamstring while under the bar or a pec tear, your body needs time to heal. During this recovery process, you’ll enter into 3 phases that are integral to getting you back to working conditions.
Phase 1: Inflammation
The initial phase of tissue healing occurs 12-24 hours after injury. This is known as the inflammatory phase. Whether you’re experiencing a tissue sprain, strain, or contusion, your body quickly responds to the trauma by initiating the following processes:
Vascular response: your blood vessels will begin to expand and become leaky, allowing the passage of immune cells into the site of injury while simultaneously removing any waste products.
Inflammatory cascade: immune cells arrive at the area of injury to initiate inflammation. You’ll notice this occurs when your skin becomes red and hot, begins to swell, and creates pain around the area.
Fibrinogen converts to Fibrin: Regardless of the injury mechanism, you’re likely to experience small tears in the blood vessels surrounding the injured area. The body responds to this by converting fibrinogen to fibrin, a long-thread-like protein. Over time, this tangled web of fibrin hardens, forming a blood clot.
How to Train During the Inflammatory Phase
Simply put, you should NEVER be mechanically loading in any way during this phase of injury repair. In other words, you should be avoiding any deep tissue work, lifting weights directly onto the tissue involved, or stretching. Based on fibrin’s lack of tensile strength, you’re very likely to tear the web-like networks carefully being laid down, causing you to return to the very beginning of this phase.
The inflammatory phase lasts about 3-5 days, depending on both the extent or severity of the physical damage and the amount of blood flow available in this area. Greater blood flow means more inflammatory cells can arrive in the area and create this response. You can, however, train other body parts. In fact I actively encourage you to do this. Modifying your training rather than resting is my advice. If you have a minor pec injury, train legs. It’ll keep some of your condition, but more importantly, it’ll keep your head from falling off.
Phase 2: Proliferation
Following the initial inflammatory phase of your journey to tissue repair, you’ll arrive at the proliferation phase. There are two significant milestones during this phase:
New blood supply: during proliferation, there is the ongoing growth of new capillaries and blood cells to replace the previously damaged vessels. This process, also known as angiogenesis, encourages better circulation to the site of injury.
Type III collagen replaces fibrin: following the successful formation of the fibrin blood clot, type III collagen fibres arrive at the scene as a stronger replacement.
How to Train During the Proliferative Phase
Injury is widespread during the proliferation phase of healing. This is the phase where pain begins to subside, and you’ll start to feel like you can head back in the gym. While type III collagen is more robust than fibrin, it is still much weaker than type I collagen, which is our end goal. Over exceeding your tissue tolerance through mechanical load can cause you to tear this tissue very easily.
A good rule of thumb during the proliferative phase is if you can’t tolerate bodyweight exercises throughout the day to day activities, such as moving around the house, getting in and out of bed, carrying groceries, etc., you need to back away from loading your muscles entirely! It’s important to avoid any plyometric movements such as quick changes in direction, ballistic movements, etc. Our Mofo Anatomical Adaptations Programme is ideally suited for this phase of repair. This is a bodyweight programme aimed at maintaining functional fitness and condition while you’re unable to load the tissues directly. During this phase, you’ll also begin to reload the tissues using a carefully planned reloading programme; note the word ‘careful’.
Phase 3: Remodelling
Last but not least is the remodelling phase of injury repair. This phase will have considerable overlap with the proliferation phase as the connective tissue is still developing in the area.
The purpose of the remodelling phase is to allow collagen to mature from type III to type I fibres, which is a stronger version than the last. Typically, this phase lasts 4-6 weeks but can be up to a year, depending on your training routine.
This phase will see you regaining some strength, your pain will be minimal, and you may be lured into a false sense that your injury has healed. You ain’t wolverine guys and girls. Now is not the time for heroics. This is probably the phase most of my clients reinsure themselves if they go off plan, be warned!
How to Train During the Remodelling Phase
Injuries can still occur during this phase as people tend to over-cook things in the gym either by lifting too much or too often. This is probably the most challenging phase to control as a coach or therapist, you’ll feel ready to smash the weights again, but your tissues are still remodelling. Rush this phase, and bang, you’re back to square one and reinjured.
The best way to reduce your risk of injury is to focus on progressive overload. Starting with your activities of daily living, these basic bodyweight movements should be both easy to accomplish and pain-free before scaling up in weight. This is where the concept of progressive overload works a dream.
The Art (& Science) of Rehabilitation
If you want to train and perform like a pro, you first need to recover like a pro. Here are the top tips to get you on the road to recovery as soon as possible.
Don’t Completely Rest.
Yep, you heard me right, don’t rest. Rest is not the best medicine when recovering from an injury, at any stage of the healing process aside, perhaps the first couple 24-48 hours after being injured or if you’ve had a catastrophic injury requiring surgery. Research has shown that early movement following sprain, ranging from a mild ankle sprain to a complete ACL tear and reconstruction, actually has more beneficial long term outcomes (1). Hamstring strains have shown to have quicker functional movement gains with early rehabilitation (2).
Modify Your Training
Never over-exceed the load tolerance of your injured tissues as you progress. It takes 6-12 weeks on average for your injured tissues to recover their tensile strength. Use a periodisation method called ‘auto-regulation’ to train based on how you feel rather than chasing numbers or load.
Focus on Progressive Overload
Working from type III collagen to type I collagen is best accomplished through slow and controlled progressive overload. Once your bodyweight movements are accomplished with ease, you can then scale up to light weights (emphasis on the ‘light’).
Less is Always More
If you can’t handle body weight, you shouldn’t be chasing PB’s. Making small wins every day can result in even more significant long-term gains down the road. Even though this may not be evident at first, have faith in the process. Never risk re-injury for the sake of accomplishing a PB.
Wright, R. W., Haas, A. K., Anderson, J., Calabrese, G., Cavanaugh, J., Hewett, T. E., … Williams, G. (2015). Anterior Cruciate Ligament Reconstruction Rehabilitation: MOON Guidelines. Sports Health, 7(3), 239–243.
Heiderscheit, B. C., Sherry, M. A., Silder, A., Chumanov, E. S., & Thelen, D. G. (2010). Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. The Journal of orthopaedic and sports physical therapy, 40(2), 67–81.