Training Around An Injury
A few years back I wrote an article for T-Nation called Fight the Injury Blues: Keep Lifting. I think one of the biggest mistakes athletes make is that they completely shut down, physically and mentally, after suffering an injury that necessitates a limitation in their training/practice/competition. Some injuries may in fact require complete rest, but these are by far the minority and most of these only require complete rest for a week or two. The article outlines a few examples of what injured athletes can STILL do from a training standpoint, and the neurological benefits that are parlayed to the injured limb when the opposite limb is trained. The research in this area is interesting. If you haven’t read the article yet, take a minute to do so after you finish reading this post.
I recently got a question from a Canadian university player in the Atlantic University Sport league that read:
“Yesterday I read one of your old t-nation articles about training while injured and it touched a bit on unilateral training and the bilateral transfer involved (10% to 77% i believe it said). I was wondering if that kind of training would create imbalances in strength and muscle size. I’m going in for hand surgery soon and want to continue training my left arm/hand if its beneficial. What type of set/rep range would u hover at to reduce the risk of imbalance?”
This is a great question. As you can see, there is a pretty big discrepancy between the upper and lower limits of strength transfer from one side to the other. To take a step back, what the 10%-77% numbers are implying is that if you only train ONE side of your body (e.g. only 1-Arm DB Chest Press or 1-Leg Squat on the left side), 10-77% of the strength gained on that side will also be gained by the right side. In other words, the right side does nothing, but gets 10-77% stronger.
This “transferred” strength improvements results from the wiring of the nervous system. In an effort to oversimplify the complexities of the nervous system, the body adapts to things it does repeatedly. When the nervous system is forced to send signals for strong contractions to one side, it “learns” how to do so for the other side as well. The 10-77% range is a large one, but the strength transfer will be greater if you use compound exercises (multi-joint movements), slow down the eccentric phase of the lift, and maximize concentric acceleration.
To address the question at hand: Yes, training one side will cause imbalances in strength and size. While muscle imbalances (a somewhat vague term) are one of the major predictors of injury (second to previous injury), there are some important qualifiers in this situation.
1) Consider the Alternative
The alternative to training the “good” side only is to avoid training those segments of the body altogether. Physically, this will cause an equally undesired atrophy of the musculature AND neural drive to the musculature. In this scenario, the athlete needs to restore the lost muscle mass and neural efficiency bilaterally, which will not only set them back quite a bit in their training, but may also require focused dietary changes to sufficiently increase the caloric and protein intake to allow for training-drive hypertrophy.
Mentally, most athletes are extremely competitive and active, and don’t respond well to being told to completely shut it down for extended periods of time. Again, depending on the injury, rest may be an advisable solution, but in most cases, it will do more harm than good.
2) Injuries Inherently Cause Imbalances
There is no avoiding imbalances following an injury. Whether it’s thumb surgery or a shattered femur, the neuromuscular system is going to adapt to minimize stress to the impaired area. That is why rehabilitation is so important; the goal is to restore symmetry across the injured area and between the injured and uninjured side. Training the uninjured side will minimize strength losses bilaterally, so that there is less ground to make up upon getting cleared for training. This also highlights the importance of ramping up training/sports participation over a period of time instead of just jumping right back in. The body requires time and focused effort to restore symmetry. Just because an athlete is no longer injured does not mean he’s ready to return to play; they’re just at a different stage on the Injury-Optimal Performance continuum.
With regards to what set/rep ranges to utilize, the important thing to remember is that the transferred adaptations are neurally-driven strength improvements. Therefore, in order to maximize transfer, you’ll want to stay in neurally-driven strength improvement set and rep ranges (in general, 3-6 sets of 3-8 repetitions). If higher rep ranges are utilized then there will be more of a hypertrophic effect on the working musculature that will not be experienced by the injured side.
The other thing to consider, in this case, is that you can do anything that takes your hand out of the movement. Remember, it’s not an upper body injury, it’s just your hand. There are ways to train around that, such as doing:
Arm Strap Pulldowns
And you can do these in whatever rep ranges you feel are most advantageous for your situation because they aren’t unilateral movements. You won’t have to worry about the degree of transfer from one side to the other.
Hope this helps. The big take home from this is that injuries shouldn’t cripple the athlete. Find ways to train around the injured area so the athlete can continue to make progress, or, at the very least, minimize performance losses associated with the healing and rehabilitation phases.
To your success,