In Medical/Injuries, Videos

June 16, 2009

Video Article

The last thing most athletes recovering from an acute injury should do is take a month off from CrossFitting, Kelly Starrett told participants at a one day seminar at CrossFit Santa Cruz on March 14, 2009. Starrett is the owner of San Francisco CrossFit and a Doctor of Physical Therapy.

In part 2 of our series on how to train through acute injuries, Starrett said conventional advice can sometimes be mistaken. The recovery phase is when athletes need CrossFit most. When it comes to fitness, it’s a case of use it or lose it. Workouts should be modified, not abandoned. Do a workout on one leg, if necessary. Or consider Tabata intervals on day one of the recovery program, and let the intensity find you.

Working out increases blood flow and promotes healing. It drives insulin sensitivity, restores proteins and gets the whole system looking for anabolic enzymes. The recovery phase from an acute injury is also a great time to tackle your “goat” - the stuff you hate to do, but need to do.

Injured athletes are still athletes. They need to avoid feeling sorry for themselves and get their butts back into the gym. And quickly.

8min 34sec

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19 Comments on “Training Through Acute Injuries,
Part 2 ”

1

Darren Coughlan wrote …

excellent clip on why to train injured.

in the future Id be interested to see Kelly address back injuries with training.

2

wrote …

I would as well. Especially lower lumbar disc injuries.

3

wrote …

Great series so far....If you are in rehab, your physical therapist SHOULD be training you this way!

4

wrote …

WoW!!!! Exactly what I needed. I have already started to rot from my torn pec surgery last Tuesday. 5.5lbs gone in one week. I am getting after it.

Thanks Kelly!!!!

5

wrote …

As a healthcare provider, I couldn't agree with Kelly any more. The current stigma is resting to heal, which as we all saw makes no sense. Motivational speakers say that "everything is an opportunity" and rehab is no different...getting your goat and maintaining your systems! You have the opportunity to rock out the things you have been neglecting and in turn improve your entire system to be stronger than pre-injury.

As far as for low back/disc, etc. The concept is the same. Modification of the workouts to prevent exacerbation of the condition while at the same time up-regulating all the things Kelly touched on. But, specifics never hurt.

Right on brother!!!

6

wrote …

i totally agree with all of this but you have to be careful with disc injuries and not overdoing it after surgery. from my understanding there is a higher chance or re-herniation after a discectomy within the first 3 months, but from what my surgeon told me the risk is only about 8%. personally i was told not to do anything for three months aside from walking and not lifting anything over 10lbs. that advice didnt last very long for me. i had a disectomy at two different levels (L4-L5 and L5-S1 and also a bilateral, hemilaminectomy at L4 and L5. this was a pretty big surgery for me at 32 years old) and shortly after surgery i was doing a few air squats here and there (like a grease the groove approach), then progressing to 20lb dynamax ball squats, then goblet squats with a 1 pood, then 1.5 pood KB). later progressed to other exercises like VERY strict push-ups and strict pull-ups (any sort of kipping pre-op would send shockwaves down my legs). i am 6 months out and am still scaling some WODS, in particular those that call for lifts overhead because when i get heavier and make a mistake i feel it, but recently OHS's my old PR though of 213lbs, and tried 220lbs, jerked it and got to the bottom but lost it on the way up.

eventhough i started performing functional movements as soon as a i felt i could i have been told that overdoing it early can actually lead to increases in scar tissue formation, but have also been told that the sooner you start moving the less adhesions you'll form, so i dont really know the exact answer to that one,and not sure how true both those statements are, but i would say i am not feeling any ill-effects from starting back earlier then recommended (but being smart about it).

my injury was more than a simple discectomy and laminectomy since i had a discectomy at 2 levels, and since the laminectomy was on both sides of two different vertebrae my neurosurgeon wanted to take a more conservative approach to the laminectomy becasue if too much material is removed the spine could become unstable, then i would need a spinal fusion, which is an absolute last resort. the down side to being conservative is that i am going to require another laminectomy, probably later this year because i am still having symptoms in my right leg and buttock (enough to warrant another operation, trust me, nerve pain is the worst), but at least i can straighten my right leg now, have a fairly decent quality of life back where previously it was awful (take someone who previously was very active, sub 5:00 fran, 213 OHS, could do muscle-ups all day and then make them bed-ridden and in pain 24/7 where all they could do was barely get through a day of work)no linger walk without a limp and gained back the 20lbs i lost from being unable to CF for over a year!) now its a slight hinderance that is annoying instead of being totally debilitating.

and just to let people know, my injury wasnt from CrossFit. i weigh 180 lbs and was stacked while training brazilian jiu-jitsu buy a guy who weighed around 230-240lbs went aggro on me, stacked me and compressed my spine. i dealt with it non-surgically for over a year until finally biting the bullet. (my originally doc told me there were no herniations and i went through injections, PT, accupuncture and pain mgmt, but later got a myelogram (the gold standard) and my surgeon was shocked that i could even walk. he later told me that not only were the discs herniated, but during surgery he had to retrieve disc fragments that had actually broken off and were floating around.

7

wrote …

You are right. Recommendations from (MD, DC, DPT, DO, etc) should be followed, but those recommendations should reflect the concept Kelly was lecturing...or you should be in the market for a new provider!

8

wrote …

the reason i actually went with this particular neurosurgeon was because he actually encouraged me to return to CrossFit and most other activities that i had done prior to getting injured. he was recommended by a fellow CrossFitter, and is one of the best neurosurgeons in southern california, plus i work as an RN in critical care and have met numerous other healthcare providers who absolutely raved about the guy, which is uncommon with neurosurgeons! the only activity he did not recommend me returning to was jiu jitsu, which i think is fair. to be quite honest i did not want to risk getting injured again and going through what i went through for the last year and a half. its just not worth it. i'd rather CrossFit anyway.

my previous provider, a DO, was more traditional and told me to stay away from o-lifting, CrossFit, etc, and he was the one who initially told me that i didn't have any herniations either.

9

wrote …

Totally agree Kelly. I'm also a PT in Washington, and use the same principals with my patients and myself. One thing I would like to reiterate from the clips on shoulder impingement is the importance of posture with rehab. Unless your injury was caused by trauma or a congenital issue, then posture was involved. So, returning to the same exercise routine using your old posture/form will only re-exasperate the same injury. Form/posture need to be emphasized. If you get pain(inhibitor) with a motion, there has to be a flaw in your posture/form. So, even in the "healthy" athlete, pain with an exercise/motion will result in weakness in that motion by the natural neurological inhibition that pain causes. Continuing to "work through the pain" with an exercise/motion without addressing the postural/form flaw in the movement "will" cause injury.
What Crossfit does better than any other workout program I have ever been involved in is emphasize correct form and posture. So, if you are getting pain with a motion/exercise grab your trainer, and have them break down your form with the offending exercise. It could save you the expense, and or time off caused by an injury.

10

wrote …

Hopefully Kelly will chime in on all this disk talk.
I have been diagnosed by a chiro with a disk issue. I did it while squatting deep with bad form. I was flexing my abs to the point that I eliminated the curve in my spine as I got down in to the squat. Apparently my freakishly tight hams, calves, and low back played a big role in the bad form too. Unfortunately I learned all about the importance of the spine curvature in the K-Star series and other exercise physiology articles in CF Journal right after I messed myself up.
I am assuming everyone else here with prior disk injuries will recognize the symptoms; pain down the leg in the morning and after long periods of sitting later in the day, cobra pose creates a pinch in the lower back, looking down and straightening the leg out front sends pain down the leg. The pain is in the glute and in the calf but nor so much in between. Thoughts?
Another doctor diagnosed it as a muscle strain in the back. It may be a little of both but I would appreciate some feedback.
I should have kept working out but I stopped and it got progressively worse. Actually the chiro told me to lay off but I have been doing some goat work and feeling slightly better. I even attempted deadlifts today with a real strict, tight arch in the back and felt great. We'll see how that feels in the morning and through the next couple days.
I am strongly considering visiting an affiliate in Chicago for once in my life if I can confirm that he is competent to work with me through the injury without messing me up. I'm also afraid I will mess myself up by doing too much too soon.
Thanks so much for the articles, videos and advice. I can't possible thank Crossfit enough.

11

wrote …

Just something I thought I throw out there because it relates to what KS was talking about. What about illness vs. injury in crossfit training. If someone has a cold, flu, or persistent infection of some kind do all the same factors apply? The reason I ask is because for myself in some cases training through a cold has made things worse.... full bore intensity really hammers the immune system. If you give everything to your WOD..what's left for healing the cold flu etc...

Andrew

12

replied to comment from Andrew Gardiner

Why would you bring your viral infection into a place where other oeople can come into contact with it.

13

replied to comment from Andrew Gardiner

Andrew-- Kelly is not talking about illness they are 2 totally different things. He is talking about getting back to CF while healing from an injury. You can work on areas not effected by the injury and slowly begin working in the wounded area when cleared to do so. He address how this creates a healing environment within the body which very much aids the injury in the healing process. Sickness is different in that you may now be exposing others to the virus, infection, bacteria that you have. With an injury you are not putting others at risk for or exposing them to anything that may be harmful. Kelly is dead on with the doctors response to someone who is able to begin returning to CF as they continue to heal. Thanks KStar

14

wrote …

Great clip, I have basically always lived my life this way just because I couldn't stay still. My girlfriend broke her wrist and she has been very fit but she had pins put in her wrist and now even a month out she has very intense pain. Had a pin removed last week, and the doctor didn’t indicate there were any problems with healing. I would like to get her back crossfitting but she has trouble with pain even when she isn’t doing anything. Any suggestions for dealing with pain?

15

RimTruth, that is excellent advice about posture .... dealing with technique ... dealing with the root cause of the injury (if in fact it was due to posture).

16

John Velandra wrote …

Great vid series and comments.

QUESTION to throw out there to Kelly, Rim, and any other medically qualified person to share...

I have a 49yo competitive athlete preparing for an abdominal hysterectomy in the next month or so. Currently involved in both pl & oly lifting as well as CF. I'm in the process of developing a post-rehab protocol for us to work once all is said and done. The problem is there is little to NO available info to the female athletes out there about this (or I can't find it).

Topics trying to find out...
1. Post rehab movements (once able to walk again, etc) or guidelines beyond common sense?
2. HRT consequences as it relates to healing?
3. Same, but as it relates to exercise and recovery?
4. Supplementation ideas for healing, training and recovery? She currently eats paleo / PZ with upwards of +4 fat blocks
5. Long term effects for competition?

17

wrote …

I had this issue arise about a week ago, with back to back WOD involving deadlifts while the week before I did "Linda with 355". My back has been sore in the lower spine area, which has prevented me in Cross fitting for about a week now, really sucks. There is a pain that is like a tearing like feel. On Monday I will attempt to return. I have used acupuncture to relieve some of the pain which has helped but can be costly. I am glad I stop lifting weight per say bodybuilding and picked Crossfit to be my regime for working out. Proper form and stretching is most important. Thanks for the pertinent info Kelly.

18

wrote …

Great video, thanks Kelly. I am into 2nd week of fractured clavicle and this was very useful

19

wrote …

If anyone is still checking this thread, how would you train through lower back muscle injuries? I'd been out of Crossfit for several months and restarted in the fall. I was stupid about three weeks ago and did a two-a-day and definitely overdid deadlifts. I was sore and tried training through it and pulled a muscle on the left side of my lower back. I waited almost two weeks, thought I was ready and pulled it again. I've followed the typical icing, massage and now heat, but I feel like I can't do anything without aggravating the injury. This is interfering with playing in a hockey league, practicing for a charity hockey game thats in two weeks and training for a tough mudder in April. Any advice is welcome. I didn't follow the rules and am paying for it... how do I get back in the game as quickly as possible? Thanks all.

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