I was recently listening to the Westside Barbell podcast (Episode 21), and really enjoyed hearing Louie Simmon’s take on rehabilitation from injury, along with John Quint’s insights into loading tissue. They discuss that there are no bad exercises. Before you disagree with that statement, here is what I mean- each exercise selected for prehab/rehab/strength/conditioning should have a purpose. Sometimes an exercise that has been deemed “bad” or “unsafe” is necessary to produce the stress needed for a specific application or adaptation.
Injury (non-traumatic or non-contact) occurs because of lack of capacity of tissues (aka training) to handle that position. An example of this would be trying a new exercise at a load that is too heavy, resulting in injury. An indirect example would be an injury incurred when in an abnormal position during a football game. The player might be a lineman firing off the line, and being rotated during the hip/back extension movement. Yet another example would be an exposure to an eccentric event (an example could be downhill hiking), with no prior experience, could induce delayed onset muscle soreness, muscle damage and injury. In both situations, exposure to exercises that stress the tissues in a manner similar to the injury position could reduce the risk of injury. For the football player, it could be rounded back deadlifts or good mornings. For the hiker, it could be progressive eccentric loading for the hamstrings (Repeated bout effect of eccentric training).
Another thought that I had was the human body’s amazing capacity to adapt, heal, and demonstrate plasticity. I did a quick search and found some examples in the literature of tissue changes/ healing with exercise/ mobilization:
– Beattie PF, Arnot CF, Donley JW, Noda H, Bailey L. The immediate reduction in low back pain intensity following lumbar joint mobilization and prone press-ups is associated with increased diffusion of water in the L5-S1 intervertebral disc. J Orthop Sports Phys Ther. 2010; 40: 256– 264.
– Beattie PF, Donley JW, Arnot CF, Miller R. The change in the diffusion of water in normal and degenerative lumbar intervertebral discs following joint mobilization compared to prone lying. J Orthop Sports Phys Ther. 2009; 39: 4– 11
-Disc hydration can change with specific movements or manual treatment.
-Buckwalter JA, Grodzinsky AJ. Loading of Healing Bone, Fibrous Tissue, and Muscle: Implications for Orthopaedic Practice. J Am Acad Orthop Surg 1999;7:291-299
-Tissues in the body adapt to loads being placed upon them. I have two thoughts about this. First, there is the “use it or lose it” concept. Some describe a natural course of aging, with atrophy of muscle tissue and bone density changes. If the appropriate loads are placed on the body, progressively, could this be reversed?
-Secondly, there is a great deal of scary terminology out there regarding imaging- degenerative joint disease, degenerative disc disease, osteophyte formation, stenosis, etc. As seen in the table/ picture, each decade we live, aging/ changes in the spine occur. The interesting part of this chart is that despite the high prevalence of “abnormal findings” on imaging, the people in the study had no symptoms.
-Brinjiki W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.
-Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. J Manipulative Physiol Ther 1996;19(9):597-606.
-Although this study was not specific to just exercise, there was a good clinical outcome in 80% of the patients, along with 63% of the studied patients having a reduced size or completely reabsorbed disc herniation.
-LaStayo PC, et al. Eccentric Muscle Contractions: Their Contribution to Injury, Prevention, Rehabilitation, and Sport. JOSPT. 2003;33:557-571.
-The inability to control deceleration could be a risk factor for injury during sports. A common example is the non-contact ACL injury. The hamstring might not be able to control deceleration, and the ACL’s passive restraint of anterior tibia motion is challenged too much. Exposure of the hamstrings to eccentric muscle contractions can increase strength, and provide assistance to the ACL during cutting or deceleration on the field/court.
Kongsgaard M. Effects of Heavy Slow Resistance Training. AJSM. 2010; 38(4).
-Tendinopathy is a common problem (Achilles, Patellar, Hamstring, Rotator cuff). Heavy slow resistance training can increase the density of the tendon, as well as, return the tendon area to closer to normal size.
-Frost HM. A 2003 Update of Bone Physiology and Wolff’s Law for Clinicians. The Angle Orthodontist. 2004;74(1):3-15.
-Wolff’s Law states, “that bone in a healthy person or animal will adapt to the loads under which it is placed. If loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading.”
This post is not to say that you should ignore form, or put yourself in awkward loaded positions. The point is that progressive loading produces positive adaptations (specific adaptation to imposed demands), and as Greg Glassman once stated, “we fail at the margins of our experience.” Analyze your sport, and add exercises to your program that could address postures and positions outside the normal exercise selection. Whether the goal is rehabilitation, or training for a sport, the reasoning behind exercise selection should always be apparent.