Training With Injury
A bit of knowledge gleaned from a course I took about effective barbell/weight training for people coming back from injury ...*
... there's an evolving tendency among physical therapists NOT to send every patient with shoulder issues for an MRI. Why?
Turns out 'asymptomatic' rotator-cuff damage is found in a lot of people. They're just walking around with no pain, but the MRI says "OMG!" Supraspinatus tendons in particular. And the older we get, the more likely this is (both pain-free and painful partial tears).
I've been 'training around' a supraspinatus-adjacent low-grade tendon issue for months. What this new bit of info told me is: while I should do a better job of not pushing too hard, it's also okay (maybe even a good idea) to keep training, as long as I'm ready to back off pronto when I sense trouble. For a given definition of trouble that I'm still working on. (The wise reader will understand: that right there is the crux, knowing when the pain is NOT resolving, and being smart enough to stop, whether by letting a damaged area heal entirely for a while, or by modifying one’s program to cautiously keep it engaged while it recovers.)
Guess who's slowly ramping up my volume while ramping down my symptoms, lately?
The hypothesis here is that, yeah: training too hard is injurious (duh). BUT. So is not training at all, due to use-it-or-lose-it effects. Mainstream medicine is still getting its mind around this, and it's still common for general practitioner doctors to recommend full abstention from things in the slightly-painful zone, potentially setting people up for eventual sarcopenia (muscle loss) as they age. The negative outcomes from age-related sarcopenia are pretty clear. So the middle ground may be further into the 'train safe, but train' zone than we thought.
Don't take my word for any of this if you get better advice from people in the game longer—I’m a personal trainer, not a physical therapist. Use them, and the rest of the medical establishment, for the many things they’re good at. But that's what I've picked up.
*If you’re a fellow personal trainer or a physical therapist, the course was on the Barbell Rehab Method, offered by the good folks at https://barbellrehab.com Highly recommended.
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Disclaimer: Ideas expressed in this blog post should not be construed as official advice on how to safely perform fitness activities. Always consult with your doctor and other medical professionals as necessary, before engaging in exercise.