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The Fit 5: Training With Injuries

From cartilage tears to tennis elbow, here's how to train through the pain.

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For all of our fans who shoot us questions on our Facebook page, this one is for you. Each week, we will tap into our pool of editors and experts to help with any questions or challenges you are having with your fitness regimen.

This week, Stephen Chao PT, DPT, CSCS of Memorial Sloan Kettering Cancer Center where his clinical focus is orthopedic physical therapy and neuromuscular rehabilitation, answers questions about training with injuries.

But before you try to workout through the pain, Chao warns, "Let’s start out by saying that it is never advised to train through acute pain. Pain is a sign that damage is being dealt to some area in the body. If injuries occur, one should allow adequate time for rest and recovery before resuming exercise. Furthermore, symptoms that are limiting to your daily activities or that persist should be discussed with your doctor or health care provider."

Onward.

1) Trap Impingement — asked by Paul Blair

I have a recurring impingement in my trap area that occurred when performing a barbell upright row. I have found that it's more of a nerve problem around my C5, 6 and 7. Can you advise how I can improve this area?

“Form here is key. Start by making sure your neck is in its neutral position and that you aren’t excessively flexing your neck, which irritates the joints in your spine. Secondly, the exercises you mention cause your arm to be in an unstable position and require the muscles around the neck and shoulder to contract together and stabilize the shoulder blade. The increased stress on your shoulder stabilizers can cause them to spasm. Make sure your shoulder blades are stabilized properly by pulling them down and back before you start the movement and make sure to maintain this position throughout the entire range of motion. You may also try modifying this exercise by decreasing the elevation of your arms (i.e. shoulder-height like a row) until you get a good feel for stabilizing your shoulder blades. Lastly, start incorporating upper shoulder and neck stretches post workout to reduce spasms and joint irritation.”

2) Knee Pains — asked by Manuel Clive

What are some body weight exercises for those who have a lateral meniscus tear or those who have problems regarding balance?

"Exercises that force you to stabilize your thigh and hip position will train the control of the knee and help to protect the meniscus. Two safe exercises are body weight squats and lunges. When doing either exercise, make sure that the knee does not push forward past the toes. Perform them in front of a mirror and make sure the knee does not fall in or out throughout the full squat range of motion. You can incorporate balance by doing these exercises on unstable surfaces like foam, balance boards or rubber disks. Varying the surface forces you to stabilize the knee as well as taxing your balance."

3) Tennis Elbow — asked by Orlando Gomez

I have tennis elbow. What should I do and how should I train?

"The first thing to do is to think back to when this problem started. Is this the first time you have had it or have you had it on and off for a long time? Chronic tennis elbow or lateral epicondylitis is managed very differently than an acute case. If this is the first time you have had it ever or the first time in a very long time, then your case is acute and you should rest it, ice it frequently (2-3x/day if possible) and may benefit from anti-inflammatories. If this has been going on for a long time and continued training will cause it to recur even if it goes away, further recovery may not be total without more medical intervention. In general, you should stay away from activities that involve pulling or gripping like rows or carrying heavy bags until the pain resolves. Training should be resumed gradually and make sure you vary your exercises to spread out movements that involve gripping and pulling across your routine."

4) Shoulder Clicking — asked by Roberto J. Solis

I had shoulder surgery about 18 months ago. I was doing fine, but now my shoulder clicks when I do decline bench presses. I like to do all three benches when I work my chest, but the clicking is getting bothersome. Any ideas?

"The click might be your humerus rolling over a tendon or a small defect in the cartilage of the joint socket. If you find the clicking gradually worsens and starts to be painful, a trip to the doctor might be needed. Otherwise, you can try using an adjustable bench that can vary the amount of decline. Try different amounts of decline and see if there are angles of your shoulder that can avoid the click. You can also try switching from declined bench to declined dumbbell presses and vary the distance of your elbows from your body or the width of your grip to find a click-free position. If all that fails and there are no other problems, you might just have to get used to it."

5) Slammed Shoulder — asked by Mar D Mee

I was dumped on my shoulder in a poorly executed Judo throw and my shoulder was pushed forward a fraction of an inch. There were no tears and I now have full range of motion, but it still is a nuisance pain. I can train through it but I'm concerned about further damage. Can I do permanent damage to my shoulder? Can I do anything to get it back and place? I have been seeing a chiropractor and doing some physical therapy on my own.

“Soft tissue injuries can occur and not show up on exams or imaging studies. You may have strained the soft tissue structures of the shoulder joint socket. The pain may represent some instability in your shoulder causing irritation to the joint or it can be residual irritation from the initial trauma. The capsule does have a limited ability to repair itself and the pain may go away after a while with rest and regular icing. You may want to gently strengthen your rotator cuff to enhance joint stability. If the pain persists or worsens, contact a doctor or physical therapist."

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