Written by Ewa Januszkiewicz
This is how I felt in 2009, and again in 2010. I tore my right ACL, then followed it up 15 months later with a left ACL tear while playing premier and collegiate soccer. On top of this, I was dealing with the pain associated with spondylolysthesis (spine injury) and battling bouts of flares from Systemic Lupus Erythematosus. Two knee surgeries, a few back procedures, dozens of doctors appointments, and many days away from training, I was certain my athletic career was over.
Five years later, I’m deadlifting 405, benching 165, and squatting 315 pain free. My body is stronger than it ever was, and I attribute this success to proper programming. After tearing my left and right ACL, I sought out the guidance of Ryan Gleason, an athletic and strength coach in Southern Connecticut. Ryan helped me rehabilitate my injuries, return to the soccer field, and even influenced my decision to become a competitive powerlifter.
I want to preface this entire article by saying two things. First, much of this article is a personal narrative of how I dealt with injury and what I uncovered about competing, programming, and even myself in the process. Second, what is written here is not medical advice. If you are struggling with an injury, seek out the help of a medical professional, and contact a trainer who has experience working with athletes who have sustained injuries. If you need help, check out the Clinical Athlete to be directed to a medical professional who will understand your goals and aspirations.
Ryan’s first and most important rule: if it hurts, stop. This stuck with me for a few reasons. First, I was always someone who pushed my limits, regardless of how I felt. I had the all too familiar ideology, “no pain, no gain”. Push through it until you can’t push any further, right? This is the furthest thing from the truth. If it hurts, STOP. Now don’t get me wrong, there is something to be said for people who can work through discomfort. However, there is a HUGE difference between pain and discomfort. Take the time to get to know your body (although pain should be a fairly obvious feeling) so that you can easily differentiate between the two. Pain is a direct neurological response your body uses to tell you that you are risking injury, and should therefore stop what you’re doing because you may be inflicting harm. When you have pain, you oftentimes also have inflammation. You don’t necessarily need to SEE swelling to have inflammation, which is your body’s way of protecting itself from harmful biological agents. Allow your body to thoroughly rest and recover before pushing yourself to do more. Your program needs to incorporate plenty of time to rest as you rebuild your athletic stamina. This might mean going to the gym 3 days a week to start and increasing the amount of time you lift as your healing/muscle building progresses.
The next critical component of proper programming post injury is to incorporate strategic exercises that isolate the muscles you are attempting to strengthen. For my knee injury, I focused on unilateral, or single leg work. The type of exercises ranged as well; non-weight baring exercises, body weight, resistance movements, functional movements, stretching, and weight training were all incorporated, depending on my goal for the day. The major focus areas were functionality, strength and hypertrophy. Because the unilateral exercises were minimally eccentric, I was able to recover quickly, allowing me to do more. Most of the work mentioned here took place about 2 months post surgery, after proper mobilization, flexion, and extension have been achieved through my work with physical therapists. A typical lower body training day for my post-ACL tear had various combinations of the following:
Warm-Up / Foam Roll / addition of light plyometric exercises as strength increases
3×10 Single Leg Box Squats
3×10 Leg Extension with resistance band
3×10 Side Step with resistance bands
3×12 Lunges – progressively adding weight
3x 8 Step-Ups
3×10 Glute Ham Raises
As I became more comfortable and some strength was regained, the following exercises were incorporated:
Of course there are a multitude of other exercises that could be added to your rehabilitation program. Please seek a coach or a physical therapist that can help you in exercise selection.
My back injury, spondylolysthesis, is a chronic, degenerative disorder in which the vertebrae are fractured and slip out of place. To treat my spondy, I have continually sought out medical treatment. My medical team includes a physical therapist, my strength coach, my chiropractor, my orthopedic doctor, and my massage therapist. These individuals work together in conjuction with me to ensure I am pain free and preventing further injury. With the help of my team, I have been able to identify movements and activities that aggravate all of the muscles associated with my condition. Weight training, luckily for me, happens to NOT be one of them. In fact, proper programming for my back injury has actually improved my symptoms and strengthened the surrounding muscles so that I am able to do more than I was previously able to do. Examples include: Deadlift, good mornings, low bar squats, sumo deadlift, glute ham raise, 45 degree back extension, deficit deadlift, and chest supported rows. One key factor here is that these exercises will not help you, and may even hurt you further, if you do not execute them with proper form. This is critical. A typical initial back rehabilitation training day for me looked like this:
Warm-up / Foam Roll / light plyometric exercises
3×10 Military Press
3x 5 45-Degree back extension – the amount of reps dramatically increased throughout a cycle
3×10 Chest Supported Row
3×10 Med Ball Circuit (straight leg sit-up, toe touches, russian twist)
3×10 Glute bridges – add marching as you advance
3×3 30 Second Planks alternating sides (forward, left, right)
Deadlifts and Good Mornings were added once pain was properly managed.
Again, there are a multitude of other exercises you can choose to maximize stabilizing and strengthening your upper, mid, and lower back.
My training has consistently focused on strengthening my back, continues to incorporate exercises that help prevent pain, and allows for proper physiological functioning.
A component of my training that still poses challenges is completing cardio. Whereas I used to simply run, I now have to be very strategic with my cardio. Things like thrusters, jump rope, kettle bell swings, and running cause significant pain and tightness. I tend to avoid any exercise that puts high stress on my low back. Any dynamic movement that requires the force to be absorbed by the spinal column has to be avoided. My cardio program now consists of circuits that are high intensity. One of my favorite intervals looks like this:
Ropes – 30 seconds
Rest – 20 seconds
Wall ball – 30 seconds
Rest – 20 seconds
TRX Pike into pushup – 30 seconds
Rest – 20 seconds
Rower – 30 seconds
Repeat 3-6 times with maximal intensity.
I recommend doing this with a few other motivated friends because it really sucks otherwise. If you need more ideas for creative cardio, I suggest Jen Sinkler’s book, Lift Weights Faster. She gives tons of quick circuits and cardio ideas that are powerlifter friendly.
Bracing and breathing have played a critical role in my training regimen. Dr. Quinn Henoch of Darkside Strength has designed a program specific to my condition and my goals. When programming around your injury, you need to remember that weightlifting is not the only component that needs to have a focused program. My bracing and breathing program incorporates hip flexor stretches, increasing my range of motion with hip extension, pelvic control, increasing tolerance to braced extension, improving the squat pattern, and core stabilization. It it imperative to uncover the root of the problem that caused your injury, and take the time to then correct it. Giving yourself the necessary time to improve physiological function will prove beneficial for future success in lifting.
The last, and in my opinion, one of the most valuable parts of programming around your injury is rebuilding confidence. I distinctly remember my first time getting back onto the soccer field after my ACL tear. My emotions were raw, overwhelming, and uncontrollable. I was filled with angst and excitement, fear and anticipation, all at the same time. The same goes with getting under the barbell again for the first time. Returning to squatting and attempting heavy singles after one of my many back procedures was a defining moment for me. It was a sort of, “make it or break it” scenario. My heart was beating in my throat and even if I wore metal armour I would not have felt safer under that bar. My confidence was faltering; I had been away from squats for so long. But with each successful rep, I felt better, calm even. I was slowly restructuring my mental game. I say “restructuring” rather than rebuilding here with purpose. I was not passively gaining confidence. I was mentally building myself up. I was explaining to myself that I am adequate, ready, and strong enough to be successful again. I was rethinking how I felt about the iron. I was distinguishing pain from discomfort. I was composing myself before each squat, creating new, improved cues for successful execution, and positively reinforcing each motion. I was actively building mental stamina. This factor often goes unnoticed and undiscussed in athletics. However, I feel that a great strength coach will build a successful program for those recovering from an injury only if they can anticipate the feelings of their athletes, whether or not they show those emotions. Choosing an adequate recovery pace, very discrete training cycle goals, and providing mental and emotional support to the athlete needs to be indispensable when creating a recovery strength program.
Properly programming for a lifter after they’ve sustained an injury is crucial to their success on the platform long term. Returning from an injury is not a rapid process, and the athlete’s program must therefore provide short term and long term goals for sustainability. The program must also focus on improving the athlete’s functionality and strength. Resist overload work in the early stages, and include lower weight hypertrophy training. Ensure to focus on the root cause of the injury, and use both medical and strength training strategies to physiologically correct the problem. Work on injury prevention techniques, such as breathing and bracing in order to continue executing lifts with proper form, even after the athlete has recovered and is back to lifting heavy weight. Finally, remain positive throughout the process, so that your athlete is also positive. Not only is the brain creating neurological connections that result from repeated and corrected movement patterns, but also from the way the athlete is thinking and feeling about his or her training.
Cover Photo by 9for9 Media