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

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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.

Ohhh My Hip…Ohhh My Leg…

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Though I don’t really mention this to people, I deal with almost constant body pain. The bizarre thing is that most of my chronic pain issues are located on the right side of my body. I wake up almost every night from intense pain in my right shoulder whenever I roll onto my right side. The pain in my shoulder is the result of a rotator cuff tear which I sustained in April of 2013 and an acromio-clavicular joint dislocation which occurred in December of 2014.

Then there is my right hip which goes into spasm almost daily, and sends a wicked pain along my tensor fascia lata, iliotibial band and peroneus longus (aka lateral thigh and leg) which at times literally takes my breath away. Fun stuff. I power through the pain, especially when a heavy leg day looms ahead, but this chronic pain has me near tears on some days. I am beginning to wonder if I have tensor fascia lata (TFL) syndrome.

My right tensor fascia lata muscle is always tight and inflamed, as is my right gluteus maximus. When my hip spasms, both of these muscles seize up as well. As a result of this ongoing issue, I often dig my knuckles right into my hip to address trigger points and to get some relief, and I also must get deep tissue massages on a regular basis to keep the spasms in check somewhat. I am actually known at the places where I get massages for being the fitness lady who needs at least 90 minute massages to address my musculoskeletal issues!

I recently stumbled upon a great post, written by by Stephen O’Dwyer, CNMT, which I am pasting here:

How the Tensor Fascia Lata (TFL) Causes Hip Pain

This muscle causes pain in two primary ways:

1) Once the TFL has been tight and ischemic for some period of time (it’s different for each individual), it can develop myofascial trigger points.

Trigger points can then refer pain to other parts of the hip, the groin, the buttocks and even down the leg.

2) When the TFL becomes chronically contracted it can exert a mechanical strain on other muscles by distorting joint movement.

For example the gluteals or the piriformis muscle often suffer from an unnatural “pull” from an excessively tight TFL.

Pain, then, might be felt in one or more of the following areas…

• Deep in the hip joint

• Into the groin

• Wrapping around the outer hip

• Deep in the gluteal muscles

• The sacroiliac joint

• Traveling down the leg

What Causes Tensor Fascia Lata (TFL) Dysfunction?

I have been considering for a long time how the TFL becomes excessively tight and locked up (aka dysfunctional) and have concluded that there are two chief reasons…

1) Weakness in the rectus femoris muscle.

The rectus femoris, the top quadriceps muscle along the front of your thigh, is your secondary hip flexor (after the psoas and iliacus which are your primary hip flexors).

And the rectus femoris muscle so often becomes weak as a result of the second reason for TFL dysfunction…

2) Excessive tightness and shortening of the psoas and iliacus.

This is a common occurrence in many of us who sit for long hours at a desk and/or commuting in our cars. The primary hip flexors, the psoas and iliacus, are put into a shortened position when we’re sitting. This can cause them to adapt to the shortened position.

Chronic shortening of the primary hip flexors, the psoas and iliacus, can causes the secondary hip flexor, the rectus femoris, to atrophy.

I believe this occurs, in part, because short hip flexors will abbreviate your stride thus reducing a full and natural leg swing.

In runners who are heel strikers this problem can be even more exaggerated. The quadriceps, and especially the rectus femoris, are severely underused.

In the reaching stride characteristic of heel strikers, the leg extends and straightens at the knee as the foot hits the ground. This leg movement disables the quadriceps muscles.

An aside for runners: underuse of the quadriceps can be rectified using the “barefoot running technique.” This technique does not require one to actually run in bare feet but rather to…

1) Adopt the upright, “running on hot coals” running method

2) To use a running shoe without the beefed up heels of conventional running shoes which don’t allow your foot to go through its full range of motion.

I recommend the Merrell’s Pace Glove for Women or Merrell’s Trail Glove for Men (the shoe I run in).

How to Treat Tensor Fascia Lata (TFL) Dysfunction

There are three strategies that alleviate excessive tightness in the tensor fascia lata:

1) Direct manual therapy treatment of the tensor fascia lata
I find that putting a client in a side-lying position with a pillow between their knees (and one to support their head and neck) is optimal.

Then direct manual pressure applied at different angles will help to locate the greatest “liveliness” in the muscle (I like to use this word instead of “pain”).

Gentle but detailed work will produce the best, most lasting results.

2) Maintaining flexibility in the entire hip

Stretching of the hip flexors and the entire hip and leg.

See Hip Stretches for excellent video support.

3) Strengthening the quadriceps
I’m not a fan of seated leg extensions on a weight machine to accomplish this.

Much more effective are single leg squats. If squats are not possible due to pain, then sitting against a wall is an excellent strategy.

Your knees should be at a 90 degree or right angle. Otherwise it’s not stable for your knees.

I love this article because it discusses a very common scenario which I see in my patients and which I am also personally experiencing. I definitely have a weak rectus femoris, partially due to the overactivity and spasm of the psoas and iliacus. Over the years I have had osteopathic manipulation to treat the psoas issue, but it keeps flaring back up. The weird thing is that I don’t necessarily sit for extended periods of time, yet my hip flexors are always tight. So if you have hip pain which never seems to resolve, you should check out the site where I found this article:

http://www.lower-back-pain-answers.com/tensor-fascia-lata.html#axzz3eaeKtVlT

I also highly recommend the stretches demonstrated on this link: http://www.lower-back-pain-answers.com/hip-stretches.html#axzz3eaeKtVlT

If you truly suffer from chronic, daily hip pain, then you can carve out a few minutes each day to perform these exercises. I have been so miserable from the pain in my hip that I am going to start doing these stretches every day. I will post a follow-up after doing these stretches consistently to provide personal feedback on the efficacy of these stretches, but the theory behind these stretches is so solid that I am sure they will make a big positive difference in my hip issues.

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.