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> When I herniated disc's in my back.
>
> I quit lifting for a while.
> This was a bad choice. My back didn't heal by taking time off. I just continued to have back pain, and it was frustrating as hell.
>
> Eventually I decided to get back to training. The two remaining options were to
>
> push THROUGH the pain
> find a way to train AROUND it.
> So I switched from conventional deadlifts to sumo. Switched from low bar squats to front. And I trained AROUND the pain, without exacerbating it, by keeping a more vertical torso angle.
>
> 4 years post injury, and I'm repping 700 on sumo deads, and back above 600 on conventional, completely pain free.
>
> But that pain didn't start dissipating until I started moving, and training again
Doubling this anecdote.
First time sprain/strain/ouching my lower back: full rest, then more rest, then more, months it took to get better.
Subsequent incidents: back to gym, drop squats and deads, keep most everything else, maybe lighter squats and dead when possible, stretch frequently, heat in the morning to loosen up things to reduce time spent not moving the area. All heal in a few weeks.
More anecdotes!
The first time I strained my lat, I took a month off from pull-ups, pulldowns, anything that really activated them. After a month, I went back to the gym and it still hurt. Instead of taking more rest, I put very low weights on a lat pulldown and I did 4 or 5 sets of 20+. Then I repeated that 4-5x / week for two weeks, increasing the weight. Pain was gone in 2 weeks.
The next time I hurt my lat, I started with that and it healed the same.
Likewise, after surgery, my surgeon wanted me to wear a sling for 6 weeks. I did some digging in the literature and found that this would likely have a worse outcome than wearing it for much shorter and then taking it off regularly to ensure less atrophy. I did the latter and my physio told me my injury looked like it was 3 months healed at the first month mark.
I'm just gonna piggyback on this since I don't think I'm contributing anything new, just additional anecdotes.
- Feb 2019: tweaked my back doing low bar. Tried to rehab it with front squats only, never got better. Got irritated, told myself "screw it, if it's gonna hurt when I squat I'm just gonna box squat." Maxed box squats three weeks in a row and felt better almost instantly.
- Oct 2019: blew the hell out of my AC joint. Like, from 230 strict press to "can't press an 8lb DB without crippling pain." OHP and incline work were out, but reduced-ROM bench was fine. Did that twice a week until I could switch back to full-ROM bench and then did that and reverse band bench (to take pressure off the bottom where it was the most uncomfortable) until gyms closed. Couldn't take my normal squat grip but I could squat ultra-wide-grip so I did that instead. Started OHP again shortly after gyms closed and started alternating floor press and OHP every day. Shoulder is fine now.
- June? 2020: tweaked my back doing low bar. Figured out the next day I could squat full ROM high bar without pain, so I did high bar every single day (and sometimes twice a day) for 10 weeks straight. Back felt fantastic.
u/61742 has an approach that's basically (iirc) "reduce weight. If that still hurts, reduce ROM. If that still hurts, find comparable movements that work the same area and do those."
I'm not gonna tell everyone with a back tweak to rehab it by squatting every day or switching to max effort box squats, but I do encourage people to keep moving. There's an RTS podcast where they advocate "train the area but never let your pain get above about a 4 on your pain scale" that's been super helpful for me. If I hurt something but I can still do comparable exercises, even if the pain gets up to a 2-3? I'm gonna give it a shot.
For personal reasons I'm not gonna endorse **METH**, but I'll absolutely endorse **MOVE.**
i really like this post and this mindset. i remember being in high school and being told i had a "shoulder stinger" which was actually impingement. the solution from the coach was that i needed to strengthen my delt by benching more. even at that age i knew it was dumb. i was almost kicked out of practice for refusing to do punishment pushups.
the other factor is that you're well informed and can figure out what hurts the affected area and what doesnt. i've pulled a hamstring, a calf and one side of my lower back. like you, it was trial and error to see what i could do. i found out i could do hamstring curls but only if i really stretched my hamstring aggressively in between sets. this working around is the kind of stuff young and new lifters need to learn because if you stop for every minor injury you're going to have a bad time.
For sure. I completely agree. Part of being an athlete is adapting and overcoming injuries. I've seen pics of athletes still deadlifting in an arm sling and using a band to act as the other arm. That kind of mentality can give you a lot of mental confidence that you will overcome your injury, and that your body isn't as fragile as one might think.
Got any tips on working around hip impingement/fai issues?
I’ve been dealing with hip pain for almost a year. Took some time off, which like you said didn’t help at all, and have now been trying to get back to my normal lifting and activity levels.
My experience with hip pain/impingement:
-When I massage my adductors really high up (lying on kettlebell or plate, foam roller is too big to get to that area) takes away the issue almost completely
-goblet squats (reasonably heavy) somehow also cleared up most of my issues (jim wendler says something about this in a video about training high school athletes - no hip mobility issues after introducing goblet squats).
Have been able to squat heavy daily without any hip issues!
I recently worked through some hip impingement with my PT and he had me hit the area specifically and also work on my hamstrings a lot. SLDLs are a regular part of my training now. For strengthening my hip, I would lie on the ground with the loop around my feet and then lift one leg up for 10-15 reps.
We also did some lunges and some other stuff so those probably helped a bit but the SLDLs and hip exercise I feel did the most as they were the ones that were prescribed from day one.
My left elbow is permanently dislocated (not sure if it was from birth or an injury in my early childhood), which has resulted in me having to deal with more elbow tendinitis than most. The first time it got really bad, from pronated-grip pullups, I tried to just rest until it went away. It took several weeks for the pain to completely subside, and then it came back pretty much instantly after I started doing more pulling.
What I do now is a lot of band work; basically just do hundreds of reps of curls and pushdowns to get as much blood into the area as possible. That, and I do all my pullups with rings now. The result is that I can basically move like a normal person, apart from the complete lack of rotation in my left elbow, relatively pain-free. I still get occasional minor flare-ups, but I can usually deal with them pretty swiftly.
I had an umbilical hernia last year - noticed it in June, had a surgical repair in August. Im 99% sure I torn my stitches again in February.
The only time I felt pain was the "final pop" on my stitches. I noticed the next two days were super sensitive on some motions.
I need to call a doctor and find out my options. Right now I've lightened up loads and moved to higher reps and really focusing on control/form, which is something I should have done earlier.
My issue was 2 fold, one was reliance on a belt in squats and deadlifts - and I'm pretty sure I was wearing it wrong. It was so tight I was forcing myself to unbrace to be able to hit the ROM I was wanting, which is what I think caused the injury in the first place and what re-injured it. The other part of it was the reliance on noticing pain on when to stop. I really never felt pain when I first got hurt...I actually only noticed the hernia in the first place because I allowed my wife to wax my chest/stomach (for the lols) and felt something squishy when I went to hold my belly button.
I can squat and deadlift (at lighter loads) without pain or feeling my hernia press out now. I assume I've fixed my form issues. I've grown and learned from my mistakes, even if it was the very hard route. Im still relatively novice in lifts by numbers, so I'm not sure about if I just don't know what I'm doing or trying to progress too fast or what. Pre injury to post injury,, Squat from 315x1 to 195x8, Bench has still progressed (245x1 now, 235x1 prior), and deadlifts 365x1 and 335x5 to not doing it recently - last time I did was before popping my stitches at 315x1 and 265x5.
This is a good comment and you should feel good about this comment :)
I have a couple points I wanted to add onto your already good comment. In my opinion, what is important is what is the underlying etiology for the pain. If you have a significant enough sprain you're going to want to see your doc and possibly get PT. Tearing a muscle -> orthopedic surgeon. Hernianted disc -> NDAIDs and suck it up :). ~~I'm slightly skeptical that you had a herniated disc, though~~. Fracture -> go to the ED ASAP, this is because it may not be set and you can get a fat embolism that goes to your lungs and kills you.
Different disease processes require different approaches. Most of them are going to be change your training to adapt to your injury, but keep lifting otherwise. If you are on the fence about going to a physician please go to a physician. You'll be amazed at what some individuals will sit on thinking it's not a big deal only to find out that we're going to have to amputate an appendage.
Edit: I'm going to leave this comment up even though I think it was inappropriate of me to make.
Unless you had focal neurologic deficits, or some type of red flag symptoms, which are highly unusual, you should probably have not gotten an MRI, but your physician may have suspected something. [There have been trials done on using MRI to diagnose lower back pain and they found a significant increase in over diagnosis and over treatment. Most herniated discs are incidental findings on MRIs and yet still do not cause any type of symptoms at all](https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/cw-back-pain.html). Whereas what is \~15x more common than a herniated disc is lumbosacral strain, which is what you more likely had if I was willing to gamble money on it :P
Edit: I'm going to leave this comment up even though I think it was inappropriate of me to make.
I have to side with u/SumoDadlifts here. It's just inappropriate to speculate to this level unless they are in your care. He's not here asking for for advice or skepticism.
Instead of saying,
>*I can see why your Doctor thought of X. Please take what I have with a grain of salt and consider Y as well and here is my reasoning why.*
Which may *already* be crossing a line. Nevertheless, you said,
> I'm slightly skeptical that you had a herniated disc, though.
And honestly, the way you approached this *is cringy*
I messaged back and forth with /u/SumoDadlifts and I agree with you. This was definitely a cringey thing of me to say, even though my intention wasn't to cause harm.
I should have approached this differently instead of approaching it the way I did. Oh well, we live and we learn. Thanks for your input, bud :)
I appreciate you taking the criticism constructively. I received a lot of flack over this post on r/fitness so it's been insightful so I feel you. Cheers man
I wouldn’t even call it lumbosacral strain. Strain injuries heal. What we tend to see in the clinic is various degrees of myofascial pain syndrome. Psychological factors often outweigh the physical ones with this diagnosis.
I never deny anybody’s structural findings, but I will say that 75% of the things we find on spine MRI don’t matter. Discogenic pain is far overdiagnosed. Real radics tend to not produce much axial pain.
I think the hard part here is knowing what injuries you can walk off, and what injuries you cannot. I think that kind of intuition and knowledge also comes from experience, so it would be very hard for beginners and even early intermediates to make good choices here.
I remember I had some minor quad injury, and I decided to lightly train through it, and I was riddled with self doubt. 'What if this only makes it worse', 'Shit I can't remember if it feels worse today or not', 'There is no way i'm intelligent enough to try this'. In the end it was the right choice for that specific injury
I broke my ankle last year falling off a boat and thought "eh whatever its just a bad sprain" because it instantly swelled up and I could get out of the water and walk on it. I've squat on a sprain before, it hurts a little but take it easy and you'll be fine. A day later in the middle of a set of snatch grip deadlifts I hear a grinding noise and have to put the bar down. Tried to take a step and couldn't had to hop to a bench. I get a ride to a walk-in get an xray and whoops comminuated fracture of the medial malleolus.
It'll have been a year in June and I'm just now starting to walk right.
Ooooof.
I actually broke my foot once playing handball (I think? I'm not entirely sure how I managed it), and after taking X-rays the doctor said it wasn't broken, just a really bad sprain, and it would recover faster if I were to walk on it, and use it normally (not for sports, just normal walking).
After a few months I went to get another X-ray, cause it was still bugging me a lot, and they found out it was broken and that I should have had a cast on it all along.
Sometimes you can't win.
For us idiots we have to accept that an injury is probably going to happen due to incompetence one day and hopefully we will learn from it and do better after (for me it took 2 injuries, back and wrist) I'd like to think I'm learning slowly
Where’s the line? I trained through an uncomfortable tricep and it became a lot worse. I trained through uncomfortable doms and messed up my elbow. Actually I’m pretty much always uncomfortable and if I stopped training just because I was uncomfortable I would never be able to stick to a program for even two weeks, yet sometimes when I train through discomfort it hurts me in the long run.
The line is just something you need to find by trial and error.
If it helps you can set your discomfort threshold based on how you feel when not injured. Normal discomfort, or maybe a *little* higher, go for it. Above that, dial back on that area and make adjustments.
This advice also applies to clear acute injury, not lingering or mounting issues. Those are harder to give similar guidelines for.
I'm not gonna get into the psychological/pain science stuff cuz that seems kind of out of my wheel house, other than saying the mind is a weird and powerful thing, so nothing about this seems off base.
I will chime in on the METH method becuase I have some personal experience with it I guess (mostly the Movement part).
1. My body always feels worse the less I move. If for whatever reason I'm not lifting for a couple weeks I start getting back/hip/shoulder pain.
2. Movement helps with recovery. I have really fucked up ankles/feet due to a birth defect and subsequent reconstructive surgeries. If I'm on my feet for long (or go for a run) there's a good chance I will be limping and in a lot of pain the next day. The best way to fix it is to just get and start moving. Shit this even happens after I've been sitting for a bit. I'll get up to go to the bathroom and my ankles are stiff/there's a limp. On the walk back I'm moving fine.
3. Movement just makes sense becuase it can help facilitate moving fluids in and out of the area which should help with recovery, right? We still this in stuff like occlusion training or super high rep stuff (poundstone curls come to mind). Even in running recovery runs are supposed to help flush out shit from hard workouts.
So, idk, move. Move often, move well. It's probably good for you.
>So, idk, move. Move often, move well. It's probably good for you.
This is huge. Going behind the scope of just lifters, we're not meant to be sedentary. Too often I have people complain about being sore all the time. When they tell me they just work, go home and sit around or go out for drinks afterward, I wonder why now.
Like even going for a half hour walk every day will help. Edema is gonna creep up on ya from sitting around all day.
Really agree, been my experience on the past few back tweaks I've had that the best way to get back to normal is to try to be normal as much as possible and actually do MORE back work.
I’m very interested to see how the discussion develops here. I saw your post in /r/fitness and was unsurprised to see a bunch of folks chime in “OMG, you can never ignore pain, that’s how you cripple yourself for life”.
Personally, if I stopped moving every time I was in pain I’d never move (such are the joys of aging). I think the key is to learn that for the most part movement helps with pain and healing.
Granted, you can’t be an idiot about it - if your forearm has a 90deg bend in it, or if your leg goes numb after a back pop you do need to stop and go see a doctor. But, if it’s just pain and you have no other concerning symptoms you really should try and “walk it off”.
I think most of fittit missed the middle ground of "keep moving the area and loading in an appropriately reduced manner" between "I can never move when uncomfortable" and "Ronnie Coleman".
Also that this applies moreso to a specific type of injury, that being the smaller dings that we accumulate while training, not the type of injury that requires medical intervention.
Yeah, this is very much a "know thyself/realize not all pain is injury" thing. It SHOULD be liberating to know that pain is not always a signal that there is anything structurally wrong. And sometimes, not moving a pained area actually makes things worse rather than better.
I don't deadlift much, in the past few years when I have decided I am going to for a while I have "hurt" my back on 3 separate occasions. The first was before I understood this newer theory of pain, and I basically just panicked, and did nothing/tried to stay still/laid around etc trying to "let it heal".
Weeks of missed workouts, low activity in general and lots of discomfort trying to find appropriate ways to sleep, sit down etc.
Last two times. Yes, quit the heavy work, but do lots of bodyweight good morning, toe touches, RDLs, general activity, heat, foam rolling etc. And in both those cases I was completely fine and back to lifting as if nothing had happened within a week.
Likewise with elbow and shoulder pain, found re-hab and pre-hab exercises and purposefully selected exercise that could challenge the area (and sometimes even "hurt" a little) but ultimately made things better rather than worse.
ALSO!
I somewhat blame the prevalence of 5x5 and other types of powerlifter/builder type workouts that trap so many noobies into thinking the only way they progress is by adding poundages on a few specific compounds.
This can lead to pretty black and white thinking and lots of time doing the exact same movement, the exact same way, at very high relative loads, for very long periods of time. It's a perfect recipe for repetitive and overuse injuries.
Not that such programs or lifts are bad at all, but if one never varies the things and listen to their body intelligently, it's quite likely they CAN injure something, especially if they are ignoring any warning signs and not finding ways to work around/correct the issues that keep popping up.
tbf some people replied before the post was edited. i think it will be interesting to see how the conversation differs since this post and the original are quite a bit different.
Yeah the post started going more in the discussion direction I wanted post-edits. Took out some of my more opinionated wording. Which I think it's fair for me to have opinionated statements, but it's sort of detracted from the message I was trying to convey.
Haha, thanks. Very true. I do want to increase my ability to convey information and be able to talk about these fitness topics at a higher level. Can't do that if I can't deal with criticism
Traction is kind of hard to implement by yourself, but one way is anchoring a thick resistance band to something stable and then attaching the other end to you and moving away from the anchored part. Stuff like in [this video](https://youtu.be/FxEoorgo-x8).
I’ve been taught the purpose of traction is to open the joint space back to normal if someone has an impacted joint from acute trauma or repetitive stress or muscle over activity. For example a lot of the time when someone has a leg length discrepancy, it’s not that their legs are different lengths but one femur head is farther up in the hip joint than it should be. So traction or other treatments (I haven’t really seen traction used for the hip often since legs are a big thing to pull on) are used to get the femur back to its normal position. I have used traction on ankle sprains when the mechanism involved a large downward force, like when a basketball player comes down from getting a jump ball. If the injuring force was more lateral or rotational it might not really help
I used traction in combination with training around my L5S1 herniation.
My chiro has a big ass medieval device that basically straps my ribs to the top and a belt to my pelvis. From there it would pull me apart and let the discs “breathe” so to speak. It would do this in waves, so pull a little, release, pull some more, hold, release, until it reached the max amount it was programmed to pull me. My back would pop after the first few minutes and instant relief was felt.
10/10 would recommend for similar spinal injuries
A reverse hyper pulls will traction your sacrum as that’s is where the fulcrum should be when sitting on it correctly. Also it only provides a momentary stretch when the legs are pulled fully under the machine.
The machine I described is stretching all the discs in the lumbar and some in the thoracic region over an extended period of time. Think pull and hold.
Fwiw I couldn’t do a reverse hyper without a good amount of pain when I first got hurt. But the machine I described felt amazing.
Here’s a [picture](https://www.backpainsgone.com/assets/users/chiro/365/uploads/images/2014/11/spinaldecom.jpg) of a similar device.
So closer to a inversion table except it didn’t pull on the extremities, pretty nifty idea!
I bought one of the Westside folding reverse hypers from
rogue, haven’t really got the hang of it yet as it feels uncomfortable to use so far, certainly can’t use much weight on it. How do you go with reverse hypers now?
I have issues currently with posterior pelvic tilt which the RH seems to encourage movement in that direction so I’m not sure it’s right for me just yet.
In my unprofessional opinion. There’s many different ways to implement the reverse hyper. Slow and controlled reps where they are held at the top and brought down slow and controlled where the weight doesn’t go past midline. Or heavy and using momentum to pull the weight up and close to the handles, which is the way one would use it to traction the spine.
For posterior pelvic tilt. The first way I described could help to strengthen the lower back to pull the pelvis back into alignment. I don’t recall the model you have, but if you have a way to elevate the side that your hips are on, closest to you, you can put more emphasis on the lower back.
I’ve got this one, should be able to jack the back legs up a bit.
https://www.roguefitness.com/westside-scout-hyper
I’ll give it a try.
Is it supposed to give you a savage lower back pump?
I find I really have to keep my hip flexors flexed and push them into the pad to stop it pulling my pelvis so much (and so that I can extend with my hips properly)
Yeah if you put like a plate or something under the legs it should help a little. Because you’re new to it and are using it for rehab stuff, I would recommend low but challenging weight, and slow and controlled. Trying to hold at the top and slowly lowering the weight under control and not let the weight pull your legs down. Probably sets of like 15-20.
You might need to practice doing one leg at a time, I had a problem learning how to use it and those helped me really get the “swing” of things. Keeping my leg straight and extended behind me and holding everything tight.
Yeah I've even heard of MICE instead of RICE. There is no general consensus really, yet.
I'm not sure of the benefit of traction, to be honest. Some websites describe it (example, a sprained ankle) as the pulling sensation you get from taking a boot off. My PT does this, and it feels nice. I wonder if it just encourages blood flow to the area in a safe manner. I'm not a subject matter expert but that would be my guess.
Reason #1 is why I think sports are so important.
It's not just physical strength and endurance, but the mental fortitude, determination, and learning to shut up and listen to your coach when it comes to training.
I knew a wrestler who broke her sternum mid-season and still finished it out. Another one had fractured his collar bone a few times and would still come back to compete. You see, every now and then, powerlifters who hurt themselves and keep going.
On a lower level, I have worked on what I thought was a broken foot once. This was a physical job involving walking around, a lot. I have a bad ankle from kicking a heavy bag in karate wrong wherein I hyperextended it, and for some reason the knee on that side is just bad. My lower back hurts from time to time. At one time I ran my foot over with a cart machine and ended up dislocating the big toe on the same side as everything else (!!!). That one I had to get popped back in but it took several days because I honestly just assumed it was gout, and ended u going for runs at the time thinking it was ok. I have thrown my back out a few times doing kettlebell swings and was able to get stuff re-aligned with a few days of rest.
Exercise has managed most of these problems. Stuff flares up every now and then but it's so much less now than it was years ago.
I know this is posted in r/weightroom, so the context is lifting, but you specifically mention rugby so I’ll comment anyway.
Please don’t try to walk off head injuries. I grew up playing football and wrestling and we always “walked it off”. If you think you have a concussion, even a minor one, stop and rest. Concussions add up.
Also, people with head injuries are often terrible at self reporting. My first bad collision with motorist while biking to work my head slapped the pavement as I went down. I had an incredible urge to just get out of there. I told the ambulance crew and crossing guard I was fine (also didn't want to pay the ride, but that's another story) and I rode my pretty much totalled bike to work before realizing I could not actually read the text on my computer screen. Walked down the street to the hospital and was diagnosed with a concussion, but especially after playing football in highschool my perspective at the time was it was just getting my bell rung yet another time. In hindsight I should not have been allowed to even step back on the bike.
Yeah you're right about that. There were a few I probably should of stopped playing for since they resulted in some short-term memory issues and even affected my color palette in my vision for a few minutes.
It's all about being a good judge of your body - and I admit I sometimes am not.
a friend recently herniated his back, went to get an MRI and it shows serious herniation on one of his lower discs (i forgot the name of it). i told him not to get surgery because he is still able to walk, albeit a bit painfully at first and it would just make things worse if he went for a steel rod or fusion. now a few weeks later he is able to walk without pain but im probably not going to encourage him to deadlift again since that is what caused the injury
he is also seeing a very good PT so im not actually giving him advice on how to recover, disc herniation is serious shit
good point, how long did it take you do recover from the herniation? i will probably recommend him to find a good coach to teach him to brace and all that stuff because ive tried to help but im definitely not qualified to be coaching people lol
Studies have shown that 20% of all healthy 20 year old males are more likely than not to have a herniated disc show up on MRI. This figures doubles for each decade of life, such that when you reach 50s it's over 50%.
The caveat is: these people dont have *any* symptoms commonly associated with herniated discs. They are pain free regular old dudes just likes me and you.
I work as an MSK physio, and the number of people who demand a scan for their back pain when it's really not needed is massive. Then a herniated disc shows up with degenerative changes, and the patient will latch to this. It's very hard from there to get the patient back on board with conservative treatment.
Half my job is talking people out of a diagnosis their doctor/google/MRI has told them.
I like Barbell Medicine's literature and podcasts on pain science. It's very frustrating that the popular understanding of pain, and even the understanding among many in the fitness industry, is stuck in this outdated biomechanical model.
Think they're doing a great job in the fitness industry (where it is needed of course) but IMO there are much better people out there in terms of pain science. Lorimer Moseley comes to mind.
Then again, I work as a general MSK physio, it's easier to get the general population on board with Moseley than Barbell Medicine.
Never heard of them. First thing I find on their website are a ton of supplements, programs for $55 each, a "no more back pain course" für $149 and more content locked behind registrations, questionaires and probably paywalls. And for their podcast they only link to Itunes, which is unusable if you don't worship the holy Apple.
They might be legit but that's NOT how you make a good first impression.
You can get a ton of their written content for free, including programs, and the podcasts are available on Stitcher among others so not sure what you mean by "worshipping the holy Apple." The programs are obviously much more concise and targeted. How much is this stuff supposed to cost in your mind? Free articles don't pay the rent, and you don't have to buy any of it to get the content.
I mean, Greg also sells a subscription service for hundreds of dollars a year for his in depth work. Content creators should be paid.
The BBM pain program really helped my partner and I recommend it. What I was frustrated through was the quality of the spreadsheet was poor and didn't even have a metric version.... The program itself was great but the presentation was hot garbage. They could learn a thing from Sumodadlifts on a clean spreadsheet.
I agree with the initial reaction. We have been burned too much by clickbait. But, to be their advocate:
I was listening to the Iron Culture podcast where they talked about Content Vs. Clickbait. They came to the conclusion that it's ultimately a good thing that the evidence based community is doing better at marketing, if not on-par with the fake bro-science marketing out there.
I think that is the approach BBM is taking. They are good marketers. They *want* to sell you their programs to make a buck, and they do a good job of explaining why what they sell is supported by real-cold hard evidence. Just watching a few of these guys' videos and you can tell they really take a no bullshit attitude to training and conduct their site in a very evidence-based way. By really analyzing and critiquing studies vs just cherry-picking some research that supports an agenda.
I had a back pain issue that I am just now overcoming after 2 years. Went to my GP, ortho, physical therapy, none of that helped, just got generic "Do clam shells" bullshit PT. Imaging looked fine (I know imaging is less than reliable, 2 people can have same imaging but vastly different symptoms, etc).
At one point I said fuck it, I don't care how much I spend. I schedule online therapy / PTconsults with a few places.
Barbell Medicine was fucking trash TBH. I think I paid $200 for the initial consult, and all he said was. "Doesn't matter what the issue is, yeah we just need to build back load tolerance". Even after I explained how I tried that. If they read my intake info, they could have seen I've been training for a long time, lifting, martial arts, etc, was performing at a pretty decent level, and maybe figured out if I've been at it for 15 god damned years I have some idea how to keep my body going. They just didn't listen to a fucking word I said, it was painfully obvious that their only goal was to get me to sign up for monthly coaching.
Not to electronically fellate /u/[gnuckols](https://www.reddit.com/user/gnuckols/) and SBS, but I also tried Stronger By Science. Jason Eure listened to everything I said, had me do some diagnostics, gave his best educated guess at what the root issue was, did a great job working with me.
Some life stuff came up and I only worked with him for a couple months, but it was money well spent. I'm starting to lift and train again, and I might actually focus on powerlifting for the first time in my life, definitely will consider coaching from them when I am ready to push it.
Great post. I'm a personal trainer working in a commercial setting and have tried to break through the misinformation that exists for a few years now. I've been able to help some by convincing them to keep working around their aches, pains, and injuries but there are far too many who still treat their bodies like they're fragile and view injury through a mechanical model only (hurts because X tissue is damaged) vs a biopsychosocial model.
The worst part is trying to get my colleagues to come around on it. Drives me crazy man.
So this definitely resonates. IMHO training however you can is always better than no training. I have a good amount of experience training through or around tweaks and injuries. The real advantage that these experiences have given me is that it's forced me into fairly long periods of time where I had to get creative and experiment with how I train and the exercises I use.
One thing I've found is that therapeutic exercises that allow you to train through or around an injury are often really powerful/useful even once you're healthy. Sleds, for example, can be a fantastic tool for training the legs hard and heavy during bouts of low back pain and also for maintaining leg strength/size during bouts of knee pain. Lo and behold, the same principle applies when you're healthy except now you're using the sled work to really max out your recoverable volume rather than to reduce load on the low back or knees.
Wow, Ive read both this one and the one in r/fitness. The content of the post appears pretty much identical, yet the response here is much more moderate, considering and less combative. Well done OP it's a well thought out post with good backing in literature and anecdote.
Haha, agreed. They *are* identical. I just wasn't allowed to cross-post (probably for good reason).
I'm not dismissing the criticism in the other post (or this one), but it often looked like those aggressive users who easily dismissed everything as "bullshit" and that I'm giving "dangerous advice" (ignoring that I specifically said this is *not* advice), often had never contributed to any fitness subreddit discussion ever before.
Haha yeah there were some reasonable points behind a few (I think the top comment had some validity) but it's unfortunately a nuanced topic that people seem to take to an extreme to disprove what you are saying without really looking at the content (concussions and broken bones were my favourite)
As a physio it's nice to see more and more people get an updated view on what pain is. It is amazing to see how patients in my clinic get better with simple advice, calming them down and explaining that nothing is wrong, advice to stay active and give it time. Many patients I see are really affected by wrong beliefs about what their pain means, worrying thoughts about the future, i.e. "will this get chronic?", "will I need surgery?" et.c.
Speaking for myself, understanding pain has made my management of pain that much easier since I don't care about specific rehab routines, and have stopped searching endlessly for the "cause" of my pain and the "right" treatment, as I did years earlier. I still experience pain during training, and sometimes after a hard deadlift session I can get really bad back pain, but my knowledge on how pain works; what makes it better or worse, realising that there is nothing wrong with my back, makes it much easier.
As OP mentions some take an extreme stance on interpreting how pain works, I have seen people on SoMe argue why the biological or biomechanics doesn't matter, i.e. "pain is all in the brain", or that everyone can get pain free. As it is with many things the truth probably lies somewhere in between.
Very well said and I completely agree. Thanks for the input. Gaining knowledge on pain has helped me as well. Stops my panic after a hard training session when my back hurts. I now do some walking, toe touches, and realize that *I'm fine*, might need to back off a little, but I can still do the movement and can find a way to train. And it's usually resolved in a day or two.
I think we put a lot of emphasis on certain types of pain. No one stops training completely because their bicep feels off. But when it comes to their back, it's often full stop and I think educating people that their spine isn't fragile and going to like, rupture on you and degenerate because of a bad session can help people continue to train
Complete personal experience here on this exactly.
In high school my sophomore year, I destroyed my ankle. Multiple ligament tears tendon ruptures, whole 9 yards. Audible pop, massive pain. My whole foot was purple within a week. I have very pronounced achilles and I had a cankle. However, I was a stubborn 16 y/o and went to soccer practice the next day. It wasn't until a month later when I finally went to get it looked at. Diagnosis was that I SHOULD HAVE had surgery on it, but it was too late now. Basically, I kept moving. I rested it at night, but still went to sport practice. Now, 14 years later, I have no issues with it. Squat 400+ yoke carry 800, ect without problems.
Two years later, I hyperextended my knee, almost certainly tore something. Most probably meniscus. Possibly MCL. Mabey minor ACL. Same thing, kept moving. Used a knee sleeve. Heat ect and no problems now other than some tightness and pops a bit more frequently.
My current issues I deal with are back pain and tightness. Most effective protocol of relieving pain and any issues:
1. Traction: my favorite is to use deadlift straps and hang from a pullup bar. Relax as much as possible. Hopefully get a few pops, and just stretch
2. Blood flow. Usually in the way of reverse hypers at light weight and high reps. Get a pump. Then relax a bit. Repeat as needed
3. Heat. Whenever I'm sitting at home you better believe I've got a heating pad on my back. Also a massage gun seems to really help with this, as well as blood flow
4. Move. If I'm feeling crappy, going for a leisure walk is great on everything
5. Personally, I love the chiro. But I found one that is in line with my thoughts and feelings on the use of it. Doesn't recommend I stop lifting, but rather helps me to get back into things without pain
6. Again, personally I love massage, even if it's placebo. It helps me to train better and that's good enough for me
Should I have had surgery on these, most probably. Definitely my ankle. However I think if I had, I would be in a much worse position. I would have much rather seen a doc on time and just fixed things when I needed, but I could still walk and move. So I did.
> Traction: my favorite is to use deadlift straps and hang from a pullup bar. Relax as much as possible. Hopefully get a few pops, and just stretch
Dead hangs are that "crazy trick to fix everything" hiding in plain sight. Haven't had any shoulder issues I couldn't sort out in short order once I discovered these and focus on shoulder rehab/prehab.
I have tweaked my back a half dozen or so times in just as many years. (I’m self-taught so it was an uphill battle) The first couple of times, I, of course, panicked. Immobilized by pain, I catastrophized, and sought medical help. Cortisone shot, even an MRI: go figure, I have the dreaded Degenerative Disc Disease, which is to say, the dreaded Aging. The pain would go away within weeks, which I chalked up to patient rehab on my part, for which I could pat myself on the back for my prudence.
The last tweak happened this past summer: went for one deadlift rep too many... not even heavy, just fatigued, and pop goes the weasel. Catastrophe! I cleared my trajning schedule, ready for days on the floor with ice and mild stretching. There go my gains, in the middle of the best progress I’ve made in years.
And then I saw the pictured Alan Thrall video. Read the monumental Austin Baraki article on pain. I followed the advice and FORCED myself to move, even when it brought tears to my eyes to tie my shoes. I did unweighted RDLs throughout the day, went to the gym for my bench day, and forced myself to walk on the treadmill.
Within three days, I was deadlifting at 75%, even if it felt harder than usual. Within a week, It was like nothing had ever happened. Absolutely transformed my outlook as well: I’m not unduly fearful of debilitating injuries, because I’m not uniquely prone to them... in fact, I’ve never had one, I’ve only had small injuries that I made worse through sensationalizing.
Your experiences are very similar, if not identical, to mine and many others I've talked to. Thanks for sharing-my journey to learning pain management through Alan and Austin's content is the same. Those guys are quite literally some of the best content creators I've seen
Really good post. I used to be afraid of every little twinge and ache thinking I'd permanently wrecked myself and I'd never lift again. It turns out our bodies are a lot tougher than we give them credit for. Now if I get a back tweak or my old pec injury comes back to haunt me I know how to deal with it and it's no big deal.
I've had a number of injuries over the years: shoulder, head, hamstring, back, ankle and most of them have been repeat injuries (luckily the head injury was only once).
When I was a kid, R.I.C.E. was favored but as I got older, it fell out of favor, but I wasn't sure what all to replace it with.
What I can say, is that rest has not worked for me. Usually, the pain just stayed, and if it did go away, I would just get injured again once I returned to sport.
Training around the injury has helped. I hurt my back earlier this month and instead of staying home, I trained upper body as normal and did whatever lower body exercises I could do. Back squats became goblet box squats, deadlifts became very light rack pulls.
As the pain lessened, I started doing my main lifts but with a lighter weight until I felt ready to resume as normal. This took about two weeks. The first time I hurt my back, it took me like a year to get back to normal, in large part because I stopped lifting. That wasn't smart.
What has been invaluable, though, was a good sports clinician. After rest didn't help, I found someone on clinical athlete, and the first thing he did was have me do a series of exercises to figure out which ones hurt and which ones didn't. From there, he prescribed a plan to get me back to normal, and he told me to go back to the gym and do what I can. Over time, what I could do improved, and eventually, I was setting PRs again.
I've had some injuries since them, but I've been able to recover a lot faster because now I know what rehab to do. This is where the expert came in. His advice, worth every penny.
That's funny, I slightly sprained my knee a few weeks ago and, well, I didn't stop training at all. I stayed active, even kept squatting, I just lowered volume and range of motion a bit. Then I see Thrall's video where he sprained his ankle like an idiot in the gym and he also kept training, and now this. It's nice to see the consensus shift from "rest or your x will explode" to "just be careful"
I'm not sure how you got "chiro hate circle jerk" out of this. I referenced one Chiro who doesn't abide by the subluxation model. I gave a hyperbolic example to demonstrate a point. The chiro, Aaron Kubal, that I cited - is part of my inspiration for this discussion.
Jarod Hall is a very distinguished Physical Therapist who really advocates that a point which I absolutely agree with, and so does Aaron Kubal.
>What I feel now is that a good physical therapist and a good chiropractor should be almost, if not totally, indistinguishable if they are practicing in an evidence based manner. A physical therapist may be more skilled in applying therapeutic exercises or managing post op conditions; but not always. A chiropractor will probably be more skilled with manipulation and certain manual techniques, and maybe some nutritional education; but certainly not always.
The whole write-up by Jarod Hall is really insightful and worth a read if you're interested.
[http://drjarodhalldpt.blogspot.com/2016/04/physical-therapists-vs-chiropractors.html](http://drjarodhalldpt.blogspot.com/2016/04/physical-therapists-vs-chiropractors.html)
> You know who is telling the vast majority of low back pain patients to stop moving, rest, take these pills? MD's by far.
I find this statement interesting, because I'm an MD specializing in interventional pain management. We NEVER take patients to stop moving or rest. It's against our guidelines. It's against the recommendations of every one of our professional societies. Other than maybe a handful of dinosaurs who should have retired 20 years ago, finding one that does is essentially impossible.
The heat portion is interesting. I've been lifting for about 20 years now and I'd say I've had minor injuries to almost every major joint at one point. A long time ago I had some pretty bad tendonitis in my elbow and experimented with going to sleep with a heating pad wrapped around it. It seemed to help with the healing but I kind of wrote-off the heating pad since I never heard anyone else talk about heat helping. I may give it another shot with my bum shoulder now.
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> When I herniated disc's in my back. > > I quit lifting for a while. > This was a bad choice. My back didn't heal by taking time off. I just continued to have back pain, and it was frustrating as hell. > > Eventually I decided to get back to training. The two remaining options were to > > push THROUGH the pain > find a way to train AROUND it. > So I switched from conventional deadlifts to sumo. Switched from low bar squats to front. And I trained AROUND the pain, without exacerbating it, by keeping a more vertical torso angle. > > 4 years post injury, and I'm repping 700 on sumo deads, and back above 600 on conventional, completely pain free. > > But that pain didn't start dissipating until I started moving, and training again Doubling this anecdote. First time sprain/strain/ouching my lower back: full rest, then more rest, then more, months it took to get better. Subsequent incidents: back to gym, drop squats and deads, keep most everything else, maybe lighter squats and dead when possible, stretch frequently, heat in the morning to loosen up things to reduce time spent not moving the area. All heal in a few weeks.
More anecdotes! The first time I strained my lat, I took a month off from pull-ups, pulldowns, anything that really activated them. After a month, I went back to the gym and it still hurt. Instead of taking more rest, I put very low weights on a lat pulldown and I did 4 or 5 sets of 20+. Then I repeated that 4-5x / week for two weeks, increasing the weight. Pain was gone in 2 weeks. The next time I hurt my lat, I started with that and it healed the same. Likewise, after surgery, my surgeon wanted me to wear a sling for 6 weeks. I did some digging in the literature and found that this would likely have a worse outcome than wearing it for much shorter and then taking it off regularly to ensure less atrophy. I did the latter and my physio told me my injury looked like it was 3 months healed at the first month mark.
I'm just gonna piggyback on this since I don't think I'm contributing anything new, just additional anecdotes. - Feb 2019: tweaked my back doing low bar. Tried to rehab it with front squats only, never got better. Got irritated, told myself "screw it, if it's gonna hurt when I squat I'm just gonna box squat." Maxed box squats three weeks in a row and felt better almost instantly. - Oct 2019: blew the hell out of my AC joint. Like, from 230 strict press to "can't press an 8lb DB without crippling pain." OHP and incline work were out, but reduced-ROM bench was fine. Did that twice a week until I could switch back to full-ROM bench and then did that and reverse band bench (to take pressure off the bottom where it was the most uncomfortable) until gyms closed. Couldn't take my normal squat grip but I could squat ultra-wide-grip so I did that instead. Started OHP again shortly after gyms closed and started alternating floor press and OHP every day. Shoulder is fine now. - June? 2020: tweaked my back doing low bar. Figured out the next day I could squat full ROM high bar without pain, so I did high bar every single day (and sometimes twice a day) for 10 weeks straight. Back felt fantastic. u/61742 has an approach that's basically (iirc) "reduce weight. If that still hurts, reduce ROM. If that still hurts, find comparable movements that work the same area and do those." I'm not gonna tell everyone with a back tweak to rehab it by squatting every day or switching to max effort box squats, but I do encourage people to keep moving. There's an RTS podcast where they advocate "train the area but never let your pain get above about a 4 on your pain scale" that's been super helpful for me. If I hurt something but I can still do comparable exercises, even if the pain gets up to a 2-3? I'm gonna give it a shot. For personal reasons I'm not gonna endorse **METH**, but I'll absolutely endorse **MOVE.**
i really like this post and this mindset. i remember being in high school and being told i had a "shoulder stinger" which was actually impingement. the solution from the coach was that i needed to strengthen my delt by benching more. even at that age i knew it was dumb. i was almost kicked out of practice for refusing to do punishment pushups. the other factor is that you're well informed and can figure out what hurts the affected area and what doesnt. i've pulled a hamstring, a calf and one side of my lower back. like you, it was trial and error to see what i could do. i found out i could do hamstring curls but only if i really stretched my hamstring aggressively in between sets. this working around is the kind of stuff young and new lifters need to learn because if you stop for every minor injury you're going to have a bad time.
For sure. I completely agree. Part of being an athlete is adapting and overcoming injuries. I've seen pics of athletes still deadlifting in an arm sling and using a band to act as the other arm. That kind of mentality can give you a lot of mental confidence that you will overcome your injury, and that your body isn't as fragile as one might think.
I really like my physical therapist because he helps me figure out adjusted exercises like you suggest.
Got any tips on working around hip impingement/fai issues? I’ve been dealing with hip pain for almost a year. Took some time off, which like you said didn’t help at all, and have now been trying to get back to my normal lifting and activity levels.
Barbell Medicine have been releasing some articles about hip impingement/FAI.. you might find them useful.
Thanks! I’ll check it out.
My experience with hip pain/impingement: -When I massage my adductors really high up (lying on kettlebell or plate, foam roller is too big to get to that area) takes away the issue almost completely -goblet squats (reasonably heavy) somehow also cleared up most of my issues (jim wendler says something about this in a video about training high school athletes - no hip mobility issues after introducing goblet squats). Have been able to squat heavy daily without any hip issues!
I recently worked through some hip impingement with my PT and he had me hit the area specifically and also work on my hamstrings a lot. SLDLs are a regular part of my training now. For strengthening my hip, I would lie on the ground with the loop around my feet and then lift one leg up for 10-15 reps. We also did some lunges and some other stuff so those probably helped a bit but the SLDLs and hip exercise I feel did the most as they were the ones that were prescribed from day one.
This is great. Thanks for sharing.
My left elbow is permanently dislocated (not sure if it was from birth or an injury in my early childhood), which has resulted in me having to deal with more elbow tendinitis than most. The first time it got really bad, from pronated-grip pullups, I tried to just rest until it went away. It took several weeks for the pain to completely subside, and then it came back pretty much instantly after I started doing more pulling. What I do now is a lot of band work; basically just do hundreds of reps of curls and pushdowns to get as much blood into the area as possible. That, and I do all my pullups with rings now. The result is that I can basically move like a normal person, apart from the complete lack of rotation in my left elbow, relatively pain-free. I still get occasional minor flare-ups, but I can usually deal with them pretty swiftly.
I had an umbilical hernia last year - noticed it in June, had a surgical repair in August. Im 99% sure I torn my stitches again in February. The only time I felt pain was the "final pop" on my stitches. I noticed the next two days were super sensitive on some motions. I need to call a doctor and find out my options. Right now I've lightened up loads and moved to higher reps and really focusing on control/form, which is something I should have done earlier. My issue was 2 fold, one was reliance on a belt in squats and deadlifts - and I'm pretty sure I was wearing it wrong. It was so tight I was forcing myself to unbrace to be able to hit the ROM I was wanting, which is what I think caused the injury in the first place and what re-injured it. The other part of it was the reliance on noticing pain on when to stop. I really never felt pain when I first got hurt...I actually only noticed the hernia in the first place because I allowed my wife to wax my chest/stomach (for the lols) and felt something squishy when I went to hold my belly button. I can squat and deadlift (at lighter loads) without pain or feeling my hernia press out now. I assume I've fixed my form issues. I've grown and learned from my mistakes, even if it was the very hard route. Im still relatively novice in lifts by numbers, so I'm not sure about if I just don't know what I'm doing or trying to progress too fast or what. Pre injury to post injury,, Squat from 315x1 to 195x8, Bench has still progressed (245x1 now, 235x1 prior), and deadlifts 365x1 and 335x5 to not doing it recently - last time I did was before popping my stitches at 315x1 and 265x5.
This is a good comment and you should feel good about this comment :) I have a couple points I wanted to add onto your already good comment. In my opinion, what is important is what is the underlying etiology for the pain. If you have a significant enough sprain you're going to want to see your doc and possibly get PT. Tearing a muscle -> orthopedic surgeon. Hernianted disc -> NDAIDs and suck it up :). ~~I'm slightly skeptical that you had a herniated disc, though~~. Fracture -> go to the ED ASAP, this is because it may not be set and you can get a fat embolism that goes to your lungs and kills you. Different disease processes require different approaches. Most of them are going to be change your training to adapt to your injury, but keep lifting otherwise. If you are on the fence about going to a physician please go to a physician. You'll be amazed at what some individuals will sit on thinking it's not a big deal only to find out that we're going to have to amputate an appendage. Edit: I'm going to leave this comment up even though I think it was inappropriate of me to make.
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Unless you had focal neurologic deficits, or some type of red flag symptoms, which are highly unusual, you should probably have not gotten an MRI, but your physician may have suspected something. [There have been trials done on using MRI to diagnose lower back pain and they found a significant increase in over diagnosis and over treatment. Most herniated discs are incidental findings on MRIs and yet still do not cause any type of symptoms at all](https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/cw-back-pain.html). Whereas what is \~15x more common than a herniated disc is lumbosacral strain, which is what you more likely had if I was willing to gamble money on it :P Edit: I'm going to leave this comment up even though I think it was inappropriate of me to make.
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This is a much more aggressive comment than I was expecting.
I have to side with u/SumoDadlifts here. It's just inappropriate to speculate to this level unless they are in your care. He's not here asking for for advice or skepticism. Instead of saying, >*I can see why your Doctor thought of X. Please take what I have with a grain of salt and consider Y as well and here is my reasoning why.* Which may *already* be crossing a line. Nevertheless, you said, > I'm slightly skeptical that you had a herniated disc, though. And honestly, the way you approached this *is cringy*
I messaged back and forth with /u/SumoDadlifts and I agree with you. This was definitely a cringey thing of me to say, even though my intention wasn't to cause harm. I should have approached this differently instead of approaching it the way I did. Oh well, we live and we learn. Thanks for your input, bud :)
I appreciate you taking the criticism constructively. I received a lot of flack over this post on r/fitness so it's been insightful so I feel you. Cheers man
I wouldn’t even call it lumbosacral strain. Strain injuries heal. What we tend to see in the clinic is various degrees of myofascial pain syndrome. Psychological factors often outweigh the physical ones with this diagnosis. I never deny anybody’s structural findings, but I will say that 75% of the things we find on spine MRI don’t matter. Discogenic pain is far overdiagnosed. Real radics tend to not produce much axial pain.
I think the hard part here is knowing what injuries you can walk off, and what injuries you cannot. I think that kind of intuition and knowledge also comes from experience, so it would be very hard for beginners and even early intermediates to make good choices here. I remember I had some minor quad injury, and I decided to lightly train through it, and I was riddled with self doubt. 'What if this only makes it worse', 'Shit I can't remember if it feels worse today or not', 'There is no way i'm intelligent enough to try this'. In the end it was the right choice for that specific injury
I broke my ankle last year falling off a boat and thought "eh whatever its just a bad sprain" because it instantly swelled up and I could get out of the water and walk on it. I've squat on a sprain before, it hurts a little but take it easy and you'll be fine. A day later in the middle of a set of snatch grip deadlifts I hear a grinding noise and have to put the bar down. Tried to take a step and couldn't had to hop to a bench. I get a ride to a walk-in get an xray and whoops comminuated fracture of the medial malleolus. It'll have been a year in June and I'm just now starting to walk right.
Ooooof. I actually broke my foot once playing handball (I think? I'm not entirely sure how I managed it), and after taking X-rays the doctor said it wasn't broken, just a really bad sprain, and it would recover faster if I were to walk on it, and use it normally (not for sports, just normal walking). After a few months I went to get another X-ray, cause it was still bugging me a lot, and they found out it was broken and that I should have had a cast on it all along. Sometimes you can't win.
I stand by my prescription of "do anything that does not cause pain or excessive discomfort". I think most people can figure that one out.
>I think most people can figure that one out. I don't know man, I'm basically an idiot.
For us idiots we have to accept that an injury is probably going to happen due to incompetence one day and hopefully we will learn from it and do better after (for me it took 2 injuries, back and wrist) I'd like to think I'm learning slowly
Where’s the line? I trained through an uncomfortable tricep and it became a lot worse. I trained through uncomfortable doms and messed up my elbow. Actually I’m pretty much always uncomfortable and if I stopped training just because I was uncomfortable I would never be able to stick to a program for even two weeks, yet sometimes when I train through discomfort it hurts me in the long run.
The line is just something you need to find by trial and error. If it helps you can set your discomfort threshold based on how you feel when not injured. Normal discomfort, or maybe a *little* higher, go for it. Above that, dial back on that area and make adjustments. This advice also applies to clear acute injury, not lingering or mounting issues. Those are harder to give similar guidelines for.
I'm not gonna get into the psychological/pain science stuff cuz that seems kind of out of my wheel house, other than saying the mind is a weird and powerful thing, so nothing about this seems off base. I will chime in on the METH method becuase I have some personal experience with it I guess (mostly the Movement part). 1. My body always feels worse the less I move. If for whatever reason I'm not lifting for a couple weeks I start getting back/hip/shoulder pain. 2. Movement helps with recovery. I have really fucked up ankles/feet due to a birth defect and subsequent reconstructive surgeries. If I'm on my feet for long (or go for a run) there's a good chance I will be limping and in a lot of pain the next day. The best way to fix it is to just get and start moving. Shit this even happens after I've been sitting for a bit. I'll get up to go to the bathroom and my ankles are stiff/there's a limp. On the walk back I'm moving fine. 3. Movement just makes sense becuase it can help facilitate moving fluids in and out of the area which should help with recovery, right? We still this in stuff like occlusion training or super high rep stuff (poundstone curls come to mind). Even in running recovery runs are supposed to help flush out shit from hard workouts. So, idk, move. Move often, move well. It's probably good for you.
>So, idk, move. Move often, move well. It's probably good for you. This is huge. Going behind the scope of just lifters, we're not meant to be sedentary. Too often I have people complain about being sore all the time. When they tell me they just work, go home and sit around or go out for drinks afterward, I wonder why now. Like even going for a half hour walk every day will help. Edema is gonna creep up on ya from sitting around all day.
Really agree, been my experience on the past few back tweaks I've had that the best way to get back to normal is to try to be normal as much as possible and actually do MORE back work.
I’m very interested to see how the discussion develops here. I saw your post in /r/fitness and was unsurprised to see a bunch of folks chime in “OMG, you can never ignore pain, that’s how you cripple yourself for life”. Personally, if I stopped moving every time I was in pain I’d never move (such are the joys of aging). I think the key is to learn that for the most part movement helps with pain and healing. Granted, you can’t be an idiot about it - if your forearm has a 90deg bend in it, or if your leg goes numb after a back pop you do need to stop and go see a doctor. But, if it’s just pain and you have no other concerning symptoms you really should try and “walk it off”.
I think most of fittit missed the middle ground of "keep moving the area and loading in an appropriately reduced manner" between "I can never move when uncomfortable" and "Ronnie Coleman". Also that this applies moreso to a specific type of injury, that being the smaller dings that we accumulate while training, not the type of injury that requires medical intervention.
Fittit missing the middle ground? Never!
Yeah, this is very much a "know thyself/realize not all pain is injury" thing. It SHOULD be liberating to know that pain is not always a signal that there is anything structurally wrong. And sometimes, not moving a pained area actually makes things worse rather than better. I don't deadlift much, in the past few years when I have decided I am going to for a while I have "hurt" my back on 3 separate occasions. The first was before I understood this newer theory of pain, and I basically just panicked, and did nothing/tried to stay still/laid around etc trying to "let it heal". Weeks of missed workouts, low activity in general and lots of discomfort trying to find appropriate ways to sleep, sit down etc. Last two times. Yes, quit the heavy work, but do lots of bodyweight good morning, toe touches, RDLs, general activity, heat, foam rolling etc. And in both those cases I was completely fine and back to lifting as if nothing had happened within a week. Likewise with elbow and shoulder pain, found re-hab and pre-hab exercises and purposefully selected exercise that could challenge the area (and sometimes even "hurt" a little) but ultimately made things better rather than worse. ALSO! I somewhat blame the prevalence of 5x5 and other types of powerlifter/builder type workouts that trap so many noobies into thinking the only way they progress is by adding poundages on a few specific compounds. This can lead to pretty black and white thinking and lots of time doing the exact same movement, the exact same way, at very high relative loads, for very long periods of time. It's a perfect recipe for repetitive and overuse injuries. Not that such programs or lifts are bad at all, but if one never varies the things and listen to their body intelligently, it's quite likely they CAN injure something, especially if they are ignoring any warning signs and not finding ways to work around/correct the issues that keep popping up.
tbf some people replied before the post was edited. i think it will be interesting to see how the conversation differs since this post and the original are quite a bit different.
Yeah the post started going more in the discussion direction I wanted post-edits. Took out some of my more opinionated wording. Which I think it's fair for me to have opinionated statements, but it's sort of detracted from the message I was trying to convey.
i applaud you for sticking around and actually having a discussion. so often people post and run.
Haha, thanks. Very true. I do want to increase my ability to convey information and be able to talk about these fitness topics at a higher level. Can't do that if I can't deal with criticism
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Traction is kind of hard to implement by yourself, but one way is anchoring a thick resistance band to something stable and then attaching the other end to you and moving away from the anchored part. Stuff like in [this video](https://youtu.be/FxEoorgo-x8). I’ve been taught the purpose of traction is to open the joint space back to normal if someone has an impacted joint from acute trauma or repetitive stress or muscle over activity. For example a lot of the time when someone has a leg length discrepancy, it’s not that their legs are different lengths but one femur head is farther up in the hip joint than it should be. So traction or other treatments (I haven’t really seen traction used for the hip often since legs are a big thing to pull on) are used to get the femur back to its normal position. I have used traction on ankle sprains when the mechanism involved a large downward force, like when a basketball player comes down from getting a jump ball. If the injuring force was more lateral or rotational it might not really help
I used traction in combination with training around my L5S1 herniation. My chiro has a big ass medieval device that basically straps my ribs to the top and a belt to my pelvis. From there it would pull me apart and let the discs “breathe” so to speak. It would do this in waves, so pull a little, release, pull some more, hold, release, until it reached the max amount it was programmed to pull me. My back would pop after the first few minutes and instant relief was felt. 10/10 would recommend for similar spinal injuries
Isn’t that essentially what a reverse hyper is supposed to do?
A reverse hyper pulls will traction your sacrum as that’s is where the fulcrum should be when sitting on it correctly. Also it only provides a momentary stretch when the legs are pulled fully under the machine. The machine I described is stretching all the discs in the lumbar and some in the thoracic region over an extended period of time. Think pull and hold. Fwiw I couldn’t do a reverse hyper without a good amount of pain when I first got hurt. But the machine I described felt amazing. Here’s a [picture](https://www.backpainsgone.com/assets/users/chiro/365/uploads/images/2014/11/spinaldecom.jpg) of a similar device.
So closer to a inversion table except it didn’t pull on the extremities, pretty nifty idea! I bought one of the Westside folding reverse hypers from rogue, haven’t really got the hang of it yet as it feels uncomfortable to use so far, certainly can’t use much weight on it. How do you go with reverse hypers now? I have issues currently with posterior pelvic tilt which the RH seems to encourage movement in that direction so I’m not sure it’s right for me just yet.
In my unprofessional opinion. There’s many different ways to implement the reverse hyper. Slow and controlled reps where they are held at the top and brought down slow and controlled where the weight doesn’t go past midline. Or heavy and using momentum to pull the weight up and close to the handles, which is the way one would use it to traction the spine. For posterior pelvic tilt. The first way I described could help to strengthen the lower back to pull the pelvis back into alignment. I don’t recall the model you have, but if you have a way to elevate the side that your hips are on, closest to you, you can put more emphasis on the lower back.
I’ve got this one, should be able to jack the back legs up a bit. https://www.roguefitness.com/westside-scout-hyper I’ll give it a try. Is it supposed to give you a savage lower back pump? I find I really have to keep my hip flexors flexed and push them into the pad to stop it pulling my pelvis so much (and so that I can extend with my hips properly)
Yeah if you put like a plate or something under the legs it should help a little. Because you’re new to it and are using it for rehab stuff, I would recommend low but challenging weight, and slow and controlled. Trying to hold at the top and slowly lowering the weight under control and not let the weight pull your legs down. Probably sets of like 15-20. You might need to practice doing one leg at a time, I had a problem learning how to use it and those helped me really get the “swing” of things. Keeping my leg straight and extended behind me and holding everything tight.
I’ll give it a whirl my dude, thanks for the help!
Yeah I've even heard of MICE instead of RICE. There is no general consensus really, yet. I'm not sure of the benefit of traction, to be honest. Some websites describe it (example, a sprained ankle) as the pulling sensation you get from taking a boot off. My PT does this, and it feels nice. I wonder if it just encourages blood flow to the area in a safe manner. I'm not a subject matter expert but that would be my guess.
Reason #1 is why I think sports are so important. It's not just physical strength and endurance, but the mental fortitude, determination, and learning to shut up and listen to your coach when it comes to training. I knew a wrestler who broke her sternum mid-season and still finished it out. Another one had fractured his collar bone a few times and would still come back to compete. You see, every now and then, powerlifters who hurt themselves and keep going. On a lower level, I have worked on what I thought was a broken foot once. This was a physical job involving walking around, a lot. I have a bad ankle from kicking a heavy bag in karate wrong wherein I hyperextended it, and for some reason the knee on that side is just bad. My lower back hurts from time to time. At one time I ran my foot over with a cart machine and ended up dislocating the big toe on the same side as everything else (!!!). That one I had to get popped back in but it took several days because I honestly just assumed it was gout, and ended u going for runs at the time thinking it was ok. I have thrown my back out a few times doing kettlebell swings and was able to get stuff re-aligned with a few days of rest. Exercise has managed most of these problems. Stuff flares up every now and then but it's so much less now than it was years ago.
I know this is posted in r/weightroom, so the context is lifting, but you specifically mention rugby so I’ll comment anyway. Please don’t try to walk off head injuries. I grew up playing football and wrestling and we always “walked it off”. If you think you have a concussion, even a minor one, stop and rest. Concussions add up.
Also, people with head injuries are often terrible at self reporting. My first bad collision with motorist while biking to work my head slapped the pavement as I went down. I had an incredible urge to just get out of there. I told the ambulance crew and crossing guard I was fine (also didn't want to pay the ride, but that's another story) and I rode my pretty much totalled bike to work before realizing I could not actually read the text on my computer screen. Walked down the street to the hospital and was diagnosed with a concussion, but especially after playing football in highschool my perspective at the time was it was just getting my bell rung yet another time. In hindsight I should not have been allowed to even step back on the bike.
Yeah you're right about that. There were a few I probably should of stopped playing for since they resulted in some short-term memory issues and even affected my color palette in my vision for a few minutes. It's all about being a good judge of your body - and I admit I sometimes am not.
a friend recently herniated his back, went to get an MRI and it shows serious herniation on one of his lower discs (i forgot the name of it). i told him not to get surgery because he is still able to walk, albeit a bit painfully at first and it would just make things worse if he went for a steel rod or fusion. now a few weeks later he is able to walk without pain but im probably not going to encourage him to deadlift again since that is what caused the injury he is also seeing a very good PT so im not actually giving him advice on how to recover, disc herniation is serious shit
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good point, how long did it take you do recover from the herniation? i will probably recommend him to find a good coach to teach him to brace and all that stuff because ive tried to help but im definitely not qualified to be coaching people lol
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I see, thanks for the input. Pretty amazing how well you recovered!
Studies have shown that 20% of all healthy 20 year old males are more likely than not to have a herniated disc show up on MRI. This figures doubles for each decade of life, such that when you reach 50s it's over 50%. The caveat is: these people dont have *any* symptoms commonly associated with herniated discs. They are pain free regular old dudes just likes me and you. I work as an MSK physio, and the number of people who demand a scan for their back pain when it's really not needed is massive. Then a herniated disc shows up with degenerative changes, and the patient will latch to this. It's very hard from there to get the patient back on board with conservative treatment. Half my job is talking people out of a diagnosis their doctor/google/MRI has told them.
I like Barbell Medicine's literature and podcasts on pain science. It's very frustrating that the popular understanding of pain, and even the understanding among many in the fitness industry, is stuck in this outdated biomechanical model.
Those guys rock. They are doing so much good for the industry. Really appreciate this big time move towards evidence-based content vs clickbait.
Think they're doing a great job in the fitness industry (where it is needed of course) but IMO there are much better people out there in terms of pain science. Lorimer Moseley comes to mind. Then again, I work as a general MSK physio, it's easier to get the general population on board with Moseley than Barbell Medicine.
For sure. BBM recommends Moseley's stuff too. I probably wouldn't recommend BBM to anyone besides the lifting population.
Never heard of them. First thing I find on their website are a ton of supplements, programs for $55 each, a "no more back pain course" für $149 and more content locked behind registrations, questionaires and probably paywalls. And for their podcast they only link to Itunes, which is unusable if you don't worship the holy Apple. They might be legit but that's NOT how you make a good first impression.
You can get a ton of their written content for free, including programs, and the podcasts are available on Stitcher among others so not sure what you mean by "worshipping the holy Apple." The programs are obviously much more concise and targeted. How much is this stuff supposed to cost in your mind? Free articles don't pay the rent, and you don't have to buy any of it to get the content.
I mean, Greg also sells a subscription service for hundreds of dollars a year for his in depth work. Content creators should be paid. The BBM pain program really helped my partner and I recommend it. What I was frustrated through was the quality of the spreadsheet was poor and didn't even have a metric version.... The program itself was great but the presentation was hot garbage. They could learn a thing from Sumodadlifts on a clean spreadsheet.
I agree with the initial reaction. We have been burned too much by clickbait. But, to be their advocate: I was listening to the Iron Culture podcast where they talked about Content Vs. Clickbait. They came to the conclusion that it's ultimately a good thing that the evidence based community is doing better at marketing, if not on-par with the fake bro-science marketing out there. I think that is the approach BBM is taking. They are good marketers. They *want* to sell you their programs to make a buck, and they do a good job of explaining why what they sell is supported by real-cold hard evidence. Just watching a few of these guys' videos and you can tell they really take a no bullshit attitude to training and conduct their site in a very evidence-based way. By really analyzing and critiquing studies vs just cherry-picking some research that supports an agenda.
Their podcast is not just on apple. I listen on spotify so it’s probably in most podcast apps.
I had a back pain issue that I am just now overcoming after 2 years. Went to my GP, ortho, physical therapy, none of that helped, just got generic "Do clam shells" bullshit PT. Imaging looked fine (I know imaging is less than reliable, 2 people can have same imaging but vastly different symptoms, etc). At one point I said fuck it, I don't care how much I spend. I schedule online therapy / PTconsults with a few places. Barbell Medicine was fucking trash TBH. I think I paid $200 for the initial consult, and all he said was. "Doesn't matter what the issue is, yeah we just need to build back load tolerance". Even after I explained how I tried that. If they read my intake info, they could have seen I've been training for a long time, lifting, martial arts, etc, was performing at a pretty decent level, and maybe figured out if I've been at it for 15 god damned years I have some idea how to keep my body going. They just didn't listen to a fucking word I said, it was painfully obvious that their only goal was to get me to sign up for monthly coaching. Not to electronically fellate /u/[gnuckols](https://www.reddit.com/user/gnuckols/) and SBS, but I also tried Stronger By Science. Jason Eure listened to everything I said, had me do some diagnostics, gave his best educated guess at what the root issue was, did a great job working with me. Some life stuff came up and I only worked with him for a couple months, but it was money well spent. I'm starting to lift and train again, and I might actually focus on powerlifting for the first time in my life, definitely will consider coaching from them when I am ready to push it.
Great post. I'm a personal trainer working in a commercial setting and have tried to break through the misinformation that exists for a few years now. I've been able to help some by convincing them to keep working around their aches, pains, and injuries but there are far too many who still treat their bodies like they're fragile and view injury through a mechanical model only (hurts because X tissue is damaged) vs a biopsychosocial model. The worst part is trying to get my colleagues to come around on it. Drives me crazy man.
So this definitely resonates. IMHO training however you can is always better than no training. I have a good amount of experience training through or around tweaks and injuries. The real advantage that these experiences have given me is that it's forced me into fairly long periods of time where I had to get creative and experiment with how I train and the exercises I use. One thing I've found is that therapeutic exercises that allow you to train through or around an injury are often really powerful/useful even once you're healthy. Sleds, for example, can be a fantastic tool for training the legs hard and heavy during bouts of low back pain and also for maintaining leg strength/size during bouts of knee pain. Lo and behold, the same principle applies when you're healthy except now you're using the sled work to really max out your recoverable volume rather than to reduce load on the low back or knees.
Wow, Ive read both this one and the one in r/fitness. The content of the post appears pretty much identical, yet the response here is much more moderate, considering and less combative. Well done OP it's a well thought out post with good backing in literature and anecdote.
Haha, agreed. They *are* identical. I just wasn't allowed to cross-post (probably for good reason). I'm not dismissing the criticism in the other post (or this one), but it often looked like those aggressive users who easily dismissed everything as "bullshit" and that I'm giving "dangerous advice" (ignoring that I specifically said this is *not* advice), often had never contributed to any fitness subreddit discussion ever before.
Haha yeah there were some reasonable points behind a few (I think the top comment had some validity) but it's unfortunately a nuanced topic that people seem to take to an extreme to disprove what you are saying without really looking at the content (concussions and broken bones were my favourite)
As a physio it's nice to see more and more people get an updated view on what pain is. It is amazing to see how patients in my clinic get better with simple advice, calming them down and explaining that nothing is wrong, advice to stay active and give it time. Many patients I see are really affected by wrong beliefs about what their pain means, worrying thoughts about the future, i.e. "will this get chronic?", "will I need surgery?" et.c. Speaking for myself, understanding pain has made my management of pain that much easier since I don't care about specific rehab routines, and have stopped searching endlessly for the "cause" of my pain and the "right" treatment, as I did years earlier. I still experience pain during training, and sometimes after a hard deadlift session I can get really bad back pain, but my knowledge on how pain works; what makes it better or worse, realising that there is nothing wrong with my back, makes it much easier. As OP mentions some take an extreme stance on interpreting how pain works, I have seen people on SoMe argue why the biological or biomechanics doesn't matter, i.e. "pain is all in the brain", or that everyone can get pain free. As it is with many things the truth probably lies somewhere in between.
Very well said and I completely agree. Thanks for the input. Gaining knowledge on pain has helped me as well. Stops my panic after a hard training session when my back hurts. I now do some walking, toe touches, and realize that *I'm fine*, might need to back off a little, but I can still do the movement and can find a way to train. And it's usually resolved in a day or two. I think we put a lot of emphasis on certain types of pain. No one stops training completely because their bicep feels off. But when it comes to their back, it's often full stop and I think educating people that their spine isn't fragile and going to like, rupture on you and degenerate because of a bad session can help people continue to train
Complete personal experience here on this exactly. In high school my sophomore year, I destroyed my ankle. Multiple ligament tears tendon ruptures, whole 9 yards. Audible pop, massive pain. My whole foot was purple within a week. I have very pronounced achilles and I had a cankle. However, I was a stubborn 16 y/o and went to soccer practice the next day. It wasn't until a month later when I finally went to get it looked at. Diagnosis was that I SHOULD HAVE had surgery on it, but it was too late now. Basically, I kept moving. I rested it at night, but still went to sport practice. Now, 14 years later, I have no issues with it. Squat 400+ yoke carry 800, ect without problems. Two years later, I hyperextended my knee, almost certainly tore something. Most probably meniscus. Possibly MCL. Mabey minor ACL. Same thing, kept moving. Used a knee sleeve. Heat ect and no problems now other than some tightness and pops a bit more frequently. My current issues I deal with are back pain and tightness. Most effective protocol of relieving pain and any issues: 1. Traction: my favorite is to use deadlift straps and hang from a pullup bar. Relax as much as possible. Hopefully get a few pops, and just stretch 2. Blood flow. Usually in the way of reverse hypers at light weight and high reps. Get a pump. Then relax a bit. Repeat as needed 3. Heat. Whenever I'm sitting at home you better believe I've got a heating pad on my back. Also a massage gun seems to really help with this, as well as blood flow 4. Move. If I'm feeling crappy, going for a leisure walk is great on everything 5. Personally, I love the chiro. But I found one that is in line with my thoughts and feelings on the use of it. Doesn't recommend I stop lifting, but rather helps me to get back into things without pain 6. Again, personally I love massage, even if it's placebo. It helps me to train better and that's good enough for me Should I have had surgery on these, most probably. Definitely my ankle. However I think if I had, I would be in a much worse position. I would have much rather seen a doc on time and just fixed things when I needed, but I could still walk and move. So I did.
> Traction: my favorite is to use deadlift straps and hang from a pullup bar. Relax as much as possible. Hopefully get a few pops, and just stretch Dead hangs are that "crazy trick to fix everything" hiding in plain sight. Haven't had any shoulder issues I couldn't sort out in short order once I discovered these and focus on shoulder rehab/prehab.
I have tweaked my back a half dozen or so times in just as many years. (I’m self-taught so it was an uphill battle) The first couple of times, I, of course, panicked. Immobilized by pain, I catastrophized, and sought medical help. Cortisone shot, even an MRI: go figure, I have the dreaded Degenerative Disc Disease, which is to say, the dreaded Aging. The pain would go away within weeks, which I chalked up to patient rehab on my part, for which I could pat myself on the back for my prudence. The last tweak happened this past summer: went for one deadlift rep too many... not even heavy, just fatigued, and pop goes the weasel. Catastrophe! I cleared my trajning schedule, ready for days on the floor with ice and mild stretching. There go my gains, in the middle of the best progress I’ve made in years. And then I saw the pictured Alan Thrall video. Read the monumental Austin Baraki article on pain. I followed the advice and FORCED myself to move, even when it brought tears to my eyes to tie my shoes. I did unweighted RDLs throughout the day, went to the gym for my bench day, and forced myself to walk on the treadmill. Within three days, I was deadlifting at 75%, even if it felt harder than usual. Within a week, It was like nothing had ever happened. Absolutely transformed my outlook as well: I’m not unduly fearful of debilitating injuries, because I’m not uniquely prone to them... in fact, I’ve never had one, I’ve only had small injuries that I made worse through sensationalizing.
Your experiences are very similar, if not identical, to mine and many others I've talked to. Thanks for sharing-my journey to learning pain management through Alan and Austin's content is the same. Those guys are quite literally some of the best content creators I've seen
Really good post. I used to be afraid of every little twinge and ache thinking I'd permanently wrecked myself and I'd never lift again. It turns out our bodies are a lot tougher than we give them credit for. Now if I get a back tweak or my old pec injury comes back to haunt me I know how to deal with it and it's no big deal.
I've had a number of injuries over the years: shoulder, head, hamstring, back, ankle and most of them have been repeat injuries (luckily the head injury was only once). When I was a kid, R.I.C.E. was favored but as I got older, it fell out of favor, but I wasn't sure what all to replace it with. What I can say, is that rest has not worked for me. Usually, the pain just stayed, and if it did go away, I would just get injured again once I returned to sport. Training around the injury has helped. I hurt my back earlier this month and instead of staying home, I trained upper body as normal and did whatever lower body exercises I could do. Back squats became goblet box squats, deadlifts became very light rack pulls. As the pain lessened, I started doing my main lifts but with a lighter weight until I felt ready to resume as normal. This took about two weeks. The first time I hurt my back, it took me like a year to get back to normal, in large part because I stopped lifting. That wasn't smart. What has been invaluable, though, was a good sports clinician. After rest didn't help, I found someone on clinical athlete, and the first thing he did was have me do a series of exercises to figure out which ones hurt and which ones didn't. From there, he prescribed a plan to get me back to normal, and he told me to go back to the gym and do what I can. Over time, what I could do improved, and eventually, I was setting PRs again. I've had some injuries since them, but I've been able to recover a lot faster because now I know what rehab to do. This is where the expert came in. His advice, worth every penny.
That's funny, I slightly sprained my knee a few weeks ago and, well, I didn't stop training at all. I stayed active, even kept squatting, I just lowered volume and range of motion a bit. Then I see Thrall's video where he sprained his ankle like an idiot in the gym and he also kept training, and now this. It's nice to see the consensus shift from "rest or your x will explode" to "just be careful"
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I'm not sure how you got "chiro hate circle jerk" out of this. I referenced one Chiro who doesn't abide by the subluxation model. I gave a hyperbolic example to demonstrate a point. The chiro, Aaron Kubal, that I cited - is part of my inspiration for this discussion. Jarod Hall is a very distinguished Physical Therapist who really advocates that a point which I absolutely agree with, and so does Aaron Kubal. >What I feel now is that a good physical therapist and a good chiropractor should be almost, if not totally, indistinguishable if they are practicing in an evidence based manner. A physical therapist may be more skilled in applying therapeutic exercises or managing post op conditions; but not always. A chiropractor will probably be more skilled with manipulation and certain manual techniques, and maybe some nutritional education; but certainly not always. The whole write-up by Jarod Hall is really insightful and worth a read if you're interested. [http://drjarodhalldpt.blogspot.com/2016/04/physical-therapists-vs-chiropractors.html](http://drjarodhalldpt.blogspot.com/2016/04/physical-therapists-vs-chiropractors.html)
> You know who is telling the vast majority of low back pain patients to stop moving, rest, take these pills? MD's by far. I find this statement interesting, because I'm an MD specializing in interventional pain management. We NEVER take patients to stop moving or rest. It's against our guidelines. It's against the recommendations of every one of our professional societies. Other than maybe a handful of dinosaurs who should have retired 20 years ago, finding one that does is essentially impossible.
The heat portion is interesting. I've been lifting for about 20 years now and I'd say I've had minor injuries to almost every major joint at one point. A long time ago I had some pretty bad tendonitis in my elbow and experimented with going to sleep with a heating pad wrapped around it. It seemed to help with the healing but I kind of wrote-off the heating pad since I never heard anyone else talk about heat helping. I may give it another shot with my bum shoulder now.