I think the more common term for “non-acute injury” is “overuse injury“, but I just don’t love that term as it feels like it implies it’s your fault somehow. So I’m going with non-acute, even though I wish I had a term that wasn’t judgy but also was just a word versus the opposite of a word with ‘non’ in front of it. Either way – that’s what I mean.

The primary goal with injuries is to train pain-free while also training as close to normally as possible. There are four key concepts to achieve this: 

1. If it hurts, the exercise is likely either not a good choice or the form is off. Visual signs that form is off include the knee moving inward too much or moving forward too much, or in the case of split squats and lunges, the back leg doing the majority of the work. 

2. With some injuries, especially ones you’ve had for a long time, you may not be able to fully straighten the knee. This means you’ll likely struggle with form on exercises like deadlifts and kettlebell swings (both are typically great with knee issues), as it’s very hard to fully straighten the hip if the knee isn’t straight. (Try it now on the side where you can straighten your knee – stand with your knee bent a bit and try to engage your glutes and lower body. Now straighten your leg and do the same. You’ll likely notice more muscle activity with the straight position.). Exercises requiring a completely straight knee are still good choices if you can’t fully straighten your knee, but you should be aware that your form won’t be perfect. That’s okay. It’s a nice idea to think you can regain full knee range of motion with training, and maybe you can. But if you haven’t had full range for years, “some improvement” might be a better goal. At Custom Strength, we program knee straightening exercises when someone has a knee injury, although we do it with the primary goal of strengthening the thigh muscles; and with regaining knee extension as a secondary goal. 

3. If you have a knee injury, you may not be able to kneel on that knee without pain, which can limit your stretching and core exercise options. Sometimes if you use a thick enough mat the kneeling exercises become possible without pain, and also trying to slightly adjust the position you take on the mat can help (shift your weight a bit forward or backward). But if those don’t help, or if you have been told to not kneel due to a knee replacement or some other reason, then we’ll need to scrap kneeling. It’s okay – there are lots of core exercises that don’t require kneeling.  

For example, here’s an alternative to a half-kneeling hip flexor stretch:

Bench hip flexor stretch

And you can find an alternative position for half-kneeling core exercises like chops and lifts here.

4. Stretching and rolling your quads can have a positive affect on whether an exercise bothers your knees, so rolling and/or stretching your quads before doing an exercise that bothers your knee is worth trying. That said, if you can’t kneel on your knee without pain and/or can’t fully bend your knee, you may not be able to do a quad stretch. We often skip quad stretches initially for this reason, but over time we introduce a couple of quad stretching alternatives that often work well. Similarly, some people have a hard time getting down on the floor such that foam rolling may not be feasible. In this case, rolling the quads with a stick, is a great option.

This post is an excerpt from the book I’m writing about training around injuries. I’ll be posting one each week for the foreseeable future.

Elsbeth Vaino is a personal trainer and the owner of Custom Strength in Ottawa. She is also keen to announce that she has recently converted her popular Get Healthier 8 Week Challenge into an ebook, that you can find here.

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