The Ultimate 5-Step Injury Recovery Guide
When it comes to injuries, there are a million and one theories on the best way to approach recovery. Should you rest? Ice? Deep tissue massage? Seek medical attention?
Like a good scientist, our answer is "it depends."
It depends on your injury, your level of fitness, symptoms, personal history and more.
But, that doesn't mean we can't develop a template —a Decision Support System —that you can use to self-diagnose and self-rehab.
In this article, we lay out the fundamental steps for recovering from any minor injury. The goal is to arm you with enough knowledge so that you know when to seek medical attention, when to rest, and when (and how) to push through your injury to the other side.
You did it again.
You were just doing what millions of people do every day.
Lifting weights, running, playing tennis or kicking a soccer ball.
And now your knee is busted.
Or your shoulder is clicking and throbbing.
Or your elbow is so sore you can hardly pick up a dumbbell (or computer mouse).
The worst thing you can do is pretend it’s not happening.
Try to tough it out.
That’s a recipe for ending up on the operating table.
Or at least having to take a 6-8 week hiatus from working out.
The inconvenient truth is that minor injuries happen all the time.
You’ll be hard-pressed to find any high level athlete that hasn’t battled through multiple injuries.
The people who stay healthy and continue making progress over the long haul have figured out how to quickly recognize and address these minor setbacks.
There’s a fine line between pushing past discomfort and risking serious injury. But with some training experience, and being brutally honest with yourself — you can be your own rehab specialist.
While your injury — and your physiology — is much too individual to address with an exact recipe, we can still provide the framework for navigating through minor strains, “tweaks”, and other overuse injuries like tendinopathy.
That being said…
We know you're tough — but you also need to be smart.
If you suspect a serious injury or if you have any of these signs, get some help. This article is NOT a replacement for medical attention:
When to seek medical attention
• Abnormal bone, joint, or muscle positioning (e.g. it looks crooked or is misshapen)
• Excessive swelling, bruising, bleeding
• Sharp pain when performing previously pain-free movements
• Inability to bear weight on the limb or joint without it giving way
• A feeling of abnormal “looseness” in the joint
A torn hamstring is treated in a completely different way than tendinopathy in the knee, or a sprained ankle, or herniated disc in the back.
There’s just too much variability to provide an exact recovery protocol you can follow no matter the injury. So instead, the goal of this article is to:
- give you a baseline understanding of the rehab process
- help you determine when it’s OK to self-diagnose and when you should seek medical attention
- show you how to establish recovery goals and timelines
- and most important — how to prevent it from happening again
Use this guide as a template for bouncing back from your next sprain, strain or case of tendinopathy.
Let’s get into it.
Here are the 5 fundamental steps necessary to overcome any injury.
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We put together the main checklists and timelines you need to be your own rehab specialist. Keep this 4-page printable download handy:
STEP 1: Stop and PRICE.
Stop doing everything.
Even if you don’t know what caused your injury, stop.
Because you might be missing something crucial that could make it worse.
Example — Let’s say you’re doing jump squats while holding dumbbells.
And you feel a tweak in your knee.
Not a pop or a tearing feeling. Just a tweak. Like something isn’t quite right.
What do you do?
If you’re like most people, you stop doing the jump squats.
And you kick yourself for not warming up better.
Or starting with lighter weight.
Or you just kick yourself for doing an exercise that has a high potential for injury.
Then, you head on over to the leg extension machine or the squat rack and finish your workout.
Seems like a reasonable plan of action, right?
In this scenario, it most likely was NOT the exercise that got you injured.
After all, a properly warmed up human being should be able to squat down with resistance and stand up fast. Even explosively. Without injury.
So it wasn’t the exercise that got you injured necessarily.
It was knee joint positioning and imbalances in the musculature around your knee cap.
So moving on to another exercise might not make sense.
Because you could have an underlying imbalance or structural issue that needs addressed.
The smart thing to do would be to go home, research your symptoms, and figure out what’s going on. (Or consult a professional.)
Now, you can’t leave the gym every time you feel an ache or pain.
You’d never get anything done.
But you have to be smart. Listen to your body.
And know the difference between soreness, general discomfort, and problematic “tweaks” or pains.
The more training experience you have, the more you can trust your intuition about whether training through pain is a good idea. But that takes time.
My point is this: what you absolutely CANNOT do is injure yourself slightly… tweak a muscle or joint.. then keep going and turn that tweak into a full blown tear.
The second component of step one is PRICE.
PRICE stands for Protection, Rest, Ice, Compression, Elevation.
If you’ve heard this acronym before, don’t skip this part.
While it remains the go-to treatment for most physical therapists, athletic trainers, and rehab specialists — it’s not clear that it actually helps.
In fact, in some instances — P.R.I.C.E. can slow your recovery.
Let’s look at the four components of PRICE, and figure out when it makes sense to apply this old school technique:
PRICE component #1 - Protection
Not too long ago, the "P" in PRICE was added to RICE (Rest, Ice, Compression, Elevation).
The P stands for Protection. Which is too important to assume it goes without saying.
In this instance, protection means prevent further injury. This may include limiting use of a weight-bearing leg that's injured or immobilizing an injured wrist until you can get a better idea of what is going on.
Protecting the lines of stress is an important concept to remember. that is, injured tissues are more fragile than non-injured tissues.
The bottom line is simple: do whatever you have to in order to prevent any more damage. A partially torn tendon, ligament, or muscle is susceptible to a more serious injury that will prolong the recovery process.
PRICE component #2 - Rest
This means exactly what you’d think. Stop using the injured area. And don’t do any activity that irritates it. But — you have to apply some common sense here. A torn rotator cuff deserves complete rest. While tendinitis in the elbow requires a different kind (and time range) of rest.
I can’t tell you how long to rest. Or what type of rest to use. Without first knowing the severity and type of injury. For serious injuries, you clearly will be resting for quite a while. Until the injury resolves itself, or you get the necessary medical help.
But for more minor sprains or strains, movement is your best friend.
In fact, some clever writer came up with the term M.I.C.E. — Movement, Ice, Compression, Elevation — to illustrate the importance of continuing to move after injuries. This isn’t a bad idea. But there is always a rest component — even if it only lasts a day or two.
Let’s come back to this idea of “rest.” Because before knowing how long and what type of rest to employ, we have to diagnose the type and level of injury.
PRICE component #3 - Ice
Use ice, cold packs, or cold water therapy to minimize swelling and prevent excessive inflammation. The general recommendation is to apply ice for 10 to 20 minutes, three times per day for the first 48 hours.
Ice therapy makes intuitive sense. So most people don’t question its validity. Ice reduces swelling and numbs the pain. Must be good right? Plus, there is plenty of anecdotal evidence to go around. (I was religious about icing my arm after every baseball game I pitched as a kid. It seemed to help.)
But studies show that icing might actually hinder the healthy inflammation response that ensues after an injury. This can lead to abnormal collagen formation and reduced muscle fiber volume.
What is inflammation?
Inflammation is part of your body’s immune response, primarily designed to heal injuries and defend the body against foreign invaders.
In the case of a burn or injury, inflammation is a critical process for healing.
Without enough inflammation, oxygen and regenerative nutrients can’t make their way to the injury site to start the healing process.
But, when inflammation stays high for a long time, a host of cascading, negative side effects start coming to the surface.
This can lead to the breakdown of joint structures, heart disease, and even damage to your gut lining.
In one animal study, injured rats who were NOT treated with ice therapy had 65% greater cross-sectional muscle mass than the group that was treated with ice.
Human studies parallel these findings. In most circumstances, ice therapy does more harm than good.
Here’s why ice delays recovery and hinders athletic performance:
Healing Requires Inflammation
The acute inflammatory response (immediately following and injury) dilates capillaries and blood vessels, increasing delivery of oxygen and nutrient rich blood to the injury site. Inflammation also helps mobilize macrophages, a type of cell that speeds up healing and prevents infection by cleaning up damaged tissue.
And, macrophages release a hormone called IGF-1 into the damaged tissues, which kick starts the healing process.
By reducing inflammation too much immediately following an injury, you're interfering with a complex healing process.
Ice therapy reduces strength speed, and athletic performance
This is true both in the short run, and in the long run. A meta-analysis of 36 articles demonstrated that ice therapy was not effective for helping athletes recover from a non-serious injury and get back in the game (picture a baseball player icing his arm between innings, then trying to go back out and play a few minutes later). This practice reduces muscular power and endurance.
And, we already know that in the long run ice therapy can lead to abnormal tissue regeneration and reduced muscle mass in the injured area.
This begs the question, when is it appropriate to use ice therapy?
According to Dr. Gabe Mirkin, the guy who coined the term “RICE” in 1978, the answer is sparingly. If at all.
And really only to control pain.
That’s right, the doctor who founded this whole protocol has updated his opinion. And good for him. Based on new research, he determined that ice does more harm than good and publicly stated that he doesn’t support it anymore.
But even though there is plenty of research to refute ice therapy as a treatment for muscular injuries and enhanced recovery (like sprained ankles) — we still use it.
So do some of the world's top coaches, trainers and athletes.
Thing is, studies are great. We clearly love them around here.
But they’re limited. They don’t take into account the multitude of circumstantial variables you deal with when treating a minor injury or trying to improve recovery time.
So, though I respect the literature on the subject, I’m more interested in what I have seen work in the real world.
And in my experience, ice therapy has certainly helped speed up recovery time and get myself (and people I’ve worked with) back to training. Partially due to the fact that it reduces DOMS (Delayed Onset Muscle Soreness).
In the case of sprained ankles, I’ve seen time and time again that icing immediately following the injury helps reduce swelling and get the athlete back to full range of motion (ROM) sooner.
Some studies back this up. For example, ankle pain and swelling in the absence of structural damage leads to subsequent muscle weakness and range of motion loss, which could increase chance of re-injury.
So even if I’m blocking a few macrophages by icing, that’s OK.
Because whatever cellular level effects I’ve interrupted have been trumped by the fact that I can start the important rehab work necessary to regain strength and flexibility.
The same goes for nutrients that reduce inflammation.
If they improve injury recovery outcomes, reduce excess swelling, and prevent systemic inflammation — they they're smart tools to use post-injury. Bottom line.
When it comes to injuries, getting back to pain-free ranges of motion ASAP is crucial.
So I support any tools that help accomplish that goal (granted you aren't overusing painkillers and ice while simultaneously destroying tissue that clearly needs rest).
Here’s a good thought experiment to help illustrate this:
Let’s pretend you’re a 47 year old fitness junkie.
You still love to lift weights, run, and play recreational sports — but your body doesn’t bounce back like it used to.
So you use ice packs on sore muscles and hop into a cold bath a couple times per month to speed up recovery time.
Are you helping yourself, or hurting yourself by using the cold therapy?
The answer lies in what method allows you continue training.
What allows you to recover and train tomorrow, and next week, and next year. And make continuous progress toward your goals.
On the other hand, if you depend on ice and pain pills and compression wraps to get through the day, then you are living on borrowed time.
You have an underlying issue that needs addressed.
Lucky for us, we don’t have to rely only on our imaginations.
A study on non-steroidal anti-inflammatories (NSAIDs) demonstrated that trainees over the age of 65 who took anti-inflammatories during a 12-week exercise program had greater increases in muscle size than those that took a placebo.
Think about that for a minute… NSAIDs interfere with the inflammatory healing process.
So wouldn’t you expect the control group who took NSAIDs to have reduced recovery times, smaller muscles, and weakened athletic performance?
Well, that’s not what happened.
Why? Because the tool, in this case NSAIDs, allowed them to complete the training program. It helped them get back into the gym.
[See Supplements for Injury Recovery: The Definitive Guide for alternatives to NSAIDs.]
It’s tricky though. So you still have to make this decision on a case-by-case basis.
The verdict: Like any tool, ice therapy should be used only when it makes sense. If you’re in doubt, don’t use ice. Assuming you have a minor injury, tweak, or sore muscles — let your body do its own work without interfering.
But, if ice therapy or cold baths help you bounce back and continue training, then by all means use it. But only apply ice for 20 minutes at a time, and try to limit icing to the first 24 hours.
Personally, I try NOT to use ice for acute injuries or chronic tendinopathy.
PRICE component #4 - Compression
This typically involves wrapping the injured area with cotton or elastic bandages. This is another sticky subject.
Because not only does it need to be applied ONLY in certain circumstances, but doing it the wrong way can cause serious harm. Wrapping an extremity too tightly can cause nerve damage. Or at least, exacerbate swelling. Using a compression technique that is too loose causes a false sense of security, and can lead to further injury. Timing is important too.
Studies show that immobilizing a joint immediately following an injury can help accelerate the formation of granulation tissue at the site of the injury.
But the duration of reduced activity (immobilization) should be limited ONLY to the time necessary to facilitate enough healing to continue normal movements.
For a muscle tear, this means that you want just enough scar tissue to form so that you can move the joint without rupturing the newly formed tissue.
Basically, as soon as possible — you want to start moving.
If you tear a muscle or tendon, you have a long road ahead of you. And compression therapy can be helpful for the first week in order to facilitate the initial tissue rebuild. You’d have to work with your doctor or physical therapist to determine when and how to start moving again.
For more minor strains, compression can be an effective tool when used appropriately.
Compression wraps or sleeves limit mobility immediately following a minor injury to prevent further damage. And in some cases, it helps the athlete complete other training modalities. But this should only be used immediately following the injury.
The most common mistake is becoming dependent on compression to move around. The use of knee braces comes to mind.
All too often, I see people tweak their knee and start using compression sleeves or braces to support their knees.
Pretty soon, they have to wear their extra-thick knee braces just to do an upper body workout. Or move boxes around in the garage.
(Knee injuries in particular seem to benefit from leaning more toward mobility than immobility following an injury).
That’s because the musculature around the knee has atrophied.
And they’ve lost the necessary strength to stabilize the joint through full ranges of motion.
If you tweak your knee and need some extra support in order to complete a workout, just remember that you have to work twice as hard to build up and maintain the strength and mobility in your knees necessary to support them without the brace.
And just like ice therapy, compression tools are a good idea when they help you keep moving when you would otherwise be laid up on the couch.
For example, elbow sleeves and knee sleeves help tack down muscle and joint tissues into their most biomechanically advantageous positions.
This helps you move through a full ROM (Range of Motion) pain-free and trains your body to use proper form — even if you’re battling tendinopathy or a recent elbow tweak.
The people who stay healthy and continue making progress over the long haul have figured out how to quickly recognize and address these minor setbacks.
The key is not too become dependent on compression.
Feel free to use compression wraps or sleeves immediately following a minor injury so you can continue moving around and getting things done.
But remember that if you’re feeling sharp pain or the joint just doesn’t feel right, you could have a serious injury that needs addressed. Don’t use any tool to keep moving when you know you should get off your feet and see the doctor.
And, remember that if you use compression therapy that you’ll have to work twice as hard to maintain joint strength and mobility.
Studies show that completely immobilizing a joint immediately following an injury can help accelerate the formation of granulation tissue at the site of the injury. But the duration of reduced activity (immobilization) should be limited ONLY to the time necessary to facilitate enough healing to continue normal movements.
The verdict: Use compression therapy when you need it to continue moving. If you use braces, wraps or sleeves — dedicate time each day to performing low risk, pain-free movements without the compression device. Doing this at the end of each workout is a good routine to follow. I recommend this for anyone who has to use knee compression wear in order to perform knee-heavy movements (e.g. barbell squat).
PRICE component #5 - Elevation
Exactly what you think. This means raising the injured area above the level of your heart to help drain fluid from the injury. Picture yourself sitting on the couch with a swollen, sprained ankle. And placing that ankle on a high foot stool in front of you to relieve the throbbing.
We don’t need to over-complicate this one. For serious injuries, elevation helps control bleeding and swelling. For minor injuries, it helps reduce pain and swelling.
Much like ice therapy and compression, elevation is most effective during the first few hours following an injury. Beyond that, there isn’t much benefit to it.
STEP 2: Diagnose the type and severity of your injury
Here, I need to state the obvious disclaimer again. You and I are not doctors (well, you might be). So if you think you need medical treatment, by all means seek it out.
But the reality is everyone self-diagnoses their injuries.
You may not run your own MRI or determine exactly which bones are broken after falling off a ladder, but you do analyze the severity and type of injury to determine what should happen next.
Is your foot pointing in the wrong direction?
Yep, that’s pretty serious. Better call a doctor.
Are you feeling a dull ache in your elbow when performing pull ups?
That’s likely something you can fix on your own.
My point is that it’s helpful to understand the types of injuries and be able to estimate severity. That will help you decide what to do next. Including how much rest to employ, the types of movement you can safely do, and even your timelines for full recovery.
If you’re experiencing any of the following, you need to get help immediately:
- Abnormal joint or muscle positioning (e.g. joint or bone has moved outside its normal range of motion, or muscle has changed shape or position)
- You’ve lost the ability to put weight on the joint
- Excessive swelling, bruising or bleeding (or, dark colored bruising that appears within minutes of the injury)
- Sharp or excruciating pain
- The injury is not improving after 2-3 days of implementing the R.I.C.E. strategy
Though we always recommend getting medical help if you have any doubts — here are some signs that you have a minor injury that you can self-treat:
- Minor pain or discomfort during a specific range of motion
- Dull throbbing in joint site
- A “tweak” feeling when performing a weight bearing movement or in the stretched position (that still allows you to put weight on the joint)
...The Key: You can still complete the movement, even if it hurts. The joint does not “give away” or feel “loose” when performing a previously comfortable movement.
From here, you should be able to roughly determine whether you’re experiencing an acute injury (traumatic event) or overuse injury (resulting from repetitive movement).
Now let’s look at the types of injuries.
According to WebMD.com, the seven most common sports injuries are:
- Ankle sprain
- Groin pull
- Hamstring strain
- Shin splints
- Knee injury/ACL tear
- Knee injury: Patellofemoral syndrome (overuse injury resulting from kneecap rubbing against thigh bone)
- Tennis elbow (epicondylitis)
This is pretty close to what I’ve seen. Although I think low back and shoulder injuries should be #1 and #2 on this list.
What’s interesting is that virtually all of the top 7 injuries listed above have an overuse component. They result not only from a sudden and dramatic injury, but repeated damage overtime.
Sure, sprained ankles can occur during sports activities even if you have rock solid musculature around your lower legs. But most likely — an imbalance, mobility issue, or muscle weakness led to the injury.
Soft tissue injuries (damage to muscles, ligaments, or tendons) fall into two main categories: acute and overuse.
Acute injuries are caused by a sudden trauma. A fall that tears ligaments in your shoulder. Or a misstep that rolls your ankle. All sprains, strains, and contusions (bruises) fall into this category.
Overuse injuries occur over time from repeated stress. Shin splints is a good example. The repeated stress of running on hard ground (and/or with bad form) causes damage to the muscles around the shin and tendon insertion points.
Here, we need to get into the weeds for just a bit.
We'll look at the common types of acute AND common overuse injuries. Understanding these types will aid you in recognizing and treating future sprains and strains.
What about back pain?
Back pain is a different animal. Though most back pain is NOT caused by injuries that affect the spine or put it at risk — you need to be sure you aren't dealing with a nerve issue or structural issue. If you are experiencing any of the symptoms below, you need to get a professional (medical) opinion. If not, then you can likely self-treat your back pain:
- Numbness or tingling
- Loss of feeling
- Loss of motor control
- Severe immobility
Sprains, Strains & Contusions
 “Sprain” refers to an overstretching or tearing of a ligament — a type of tissue that connects a bone to another bone.
Injury Severity: By Grade
Grade 1 - Mild Sprain: Slight overstretching has occurred with some damage to the ligaments (not substantial tearing).
Grade 2 - Moderate: Partial tearing of the ligament has occurred.
The tell-tale sign that you have at least a Grade 2 Sprain is a “loose” feeling in the joint, or sudden instability in the joint.
Grade 3 - Severe: Complete tearing of the ligament.
You’ll usually know if this occurred because the joint is unusable and extremely painful. You can’t put weight on it without it giving way.
While Grade 2 and 3 sprains require medical attention — potentially even surgery — you can usually resolve Grade 1 sprains on your own.
Pain, swelling, and bruising will likely occur in all three grades, to different degrees.
So the key to determining the grade of injury lies in how much stability in the affected joint has been lost.
 “Strain” refers to minor injuries directly to muscles or tendons — the tissue that connects muscle to bone.
If you are experiencing sharp pain when attempting to perform a previously pain-free movement, you may have a severe strain (tear) that requires medical attention.
For severe injuries, an MRI (Magnetic Resonance Imaging) scan will help your doctor understand the severity of the tear.
If you experience a dull pain or twinge when performing a previously pain-free movement, but are still able to complete the movement, you likely have a partial tear.
If you play your cards right, these types of strains can be resolved within a few weeks.
The key is to not let a minor strain turn into a partial tear, or let a partial tear turn into a full-blown tear.
Sprain vs. Strain
Sprain refers to an overstretching or tearing of a ligament — a type of tissue that connects a bone to another bone.
Strain refers to minor injuries directly to muscles or tendons — the tissue that connects muscle to bone.
 Finally, contusions (a.k.a. bruises) are injuries to tissue resulting from a direct blow. They cause damage to muscle fibers and connective tissue — often without breaking the skin. This is why bruising occurs — it’s essentially bleeding under your skin.
Because contusions, sprains, and strains can all appear the same on the outside — purple bruising, swelling, etc. — it helps to understand what caused the injury in order to classify it.
If you banged your thigh on a metal bench, you’re likely just dealing with a simple contusion. You can continue training and moving normally, even if it hurts.
But if you experience bruising near a joint or where a muscle inserts into the joint, you might be dealing with more than just a simple contusion.
Unlike sprains, strains and contusions — overuse injuries are caused by small stresses that repeatedly aggravate tissues.
According to Dr. David Geier, renowned orthopedic surgeon and sports medicine specialist, around 50% off all sports injuries are the result of overuse.
The percentage of overuse injuries in the general population (versus a trauma) are even higher.
While there is plenty of work that can be done to prevent sprains and strains, knowing how to prevent and manage overuse injuries is one of the most important capabilities an athlete can possess.
Tendinitis is the most common overuse injury. It’s caused by repeated stress that aggravates and damages a tendon, or the sheath surrounding the tendon. Golfer’s Elbow, Shin Splints, and Jumper’s Knee are all essentially tendinitis.
Initial symptoms include discomfort and intermittent sharp pains. Those symptoms can quickly escalate as the tendinitis worsens, leading to more intense pain, swelling, and loss of mobility and strength.
There are two keys to conquering tendinitis:
1) Intervene early and actively.
2) Fix the imbalance, weakness, or fault in your posture that caused the tendinitis.
Most people think you can train your way through tendinitis. But this is rarely the case. Once it sets in, it’s difficult to get rid of without a strategic, focused plan.
And if you ignore it, your tendinitis can turn into tendinosis. And you don’t want to deal with that. Trust me on this one.
Tendinosis is separate from tendinitis. It refers to the degeneration of the tendon’s collagen in response to chronic overuse.
This condition generally occurs after tendinitis has been present for a number of weeks.
If you have had tendinitis for more than 6 weeks — you’re likely dealing with tendinosis.
At this point, your body’s initial inflammatory response has come and gone. So you likely won’t see advanced swelling and redness. But you’ll still feel pain when performing movements. And without intervention, it can be become totally debilitating.
Tendinosis is characterized by abnormal collagen formation (aka scar tissue) — which is your body’s attempt to repair the injury.
Scar tissue is composed of the same protein, collagen, as the tissue it replaces during the repair process. Problem is, scar tissue doesn’t form in the same way that the initial collagen fibers were aligned.
Instead of the optimal basket-weave formation where the fibers cross over each other — scar tissue forms in crude, parallel layers. Not only is this new abnormal formation less flexible, it’s also weaker and more prone to further injury.
[See Related: The Definitive Guide to Collagen Synthesis]
The terms "tendinitis" and "tendinosis" have been largely replaced by a new term: tendinopathy.
Tendinopathy is a broader term that describes the degeneration of connective tissue over time. Experts now believe that tendon injuries are usually the result of long-term overuse rather than inflammation.
This means that tendon degeneration (tendinosis) is not simply the result of unchecked, chronic inflammation (tendinitis). They are two separate outcomes from the same injury.
The degeneration and weakening of connective tissue in overuse injuries has a separate cause, or pathology, from inflammation. This is why the term “tendinopathy” is now the preferred nomenclature. It more accurately describes the sliding-scale, continuum of injury outcomes.
But this is more than just a shift in wording. Many therapists and medical practitioners are moving away from recommending inflammation-blocking treatments.
To get past tendinopathy, tendons need to become stronger and poor tissue formations need to be reinforced. This can only happen with progressive, load-based exercise.
I’ve found that two tactics, in combination, do wonders for healing tendinopathy: self-myofascial release and eccentric training. Both help break down scar tissue so your body can rebuild the collagen matrix in an optimal pattern.
My Battle with Elbow Tendinopathy
I personally battled elbow tendinopathy for over 3 years.
Partly due to ignorance and party due to being pigheaded.
I was following the 5x5 Strong Lifts method — a fantastic strength training and hypertrophy program if you’re healthy enough to do it.
Basically, it involves doing the big, basic barbell exercises three times per week.
5 sets of 5 reps each.
About 8 weeks into the program, my strength had increased substantially. My metabolism was humming too, helping me shed 6 pounds of body fat without altering my diet.
But I was starting to feel a twinge in both elbows when performing pullups. Which I did 3 non-consecutive days each week.
The pain was on the inner side, indicative of Golfer’s Elbow.
In true meat-head fashion, I pushed through.
Kept on bench pressing, squatting, deadlifting AND performing weighted pullups every Monday, Wednesday, and Friday.
By week 10, the elbow pain had become severe.
I couldn’t even grip light weight objects without severe pain.
I remember examining my elbow while at work one day to see what was going on. And a sharp pain caused me to drop my computer mouse on the desk.
That was the moment I knew I had a serious problem.
Way past toughing it out.
After researching my symptoms and their timelines, and consulting with both a soft-tissue specialist and orthopedic surgeon, I was able to nail down the factors that lead to the overuse injury. And make adjustments that would ultimately lead to it the tendinitis clearing up.
- I had mobility issues in my upper back and shoulders that were forcing my elbows to overcompensate (I was unable to complete weighted pullups to exhaustion without serious faults in my form).
- I wasn’t warming up properly. At the time, I was using my lunch break at work to hit the gym. With 15 minutes of travel time plus changing clothes, that left me with only 30 minutes to perform a warmup, workout, and cool down. So I had all but skipped the warmup entirely, increasing my risk of injury.
- I was in a constricted seated position nearly all day. But that wasn’t the worst part of it. The worst part was that I was going from sitting at a desk with my elbows constricted ---immediately to the gym for some heavy lifting. Then right back to my desk with elbows tucked under my keyboard again.
So each time I did microscopic damage to the muscles and tendons in my inner elbows, I exacerbated the micro-tears by not lengthening them out each day to help correct the problem. I would immediately go back to my desk, and my poor elbows would attempt to heal themselves — but instead forming abnormal collagen structures (scar tissue) because of my bad positioning.
- Not intervening earlier. Clearly, I should have addressed the problem sooner. If I had took stock of the situation and started a recovery program immediately, I could have avoided the injury turning from tendinitis to tendinosis.
Bursitis is not as common as tendinitis. And is typically easier to diagnose. In this condition, the bursae (soft, fluid filled sacks that surround and protect joints) become inflamed. It’s usually caused by performing repetitive movements with bad form or by general overuse.
Although it’s rare to have an inflamed bursa the size of a golf ball sticking off your elbow or knee, you’ll likely notice a round protruding sack from the area of injury.
Though bursitis can resolve itself, you should seek medical attention if you think you have bursitis. The inflamed bursa can become infected, or it may require a minimally invasive surgical removal. Your doctor will likely recommend a mix of NSAIDs and corticosteroid injections to get rid of the pain and swelling.
...OK... we got through it! Those are the common types of injuries you should be aware of.
At this point, you’re just about ready to put together a rehab plan. But first, you need to understand what caused the injury.
STEP 3: Understand the cause
After you’ve gone through the logic of Step 2 (understanding type and severity of injury), you’re half way to understanding what caused it.
We use a simple checklist for this step.
Acute vs. Overuse Injury: Simple Diagnostic List
- Was the injury the result of a dramatic event? (fall, dive, stretching outside of normal range of motion, performing explosive movement, performing heavy weight-bearing movement)
- Do you have a history of injury or surgery at the injury site?
- Did the injury occur after performing a new exercise you are not well-trained in?
- Have you experienced pain, discomfort, tingling, or weakness in the injury site prior to the injury?
- Did the injury slowly progress, starting with minor discomfort?
If you answered Yes to any of questions 1-3, you’re likely dealing with an acute injury.
If you answered Yes to questions 4 or 5 (but not to questions 1-3), you’re likely dealing with an overuse injury.
This isn’t an exact science, so you have to use some common sense here.
People typically know if they injured themselves suddenly (acute). Likewise, if you think back — you should be able to recall if pain or movement problems occurred gradually (overuse).
The reason you want to understand the cause of the injury is so you don’t make it worse. And so you don’t end up doing it again.
Like in my case of developing tendinosis in both elbows, there was a multitude of factors. It took me weeks to put everything together. But now that I know each misstep I made, I know exactly how to prevent it from occurring again.
The important thing here is not to rush to a conclusion. Get an idea of what movements, events, imbalances, and weaknesses could have led to the injury.
Then think about other lifestyle factors (like sitting at a desk all day which constricts movement and blood flow). And continue seeking to understand all the factors that caused your injury throughout the rehab process.
This leads us into Step 4: Develop a rehabilitation plan.
STEP 4: Develop a rehab plan
To give us some context, let’s zoom out and look at goals that can be applied to virtually any minor injury.
Assuming you have a minor injury, you can establish some rough timelines for when to graduate through each phase of recovery.
Phase 1: Immediate
This is the time period immediately following the injury. The main goals are to control swelling, inflammation, and pain — as well as establish safe ranges of motion. This phase can also be used to more accurately assess the seriousness of the injury. This is the time to get in with a trusted physical therapist and create a plan for the next 6-8 weeks.
As you begin moving through basic ranges of motion, you’ll be able to tell whether normal movements are possible without severe pain, looseness in the joint, or a feeling of impending injury if you continue the exercise.
Examples of non-weight bearing movements for a knee problem might include seated flexion and extension, and light stretching of the quadriceps and hamstrings.
Assuming these basic movements are possible without risking further injury, this first week is crucial for establishing how the tissues will heal. So again, movement is your friend.
The duration of this phase is typically around a week, and depends upon the progress of swelling, inflammation, and pain-free ranges of motion.
Phase 2: Initial Rehabilitation
The main goals of this phase are to eliminate swelling and inflammation, and regain full range of motion. Ice therapy is no longer necessary, but compression therapy may be useful during light resistance and stretching movements to help tack down and re-establish proper joint tissue positioning.
Massage therapy, such as deep tissue using a mobility blade, can be started here to break up scar tissue. Examples of light resistance training for an elbow problem could include bicep curls with five pound weights, wrist exercises, or modified pushups with knees on the floor — all dependent upon pain and strength levels.
Phase 3: Stability
While mobility through normal ranges of motion is vital to preventing a future injury and functioning normally — your focus here should be on improving joint positioning and establishing a solid structure.
This is accomplished by performing compound exercises with a focus on perfect form through pain-free ranges of motion.
I have an ax to grind with this step...
Because I spent countless hours following boring stretching routines to “rehab” my busted up shoulders over the years. Now I know that I would have been better served to focus first on mastering shoulder stability (instead of mobility/flexibility).
The bottom line is this: before you get fancy --- focus on mastering basic movements through full ranges of motion. For the shoulder, that would include being able to press weight overhead (into full extension) and perform a weighted row — even if you have to start with super light weights.
And, make sure your form is perfect, and the start and end joint positions are optimal.
Stability > Mobility.
Phase 4: Back to Baseline
In this phase, the goal is to return strength, mobility and performance to where it was prior to the injury. This means increasing resistance, working through more difficult ranges of motion with mobility (flexibility) training and incorporating sports-specific movements to challenge the nervous system.
But, if your recovery progresses more slowly than what is outlined above, don't push it. Listen to your body, and at all costs, prevent further injury.
Phase 5: Preventive
This final phase is also the one most commonly skipped. The primary goal here is to not only understand the factors that led to the injury, but to use pre-habilitative (prehab) movements to mobilize stiff tissues and build strength in order to correct muscle imbalances.
Once again, diving into specific case scenarios is way beyond this article. It would take books.. But with some common sense, a little research on your end, and potentially leaning on professionals to help you assemble a post-injury plan — you can setup your own prehab plan.
And, you should.
You should understand the causes, how to address them, and what to do if the injury occurs again. Or, more commonly — if minor symptoms approximating the injury surface later. The second time around you’ll see the warning signs and be able to intervene before it gets serious.
The specifics of your rehab plan are highly individual, including the exercises you should perform. I encourage you to seek help from a doctor or physical therapist here. And do your own research as well. No one knows your body quite like you do. So it’s important you understand the commonly prescribed approaches for your situation, and the desired timelines and outcomes.
Keys to Rehab Plan Success
Step 5: Create a template to address flair ups or minor recurrences of the injury
This one right here separates the men from the boys.
Or more accurately, separates the people who remain strong and vital throughout their life… from those who are plagued by injuries.
The sad reality is that once you injure yourself, your body is different. The tissues have been permanently altered.
And all those little injuries add up. Especially the ones that are RE-injuries of previous ones.
“In those days, I did what was necessary for me to win. This included training with heavy weights: a precursor for injury. So if I could do it over again I’d train with lighter weights, higher reps, no sets below 10 reps, with negatives slower than positives, and avoid injury. If I had done that, my physique wouldn’t have been quite as bulky, but with more definition and less pain.”
Frank Zane was the master of form and proportions. Compared to other bodybuilders of his day, Zane’s approach was out of the ordinary. He focused on lighter weights, higher repetitions, and absolutely perfect form.
We're not knocking heavy weight training. It certainly has a place in safe, pain-free exercise programming when applied intelligently. The main point is that Zane understood that even minor injuries add up over time.
Especially RE-injuries of previous ones.
Six months may go by. A year. Three years. But eventually, you’ll feel a pain in that old injury area.
What are you going to do about it?
If you’re like most people, you’ll do the same thing you did the first time. You'll ignore it. Or wait too long to intervene with corrective exercise.
Instead, outsmart it. Take notes on your entire experience the FIRST time.
The timelines, the exercises, what hurt, what helped. And use that do develop a template for fixing the injury when it comes back.
You don’t have to wait for a full-blow tear to employ this either.
In my case, I have a printout of a daily routine that incorporates stretching, resistance training and massage therapy if I feel a twinge in my elbows again from my bout with tendinopathy. And a weekly approach that allows me to continue training without further injury.
The few times I’ve really torqued my elbows with a heavy week of training or doing something stupid in the gym, I’ve been able to resolve the pain in just a few days.
Your goal here is to create a template that makes the rehab process think-less. Which is good. Because the knuckle-dragging side of you might just decide (again) that you’re going to tough it out.
Step 5 is about being smart. And disciplined. Both necessary attributes if you want to avoid injury and be able to use your body to its potential — especially as the years go by.
I hope this article helped you understand how to approach injuries from a strategic perspective.
While your body and injuries are unique, you can use this framework to assess the seriousness of your injury, and figure out the appropriate next steps.
And of course, seek medical attention if you have any doubts.
With a little research — you can assemble your own post-injury rehabilitation plan.
Just don’t forget that “prehab” is just as important.
And, after focusing on the BIG stuff outlined in this article — you've earned the right to check out the supplements proven to bolster the injury recovery process.
After reading this article, how will you change your attitude toward injury prevention and post-injury rehab?
Let us know what you think in the comments section below.
Keep this checklist handy
We assembled a "cheat sheet" of the main concepts, checklists and timelines you need as reference points. Save this infographic so you can blast through your next minor injury and never look back: Download the article summary here.
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Author: Scott Hogan
I created SaltWrap to bring together the most practical ideas in therapeutic sports nutrition, corrective exercise, and functional fitness — with the goal of keeping you (and myself) strong, mobile, and built to last.
I've worked as an A.C.E. Certified Personal Trainer, Orthopedic Exercise Specialist, and nutritional supplement formulator.
But more importantly — I've spent most of my life battling injuries, joint pain, and just being plain beat up. So I know what it's like to struggle toward fitness goals.
SaltWrap is here to push you through injuries, setbacks and perceived physical limitations. To a place beyond what you think you're capable of.
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