We enjoy training pretty much everyone at Custom Strength, but if you were to ask what our specialty is, I’d probably say it’s training people who have injuries that make it tricky for them to know how to train themselves. We’ve become good at this partly because we’re into customizing workouts (you know; cuz it’s in our name), and partly because many of our clients have been refered to us by their health care practitioner, which means over the last 12 years, we’ve gained a lot of experience with this. And now I’m going to share the “secrets” to our success in this area.

Here is our 6 step approach to training in the presence of injury:

1. Start with an assessment. Our assesment involves a conversation about goals, injury or health stuff that may be relevant to working out, a chat about other physical activities (more for athletes to make sure the training complements vs conflicts), and having them do a series of movements to help us see how the person moves. The series of movements we ask our clients to do is based on the Functional Movement Screen or FMS, but really it can be any series of movements. The key, in my opinion, is that it should give you enough information to help you put together the best workout program that you can, and more importantly, it should be movements the person can do so that they leave thinking working out at a gym is for them. If you’re not sure how to do this to yourself, give this post a read and try the version of Dr. Frost’s 7 Movements (just before the first table). What I want to learn when I have our clients do a few movements is:
   1. Is there pain in any of the movement types we typically program for clients (eg shoulder pain lifting arms overhead; pain in the knee with squats or lunges; pain in the back with a hip hinge or pushup)
   2. Are they super bendy or super stiff or somewhere in between?
   3. Do they have unexpected movement patterns (like shifting to one side during a squat or getting cramping in their hamstring during a glute bridge)?
   4. Is the person comfortable kneeling and getting up and down from the floor?
2. We have a programming system. If you want to be able to create appropriately challenging workouts that fit in a set period of time, a training system is a great idea. When I first started training people, I spent up to an hour and a half creating each new program. I was so proud of those programs! They were my little works of art. Now I spend somewhere between 5 and 20 minutes writing each new program, and the programs are much better than those earlier ones. I’m able to do this because we have a programming system that helps to keep me focused. It has placeholders for exercise types I think are important for most people, and it also has palceholders for exercises that I deem appropriate for the individual, once I know more about them. In addition to saving time, this system also ensures I don’t end up with a 2 hour workout when the session is only 55 minutes. It also ensures we don’t end up overtraining certain parts of the body or forgetting about others. If you train yourself, you probably have a system too. If you’re not sure what it is, take a look at your workout log and you can probably figure it out. Or alternatively, just take your regular workouts but then make adjustments noted in #3 below.
3. Learn what exercises typically affect various injuries. This is the most important aspect of creating a training plan for someone who has an injury, or history of injuries. You have to know what exercises typically irritate injuries. This is a topic where you can keep learning and getting better and better at it, but I’m going to share a few basic ones for you to get started. Note that these are basics and not always true. Some of these exercises will be fine for some people with these injuries, and other exercises may not be okay; but as general rules, these fit pretty well. If someone has a:
   1. Shoulder injury, avoid bench press, lateral and forward raises, and overhead presses; but most horizontal rowing should be good.
   2. Back injury, avoid squats and deadlifts (but split squats will probably be great), and be mindful of arching with overhead exercises, and consider regressing core exercises (try starting with incline planks and side planks, for instance).
   3. Hip injury, avoid squats, consider Romanian deadlifts instead of conventional ones, and you may be better with tall kneeling positions over half-kneeling (or use a riser under the back knee in half-kneeling)
   4. Knee injury, avoid squats, and split squats and lunges (but deadlifts will probably be great).
4. Create a workout program for them, based on the assessment and our training system. When we do the assessment well, it tells us everything we need to know about putting together the best possible program for that person. We know what they want to achieve; what hurts (if anything); and where they can use a little extra work. And if we listen well, we also know if they have insecurities about any particular exercises or movements. We then plug all that into our program template to create our best first draft of their first workout program with us.
5. Ask how each exercise feels and where they feel them. I can’t stress how important this is. Bodies are fascinating and sometimes they don’t respond to an exercise in the manner we think they will. When we started asking “where do you feel that” I was shocked at some of the answers. That wasn’t what we were trying to accomplish! And in some cases, what we were accomplishing (working the back in a plank for instance) was proabably not helping. By doing this, we can either re-coach the exercise, or if that doesn’t work, we just change the exercise. In addition to asking how the exercise feels, watch their movement between exercises. For instance, if someone is doing a back stretch after a deadlift or plank or glute bridge, that might be a sign that their back tightned up after doing that exercise. Or it might just be that they like stretching their back. Ask. And if they are tightening up, you probably need to re-coach, regress, or replace an exercise. If you are training yourself, then ask yourself and pay attention to what you’re feeling both during and after the exercises.
6. Check in the next day. Sometimes everything feels great during a workout but then a few hours later, that injured area may not feel so great. But people are often shy to reach out and tell you this because they don’t want to seem like they are whining. Get in touch with them and ask how they felt after. If you’re asking the question, they will usually feel comfortable answering.

That’s it; that’s all. Of course there’s a bit more to it, but these basics should be enough to get you well on your way.