Should You Train When Injured?

A question that I hear a lot in the fitness world is “should I work out when I’m injured?”. I have found that most people fall into one of two categories when an injury occurs — either ignoring the pain and training right through it (bad idea), or stopping training all together until the pain goes away (possibly a good, but generally a bad idea depending on the injury).

injured

In my work as an athletic trainer, I deal with injuries every single day. Injured athletes are the foundation of my job, and many times there is simply not an option to just stop training all together. Whether I’m evaluating a new injury or treating chronic pain, the constant question I get from patients is “So what can I do?”. Working with athletes can be both frustrating and inspiring, because most of them want to train through/play through anything. I have certain athletes who would continue playing a basketball game if one of their legs fell off, if only I would let them. Determination is a wonderful trait, but can also be detrimental if one pushes too much through damaged or injured tissues.

So how do you determine whether you should train/workout when injured? And how do you decide how much is enough, or possibly too much? The broad answer, to which there are of course exceptions, is that an injury should not stop you from doing all physical activity. Barring the extreme (multiple fractures, severe trauma, etc.), there is almost always a way to train around an injury. The key word there is “around”, and the key concept is to learn how to do this safely. That being said, “No Pain, No Gain” is actually the most dangerous concept when it comes to healing from an injury. Damaged tissues need time to heal, and a lot of times they need a little bit of help to create the most optimal healing “environment”.

ankle

You’re not going to be running on this bad boy any time soon! 

If you sprain your ankle, this does not mean that you should be lying around on the couch every day for weeks on end. In fact, after a couple initial days of rest and healing, your body will benefit greatly from movement and healthy blood flow. And the wonderful thing is that this doesn’t mean you have to stick to just upper body exercises (or lower body exercises, in the case of an upper body injury). Research has proven time and time again that when you have a unilateral extremity injury (ankle sprain, broken wrist, etc.), that training the opposite side can produce training effects on the injured side. It’s called Cross-Eductation, and to me it’s just more proof that the human body is pretty darn amazing. It has to do with neural pathways and the connection between the brain and your muscles. I won’t get too far into detail in this post, but can do that later on if people would like!

F1.medium

[Source]. In this study (click the link to read details), patients who trained their right arm while the left arm was in a cast showed just about equal strength after being immobilized for three weeks, compared to the significant loss of strength displayed by those who didn’t train the right side.

Yes, you can (and should) train the opposite side in order to see progress in the injured side. Many people won’t do this for fear of getting “lop sided”, but with a little careful planning and execution, that won’t be the case. True, you should not train one side of your body for months on end, but unilateral training while healing will help to keep you stronger all over, not just on the healthy side. There have even been studies which show that visualization exercises can slow muscle atrophy in an injured limb, and that just blows my mind. The human brain and nervous system is an amazing thing, no?

Think of it this way: If you sustain an injury, once it is healed you can either start back at square one because you have stopped training altogether, or you can start somewhere in the middle because you’ve kept up your fitness throughout your healing process. Even if you are not able to do any heavy strength training or high impact activity, doing something while recovering from an injury is almost always better than doing nothing. At the very least, mobility work (foam rolling, stretching, range of motion) can help keep your muscles and tissues healthy while the injured site heals. If you sprain your ankle and then simply stop moving for a couple of weeks, you’re going to have more problems than just your ankle when you start up again. Your muscles and fascia are going to be tight and immobile, leading to poor movement quality and possibly another injury. Doesn’t sound too wonderful, does it?

So what should you do after you sustain an injury? Well, the first thing you should do is get checked out by a medical professional. But if you get the okay to keep exercising, there are certain steps you can take to keep the rest of your body healthy in the meantime:

1. Start with mobility work. Foam roll daily, general stretching, maybe even some yoga poses (those that don’t aggravate your injury). Keeping your body mobile is the most important thing for tissue; without movement, muscles, tendons and fascia can become shortened and fibrotic. As said earlier, this can lead to further injury once your workouts ramp up again. Take care of your body and it will take care of you.

2. Train away from the injury. If you have a lower body injury, ease back into things with an upper body workout. If you have a back or torso injury and you have been told that it’s safe to exercise, start with something low impact like a recumbent bike, swimming, or just walking daily. Add in isolation extremity exercises such as bicep curls, lateral raises, calf raises, and other smaller lifts.

3. Train opposite the injury. Let’s go back to the ankle sprain for a minute. If you injure your left ankle, doing things like single legs squats, step ups, glute bridges and single leg leg press on your right side will help immensely. At a certain point of healing, you’ll also be able to start doing these exercises with your left leg again, and because of cross-education, you won’t be starting at square one. Feel funny about going to the gym and only training one side? Honestly, people are too worried about themselves to notice that you haven’t done your single leg squats on your left side as well. Besides, if anyone says anything to you, you can just spout off all of your awesome knowledge about cross-education and blow their mind a little bit.

4. Train the injury. Don’t tackle this one on your own, but at some point (usually sooner rather than later), rehab will be necessary to get you back on track. See a qualified professional to help you through this (athletic trainer, physical therapist), so that you can get back to being the badass that you are!

Long story short? If you’re doing something in your workouts that’s making your injury worse — you’re doing too much. But there’s no reason (unless you’re told by a medical professional) to let all of your hard earned progress go to waste! Training doesn’t have to be all or nothing. Sometimes we have to take some steps backward in order to continue moving forward, and finding that right balance is the key.

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9 thoughts on “Should You Train When Injured?

  1. I love these posts, Steph! It’s so informative! When I had a stress fracture a couple years ago, I had to wear a boot for 4-6 weeks. Instead of sitting around and feeling bad for myself because I couldn’t run, I made sure to stay active. I rode the upright bike with my boot on, I lifted free weights sitting down, I did core work. I ended up feeling pretty good after I got the boot off and started from somewhere in the middle like you said, instead of square 1. Great tips!

  2. Hi, I’ve been reading your posts for about a year now and I like this one. I’m an athlete who definitely understands pushing through injury isn’t a good thing. I had my left ankle reconstructed two years ago after running over a year with two torn tendons and shifted bones in my foot (I don’t remember the medical names of them to be honest). It took over a year to get back to 75% of the workouts and I am still feeling the effects 2 and 1/2 years post op. I had another stress fracture in the same foot last year and have had lower back pain/spasms consistenly since the spring. My AT attests it to a muscle imbalance from the surgery. Any advice or commentary?

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  4. Great article. I am just coming off 4 months of a leg cast from a delayed union fracture. I think a rest could be good for a short while, depending on the injury, but this forced me to be a bit more creative with my workouts. Now I wished I had done more with my other leg!

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