On Physical Injury
August 21, 2020 · C.E. Carter
As an athlete, I can confirm that being physically injured is really disheartening. It’s an inevitable reality of pushing yourself in any physical domain that you will eventually get injured somehow. If you don’t get hurt every once in a while, chances are you’re missing out on a lot of performance. To some, the prospect of getting injured is a strong deterrence from engaging in any athletic activity at all. On the extreme end of the spectrum are those who say “with all of the wear and tear that exercise puts on the body, it’s not worth it to do any sort of hard training”.
Against this attitude, let’s consider the end state of a human being. Every human being who has ever existed has died of trauma; trauma, in the technical sense that something or another “overwhelms” our body and cause it to cease functioning. Dying in a car accident produces a different kind of trauma than dying of cancer or dying of old age (which is a state in which life itself is too much for an infrailed body to bear). At some point or another, every human being will experience bodily dysfunction, either as a function of trauma or disease, or as a slow decay into inability. Physical pain is an unavoidable part of the human experience, whether you train hard or not. Those who believe that they will be able to ride out their life injury-free by not performing any physical activity are sadly mistaken. They are deluded into believing that they are in control of all of the variables in their life, and grossly underestimate the need for the positive benefits of hard physical training in everyday life. Calamity, crisis, danger, or simple necessity may manifest from the aether at any moment, demanding more of us than we were expecting to give. Ironically, regular physical training is the best way to hedge against these risks, and failure to prepare in this way broadens the number of possible ways in which an untrained person may become physically injured. Men who regularly train to lift heavy things are more likely (although not very likely at all) to hurt their back doing so in the gym, but are far less likely to hurt their back in the real world when their body is demanded to perform in a situation where back strength is a necessity. Further, the absence of hard physical training opens the untrained person up to other kinds of physical risks, such as heart disease, obesity, frailty, muscle atrophy, bone density loss, and all other manner of comorbidity that arise from a sedentary lifestyle. A responsible adult with an ability to compute and assess risk should not avoid hard physical effort purely on the basis of the risks themselves. Human experience alone makes the risk to reward ratio worth it.
That being said, there is a chance of incurring physical injury from any physical activity. The likelihood of these events are not negligible, but they are not as overblown as the Conventional Wisdom would suggest they are. Field sports, by far, are the most dangerous with respect to injury rate. One study measured an average of 6.2 injuries per 100 hours of training time for the sport of soccer. Football, by contrast, posts approximately 1.3 injuries per 100 hours, and barbell sports like Olympic weightlifting and powerlifting have injury rates on the order of 0.001 injuries per 100 hours. Shear forces from the running, turning, and change of direction which is constantly required from field sports are the reason why knee, hip, and ankle injuries are so prevalent even among high school athletes. Additionally, these injuries are far more likely to cause growth plate injuries in children than exercises like squatting, deadlifting, pressing, cleaning, or snatching, due to the nature of the loading. This is also to say nothing of the neurological injuries which may be incurred by these sports, both of an acute and chronic. Concussions are fairly debilitating acute injuries whose risks are often fairly downplayed, and the United States is experiencing nothing short of a pandemic of chronic traumatic encephalopathy (CTE), especially among football players, fighters, and other sports where frequent collisions are experienced. The most debilitating injury you can incur from lifting weights are muscle belly tears, sprains, strains, or slipped discs, and almost all of these can be avoided by exercising humility and rationality.
In a fairly unglorious display of my momentary lack of either of these qualities, a couple weeks ago I made the stupid decision to wear my belt and go heavy on deadlifts. In hindsight, wearing a belt while pulling heavy weight from the floor is almost invariably a bad idea, and is responsible for a lot of injuries like the one I subsequently incurred. A belt gives you the proprioceptive cue that you have properly set your back to pull, when in fact you haven’t. That’s exactly what happened to me: belt on, lazy brace, big pull, and a little snap crackle in my low back. It was a dumb decision, and it happens.
I’ve had a couple injuries throughout my athletic career. Though injuries can arise from a number of circumstances, in practice they are incurred from principally two: overuse (a function of pride) and trauma (a function of stupidity). Tweaking my back was an injury which arose from stupidity; I had no reason to be going for that kind of weight on the day that I did, and I paid for it with physical pain and a couple weeks of low intensity training. Most of my other career injuries were incurred due to overuse, when things in the body just tend to wear out after not being able to heal for weeks or months. Joints and connective tissue heal and adapt more slowly than muscle, so lifters have to manage stress across different structures of the body accordingly. Olympic weightlifters (like me) often do well to back off on the snatch and the clean and jerk every so often and just focus on building muscle or getting more conditioned, for this reason. Endurance athletes often make the mistake of training too often and ending up with similar kinds of injuries. Runners who don’t back off their mileage every once in a while can end up with a case of tendonitis, IT band syndrome, shin splints, or plantar fasciitis. I’ve learned a lot of this by reading and researching, but not without experiencing a few pain points firsthand.
For the immediate duration of time after a traumatic injury, the injured structure should be immediately stabilized and immobilized; a broken leg needs to be reset and splinted, a torn muscle belly needs to be immobilized, and so on. However, once the injury has been contained and evaluated, there has to be For tears, sprains, strains, and the like, ice is almost never a good idea, since cold temperature suppresses the body’s initial inflammation reaction to the trauma, and slows the healing process. Overuse injuries, on the other hand, are more often “identified” than experienced as a singular event. For these, admitting that you’re hurt is the first step to recovery.
The Conventional Wisdom dictates that the best way to heal an injury is the Bed Rest Protocol. Very simply, the protocol dictates that you should lie around until you’re healed up. Any athlete with a decent amount of experience will tell you this just doesn’t work. You have to make things heal. As soon as light movement can begin after the injury has been identified, it should. For most injuries, there will be a movement which serves to get blood flow to the affected region, as well as stimulate a little bit of inflammation to keep the healing process going. An example of this is the Starr Rehab Protocol, a healing methodology developed by Olympic weightlifter Bill Starr to heal muscle belly tears. The protocol involves doing high-repetition (20-30 reps per set) exercises, like squats or deadlifts, to bring blood flow and immunological stimulation to the affected area, in essence “telling” the body to repair the affected tissue. Mark Rippetoe of Starting Strength developed a similar protocol with high repetition chin ups to heal biceps tendonitis. I developed a case of tendonitis in the front of my left hip when I switched legs in the split jerk a little over a year ago, and I was able to heal it by lying on my back and contracting the affected area against a band and holding it isometrically for 20-30 seconds at a time. In general, blood heals, and reps heal. Variations in training lifts can also help with accommodating and healing an injury. An athlete with a pec tear might not be able to bench press, but maybe they can still press overhead. Likewise, an athlete with a knee injury might not be able to squat, but perhaps they can still get some training stimulus on their quads and hamstrings by deadlifting instead.
The job of an athlete experiencing an injury is to remain calm and rational in order to make the best decision about how to proceed with the healing process. It’s easy to panic and become emotional (“I’ll never be able to train again!”), and these moments have their place in the recovery process. Acknowledge them, get a little emotional, go home, have a beer, and get some sleep. Tell yourself you’ll heal up quickly, and you’ll be back to regular training soon in no time, because you will. The key to convincing yourself of this is to make a plan to recover and heal. Identify the exercises which seem to aggravate the injury, and which ones seem to facilitate the healing process, and set some reasonable training frequencies and volumes for those exercises.
Back injuries are especially susceptible to being milked by people. A lot of people with back pain or back injuries will avoid moving in ways which might be advantageous to helping their situation. “I’ve got a bad back”; no, you have a human back that was designed to move, even when it’s hurt. The scientific literature has finally caught up to what lifters have understood for hundreds of years: the bed rest protocol does not heal these kinds of injuries. Again, you have to make them heal. For my back tweak, I could hardly squat my second warmup without pain, but I could do back extensions, light deadlifts, and even snatches and cleans with no problems at all. I made it my prerogative to do 3 sets of 10 back extensions every training session as my first exercise, to get good muscle activation and blood flow to the region. Then, I focused on what I could do: light deadlifts on a simple linear progression, snatches and cleans and jerks depending on how I was feeling, and a bit more pressing volume to boost my morale. Instead of seeing the injury as something which impeded my training, I chose to see it as an opportunity to learn about back injuries, and to focus on getting stronger at some weaknesses I had been neglecting for a while. After a couple weeks of this, I’m squatting again, almost back to normal.
Training, as a process, is a remarkably simple and logical progression, but it is not always a predictable sequence of events. A mature athlete plays the long game by considering each day in the context of the next months and years of progress. Future gains in performance and overall well-being are worthy aspirations to make sacrifices in immediate perceived training success. Do your future self a favor.