Injuries Suck Ass
It’s the playoffs. My high school hockey team is locked in at two-two, the faces of our student section show their nervousness, their hands held up like they’re praying to the Hockey Gods (yes they’re real don’t @ me).
My body was worn out from a long season. But we just had to win three more games to capture a state title.
The opposing team wasn’t making it easy.
In the second period, I held the puck at the blue line, with a lumbering senior (I was a freshman) barreling towards me. I faked left, and scooted right to avoid him, enough to keep possession but not enough to fully evade him. His shoulder rammed into my left leg. I passed the puck up to my teammate and glided off the ice. As soon as I got to the bench, my left quad throbbed.
Fortunately, the second period was almost over.
At the start of the third period, I felt okay. Not great, but good enough. It was the playoffs, I didn’t have a choice.
Before my third shift, adrenaline had taken over.
As I hopped over the boards, I hurdled my right leg over first…
Instantly in pain, I skated around the ice for about ten seconds, striding with my already-banged-up left leg, and unable to flex my right hip.
As the trainer wrapped it up, I heard an eruption from the team bench to my right. My stomach dropped.
Down 3-2, I had no choice but to go out there.
I strode with all I could, desperate to make a play.
The buzzer went. We had lost.
The next day I went to the trainer. I had pulled my hip flexor and would be off the ice for a while.
“Do you stretch?” The trainer asked.
“Do you do sit down a lot?”
Well, I’m in school. So yes.
I guess I’m not.
That injury encouraged me to learn all I could to never get a preventable injury again.
After high school, I became a trainer, where I’d learn more and more about injury prevention.
Now, at 21, I still feel like there’s so much I don’t understand (the more you know, the more you realize you don’t know), but I’ve picked up a thing or two about injury prevention.
Here’s what I’ve learned in the six-plus years since the hip flexor injury that crushed my high school championship dreams.
Injury prevention starts by knowing the postures that commonly lead to injuries.
First, let’s look specifically at my hip flexor injury. It was a standard overuse hip flexor injury.
Avoiding a discussion of my hips’ permanent changes, such as the femoroacetabular impingement (FAI), you should understand the common postural phenomenon that led to it: Lower cross syndrome, a posture that my body had morphed to from more than a decade of hockey.
Hockey and nearly all sports (and working out) are played with our hips low — flexed — and require powerful action of the hips with every stride. In this posture, our hip flexors tighten, as they’re constantly in the flexed position.
When these muscles in the front our hips tighten, they bring the pelvis forward..
When the pelvis tilts forward, the low back arches.
With the low back now excessively arched, the low back muscles take over actions that the hip extensors should do.
During a running stride, when you push your leg out, you’ll be using your low back too much, and your hip extensors (glutes and hamstrings), not enough.
With the hip extensors inhibited, the hip flexors control even more, and continue to tighten and tighten, leaving them vulnerable to injury (1). The same goes for your low back. Your low back tightens, causing more of an arch, which causes it to tighten more. It’s a vicious cycle, and that’s the worst kind of cycle — except maybe a carb cycle, those suck too.
Eventually, the effects go up and down your body, as your thoracic spine (mid-back) rounds, causing your shoulders to round as well. In your lower body, your calves now must sit in a more flexed position, impeding your ability to dorsiflex and worsening the problem.
This is one common issue, one particularly prevalent among athletes and lifters (anybody who spends a lot of time in hip flexion, really)
We’re not symmetrical. We have one heart on the left side, a big fat liver on the right, and an extra lobe on the right lung, to name a few asymmetries.
The asymmetries add up to cause most healthy people to shift their weight to the right side.
And over time, these asymmetries can exaggerate and cause other postural issues that lead to injury.
Three years after that hip injury, I had a weird pain on the outside of my right hip that I could play through, but in discomfort.
After that season I went to a Postural Restoration Institute certified physical therapist where I was able to diagnose the issue.
Anytime I took a stride on my right leg, my lateral hip muscles — like the glute medius — weren’t doing as much of the job of abducting the hip as they should’ve. Instead, my right quadratus lumborum, a muscle in the low back, took over to do the job.
In order stride to stride my leg back and to the side, my right back muscles had to work because my right hip muscles were too weak.
This led to more issues that were different on each side.
Working with this physical therapist, we work to balance the lower cross syndrome and the left-right imbalances.
I’ve used lower cross syndrome and left AIC (anterior interior chain, jargon for your weight shifts to the right), and they might not represent you. But if you’re an athlete (or gym rat) without a history of serious injuries (like a broken leg which would change the way you shift weight) there’s a good chance both of these postural imbalances affect you.
And if you’re not sure, going to a PRI physical therapist or another professional you trust would be the best way to find out.
If you can restore your body to balance — or even just improve your posture a bit — injury risk will recede. But, it takes time.
There’s no one method to restore posture.
Some work better than others. I’m only offering the ones I’ve been successful in implementing, both on myself, clients, and hockey teams riddled with hip and low back issues.
Understand what the issues are, and how each method combats the issues. Then, if you come across a different methodology, you can decide for yourself whether it will work for you.
Also remember that posture is fluid, changing constantly based on the positions we’re putting our body in.
So, reteaching posture is not an end goal; it’s something you have to constantly work on by finding the right strategies to include in your routines.
Our body’s fluidity is good news. Because wherever your posture is at right now, it can be improved immediately.
The first step after understanding your problem is to assess your posture. If you have low back or hip flexor pain, I can assess it for you: it’s fucked up.
If you’re asymptomatic but you’re active, you probably also have an excessive anterior pelvic tilt, a result of lower cross syndrome. In one study, 75% of women and 85% of men who were asymptomatic still had an excessive anterior pelvic tilt (2) and is even more common if you do a lot of sprinting (3). Because of the similarities between sprinting and squatting, I suspect it’s also more common for gym rats.
The only situations where wouldn’t have it, is if you play certain sports that might lead to an opposite adaption, you have a previous injury of sorts that changed your posture, or you have some significant genetic difference.
All possibilities for sure.
In this case, to figure out whether you have the extended posture, take a few pictures from the side and look at your spine arch and take pictures from the side.
You can also test it by your ability to flatten your back against a wall. If you can fully flatten your back, at least you’re able to get out of it. If you bring your feet closer to the wall and can still keep your low back flat, it’s not as big an issue.
In order to quantify it, a good physical therapist will be able to tell you (look for PRI certified therapists or a therapist you trust).
Correcting and Extended Posture
If you’re like most athletes and you have an extended posture, then the first exercises I use to get into the position is with isometrics held with deep breaths. Basically, teaching them to get into a better position, and then stay there.
And, ideally, they have direct feedback, so they can do it without a coach (especially important in online training settings).
Let’s take an athlete who suffers from the typical lower cross syndrome pattern. Their spine is excessively arched, and they may not know it.
So, I’ll just have them lie down and try to flatten their back against the ground.
In order for the back to flatten, the hip extensors need to turn on so the butt can scoop up out the way so the pelvis comes back close to neutral (like you’re humping something) and the abs need to turn on to bring the ribcage down.
Another way to think about this is like your pelvis is a full bucket of water. You want to tuck your pelvis in so no water spills. If your back is arched and pelvis forward, you’ll spill water.
If you can’t do this, first make it easier by bending your knees, even bringing them up Bring them as close to you as you need to so you can flatten your back, and then focus on the next element…
The breath is a crucial element of posture. The diaphragm, the muscle responsible for filling and emptying the lungs, acts as an antagonist muscle to the deep abdominal muscles. So, when you exhale and the diaphragm relaxes, the abdominals can contract. This helps the back flatten and restores a neutral posture.
To see specifically what exercises I use to teach the pelvic tilt, read The Art of the Posterior Pelvic Tilt.
The concept with PRI is the same: Find the right position, and breathe in the right position.
If you’re suffering from asymmetric pain, then read how I used PRI posture and breathing techniques to heal an entire ailing hockey team.
When I came up in the industry, static stretching was still quite controversial. There were concerns against stretching before the workout.
Now, static stretches are commonplace as part of a comprehensive warm-up for injury prevention. Now, you shouldn’t just stretch everything and expect to feel better. You might. But it won’t necessarily improve your posture and help prevent injuries.
Don’t just stretch because you think you should. Ask yourself why you’re stretching in the first place.
Your stretches should have a specific goal. Most likely, you’re focusing on stretching the muscles that are tight and plotting against your posture. Your hip flexors, calves, and pecs are a few examples.
Doing a hip flexor stretch will lengthen the overly tight hip flexor muscles. Maybe not permanently, but enough to temporarily increase your hip extension so you can lift and run without a compromised posture, and that will help you prevent injuries. While there are exceptions and stretching is not for everyone, stretching for even ten seconds increases your range of motion (4).
I’m not sure why foam rolling is still debatable. Have you ever foam rolled, bro?
It feels awesome and once you’re done you can definitely get into better postures and positions.
I guess the effect of foam rolling is inherently hard to study.
But I’ve never met anybody who foam rolled and didn’t feel better after. And, I know manual therapists who’ve seemingly magically healed chronic injuries and made the athlete feel better right away. I learned how to do self-manual therapy for myself and clients with this great resource, Trigger Point Therapy Workbook. If you have chronic, nagging pains, this book may be the guide to fixing it.
Again, like stretching, focus on the tight muscles: quads, thoracic spine, pecs, and calves.
There’s also almost no risk or downside (just don’t be an idiot and roll your neck or something).
Mobility is kind of a loaded term these days. There’s definitely a lot of overlap in this between stretching and the breathing exercises, which are all about turning on certain muscle groups. Mobility is not really any different.
Mobility is when you actively get into a posture, it just focuses on certain joints and positions.. For example, I might know I’m having issues at the bottom of a squat, so I’m going to do the spiderman external rotation stretch and really focus on getting the front leg to sink into a squat.
Or, I know my thoracic spine rotation is shit, so I’m going to go through some side-lying windmills and concentrate on moving only through my t-spine.
The reason we’re working so hard to restore our posture at the beginning of workouts is so when you squat, bench press, and sprint, you won’t compensate.
So make sure you’re taking the postural principles and applying them to the actual exercises also. Setting up in the right posture is especially important if you’re lifting heavy weight.
Don’t work so hard to improve your posture and then fuck it up when it matters most.
Let’s take a deadlift (any variation) for example. You’re standing with your toes underneath the bar. Reach your arms out and take a big exhale. As you exhale, tuck your butt underneath you to flatten your spine and turn on your hip extensors.
Maintaining that posture, keep breathing, and go do your deadlifts. In this posture, you’re much less likely to hurt your back, because you’ve already activated the muscles (glutes, mainly in this example) that should actually be doing the pulling.
At first, this will be hard. I went from doing hex bar deadlifts for reps in the three and four hundreds, to using literally 95 lbs. But then, I ingrained the habit, and quickly went back up in weight. So, you’ll have to leave your ego at the door.
Also keep in mind, when you do this, you won’t be able to see a difference in your form. But you’ll feel it. Here are two pictures. In one I’m using my back, in the other, all glutes.
You can also do everything right, but if you’re just choosing exercises your body won’t be able to find the right posture for, you’ll increase your chance of injury.
Let’s take an extreme example: the snatch.
I don’t have the shoulder OR hip OR ankle mobility to do that correctly, let alone with load. Sure, you could argue I should work on getting to it. But until that day comes (it won’t and I’m okay with it), I’m not going to train that movement with any load besides a dowel rod.
But, even a lot of conventional strength training exercises might be bad options. Back squats still require a lot of shoulder external rotation. A front squat, or single-leg variations are just safer options because they’re easier positions to get into and they don’t need as much load.
The hex bar is almost always better than the traditional deadlift.
Dumbbells will be more shoulder-friendly than a barbell.
The point is, choose exercises that work for your body. Maybe you could barbell bench press with no pain ten years ago, but now it hurts your shoulder. Do dumbbells feel fine? Yes? Okay, then just do a dumbbell bench press. There are no exercises you have to do. Only choose exercises that work best for you.
You also may just be choosing the wrong category of exercise. Are you doing too much pushing and not enough pulling? Too much squatting and not enough hamstring curling? These sorts of imbalances would set you up for postural issues and then injury.
For example, if you bench press a lot but rarely do rows, your shoulders will get stronger and your pecs will shorten, bringing your whole shoulder joint forward and rounding your shoulders. This can lead to shoulder pain, upper back pain, and poor shoulder rotation that then leads to other issues. To have your shoulder joint comfortably sitting in its socket, to can’t disproportionately do one over the other. This is upper cross syndrome.
Putting this all together, you should add these injury prevention (and performance-enhancing) methods into your warm-up.
I know, I never wanted to be one of those guys who takes thirty minutes to warm-up. This should all take fifteen minutes tops. Just fifteen minutes a day on training days to take huge steps to prevent injuries.
Each one of these should take about three minutes before your workout. In fact, from now on, just consider it as part of your workout.
I also, in place of rest periods, often place some kind of stretch or posture drill into the workout. You can do extra mobility when you would’ve been on your phone anyways. You might get some stares for lunging in between bench press sets, but it’s either that or tearing your hip flexor.
For example, on a bench press day, the series may go:
You can put any posture/mobility drill there, as long as it doesn’t interfere with the lift, in this case, bench press.
Finally, this should be obvious but I have to say these. If you’re doing all these steps and you’re still in pain. Lower the weight. Stop doing the exercise. See a professional.
Taking time off is okay. You won’t lose all your gains in a week. But you will lose your gains if you have to take three months off.
Sometimes injury prevention is as simple as load management.
It was my senior year of high school. I walked into my English teacher’s classroom and reached onto the bookshelf on the right containing at least thirty copies of the same red textbook.
I grabbed six, and plopped them on my desk, then went and got six more to place next to the other six.
The glares commenced from around the room. Nobody was quite sure what I was doing. Then I moved my chair to the corner of the room, and rested my pen on top of the books, waiting for our writing prompt to start class.
I didn’t ask if I could. I abided by the old maxim (probably) that goes, “It’s better to beg for forgiveness than ask for permission.”
My teacher came in, glanced at me for about half a second, laughed, and started teaching.
Rinse and repeat the makeshift standing desk for every class.
I don’t want to be one of those “sitting is the new smoking” guys but sitting is the new smoking. So don’t sit so much.
Sitting puts us exactly in the position that tightens our hips, arches our spine, and rounds our shoulders. No bueno, tío.
Unsurprisingly, prolonged sitting leads to lower back, neck, and shoulder pain (5). It also, as an added benefit to being in this posture without doing something active, inhibits our glute activation, turning off the muscles that are supposed to counter the tight hip flexors and overpowering low back.
It’s bad for your beautiful butt. If that’s not enough to convince you to sit less, I don’t know what is.
I’ve always wanted one of those dope adjustable desks where you press a button to adjust the height. But, while I’m a big proponent of finding a workspace that undulates up and down as you please, it’s not the only option.
Most offices and classrooms have books, so you can follow my model. Or you can buy foldable stools that slide into a briefcase. I’ve never seen any myself, but they sound kind of sick.
As a rule of thumb, do two minutes of mobility for every thirty minutes of sitting. I pulled this rule of thumb out of my ass, but it seems like a good guideline. I find the couch stretch to be perfect to offset the postural considerations and prevent injuries.
And, if you want to take it to the next level, and if you’re working at home, look into a treadmill desk. Treadmill desks probably deserve their own article, so I won’t get into it here.
While standing is better than sitting, for people with poor posture, standing may hurt their back after a while. This makes sense because if you stand with your pelvis excessively forward and your spine arched, your low back will bear more weight and eventually start to ache. So, having the option to sit and stand as you please is key.
But, having the option to walk gives your body a gait work off of and spreads out the stress.
I live in a city (and walk nearly everywhere) so I won’t be a treadmill desk guy anytime soon. But if you’re working from home, it might be a great option for you.
The point is, your lifestyle and daily habits will also have a huge impact on your posture and your chance of injury. If you do everything right for an hour of working out, but you’re in poor positions the rest of the day, you’re fighting an uphill battle.
So find ways to break up your sitting habits, whether that’s with a standing desk, frequent walks, or regular office mobility sessions.
If you eat like shit, you’ll feel like shit. And that, whether directly or not, won’t bode well for keeping your body healthy and pain-free.
The older you get, the more you can do the right things and still wind up with nagging injuries here or there.
Specifically, with regards to your diet, you need to worry about inflammation. So, that starts by focusing on eating foods with anti-inflammatory benefits. No, I’m not talking about Advil, that’s like cutting your arm off to draw blood.
Fish also show anti-inflammatory properties, thanks to their high concentration of omega 3 fatty acids. Omega threes have been shown to decrease inflammation (9).
And, unless you eat quality seafood on a regular basis, you’re probably not eating enough and eating too much omega 6 by comparison. A disproportionate Omega 6:3 ratio can actually increase inflammation, so it’s important to have tons of omega 3’s in your diet (10). That’s why fish oil supplements have stood the test of time.
So you can check out our list of the best vegan omega-3 supplements for more on this.
In addition to worrying about inflammation, the other concern is recovery. As you age, it takes longer to recover from workouts. During these bouts in between, you’re likely in a bit of a fragile state, as your body heals from hard workouts.
So, foods that enhance recovery are key. And, while, we can make this complicated, it really boils down to eating enough protein. If you’re not getting around one gram per pound of protein each day, that’s an area where you might be able to find some easy progress.
In particular, new research on collagen protein peptides suggests it may be a useful supplement for recovery.
Collagen is just a protein, and peptides are basically more broken down — and therefore more useable — versions of collagen.
Collagen peptides in particular support injury prevention because they may improve recovery (11) and joint health (12), in addition to the well-supported research on their benefits for skin health. So, if you’re looking for a supplement to try, and you’re already covering the basics, look into a good collagen peptide.
Of course, you don’t have to go hardcore on all of these. You should experiment and see what works for you.
That’s what a huge part of the battle is when it comes to preventing injuries: finding the activities, exercises, diet, and lifestyle choices that work for you and keep you healthy.
Finally, if you’re not feeling any nagging injuries, then now is the time to start preventing injuries. Everybody stretches their hip and works on their breathing once they’re in pain and don’t want to be in pain anymore.
But those who avoid preventable injuries over a long period of time, have developed habits to never let those tweaks sneak up on them.
And then, if they do sneak up on you, you’ll already know what you need to do so smush them before they flare up too much.
So, I encourage you to try all of these strategies and take what works best for you.
Injuries are the worst. Just the worst. Now, freak injuries can happen, so nobody can guarantee you won’t get injured. But the old adage has been that they’re just part of the price you pay for being active. I call bullshit on that. There’s no reason why you can’t all but eliminate nagging pains and injuries, even as you get older and older.