When Your Joints Rebel: How To Modify Your Lifting Regimen So You Can Train With Joint Issues

You are a beast in the gym…that is, until a joint injury or flare-up from arthritis, bursitis or sprain threatens to deflate your motivation as a result of the pain. While it is always important to take preventative measures to protect the joints, such as warming up the surrounding soft tissues properly, using proper form during exercises, and taking supplements which promote joint health, there may be times when joint discomfort is so significant that a little TLC needs to be added to the regimen. The recommendation of complete rest usually falls on deaf ears when a fitness fanatic is the one suffering from joint woes, because the general mindset for such an individual is to push through the pain and continue training. However, in most cases, the pain and inflammation will throw a wrench in the works by adversely affecting range of motion and strength. As long as the joint pain isn’t severe, and is not caused by direct, acute injury to the joint, exercises can usually be modified to alleviate load stress on the affected area.

There are a number of exercise modifications which can be made to weightlifting exercises to minimize the loading on affected joints while still effectively training surrounding muscle groups. Bear in mind that you might not be able to perform certain exercises at all, even with a modified grip or stance. The most important thing is to pay attention to your body and stop doing anything which exacerbates the joint discomfort.

SAVE YOUR SHOULDERS AND ARMS

Since shoulder joint issues are relatively common, most of the suggestions made in this article for exercise modifications for the upper body will take this into account. Depending on the degree and location of shoulder pain, you might still be able to perform shoulder presses, but do not perform them behind the neck as they can cause impingement. Incidentally, you will also need to avoid pulling the bar behind your head when doing lat pulldowns. To perform overhead presses, use a straight bar with a grip slightly wider than shoulder width apart, or use dumbbells, and use a light weight. Another exercise which should be modified when shoulder pain is an issue is the bench press. Chest presses should be avoided on an incline bench due to increased abduction and a corresponding increased shear stress and strain on the glenohumeral joint.

Shoulder joint pain can also interfere with lower body barbell exercises like the back squat and lunges. Since the barbell must be stabilized across the back, the shoulder must remain in an externally rotated and abducted position. Even barbell deadlifts force the shoulder into a gravitational load in extension which can be enough to aggravate shoulder joint issues if a heavy weight is used. Modifications to these exercises include performing front squats while holding onto a kettlebell or dumbbell, and switching to dumbbells when performing lunges and deadlifts.

Most cases of shoulder pain from joint instability or arthritis can make it impossible to perform a plank for an extended period of time due to the superior-posterior stress across the shoulder joint complex, but this is easily remedied by modifying the plank so that you rest on your forearms instead of your hands, thus shortening the lever arm and decreasing the stress load.

If you have issues with your elbows, it is wise to avoid pullups, pushups, mountain climbers, overhead tricep extensions and planks, but bicep curls may also be difficult to do, especially as you supinate and flex the elbow. The elbow joint is a tricky one to train around, and the best approach is to completely avoid any direct movements which involve the elbow flexors if the pain is severe. If the pain is minimal, regular dumbbell bicep curls, hammer curls and cable tricep extensions can be performed with light weights. Using a false grip on dumbbells (in which the thumb is not engaged in opposition around the bar), using a cuff around the arm with a cable assembly, or switching to weight plates with a neutral (palms in) grip can also be helpful in minimizing the strain on the elbow stabilizers during delt training routines.

Wrist pain can often be eradicated by using lifting gloves which have wrist support to counteract some of the stress. Since bench dips can aggravate sore wrists, they should be avoided and replaced with cable tricep extensions, which can be performed without extending the wrist. Traditional pushups also force the wrists into a hyperextended position, but a simple switch in hand position, in which the fingers point out to the sides, with hands at least shoulder width apart, will minimize joint stress during the down phase of the movement.

WEIGHT BEARING JOINTS

If you have issues with the joints in your lower extremities (hips, knees, ankles, feet), ballistic movements, such as the ones performed in plyometrics and calisthenics, should be avoided. Unfortunately, exercises which are considered staples in a weightlifter’s regimen, such as squats, lunges and leg presses, can also wreak havoc on achy hips and creaky knees, especially if poor form and heavy weights are used. It’s best to trade these in, at least for a while, and instead turn to leg lifts on all fours, wall sits, front leg raises against a wall, and single leg deadlifts, all of which decrease the load on the hips and knees while still providing good isolation.

Since ankles and feet take the brunt of weight bearing, they should be babied when flare-ups occur, which means that calf raises, leg presses, and squats should be avoided and replaced with moves which do not require excessive joint motion under a loading force. Foot stance should be maintained at shoulder width to maintain the ankle position in a neutral plane and avoid any inversion or eversion. Mat exercises are also an excellent alternative to hardcore standard weight machines when dealing with joint flare-ups in the ankle or foot.

OHHHHH MY BACK

The incidence of low back pain is extremely high, especially among fitness devotees. Since it is usually triggered by extreme positions of flexion or extension, something as simple as standing with your heels on two weight plates and dropping the amount of weight lifted can be enough to maintain a more upright position and avoid the excessive lumbar flexion often seen with back squats. Another modification which spares the low back as well as the knee is performing Bulgarian squats, which keep the upper body in a vertical plane.

If you experience joint pain in your neck or upper back, you should avoid exercises mentioned earlier such as behind the head lat pulldowns and military presses, both of which cause excessive flexion in the cervical spine. In some cases, you will need to omit exercises which involve the use of a barbell behind the neck since this type of load increases flexion stress. You can modify these movements by using dumbbells or by switching to a machine, for example, switching from barbell squats to hack squats.

The most important thing to remember is to listen to your body and stop any movement if you feel sudden pain. By training wisely and making necessary modifications while your joints are inflamed, you will be able to bypass injury and continue to make gains at the gym.

Joints That Snap, Crackle, and Pop

joint-popping

You’re sitting with friends, and you reach for something next to you, when you hear a pop in your shoulder. There’s no pain, yet that popping sound has you concerned that something is wrong. Should you worry?

Popping or cracking sensations and sounds can occur just about anywhere in the body and, if they aren’t expected or commonplace for an individual, can be alarming. Scientists can’t agree on what it is exactly that causes all those strange noises, but one theory is that as tendons and ligaments tighten around or move over a joint, the result is snapping, popping or cracking. As for popping knuckles, one popular idea is that air bubbles within joint fluid escape, causing a popping sound, while another belief is that a vacuum is formed when the joint is adjusted, causing synovial fluid to rush into the space. It’s a different scenario with arthritic joints, which may creak and grind as a result of bone moving across bone.

Just because your body might make those strange sounds when you move, such noises and movements don’t necessarily mean bad news. However, any time those noises or movements are accompanied by pain or restriction of movement in the body part moved, it’s time to have it evaluated by a physician.

Oil and Water: Is Crossfit Detrimental For Developing Aesthetic Muscle? (repost)

I truly enjoyed writing this article which was featured on Sports Nutrition Supplement Guide. You can see the published post here: http://sportsnutritionsupplementguide.com/training/crossfit/item/1389-oil-and-water-is-crossfit-detrimental-for-developing-aesthetic-muscle#.V1HlOvmlyWg

Read on to find out what I think about Crossfit:

Could someone please tell me why this move is even necessary?  It's dangerous and incredibly damaging to the joints and soft tissues in the body.

Could someone please tell me why this move is even necessary? It’s dangerous and incredibly damaging to the joints and soft tissues in the body.

I will boldly state right now that I’m not a fan of Crossfit, and will be delighted when its novelty wears off. I’ve dedicated my life to supporting, empowering, inspiring, guiding, coaching and otherwise promoting any activity that gets people moving. This is one reason I waited to publicly write about my arguments against the principles of Crossfit. The other, more specific reason, is that it’s become more common to hear NPC and IFBB competitors ask if Crossfit will enhance their efforts to get into contest shape. If the latter is you, let me cut to the chase. Not only will Crossfit widen your waistline as a result of the constant heavy “functional” lifting, it will also cause cortisol spikes, which make your body hold onto belly fat for dear life.

Before I get into why Crossfit is counterproductive to developing aesthetic muscle, a word to those who have found Crossfit gets them active, and has not caused them injury. Keep it up. If it’s Crossfit you need to keep you moving and motivated to be fit, don’t stop on my account. If however, Crossfit just doesn’t feel right, or your goal is to create your best body, and give you the best chance to stay injury free, read on. You’ll find that you don’t have to become part of the latest fitness craze to reach all of your fitness goals and then some.

CrossFit’s Unnecessary Nine

We begin our class with a review of the nine fundamental exercises that CrossFit is built upon:

Air Squat
Front Squat
Overhead Squat
Shoulder Press
Push Press
Push Jerk
Deadlift Sumo
Deadlift High Pull
Medicine Ball Clean

Oh boy, I can only imagine how many lumbar disc herniations have occurred in weekend athletes as a result of performing most of these movements, not to mention the rotator cuff strains and tears from the stress on the shoulders. First off, it just annoys me to know CrossFit renamed the free squat or bodyweight squat to Air Squat in an effort to be catchy and original. Then again, I see no point in getting a client to perform 200 or 300 “air” squats in a row, not unless your objective is to drive your client to complete exhaustion and overtraining. Based on what I have witnessed with the design of CrossFit regimens, exhaustion and overtraining is the inevitable outcome.

CrossFit routines also incorporate other exercises such as pull-ups and pushups. What bothers me here is that these movements are performed in a high rep range, to the tune of 100 or more. Then the client may be pushed to do tire flips or one of the Olympic lifts that CrossFit has managed to make faddish, even though they were developed over 100 years ago.

One of the calling cards to CrossFit workouts is training at “super high intensity”, which taken in correct doses are fundamental to conditioning. As it is used in CrossFit programming, the benefits are far outweighed by the negatives they incur. In CrossFit context, they tax the central nervous system to an excessive degree. Crossfit fanatics may love the feeling of being pushed to the limit, but this borders on being DANGEROUS. When the body is fatigued to the extent that it is in a Crossfit routine, the risk for muscle breakdown and frank rhabdomyolysis is considerable. No physical discipline is worth the risk of landing in the hospital.

I understand that Crossfit offers a great social environment and a feeling of camaraderie, but at what price? Every single person I know who is a fan of Crossfit has been injured while doing it. The suggested Crossfit regimen of 3 days on, 1 day off is too rigorous when you consider the fact that Olympic lifts are part of the core of Crossfit training. The body simply cannot repair itself in enough time. To fatigue a Crossfit client by having him/her do a WOD (workout of the day for those of you not familiar with Crossfit) and then stack on deadlifts for reps or 5 foot high box jumps is insane.

Benefits drop dramatically when the body is completely depleted like that. The Crossfit ideology of deplete and endure is BS. In contrast, bodybuilders and physique enthusiasts, train hard and heavy, and yes, they often train to depletion or failure, but they certainly aren’t going to attempt 100 pull-ups after destroying a traditional back workout. They understand the law of diminishing returns all too well.

Proponents of Crossfit often state that the training is functional and enhances the day to day activities which people perform. When was the last time you had to do a clean and jerk while on the job? Unless you work as a firefighter, stock room clerk or some other physically demanding work role, I seriously doubt that you are performing movements which mimic what happens while in a Crossfit box. Besides, if you’re injured as a result of Crossfit (or should I say WHEN), you can’t possibly perform any challenging physical movement which strains your injured body part.

For those of you who compete in the NPC or IFBB (or INBA, WBFF, etc.), don’t expect to be able to incorporate Crossfit into your contest prep training and sculpt your physique in the manner required for bodybuilding. I actually had a client who begged me repeatedly to let her do Crossfit two days a week despite my recommendation that she abandon it and focus on traditional weight lifting. I finally acquiesced, and allowed her to incorporate Crossfit as part of her training.

As I had predicted, she sustained an injury, her waist widened from all the heavy complex movements which made her midsection boxy, and she became soft as a result of the cortisol spikes which the high intensity Crossfit training created. After 3 weeks of seeing all her efforts from pre-Crossfit training unravel, I asked her to reconsider her decision to engage in Crossfit. As soon as she stopped doing Crossfit, her waist began to nip in, and her body began to tighten up again. Amen for old school weightlifting!

If it sounds like I am saying you will have to decide between doing Crossfit and competing in any of the bodybuilding divisions, I am. You simply cannot create the nipped in waist and beautiful taper that defines every single bodybuilding division. If you do Crossfit, you will create a strong body (plus some injuries), but you will also widen your silhouette and carry a layer of fat as a result of all that cortisol you will release from constant high intensity training. Look at a typical Crossfit athlete. Shoulders are broad, quads and hams are thick, and the abdominal region is thick and boxy. That is what happens when compound Olympic lifts are performed on a regular basis. If that is your aesthetic ideal, by all means knock yourself out with Crossfit, but you will be destroyed on a bodybuilding stage. On the subject of Olympic lifts, even power lifters have the sense not to rep out on these movements. Yet Crossfitters, blinded by the so-called warrior mentality that leads them to do stupid things that invite injury, will rep out on movements which recruit a tremendous amount of muscle fibers and hence tax the central nervous system. I am willing to bet that the Crossfit nation contends with adrenal burnout, permanent muscle damage, and repetitive tendon and ligament ruptures on a relatively consistent basis, and that such negative aspects will eventually cause the demise of this fad sport.

I will always staunchly defend the focus and the principles behind bodybuilding. I know that NPC and IFBB competitors are true warriors and know how to push through grueling training. I also strongly believe that for the most part, most competitors are smart enough not to over train or invite injury by performing movements which are biomechanically unsound. The world of bodybuilding not only rewards strength, but it also recognizes the aesthetic ideal which all bodybuilders aspire to achieve, regardless of division. Bodybuilding is not about flipping a massive tire across a gym, it’s about sculpting and defining muscle.

I Need An Oil Can

Lately I have been in CONSTANT pain from inflammation in my neck, shoulders, elbows, wrists, hips and ankles which has me creaking like the Tin Man from the Wizard of Oz. I wouldn’t mind it so much if the pain patterns were completely predictable, but there have been days when the pain has shifted from one side to another. No amount of massage or adjustment seems to calm things down either. Granted, I have not been as diligent about taking my daily supplements due to almost two weeks of international travel which threw my daily routine off track in a big way. Now that I am back in the States for a while now, I plan to get back into my daily rhythm which will hopefully cause most of my aches to abate.
Tin Man
As a result of the pain I was enduring, I had a massage last week while in Bali. It was an amazing deal at 120,000 rupiah (about $10 U.S.) for a full hour of shiatsu massage, so I jumped on it. What I had forgotten was that shiatsu massage can hurt like a mother^%#@$* due to its focus on trigger points and deep pressure. I was writhing in pain for the entire hour, but figured I needed the torture. Usually if my patients experience deep massage, I will tell them to take arnica or ibuprofen for the next 24 hours to address inflammation, but since I am a doctor (and doctors really DO make the worst patients), and also since I had no access to anti-inflammatory agents, I tolerated the pummeling I got and simply hydrated as much as I could. The next morning, I was in so much pain that I could barely walk, and I couldn’t turn my head at all. Stretching was almost impossible because my range of motion was terrible. Thankfully, my range of motion increased gradually as the day progressed and my muscles warmed up.

After dealing with such intense discomfort for a while now, I think I will take my own advice and resume my daily intake of antioxidants, glucosamine, and turmeric. For those of you who may also be feeling like a poorly oiled tin man, you might want to follow suit.