Personal Lessons from Being Injured
To prevent sports injuries, don’t train through pain and focus on proper exercise techniques.
Link to the Original Essay
No matter what sport you play, injury is an inevitability. If you become an expert at any physical endeavor, your body will eventually fight back. Unfortunately, it is often assumed that this is only the case with extreme sports like mixed martial arts, weightlifting, or football. Likewise, many view golf as an incredibly boring and passive sport. Whether or not such opinions about golf are true, one needs to look no further than Tiger Woods and the myriad of back injuries he has sustained in his career to see my point.
I am a powerlifter. This means, as an athlete, my primary objective is to get as strong as possible on the barbell squat, bench, and deadlift, using proper form. I have had my share of injuries in my lifting. I have been very fortunate to say that none of them have been severe — yet. Before getting into those, I think it would be helpful to show the injury rate across different sports. It is, I feel, an informative piece of preparatory data for any person, athlete or not. This is especially apparent in corollary because it is quite plausible to state that inactivity makes people much more injury-prone than regular activity. As asserted by Dr. Eric Helms in The Muscle & Strength Pyramid, “Unfortunately, serious resistance training can result in injury. Fortunately, the risk I not that high and I would argue the health benefits of a life that includes lifting [or sports in general] far outweigh the negative effects of the injuries you might sustain along the way.” (1) This data is important because even if you do everything right in your respective sport, injury is inevitable.
The research, as reported by Keogh, Windwood, Assaet al. l, and Videbæk (2, 3, 4, 5) done on cross-sport injury rates, studied the average number of injuries sustained per 1000 hours across different athletic pursuits. As a powerlifter, I fit into the category of being prone to an occurrence of 5.8 injuries per 1000 hours of training. In contrast, a bodybuilder is prone to only 0.24 to 1 injury per 1000 hours of training. The injury rate for CrossFit was shown to be 3.1 injuries per 1000 hours of training. The most injury-prone weightlifters are Strongman competitors, who averaged 4.5 to 6.1 injuries per 1000 hours of training. On the surface, this makes it seem as if weightlifting in its various manifestations — maybe aside from bodybuilding — is a dangerous endeavor. However, some sports leave their athletes more injury-prone than weightlifting. For instance, basketball players showed an injury rate of 8.5 to 11.1 injuries per 1000 hours of practicing and playing their sport. Likewise, runners showed an injury rate that ranged from 2.5 to 33 injuries per 1000 hours of training in novice runners and 17.8 injuries per 1000 hours of running in recreational runners.
The moral of citing these numbers is that we all get hurt. But perfectionism can only get us so far when it comes to injury prevention. Proper technique, mobility, programming, and adequate nutrition, can only diminish the onset of injury to a modest degree. But, as athletes, it is only a matter of time until it happens. I hope my experiences with injuries can shed some light on what to do and what not to do when you get injured.
My first injury became apparent to me in April of 2018. I say it “became apparent” because I was injured for quite a while until I acknowledged it. I would come into the gym every Sunday and train low-bar barbell back squats. Each week I found myself improving. Adding a rep each week and eventually moving up in weight. Throughout all of this, I had a dull pain in my left lateral hip. My reaction to this was simply muscle soreness or one of the regular aches that came with the territory of powerlifting. Hence, I decided to ignore it.
This pain became worse and worse. At the time, I was squatting only once per week. Squatting would aggravate this pain. At first, the pain was only there when I did squats, but eventually, it would not go away throughout the week. I, however, ignored it and kept pushing through the pain. This was a boneheaded move. Eventually, the pain became so bad that it began to disrupt my form on squats, where, my left knee began to cave in. This made matters worse, as, according to a study published in Injury Epidemiology in 2015, “those who engage in such activities with incorrect technique are more vulnerable to both overexertion injuries and crush injuries because incorrect technique can cause them to lose strength and a weight is dropped.” (6) The pain began to seep into my daily life. My left knee would cave in whenever I would walk upstairs, and attempting to sleep on my left side was very painful.
Nonetheless, this did not stop my arrogant self from pushing through the pain. One day, however, I had the inevitable epiphany. I started doing my warm-up sets for squats and eventually reached the weight I intended to work with. When I started my working set, using 390 lbs, I did my first rep, and the pain was so bad that I had to rerack the weight immediately. I attempted to decrease the load by at least 10%, but this did not do the trick. I tried stretching and foam rolling, but this made the pain radiate down the lateral portion of my upper leg into my knee. Finally, I realized that I was hurt and needed to take some action.
The next day, I sought out an orthopedist. He diagnosed the injury as greater trochanteric bursitis. My doctor told me that this was treatable by conservative means. He prescribed NSAIDs, physical therapy, and at least a month of rest to do any strenuous leg exercises. This, of course, crushed me. I love working out. Having a huge portion of my training cut out was depressing. However, I began to look into the research for reassurance. Specifically, I read an article by the Clinical Journal of Sports Medicine (7) and was inspirited by the data, which showed that, indeed, non-operative treatments helped most people.
When I got back into the gym for the next 4 weeks, I essentially did what I could. What this consisted of was entirely upper body movements. This period of time allowed me to carve out space to work on weak points that I neglected before, such as my shoulders and chest. What was tricky for me to replace was cardio. The form of cardio that I do is bike sprinting. Luckily, my gym has a fan bike that allows you to simply put your feet up on the pegs and push or pull the handles. I pushed those handles as strenuously as I could so I could at least somewhat keep up the anaerobic adaptations I built up from years of sprinting.
Further, I went to physical therapy and took the NSAIDs. The latter I quickly stopped taking, however, because I found that they upset my stomach too much. I went to physical therapy twice a week. The physical therapy clinic I went to gave me a cookie-cutter sheet of exercises to do. I rarely saw my main physical therapist. More often than not, I was just passed along to various different PTAs like a number. This physical therapy clinic likewise, at times, had me there for two hours. However, this was my first experience with physical therapy, and I did not see anything wrong with any of this. I figured that this was the norm.
After the 4 weeks of rest was up, my orthopedist recommended taking a cortisone shot to top off the recovery process. I obliged. It was a painful shot, but I was willing to do whatever it takes to get better. Finally, the orthopedist said I was good to go to train legs. I asked him, “can I train them tomorrow?” and his response was “yes.”
I started very lightly and worked my way up slowly. For the first few weeks, everything seemed fine. I was progressing without any pain, and my technique on squats looked better than ever. When I reached 315 lbs, it felt great. However, when I got back home from the gym, the pain in my lateral hip was back. This was becoming very frustrating.
I went to my physical therapy clinic and told them what happened. The way they reacted baffled me. They wanted to keep on doing the same exercises as before. You know, the ones that didn’t get me any better? Immediately, the quote that is often attributed to Albert Einstein sprung to my mind: “insanity is doing the same thing over and over again and expecting different results.”
Then I went to my orthopedist, who suggested another cortisone shot. Luckily I was informed because I was aware that the data, according to Mayo Clinic (8), suggests that you should limit the number of cortisone shots you get into a particular joint to once every 6 weeks. This is for the sake of mitigating the risk of cartilage deterioration. Likewise, I realized that the advisement to let me squat the day after a cortisone shot was unadvisable for precisely the same reason.
Hence, I said no to the cortisone shot and found a new orthopedist who suggested taking at least another month off of squatting. This was beginning to feel hopeless. Eventually, I got another cortisone shot, but it did not help. I was beginning to think that I needed surgery, as the data (7) states that the small number of people who do not respond to non-operative treatment need to get a bursectomy.
I also found a new physical therapist. He was very hands-on with his treatment. He used various sports massage techniques, electric stimulation therapy and was concerned with legitimately correcting imbalances through minimalistic exercise prescriptions, which he changed rather frequently. Also, this physical therapist’s motto was “if it doesn’t hurt, you can do it.” This made me feel much less restricted than before. Because of this reassurance, I started deadlifting again, which gave me no pain. Furthermore, my new physical therapist only took up 30 minutes of my time during each session. This was a much better change of pace than my previous experience in physical therapy.
During these four weeks of recovery, however, the pain did not go away. When the 4 weeks were done, I did not feel comfortable even attempting to squat. By the fourth week, I found myself crying to my orthopedist for some relief. My dreams of competing in powerlifting seemed all but gone. He suggested that I try a homeopathic injection called Traumeel. According to The International Journal of General Medicine (9), “Traumeel is a fixed combination of biological and mineral extracts, which aims to apply stimuli to multiple targets to restore normal functioning of regulatory mechanisms.” I agreed to it. It was probably the most painful injection I had in my life. It was worth it, though, because it worked. The inflammation and pain subsided and haven’t returned since. I am now squatting over 400 lbs at a bodyweight of 165 lbs with no pain.
In April of 2019, a year later, I strained my pec doing weighted dips. I immediately took action. I stopped training my chest for at least 4 weeks, applied ice and heat to the injured area at least twice a day for 20 minutes, went to a hands-on physical therapist twice a week, and worked on weak points in the gym — which still happened to be my shoulders. Instead of allowing this to turn into a grueling 4-month excursion, it lasted only 4 weeks, precisely because I did not push through the pain, and I listened to my body. I quickly got back to my pre-injury activity level because I learned my lesson. This proactive reaction is ultimately what made the recovery process this time around so swift.
Takeaway lessons:
Don’t push through unnatural pain:
When we work out, our body and mind's natural reactions are to feel aches, the burn from the building up of lactic acid, and sometimes even lightheadedness. This is fine. In fact, there is something to be said about the strong-willed nature of pushing through such pain. It can help build character — especially if you apply that ethic to other facets of life — and is truly the only route to building a great body. However, sharp pains or any pain that interferes with proper technique is to be avoided at all costs. Don’t be afraid to take some time off, lower the weight or lower the intensity of your workout if it is inducing pain that feels out of the ordinary. Trust your intuition. If you think, “Wow, that really hurt. Should I try again?” you probably should call it a day.
Maintain Proper Technique:
This is a point that cannot be stressed enough. Unfortunately, however, finding a good personal trainer is profoundly difficult, which is because, according to The Journal of Strength and Conditioning Research, (10) “all one has to do to become a ‘certified’ trainer is to pay a fee, take an exam, and most fitness facilities will hire the individual regardless of the type of certification.” As a result, it is the case that most individuals are not well equipped to learn, let alone maintain, proper technique. Good sources of mastering technique include the books Starting Strength by Mark Rippetoe, Becoming A Supple Leopard by Dr. Kelly Starrett, and Strength Training Anatomy by Frederic Delavier.
Focus On Other Things. Search For Dormant Passions:
During my injuries, I did not only focus on my weak points in the gym. I also focused on my other passions. At the time, and still now, I really started delving into philosophy, both for my undergraduate major and for personal interest. This gave my life a profound sense of meaning because I was passionate about it. Thus, while my hip was in pain, I was absorbing the works of Plato, Bertrand Russell, Immanuel Kant, and Friedrich Nietzsche, amongst many other important thinkers.
Further, I live in New York City and have at my disposal some of the world's most eminent museums, which I began to visit quite frequently. This was something I’ve always wanted to do but never found the time to until getting injured. So pull the passions out from the back of your mind that have been lying dormant.
Life doesn’t have to stop because of your injury.
Perhaps there is something important you’ve been avoiding, and through this avoidance, you have always used training as an escape. Instead, use this time to pull things out from under the rug: we all have kicked things under there at some point and walk over it daily, pretending we do not feel the lump in the carpet. Injuries give us time to recognize and deal with this instead of using our time as athletes as a means of avoidance.
It would also help to spend more time with friends and family as well. This might help alleviate the stress of being injured, especially if you have friends and family you are very close with. Plus, these relationships, when healthy, are a profound source of meaning in our lives. Indeed, without them, the meaning we derive from our respective sports is quite reduced.
Don’t Despair, Be Patient, You Will Heal:
In Thus Spoke Zarathustra, Nietzsche wrote, “You must wish to consume yourself in your own flame: how could you wish to become new unless you had first become ashes!” (11) In the case of an injury, this is true. Being injured is not at all a pleasant state of being. It should be stated that there is a chance that you may never recover in catastrophic cases. Despite that, you can still find solace within your mind. Buddhism and Stoic philosophy, amongst many other philosophical traditions, teach that it is the case that suffering is ultimately a mental phenomenon. In the context of external negativity, you can still find tranquility. Nonetheless, it is the case that most injuries are overcomeable. To quote Nietzsche once again, “To live is to suffer, to survive is to find meaning in the suffering.” (11) Hence, when we are injured we should not despair. You will be back to your sport in no time. It is helpful to know that muscle memory is real. Muscles will regain strength, size, and adaptations quicker after atrophying than when first built, as was made clear by a 2005 study published in The Journal of Science and Medicine in Sport (12).
Do your research:
Understand your injury as best as you can before you go seeking treatment. This way, you can weed out the good doctors from the bad. Then, go on PubMed and read the latest research that has been conducted on your injury. This way, you can avoid dealing with providers that do not know what they are doing — as there are many out there that have no clue what the latest research says.
Citations:
Helms, Eric. The Muscle and Strength Pyramid: Training. Eric Helms, 2019. E-Book. pp. 40–41.
Keogh, J.W. and P.W. Windwood, The Epidemiology of Injuries Across the Weight-Training Sports. Sports Med, 2017. 47(3): p. 779–501.
Asa, U., et al Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med, 2017. 51(4): p. 211–19
Cumps, E., Verhagen, E., Meeusen, R., Prospective epidemiological study of basketball injuries during one competitive season: ankle sprains and overuse knee injuries. J Sports Sci Med, 2007. 6(2): p. 204.
Videbæk, Solvej et al. “Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis.” Sports medicine (Auckland, N.Z.) vol. 45,7 (2015): 1017–26. doi:10.1007/s40279–015–0333–8.
Gray, Shannon E, and Caroline F Finch. “The causes of injuries sustained at fitness facilities presenting to Victorian emergency departments — identifying the main culprits.” Injury epidemiology vol. 2,1 (): 6. doi:10.1186/s40621–015–0037–4
Lustenberger, David P et al. “Efficacy of treatment of trochanteric bursitis: a systematic review.” Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine vol. 21,5 (2011): 447–53. doi:10.1097/JSM.0b013e318221299c
Mayo Clinic. Cortisone Shots, 2017, https://www.mayoclinic.org/tests-procedures/cortisone-shots/about/pac-20384794. Accessed 29 May. 2019.
Schneider, Christian. “Traumeel — an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries.” International journal of general medicine vol. 4 225–34. 25 Mar. 2011, doi:10.2147/IJGM.S16709
Melton, Deana I et al. “The current state of personal training: an industry perspective of personal trainers in a small Southeast community.” Journal of strength and conditioning research vol. 22,3 (2008): 883–9. doi:10.1519/JSC.0b013e3181660dab
Nietzsche, Friedrich. The Portable Nietzsche (Kaufmann). New York, Penguin, 1959.
Godfrey, R.J. & Ingham, Steve & Pedlar, Charles & Whyte, Greg. (2005). The detraining and retraining of an elite rower: A case study. Journal of science and medicine in sport / Sports Medicine Australia. 8. 314–20. 10.1016/S1440–2440(05)80042–8.
