Painful exercise — What do we do?

December 16, 2008

I’ll paint a hypothetical situation to start: artthm

An athlete has squats in their training session on a given day, but the athlete also has a history of knee pain with squatting deep. What can we do to still make sure the athlete is working all the big leg muscles in an integrated way?

Essentially there’s two options now:

  1. Have them perform squats with a limited range of motion (only go as deep as pain-free ROM allows)
  2. Switch the exercise: Full ROM deadlifts require less knee flexion ROM than full squats

    One option -- elevated handles reduce the need for knee flexion

    One option -- elevated handles reduce the need for knee flexion

I guess my question with number 1 is by allowing partial ROM are we a) still getting enough of a benefit and b) not promoting any further imbalance as a result of altering exercise ROM?

You might be able to tell that if given the choice, I would choose option 2. That way we are still ensuring maximum benefit from an exercise. Now this scenario could be drawn out further, but this level of depth will suffice for this post.

Something to think about…

I’d love to hear how other coaches or trainers deal with this situation — especially if anything changes when working with groups of athletes/general population vs. one individual.



3 Responses to “Painful exercise — What do we do?”

  1. In my line of work I come across a different issue, being unable to rise from a chair. What we do is start with partial range of motion from a mat table in the high position and progressively lower it until the patient is able to do the sit to stand from the low position. Sometimes that takes a couple weeks, sometimes a month, sometimes they never build enough strength before the end of therapy (we usually get them up to three months before they discharge back to home- rarely but sometimes longer).

    The sit to stand, in the elderly, is one of the best strength building exercises. You’d be suprised! Or maybe you wouldnt be… Stairs are the second, but I’ve so many pt that are unable to step up a step safely :(.

    If I were using weights with a younger population, I’d probably go with number 2 as well, but for the population I work with (typically over 75- my current oldest pt is 96!) option number 1 works well.

    On a side note, those shorts in that pic look painful!

  2. Chris Brown Says:

    Well said. Is the pt place you work at within a hospital or is it its own private facility??

  3. I work in many places… I work in the hospital doing acute care for all sorts of patients (post surgery and stuff) and also do orthopedic rehab at the hospital for right after hip and knee replacement surgery and also in the rehab unit attached to the hospital where people stay 1-6 weeks.

    Then I also work for a skilled nursing facility and do rehab with the geriatric population- this is my “real” job and I spend 5 hours a day there. Then I go to an outpatient facility and do rehab for another 2-4 hours a day there.

    Mostly I do make my own schedule though and I do often work 6-7 days a week. I work at the hospital and rehab center associated with it on weekends and the elderly at the SNF and outpatient during the week.

    Plus I go to college :). I’m not busy ;).

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