As an Osteopath and Exercise Coach, I specialise in coaching people who are more prone to getting injured. Chronic back pain, persistent widespread pain, inflammatory conditions, hypermobility disorders, fibromyalgia… all conditions where the chance of injury and setbacks are much higher. Having trained many people local to Southampton and Winchester and virtually around the world, I’ve learnt a thing or two about managing injury risk.
One question I get asked a lot is: “how can I get stronger without repeating injury setbacks?”
The short answer is this:
- Start with a minimalist strength training programme. Pick three big movements (squats, push-ups and pull ups, for example).
- Start slow but progress consistently over time. Start by doing 50% of what you think you can and gradually add difficulty over time. Aim for four sets of exercises per body area. These can be in one or two workouts or peppered throughout your day.
- Adapt your training to how you are feeling. Sleep, nutrition, stress, workload… these will all impact how much you can do on any given day. Don’t expect to always to do more each session. Aim for the same level of subjective difficulty and stay consistent.
- Rest and recover well. Make sure you get enough sleep, water, high quality food (particularly protein) and make time pro-actively for relaxation. Without this your body won’t be able to regenerate and come back stronger.
- Do some cardio too. The fitter you are, the better your body bounces back from training. Start with gentle steady state cardio and build from there. Brisk walks or gentle jogs, swims or cycles are perfect.
These are my highlights but read on and I’ll give you A LOT more detail. This article will be a comprehensive guide to training while avoiding injury or flare ups. I’ll explain why these recommendations work and give you tips and tricks of how to stick to them and build healthy, sustainable training habits that will get you stronger without recurring issues with injury.
I’ll also say at this stage that if you want to get this right and accelerate your progress then working with a coach will be invaluable. Having someone in your corner to guide you along the path will save months or years of mistakes and setbacks. If it’s something you’re considering, then you can find out more about what I do here.
Getting stronger reduces your risk of injury.
If you’re reading this, then you’re trying to do the right thing. Getting stronger is one of the best ways to reduce your risk of injury and manage many different pain conditions. It’s one of the main reasons every athlete nowadays has a strength and conditioning program to support their sports training. The stronger you are, the less likely you are to get injured.
But for so many people, it’s the process of getting stronger that is the hard part. You’re trying to do the right thing and get stronger, but in the process, you get muscle pain and recurring injury.
Why is my body constantly getting injured?
To understand how to avoid injury, we need to know why you keep getting injured. The first thing to point out here is that there is only so much we can do to reduce the risk of getting injured. Injuries are a risk of training, and some degree of risk is unavoidable.
All injuries boil down to one simple principle: “too much, too soon”. When the tissues of your body are exposed to too much load in too short of a time then you get injured. This is as true for a broken bone due to a fall as it is for a chronic overuse issue such as shin splints. The first example involves an extreme load applied in a short space of time, whereas the other involves a chronically overloaded tissue not given enough time to recover.
The factors that play into tissue overload during strength training include:
- Training volume (how much you do in the gym)
- Training intensity (how hard are you pushing yourself)
- Workout structure (what order you do your workout in)
- Workout history (how skilled are you at working out, is it new to you)
- Injury history (previous injuries might predispose you to injuries in the future)
- Sleep & fatigue (how well you rest is one of the most important factors)
- Stress & mental state (stress and low mood increase your injury risk)
- Health status (certain conditions, such as hypermobility disorders, impact tissue health and healing times)
- Nutritional status (are you getting enough of the right stuff to recover well?)
This list isn’t exhaustive, but you can already tell there’s quite a lot to think about. I’ll do my best to simplify all of this for you.
The exact mix of the factors mentioned above will be unique to you. But I see common patterns arise in the clients I work with. Below are four examples that help to illustrate the different reasons people keep getting injured when trying to get stronger.
The exact reasons these people keep getting injured are different, but the principles we followed to get them stronger, heal their weak muscles and not get injuries while lifting were the same.
Chances are, one of these will resonate with your situation:
- Peter used to go to the gym when he was younger, but work and family life mean he’s barely trained in over a decade. Once or twice a year for the last few years he’s tried to start going to the gym again. He starts training 3-4 times per week and really enjoys it for 2-3 months until something goes – it’s something different every time.
- Sarah’s always been flexible and for as long as she can remember has always seemed to pick up injuries much easier than other people. She also seems to suffer with fatigue a lot more than most. Whenever she does any sports or goes to the gym, she feels like she can never do as much as other people and will be sore for days afterwards. When she does get injured, it feels like it takes forever to get better, and she has to stop doing almost everything.
- John’s always been reasonably active but put his back out a few years ago working out. It’s never been the same since. He keeps trying to get back into training but his back just seems to be getting worse despite doing less and less.
- Eliza has had recurring hip and back pain ever since having kids. She keeps trying to get back into running and the gym, but the pain keeps stopping her and she’s starting think trying to get fit and strong is a lost cause.
Quick sidenote: there is a difference between a flare up of pain in someone with persistent back pain or fibromyalgia and getting injured. In these conditions, the pain alarm system itself is hypersensitive and will throw up warning signals (ie pain) way before any real tissue damage. To read more about this you can read my blog on back pain here.
Now though, I’m going to run through the main mistakes people make when trying to get strong that lead to repeated injury.
Big mistake number one: overtraining and overuse.
In the example above, Peter exemplifies the problem of overtraining. The big reason most people keep getting injured on returning to training is doing too much too soon.
Strength training is a stressor. When you lift weights, you are deliberately damaging your muscles and stressing your nervous system to build back stronger and more resilient. To do this without getting injured, you need to lift just enough to challenge yourself and then rest well enough to recover.
When someone like Peter goes from no training to 3-4 sessions per week, likelihood is they’re not giving themselves enough time to recover, which catches up after a few months. This results in overtraining and overuse.
Signs to watch out for if you think you’re at risk of overtraining:
- Muscle soreness over and above what you’re used to, which doesn’t go away after a couple of days.
- Weights that were once doable start to feel heavier, your performance drops.
- Generally feeling tired and lethargic.
- Not feeling yourself, feeling irritable or quick to anger. Feeling low.
- Restlessness and struggling to relax.
- You start to struggle sleeping.
- You start getting ill more often than usual.
- Resting heart rate and blood pressure increases.
- For women, your menstrual cycle might start to change and become irregular.
Big mistake number two: sudden changes in training load.
This ties in with the point above, but your body hates sudden changes in training. Big jumps in training volume or intensity Is one of the primary factors in injuries, and tendon injuries more specifically.
Whenever you start any new training regime (or stop for that matter) you should build things up gradually over time. This ensures you give your body time to adapt and create the foundation to train at the level you want to aim for.
Big mistake number three: thinking more is always better.
Most health agencies around the world convergence on around 120-150 minutes of moderate to vigorous exercise per week being perfect for health.
That’s 2.5 hours in a week, including strength and cardio.
Researchers in the UK have found that just one session per week is enough to get all the strength gains that a typical person can get in their first year of training.
If your goal is to get stronger for health reasons, to support other sports or just day-to-day life, then all you need to do is one. Maximum two.
A recent evidence review suggested 4 sets per body part of 6-8 reps is ideal for the minimum amount needed to see decent results.
And it needn’t even be all done in one go. If you work from home and you want to break up your day with one set here, and another there.
Taking movement breaks throughout the day is a common strategy I recommend to my clients all the time. This way you can get stronger without really feeling like you’re doing anything, while also being healthier, possibly more productive, and avoiding injuries.
You can download an example minimalist training programme I put together during the pandemic here.
Top tip: pay attention to how you feel and adjust accordingly.
There’s something to be said for pushing through soreness and fatigue when you’re training. However, most people that come to me don’t pay enough attention to their body, to how stressed or fatigued they, and will often push themselves past their limits.
This point is SO important if you have any kind of health concern, such as persistent pain or chronic fatigue, the kind of clients I work with regularly.
Any good training programme should have a degree of flexibility built into it. And one of the best ways for you to monitor this for yourself is something call rate of perceived exertion (RPE).
RPE is simply the technical name for “how hard does this feel” and is scored out of 10.
1/10 would be sitting watching tv – you could do that all day.
10/10 would be a maximal effort session on an assault bike that leaves you lying in pool of your own sweat and tears, or the absolute maximum weight you could lift at any one time.
Tracking how hard your workouts feel automatically takes account of those variables we mentioned above. If you’re tired, stressed and haven’t eaten well, your training is going to feel harder, so a lower weight or number of sets will be rated the same as more work on a day you’re fresh. If you aim to achieve the same RPE per workout instead of weight / sets, you’re less likely to overtrain and injure yourself.
You’re also more likely to stay consistent, which is by far and away the most important factor in getting stronger. Showing up and doing less than you planned will always beat pushing for perfection and then having to take time out with an injury.
Show up. Do what you can. Rest well. Go again.
Sidenote: muscle pain doesn’t mean you’re getting stronger. Muscle pain after workouts (otherwise known as DOMS, delayed onset muscle soreness) only indicates that you’ve done something new. The pain is not necessary for progress or increased strength.
Top tip: accept your limitations.
Now this one takes some practise and is probably the hardest tip on this list. If you live with a chronic condition such as an autoimmune disorder or persistent pain – you will have to accept that you won’t be able to do what some others can, or what you used to be able to. Your body needs more time to recover or is more easily sent into overtraining or a flare up of symptoms.
This is a bitter pill to swallow. As someone with chronic fatigue and widespread pain, I get it! Trust me.
But this isn’t fatalism. Accepting your limitations is not the same as accepting your fate. It is actually the first step to improvement and a life free from those limitations. Paradoxical I know.
Once you accept where you are and stop pushing yourself to do what you think you should be able to – you’ll find that your symptoms improve and, with time, you can start to make steady progress towards strength, health, and the life you want to live.
If you don’t accept it, you will keep pushing yourself too hard, causing injury, overuse and a flare up of symptoms.
Final point: warmups, form, and stretching.
Most articles online talking about injury risk and exercise obsess over exercise form, warmups, foam rollers and stretching.
The fact of the matter is they’re not that important. The other stuff I’ve mentioned is MUCH more important.
Learning good exercise form is good to focus on to get better at strength training and lift more over time. Good exercise form leads to more efficient movement, and you’ll progress faster if you’re better at the lifts you’re performing.
But the range of perfectly safe and effective form is much wider than most personal trainers and physical therapists would have you believe.
Humans are varied and incredibly adaptable – so the idea of their being one perfect form for an exercise is silly of you think about it. Take the time to find the way of doing an exercise that feels comfortable for you and start with weights that are manageable. As you practise you will naturally find your form improve.
Take any exercise tutorial on social media with a red cross and green tick with a pinch of salt.
They’re just not that important. Any kind of gentle movement will do. Just practise the exercises you plan to do a few times with little to no weight.
Unless you do a sport that requires a lot of flexibility, stretching can largely be ignored. For most people, it shouldn’t be a primary consideration.
Sure, if you’re just not flexible enough to do the exercise you want then adding some stretching in will help. And it does help you relax at the end of a workout.
But other than that, it’s not going to reduce your injury risk in any meaningful way.
If you’re looking to get strong but injuries keep setting you back, follow these rules of thumb:
- Start slow, 50% of what you think you can do. The first few weeks you should feel like you have plenty more left in the tank.
- Start with a basic three movement workout. For example: Squats, push ups and rows. Deadlifts, overhead press and lat pull down. You can build from here over time. You can download an example minimalist training programme I put together during the pandemic here.
- Focus on consistency, not perfection. Show up and try to progress each week but factor in how you are feeling to ensure you stay the right side of your limits. RPE is a useful tool for this.
- Rest and recover well. If you’re chronically stressed, your sleep is poor, and your diet is crap you will not recover well. Take this as seriously as you do your training or your job.
- If you have a health condition that impacts your recovery, focus on the long term. Small, incremental improvements over time will amount to huge changes. Stay patient and trust the process.
- Get a coach. I know I’m biased, but getting a coach will save you years of setbacks and accelerate your progress. You don’t need one, but if you can afford it, you will not regret the decision. Book a call to discuss it if you’re serious about making a change.