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  1. #1
    digger mc-'s Avatar
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    Exclamation Anyone here in Pain? Here's what to do (99% of the time) - seriously (move it!)

    Have you read a post like this:

    "i have this pain that is [insert location on body here] that might be [insert tendinitis, pull, herniated disk, whatever here] - what do i do so i can lift again"

    Guess what?

    To Get out of Pain
    MORE than 9 times out of 10 the answer is a simple two parter you can test yourself


    1) NEVER MOVE INTO PAIN - really - do not work through pain

    2) whatever your issue, the biggie however is to keep moving the joint WITHOUT PAIN
    * how to test this:

    If there's PAIN - then STOP

    i) reduce load and try again
    retest
    if still pain

    ii) reduce speed as well and try again
    retest (ie do the movement again)
    if still pain

    iii) reduce range of motion
    retest
    if still pain - like NO movement is possible in that joint, then move something else - a joint above or below


    The above is how to test your capacity to move again in your chosen area of sport.
    If you want to accelerate actively and actually moving out of pain, then just like getting with a coach will improve one's lifts, getting with a movement specialist or movement coach will accelerate this process.

    Why do we need this extra set of eyeballs? because the site of pain is not the source of pain, and a trained person can help test the movements we need to practice/improve to get and stay out of pain.

    Then practicing movement deliberately daily is a big deal.


    Why wondering what the "it" is (tendonopathy, herniation, scoliosis) *actually doesn't matter* here more times than not

    Following he above heuristics will change your life in terms of getting back into movement, healing and so on.
    This strategy works whether you fear a disk herniation or a sprain or a name your ailment.

    Why?
    well, what else can you do? really?

    Say you have an actual diagnosis of a disk herniated. What can you do with that? What does that tell you about how to get back into performance?

    A doctor who doesn't lift may say to you "don't lift anymore"

    Are you going to follow that? I know doctors who tell people not to lift heavy no matter what: that it's just a bad idea - hey healthy people are you going to stop lifting?

    what do we know about pain and performance and injury and healing? moving works

    1) pain and injury are not the same thing. One can have an injury without pain; one can have pain long after the injury is seemingly healed.

    2) because of a whole ton of neurological activity and related healing processes, movement is a *really good idea*

    * from signalling the brain that this ROM is still needed (don't prune the nerves);
    * it's moving so it's getting better (if it doesn't move there's no information to the brain to inform state);
    * it helps flush the crud from a joint to keep it mobile;
    * it helps model the tissue to support the direction of work rather than being laid down randomly.

    3) wherever the pain is coming from - a tendon, a muscle, a disk - these are pretty much all tissue oriented issues: most of these injuries also limit movement - which is our performance space - and we want to get back to moving, right?

    NO ONE IS SAYING DON'T REST
    - one is saying - move as soon as possible as much as possible WITHOUT PAIN. So let me come onto my last point about the standard practice for dealing with what is often here pain/inflammation.

    ---
    a Note about RICE

    rest-ice-compresse-elevate

    THis is a really over-prescribed protocol in too many circumstances.
    RICE is largely designed for WHEN there is OBVIOUS inflammation.
    It is the go-to protocol because ya really are hard pressed to harm someone doing this and when there is acute inflammation, yes elevating a limb will take blood away from the area, ice will numb the sensation, compression does have an effect on edema (swelling) and rest is well chicken soup: rest this thing so that the inflammatory soup for an injury has a chance to rebuild some tissue around an injury.

    NOTE: this is best for ACUTE inflammation for a short period: when an injury has just happened. This is not a solution to sort out chronic pain. nor is it the ONLY strategy when in an acute phase.

    In Conclusion,
    HAVE PAIN? Move It - as much and as often as possible WITHOUT PAIN

    What many of us in research and practice are seeing quite a lot is that the sooner one can get a joint moving with any degree of motion WITHOUT PAIN - the faster the healing and getting back to performance .

    Because the above heuristics of stop, reduce load, speed, range of motion, retest, have a test / reassess model built in, then we have an in-built safety mechanism to gait the approach.

    ** Final final note: **
    please do consider adding in a daily, joint by joint movement program in your practice: this is a great way to reduce injuries in the first place. Blend that with good coaching for form, AND reducing fatigue in practice and there will be far fewer folks using this thread in the forum.

    about movement as bullet proofing
    http://www.begin2dig.com/2009/06/why...wreview-z.html

    not being knuckle-headed about *must do this last rep of this set*
    http://www.begin2dig.com/2010/06/one...inish-set.html

    how to test fatigue
    http://www.begin2dig.com/2010/05/sho...cognitive.html





    best

    mc
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  2. #2
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    Great post MC
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  3. #3
    digger mc-'s Avatar
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    Here's a related post about tendinopathy - vs tendonosis and tendonitis - and why these terms pretty much don't make a difference to the rehab approach - and where the latest research pretty much abandons osis and itis in favour of opathy

    the thread started with a discussion around a particular protocol for an "osis" being proposed as a good idea and some questions about terms.

    http://forum.bodybuilding.com/showth...#post767099033

    Originally Posted by mc- View Post
    here's the url
    http://www.bodybuilding.com/fun/drryan13.htm

    note that the refs from this artilce are from 2002 and before. much has moved on from this time. It's not clear that David Ryan would write the same article today.

    Given that preface.

    ok what i'd say and have said about this article before is that to say one has tendonitis or tendonosis is not particuarly useful in terms of rehab. THis distinction without a difference is largely why experts in the field have stopped pretty much using either term and now just say "tendonopathy" For instance, see

    http://www.begin2dig.com/2010/04/ecc...-ideas-as.html

    from 2008

    Indeed, as we see from the above, the idea that tendonitis is just inflammatory, rare, 14 days - is kinda dated.

    So with none of the athletes dealing with joint stuff have i found these attempts at distinctions helpful for rehab.
    I'd also suggest that the site of pain is not the source of pain: knowing that it's quite possible that someone will have inflammation for much longer than 14 days - but the effect of this might be that there's something buggered in one's forearm or foot, or there's a horrible memory chunked with this injury (pain has a large psycho-social component) that until that's addressed means that shoulder stays sore.

    What is the main takeaway from the work is the note that folks stay on vitamin I (ibuprofen, other NSAIDS) too long, and that the best thing to do is to move the joint. What the specifications are for this movement - well - who knows?

    For instance Ryan suggests

    "Please note; that this part is likely to cause pain, but not more than 60% or a 6/10. "
    I have a violent reaction to anyone saying move into pain - ever -

    If you are moving into what your brain is reading as pain, (not discomfort) but pain, then that is a signal to STOP and CHANGE - to ignore that is not a good idea -- ever-- if your life is not in jeopardy or you are not deliberately testing your endurance thresholod. in this context of rehab, neither of those should apply. There is NO NEED from the research to move into pain to induce healing.

    Ryan also suggests a bunch of stuff on speeds and times and what not. Again, i'm really suspect of prescriptions for rehab without being able

    a) to test what we're doing
    b) control speed

    For instance, Ryan states
    "Train at speeds to complete a movement at very high speeds for time intervals of 15, 30, 45, 60 seconds. " or "Reduce the speed and use more weight (1-10%) still maintaining a slower speed at first, and then progressing to a higher speed."

    Well, why? and when?

    When my colleagues and i work with athletes we agree that being able to move at speed is important - critical in fact - but that speeding up and conversley being able to SLOW down with control are both important.

    In rehab howerver, we have found that focusing on movement quality first is more important than anything else.

    SO our practice would concur with Ryan here "Determine the painful movements." is a good place to start:

    by knowing where the pain is one knows what to avoid and the range of motion that needs to be improved.

    Don't quite agree with this "Train the painful motion using lighter weights/slow movements at first, then progressing to faster and faster movements."

    What does "train the painful motion mean?" -> in the quality movement space this would mean - looking at whole movements - so say the shoulder hurts when moving the arm in front of the body. Ok - when? how big is the movement - how small? We'd have an athlete do circles with as much control as possible in both directions - as close to the pain but not into the pain as possible.

    We'd focus on movement quality before adding load. Why? Well, what happens to your movement quality when you go fast with a shoulder circle across your body - does the size change? does it stay as circular as it was or does it deform into an elipse?

    SO once we have control of the movement, we'd move into some load - with a little jump stretch for instance. again moving towards the pain but not into the pain.

    We have found that these signals from the joint area help strengthen the joint; by working with circles we also work on odd angle strength - remember injuries happen mainly at end range of motion or in deceleration. so by practicing our rehab positions for control through the ciricle we get many benefits.

    Based on this rehab work that is very controlled and focused on quality and rehab, then we just test our regular movements - like the press or whatever it is we want to do as a whole complex movement - with whatever loads, speeds and ROM's can be handled.

    **note - if rehab doesn't happen: it may be because just as the site of pain is not the source of pain, the muscle or tendon is not the issue - this may be a sign to consider as said visual, vestibular or proprioceptive issues. This is one space where a movement assessment is a good idea.
    (http://www.begin2dig.com/2010/11/wha...for-petes.html)

    You can probably guess that while Ryan specifies specific loads for rehabbing, we don't. Quality of the movement dictates what's done. Once standard speed is owned, we can work on super slow, accelerated and then sport speed as and when appropriate.

    Ryan also says "Trial and error is the best way to determine which are best for your program."

    Well, we'd say not trial and error but test and reassess. We'd also not use *just* the movement (like the painful part of the biceps curl as in Ryan's example) but would look at the range of motion in that joint - hence the circles - so in the curl example - we'd check shoulder circles and top and bottom elbow circles.

    TAKE AWAY
    - whether or not it's an osis or an itis is largely immaterial. if your arm is hanging off and you may need surgery is another issue, but there will be other markers to tell if life is that horrible.

    - assess and develop quality of movement for the WHOLE joint range of motion as with circles

    - develop control at one speed; then add load but maintain the movements; work the weak spots in that movement

    - NEVER move into pain - make it smaller, lighter, slower to control the movement and maintain quality.

    The goal of rehab is to heal the whole joint so that you can do your sport - but not *just* your sport. hence working the whole joint - and then build strength more as the rehab holds - with regular strength and conditioning.

    hope that helps
    mc, phd, cscs, Z-Health Master Trainer,
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  4. #4
    Registered User 2xChamp's Avatar
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    that helps alot! i just hurt the **** outta my shoulder and havnt been able to lift heavy all week. i can do rc exercises w/o pain so i guess ill be on the road to recovery in no time
    why be a beauty when you can be a beast?
    don't be paper mache. train to kill things
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  5. #5
    digger mc-'s Avatar
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    Originally Posted by 2xChamp View Post
    that helps alot! i just hurt the **** outta my shoulder and havnt been able to lift heavy all week. i can do rc exercises w/o pain so i guess ill be on the road to recovery in no time
    ah well -for shoulder issues, i'd recommend this thread
    http://forum.bodybuilding.com/showth...#post752238573

    best
    mc
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    Hello Sir,
    I have got a problem for which i need your help/advise. I am age 28. I started strength training with a 2 day split prog. After about 6 weeks of time I started to have pain in my collar bone , shoulder and rear upper back region. Pain persisted for 2 days so I went to see a doctor who advised me to take complete rest and no workout for 1 month (in Oct-2011). I took rest in fact upto Dec 2011, and some medicines as advised by doctor. When In new year I returned and started exercise after 2 days, the pain again re-surfaced, and I did not went since 03-Jan-12. I don't know what to do. Please advise some diagnosis or test or what i can do.. ?
    Thanks In advance.
    Shiv
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  8. #8
    digger mc-'s Avatar
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    Originally Posted by shivprakash1980 View Post
    Hello Sir,
    I have got a problem for which i need your help/advise. I am age 28. I started strength training with a 2 day split prog. After about 6 weeks of time I started to have pain in my collar bone , shoulder and rear upper back region. Pain persisted for 2 days so I went to see a doctor who advised me to take complete rest and no workout for 1 month (in Oct-2011). I took rest in fact upto Dec 2011, and some medicines as advised by doctor. When In new year I returned and started exercise after 2 days, the pain again re-surfaced, and I did not went since 03-Jan-12. I don't know what to do. Please advise some diagnosis or test or what i can do.. ?
    Thanks In advance.
    Shiv

    i'd suggest seeing a movement specialist for an assessment and guidance in what you can do to address pain and begin to function again. http://www.begin2dig.com/2010/11/wha...for-petes.html

    best
    mc
    mc, phd, cscs, Z-Health Master Trainer,
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  9. #9
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    What is the best way to cure the " tendonosis " injuries (Bicep area) beside resting? Thanks in advance
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  10. #10
    digger mc-'s Avatar
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    Originally Posted by buckybart View Post
    What is the best way to cure the " tendonosis " injuries (Bicep area) beside resting? Thanks in advance
    wow did you get a biopsy to see if you have tenonosis?
    rest sucks
    move as much as possible in as full range as possible with as much load as possible as frequently as possible without pain.
    work odd angles -
    often these kind of injuries happen from working one direction rather than an other or not engagine support muscles.

    if pain doesn't go down, get an assessment to make sure that all the support muscles are firing.
    mc
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  11. #11
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    suggestions for jaw joint pain?

    My pain issues come from my jaw joints. In June 2010 I had both jaw joints replaced due to severe TMJ. I've tried multiple times since the surgery to get back into a strength training routine, but once I start lifting anywhere close to failure I end up clenching my jaws as I lift which triggers jaw pain and migraines. I've tried to figure out how to lift without clenching my jaws, but haven't had any success. My surgeon couldn't offer any helpful suggestions. I'm wondering if there is any kind of therapist that works with issues of this type? Or how to adapt suggestions for other joint issues to work for the jaw joints?
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    Originally Posted by tlovesb View Post
    My pain issues come from my jaw joints. In June 2010 I had both jaw joints replaced due to severe TMJ. I've tried multiple times since the surgery to get back into a strength training routine, but once I start lifting anywhere close to failure I end up clenching my jaws as I lift which triggers jaw pain and migraines. I've tried to figure out how to lift without clenching my jaws, but haven't had any success. My surgeon couldn't offer any helpful suggestions. I'm wondering if there is any kind of therapist that works with issues of this type? Or how to adapt suggestions for other joint issues to work for the jaw joints?
    what is your goal? if it's strength or hypertrophy (as opposed to doing a 1RM every week), you can use lighter loads to practice working with your mouth open - with attention to that practice - and keeping your face relaxed. as you rep that in, you can work on upping the load.

    best
    mc
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    Starting last week sometime I developed a sharp "pulling" pain in my wrist. Occasionally I feel it in my forearm or side of bicep near my elbow. I mostly feel it in my wrist if I flip my palm over, and I can feel it on the outside part of my wrist near the knobby wrist bone.

    I'm not sure what brought it on, but I am new to the weightlifting world. What I do notice though is that the more I move it around and stretch it the better it feels for a bit. It only is sore when I first move it, not at rest. Also heat makes it feel alot better as well.

    Since it feels better if I move it and stretch it, do I keep going to the gym, and see if lifting strengthens it? Do I rest and start once it's healed? Whats the best course of action?
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    Originally Posted by axlrose5 View Post
    Starting last week sometime I developed a sharp "pulling" pain in my wrist. Occasionally I feel it in my forearm or side of bicep near my elbow. I mostly feel it in my wrist if I flip my palm over, and I can feel it on the outside part of my wrist near the knobby wrist bone.

    I'm not sure what brought it on, but I am new to the weightlifting world. What I do notice though is that the more I move it around and stretch it the better it feels for a bit. It only is sore when I first move it, not at rest. Also heat makes it feel alot better as well.

    Since it feels better if I move it and stretch it, do I keep going to the gym, and see if lifting strengthens it? Do I rest and start once it's healed? Whats the best course of action?
    read the first 20 or so lines of the first post in this thread.
    rinse and repeat

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    Around two weeks ago I was doing rows with a dumbbell and felt a sharp pain in my lower back. I still have great pain now. Is this normal?
    Also I have been doing barbell squats with a lot of weight, probably not helping.
    Any advice?
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    Originally Posted by Roosta78 View Post
    Around two weeks ago I was doing rows with a dumbbell and felt a sharp pain in my lower back. I still have great pain now. Is this normal?
    Also I have been doing barbell squats with a lot of weight, probably not helping.
    Any advice?
    read the first 20 or so lines of the first post in this thread.
    rinse and repeat

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    Hey I've been lifting for around 1 year now and up until now I started to feel a sort of burning like feel in my tricep. I feel it once I put weight up and every rep the pain increases. I took rest for about 2 months and did light weight to keep it relaxed but still move it around. Pain hasn't gone since. Any advice?
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    Recently sprained my left wrist. Doc said to not lift weights and rest for more than a week until fully healed. Am not liking that at all. This is an awesome post. Will be back in the gym tomorrow to assess and move w/o pain. Thank you so much!
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    Hey so I recently injured my shoulder, I was doing seated dumbbell presses and my left arm kinda fell back and I heard a crackling sound, I have been doing rotar cuff work and working on stretching it and tryin to increase my range of motion, yet the pain persists so I'm hesitant to lift heavy in fear that I'll injure it further, I lift in my job a lot (paramedic) so I need my shoulder to be in working order, any suggestions?
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    Originally Posted by drummerguydw View Post
    Hey so I recently injured my shoulder, I was doing seated dumbbell presses and my left arm kinda fell back and I heard a crackling sound, I have been doing rotar cuff work and working on stretching it and tryin to increase my range of motion, yet the pain persists so I'm hesitant to lift heavy in fear that I'll injure it further, I lift in my job a lot (paramedic) so I need my shoulder to be in working order, any suggestions?
    have you worked through the suggestions in the first post of this thread??

    best
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    I like this post about pain. I for one sometimes experiences episodes of pain while on the gym. Some of my buddies tell me that sometimes it is because of the proper position or posture when i lift some weights. It might also be that i am pushing myself too hard by lifting heavier weights too soon.
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    great thread... definitely going to follow the advice for this POS thumb injury I have had for probably a year now. I hope it isn't permanent or doesn't take ages to go away.
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    Thumbs up

    Good post, I just wish I would have been more careful with my back, but I'm sure I can find a way to get through it.
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    Hi there! I had a a dislocated shoulder and a broken collar bone and the pain is really unbearable. For two months now I have never lift weights ever since. Is there any safe, natural pain killers out there that can help with the pain? Maybe one of those supplements claiming that can also promote recovery?
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    Originally Posted by jillian24 View Post
    Hi there! I had a a dislocated shoulder and a broken collar bone and the pain is really unbearable. For two months now I have never lift weights ever since. Is there any safe, natural pain killers out there that can help with the pain? Maybe one of those supplements claiming that can also promote recovery?
    go see your doctor


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    Sometimes it seems like there is degrees of pain/discomfort. Some that you should push through and others telling you to back off or do something differently.

    I find it hard to differentiate sometimes.
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    It depends if pain decreases or stays the same during the movement; it just should not increase.

    Bill Starr Rehab for Muscle Pulls
    Mark Rippetoe:
    Here is the tried-and-true injury rehab method for muscle-belly injuries we got from Starr and that has worked for years better than any other method I've ever used. It also works well on orthopeadic injuries in general, and should be tried before anything more elaborate is used. Wait 3-4 days until the pain starts to "blur",which indicates that the immediate process of healing has stopped the bleeding and has started to repair the tissue. Then use an exercise that directly works the injury, i.e. that makes it hurt, in this case the squat. Use the empty bar and do 3 sets of 25 with perfect form, allowing yourself NO favoring the injured side. If it's ready to rehab you will know by the pain: if the pain increases during the set, it's not ready, if it stays the same or feels a little better toward the end of the set, it is ready to work.
    The NEXT DAY do it again, and add a small amount of weight, like 45 x 25 x 2, 55 x 25. Next day, 45 x 25, 55 x 25, 65 x 25. Continue adding weight every day, increasing as much as you can tolerate each workout. It will hurt, and it's supposed to hurt, but you should be able to tell the difference between rehab pain and re-injury. If you can't, you will figure it out soon enough. This method works by flushing blood through the injury while forcing the tissue to reorganize in its normal pattern of contractile architecture.

    After 10 days of 25s, go up in weight and down in reps to 15s, then to 10s, and finally to fives. During this time do NO OTHER HEAVY WORK, so that your resources can focus on the injury. You should be fixed in about 2 weeks, squatting more than you hurt yourself with.

    This method has the advantage of preventing scar formation in the muscle belly, since the muscle is forced to heal in the context of work and normal contraction, using the movement pattern it normally uses. The important points are 1.) perfect form with 2.) light weights that can be handled for high reps, 3.) every day for two weeks, and 4.) no other heavy work that will interfere with the system-wide processes of healing the tear.

    It is also very important through the whole process of healing the injury that ice be used, during the initial phase after the injury and after the workouts. Use it 20 on/20 off, many times a day at first and then tapering off to morning, after the workout, and before bed. Ice is your best friend in a muscle belly injury, holding down inflammation and fluid accumulation ("swelling") while at the same time increasing beneficial blood flow through the injury. But DO NOT USE ICE MORE THAN 20 MINUTES AT A TIME. More than that can cause more damage than it repairs.

    This may actually be the most useful post on this entire little forum of mine, and if you use this method exactly you can save yourself many weeks of lost training and long-term problems with muscle-belly scarring. Try it and see.
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    Originally Posted by Nic1 View Post
    It depends if pain decreases or stays the same during the movement; it just should not increase.

    Bill Starr Rehab for Muscle Pulls
    Mark Rippetoe:
    Here is the tried-and-true injury rehab method for muscle-belly injuries we got from Starr and that has worked for years better than any other method I've ever used. It also works well on orthopeadic injuries in general, and should be tried before anything more elaborate is used. Wait 3-4 days until the pain starts to "blur",which indicates that the immediate process of healing has stopped the bleeding and has started to repair the tissue. Then use an exercise that directly works the injury, i.e. that makes it hurt, in this case the squat. Use the empty bar and do 3 sets of 25 with perfect form, allowing yourself NO favoring the injured side. If it's ready to rehab you will know by the pain: if the pain increases during the set, it's not ready, if it stays the same or feels a little better toward the end of the set, it is ready to work.
    The NEXT DAY do it again, and add a small amount of weight, like 45 x 25 x 2, 55 x 25. Next day, 45 x 25, 55 x 25, 65 x 25. Continue adding weight every day, increasing as much as you can tolerate each workout. It will hurt, and it's supposed to hurt, but you should be able to tell the difference between rehab pain and re-injury. If you can't, you will figure it out soon enough. This method works by flushing blood through the injury while forcing the tissue to reorganize in its normal pattern of contractile architecture.

    After 10 days of 25s, go up in weight and down in reps to 15s, then to 10s, and finally to fives. During this time do NO OTHER HEAVY WORK, so that your resources can focus on the injury. You should be fixed in about 2 weeks, squatting more than you hurt yourself with.

    This method has the advantage of preventing scar formation in the muscle belly, since the muscle is forced to heal in the context of work and normal contraction, using the movement pattern it normally uses. The important points are 1.) perfect form with 2.) light weights that can be handled for high reps, 3.) every day for two weeks, and 4.) no other heavy work that will interfere with the system-wide processes of healing the tear.

    It is also very important through the whole process of healing the injury that ice be used, during the initial phase after the injury and after the workouts. Use it 20 on/20 off, many times a day at first and then tapering off to morning, after the workout, and before bed. Ice is your best friend in a muscle belly injury, holding down inflammation and fluid accumulation ("swelling") while at the same time increasing beneficial blood flow through the injury. But DO NOT USE ICE MORE THAN 20 MINUTES AT A TIME. More than that can cause more damage than it repairs.

    This may actually be the most useful post on this entire little forum of mine, and if you use this method exactly you can save yourself many weeks of lost training and long-term problems with muscle-belly scarring. Try it and see.

    Thanks for the advice...i have never dealt with daily pain before and it's annoying, although i fear it might be in my joints.
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    nice post
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