It’s been occupying my mind for a few weeks now… the idea that exercise prescription is black or white, that you either can or you can’t. However, what if within any exercise there was an opportunity to regress or progress? Take running for example, can you regress it while still technically running? I think that you can!
For one, it depends on the injury. If it’s your pelvic floor, there are a number of measures that you can take to reduce the impact, including;
- Landing pattern – on the forefoot or mid-foot rather than the heel.
- Stride length – shorter is less impact.
- Surface – grass and off-trail is lower impact than cement.
- Incline – running up hills and stairs is less impact than running down.
For the sake of the argument, lets say that the injury was a knee injury, the same “reduce impact” regressions would apply, and hopefully they could still run.
If a swimmer wants to swim with a shoulder injury, how can we modify swimming to reduce the impact on the shoulder? Firstly, i would test all sorts of strokes. Can the client:
- perform freestyle without pain (during or afterwards)?
- perform breaststroke without pain (during or afterwards)?
- perform backstroke without pain (during or afterwards)?
- hold a kickboard?
Next, we work with what the client CAN do, as well as keeping in mind WHY they have a shoulder injury in the first place. For many amateur swimmers it is a rotator cuff problem, from the hundreds of laps of forward rotation of the shoulder (freestyle) and relatively little backward rotation (backstroke). Firstly, lets get them swimming in a pattern that doesn’t exacerbate the injury, then let’s move the shoulder in a pattern that will provide muscle balance, so that their rotator cuff problems never some back (provide an antidote to the repetitive stress of a movement). However, if humanly possible, i believe we should encourage the client to keep swimming or running within their capabilities, then work upwards from there.
If we look at our runner with pelvic floor injury again, and imagine that she is handling the mid-foot landing pattern on grass and up hills, and her pelvic floor symptoms are not getting worse. We will confirm this with the physio, then we can logically increase the load another “shade of grey”; that is, increase slightly and watch what happens, try not to cross the line and overload their injury.
So how could we progress a client in this case? I would suggest:
- Jogging longer on grass
- Doing extra hill and stair repeats
- Running further generally
- Trying some flat “light landing” long intervals
All the above are slight progressions from the original “low impact” program, and can be slightly increased again if the client demonstrates they can withstand the loads through their injured area.
We do not have to be so “cut and dried” in our exercise prescription for injured clients, there are more options than cutting out whole exercise or pushing through inappropriate ones.
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