“I’m not sure I should come in for my training session today. I might have lifted something the wrong way when I was bending down to prune my roses. Now, I have some tightness and pain in my lower back and right side of my hip. What do you recommend?” read one of the emails from Revy in my inbox on a Monday morning a few weeks ago.
Revy is one of our personal training clients who frequents our fitness center twice a week. Her attendance is among the upper percentile in terms of showing up ready to go for her twice-weekly training sessions. Fueled by a light pre-workout meal, a bottle of water, and the assurance that she would show up fifteen minutes early to complete her dynamic stretching routine that has been etched into her memory banks, one could say Revy is the ideal personal training client. The coaches fight over who trains Revy because she listens and comprehends the exercise tactics we cue her to perform with intense concentration, purpose, and an eagerness to receive positive feedback.
As a woman just entering her sixties and embracing a life of retirement, Revy has embraced a fit and active lifestyle as the key to paving a path of adventure and fun to fuel the aspirations of traveling, hanging out with her friends and family, and recreational activities she’s always wanted to delve into. However, after training for over eighteen months, Revy experienced something unusual she hadn’t felt after the positive outcomes she garnered from consistently adhering to her fitness routine. Following two hours of pruning rose bushes, raking up leaves, and filling up her brown compost bin, she woke up with back pain that severely disrupted her daily activities the next day.
After reading Revy’s email, I felt sympathetic toward her discomfort. She has worked diligently to ensure the condition of her body is nurtured and operating at full capacity thanks to her efforts to eat healthy and exercise regularly. However, I understand that certain events are out of our control, and outliers in the course of everyday life can present a shift in the normal rhythm we’re accustomed to.
I trusted Revy’s intuition that exercise might make things worse. I told Revy I was confident we could adjust her training regimen to avoid exacerbating the injury. Furthermore, her program would be revised in an effort to alleviate her pain and rehab the site of her injury. This meant the coaching team knew to incorporate lower back injury prevention, stretching, and less compressive movements in her exercise prescription. As a productive intervention, we incorporate isometric and eccentric modes of exercise when participants report an onset of pain from an unlikely event in which they endured a musculoskeletal injury.
Isometric exercise can be defined as a mode of exercise in which the surrounding joints aren’t moving but are still under tension. A common example is the straight-arm plank. This position is commonly understood as positioning oneself in the starting position of a push-up and maintaining that position for a specific period of time. We usually instruct our personal training clients to hold a plank for twenty to thirty seconds to start.
Once planks can be maintained for a proficient amount of time, about forty-five seconds to a minute, we progress to the next mode of exercise, eccentric movements. Commonly understood as a slow-lowered or “negative” portion of an exercise, eccentric muscle contractions can be identified as the lengthening of a muscle fiber.
A commonly perceived normal exercise routine consists of a one-to-one ratio of lifting a load and lowering it at the same speed. Performing this mode of a normal one-to-one ratio of time in the accent and descent of the push-up is commonly understood as the traditional way of exercising. This isn’t what we wanted to do for Revy.
We knew that Revy’s body was in a state of distress. Instructing her to perform three sets of ten repetitions for her compound lower and upper body movements might exacerbate the injured area because the rate of muscular contraction and physical exertion could potentially overstress an already stressed area. Therefore, performing three sets of four repetitions of slow-lowered descent exercises would be beneficial and avoid the risk of pushing past Revy’s limitations. We put Revy in a successful situation by reducing her repetition count but lengthening the duration of the repetition. This way, she would still be performing exercise but in a modified style that decreased the mechanical movements of her joints yet still applied productive stress to her muscles. The likelihood of straining the area further decreased by reducing the amount of movement on the joints in her back and hip. Most importantly, Revy could still attend her beloved training sessions to stay consistent in her journey to be fit and strong for her everyday life activities.
It’s worthwhile to refine one’s fitness habits when an injury occurs. The last thing we want to do is either “push through the pain” and make things worse or just quit exercising altogether. We can still keep moving when an injury presents itself. After an unexpected injury occurs, take a step back, reassess what we can do, and keep pressing forward by consistently adhering to a ritual of regular exercise.
Sean McCawley, the founder and owner of Napa Tenacious Fitness in Napa, CA, welcomes questions and comments. Reach him at 707-287-2727, napatenacious@gmail.com, or visit the website napatenaciousfitness.com.
