Modify Modify Modify

The previous 2 posts provided guidelines on cardio and resistance-based exercise. I want to offer some modifications you can make to accommodate injuries and weaknesses in joints (bones) or muscle strength.

Alert 1: Don't do strength training with weights of one particular muscle multiple days in a row. Give that muscle rest for 1-2 days. If you are just starting out give the worked muscle 2 days of rest. You can do bodyweight exercises multiple days in a row AND don't forget those daily planks or plank variations! 🤪

There are many reasons why you might get injured. Here are just some of the causes:

1. Overuse - if you overtrain any single muscle or joint, inflammation can result which causes pain.

2. Genetic predisposition- issues such as arthritis and autoimmune diseases can be inherited.

3. Muscle Imbalances - you are not working agonist and antagonist muscles equally.

4. Exercise Progression - starting a workout program too aggressively or increasing the intensity of your workouts too quickly

5. Structural abnormalities- conditions like scoliosis, spina bifida, or cerebral palsy(there are many)

6. Disease - low or high blood pressure, heart disease, obesity, diabetes, or other illnesses

7. Postural deficiencies - slouching, hunching your shoulders, not being relaxed

8. Aging - becoming more sedentary and decreasing muscle mass.

9. Poor form - you perform 1 or more exercises incorrectly.

   
   

   Of course there are other causes but these are the most prevalent.

Genetic diseases, structural abnormalities and other diseases warrant discussion with a healthcare provider before beginning a workout program or dramatically increasing the intensity or duration of an existing workout. Let's examine the ones that you can work on.

#1 - MUSCLE IMBALANCES ,OVERUSE, IMPROPER FORM

Muscle imbalances occur by training an agonist muscle (prime mover) without training the corresponding antagonist muscle or vice versa. This has multiple causes. In activities of daily living (ADLs) we tend to work certain muscles harder than others. For example our biceps just get flexed and used more than our triceps just by lifting bags of groceries, or luggage etc. Injury can happen since the strength of the bicep and tricep muscles are not equal. Another common muscle pair imbalance that causes injury is between the quadricep and hamstring muscles. Once again we tend to have stronger quads than hamstrings. They get more work in ADLs.

Here is an example that I personally experienced. I was an avid runner with bad habits - I didn't warm-up before or cool down and stretch after my workouts. Eventually I started to have hamstring pain and very tight hamstrings. I knew I was at risk for muscle tears. Tearing these muscles leads to surgery, a long and painful recovery which of course leads to months of inactivity or limited activity and physical therapy.

In ANY strength workout - BE SURE you work both the agonist and the antagonist muscles. These don't have to be on done on the same day but you should work each the same number of times per week. Here are some examples:

• Biceps and triceps

• Quadriceps and hamstrings

• Chest and Back

• Shins and calves

  
  

All muscles of the shoulder are also vulnerable to injury as they are small muscles doing "heavy" lifting. We use our shoulders pretty much every time we use our upper body. There are 5 primary shoulder muscles. Most people are familiar with the 3 prime movers - Deltoid, Pectoralis major, Latissimus dorsi, or as they are commonly referred to as delts, pecs, and lats. They generate force and movement. It is very common to overuse the rotator cuff muscles which are stabilizers, not power movers.

I had rotator cuff surgery due to pain that I ignored for almost a year. By the time I went to see an orthopedist it was already completely torn and inelastic. The surgeon could not perform arthroscopy due to inelasticity. He had to cut me open. I am sure procedures have gotten better since then but I still have nightmares about that recovery. The pain was intolerable. I thought my surgeon had given me sugar pills when it was really the highest possible dosage of oxycontin. Luckily I did not get addicted.

Improper form will get you every time, especially if you maintain that for an extended time period. I highly recommend getting some instruction on proper form. This can be achieved by:

1. Working with a personal trainer

2. Seeking the advice of a physical therapist

3. Following strict suggestions on how to perform an exercise from a source known to be reputable.

Of course there are demonstrations online via sites such as youtube etc. I caution you however, to make sure the source is reputable - that it is coming from a personal training platform like ACSM or ACE who train the trainers or from an educational institution who offers programs or certifications in exercise physiology, mechanics, and brain-body connections.

Important note: It is critical to cross-train. I bring this up even though it is usually related to cardio activities. All cardio workouts affect muscles and joints that are concurrently worked - always your heart and often your arms, legs, core, and spine. Cross-training involves switching up your exercise regimen. If you do nothing but run or bike, your muscles adapt to that activity and you won't experience ongoing gains from your training. In addition, you set yourself up for overuse injuries ( you may not think you are overusing your muscles but your body says otherwise.) Repetitive use injuries are very common and preventable. They also occur over a long period of time so you may not feel discomfort for a while. However once discomfort starts it is much harder to return to pain-free activity than it is to back off any activity that causes pain and switch to another cardio workout. For example, alternating your cardio between running and biking works different muscles so overuse injuries are less likely. A bonus of this is that it is more fun and challenging to add variety to your workouts.

Important note 2: Know your body and it's limits. Everyone's physiology is different. So listen to what your body is telling you. If you try to do an exercise commonly recommended but it causes discomfort or pain, stop that and either modify the exercise or get instruction on what you might be doing wrong. Squats are a common one. However, they are some of the most important exercises you can do. Every orthopedist I have seen when visiting for knee pain tells me to stop doing squats. That is not necessary. That's just easy. Doctors treat and operate. They don't try to figure out the root cause.

Images above from Encyclopedia Brittanica - See References for citation.

#2. JOINTS

For every joint, there are surrounding muscles that must be worked to strengthen the body and stabilize the joint. For the knee which can be unstable especially in women, you must work the quads and hamstrings equally to provide stability to the knee. It is also important to work the calves and shins for knee, ankle, and foot issues. If you have ever experienced shin splints you know how painful they can be. This is usually caused by weak or imbalanced lower leg muscles. This applies to all joints in the body. You are not "working" the joint, you are working the surrounding muscles. Also, a strong core is essential for all joint and muscle health.

#3. INJURIES

If you are nursing an injury that is not an excuse for sitting on your couch. It is also not an excuse to ignore it. Pain is your body giving you a message to take action. That is beyond the scope of this discussion but you should seek help if the pain/discomfort persists for more than a couple of weeks. A physical therapist's (PT) goal is to help you recover but you have to diligently do what they suggest. Yes, it takes time‼️

You also still need to move if at all possible. If your injury is to your lower body, there are chair workouts that you can do. As long as you do not feel pain while doing an exercise, it should be ok. The goal is to get your heart rate up by using arm movements. Using weights, bands or medicine balls can increase the intensity. A lot depends on whether you can be weight-bearing at all. For example, if you tear your achilles tendon or a knee ligament you may be non-weight bearing for a period of time. Consult your PT for what routines are safe. There are also chair yoga classes. If an upper limb is injured you can still do many exercises, in fact, there are many shoulder, back and chest exercises used for rehabilitating these muscles. You may need to start with bodyweight only exercises but again, a physical therapist should be engaged. You have to be committed to recovery in order to get back to your normal fitness.

If you feel that recommended exercises such as planks and squats are not working for you due to sensitive knees, shoulders or other mechanical issues, there are modifications for everything. There is no shame in modifying. You know your body better than anyone. You want to meet it where it is - push yes but not to the point or through pain.

Shoulders, knee, back, and foot/ankle problems are 4 of the more common issues we face, especially as we age. In my next post I will elaborate on modified exercises for all of these vulnerable muscle groups.

DEFINITIONS

Agonist muscle - primarily responsible for generating a specific movement. It contracts to create motion at a joint. For example, during a bicep curl, the biceps brachii is the agonist — it contracts to bend (flex) the elbow.

Antagonist muscle - the muscle that opposes the action of the agonist. For the example above, the tricep brachii muscle is the antagonist. Fit relaxes to allow elbow flexion.

ADLs- Activities of Daily Living