© 2019 by Spinal Symmetry Pty Ltd


Returning to exercise

June 30, 2017

One of the hardest things we have to do as practitioners here at spinal symmetry is to tell our patients to take a break from the sport or exercise. Please keep in mind that we care about your long-term health when we suggest this.




When you do a certain sport or exercise on a regular basis you are at risk of repetitive overuse injury, which can come in the form of a strain, sprain or stress fracture. Some sports have a risk of trauma such as tears, fractures and dislocations as well. Depending on your body type you may be at higher risk of some injuries than others, for example if you are naturally very flexible you can be at higher risk of dislocations or rolling your ankle.







An important thing to note is that if you have had an injury once, you are much more likely to have that injury again. That is why the moment you are starting to notice signs of repetitive overuse, the smartest thing to do is to prevent further injury. You may notice this as pain during, directly after or the day following exercise (excluding post exercise muscle soreness, if that is normal for you). This might sound a little discouraging, but keep in mind that we want to help you return to exercise as much as you do, and we recognise that the benefits of exercise far exceed the risks.


Following are some helpful tips for returning back to your full exercise regimen safely. This newsletter is very generalised and won’t go into specific types or areas of injury, except from a few examples. Ask your practitioner for more specific advice to help recover from your particular injury if you are unsure. This is also focused on overuse injuries, and if you have had a major trauma, we recommend that you get the appropriate medical assessment and treatment before we examine and treat the musculoskeletal repercussions of your trauma.



Most importantly, do not panic or get depressed


It is upsetting to find out that you need to take time off from your sport or exercise, but keep in mind that it is much better to take some time to heal now, than having to deal with a chronic injury down the road and maybe having to give it up for a longer period or for good. It is helpful to set both long term and short term goals, and that will help you see the light at the end of the tunnel as well set your plan to getting back to your exercise.




Have one of our practitioners examine and treat you


An injury, especially a repetitive overuse injury can result from bad form due to an imbalance in your body. If you have a hip imbalance, it can cause a difference in your leg length, which will cause different impact patterns through you feet, legs, pelvis and spine as you are running or lifting. It will also shorten or lengthen the muscles that attach to these bones and cross the involved joints, which can have major effects on loading and contraction of these muscles. This can contribute to injury, and getting a treatment can help balance your body which will help it heal, as well as prevent re-injury.




Do your dynamic therapy


After having your body’s balance restored, we might prescribe dynamic therapy. Make sure you follow through, using your strap for 30 minutes in bed every night before you go to sleep. It is important that you stay in bed for at least 4 hours after removing your strap as it is still working until you get up and your hip joints are weight bearing again. The purpose of dynamic therapy is to help the corrections we have made to your body hold. The reason you might need this is that the ligaments in your hips and pelvis are the strongest in your body, and the way they have been tensioned while holding your skeletal foundation in a twisted position is often a chronic problem. This makes these ligaments susceptible to return to the tensioning pattern they are used to, and over time returning to the imbalance that was underlying your injury or pain in the first place. Dynamic therapy is especially important while your body is in a state of injury or healing.




Do something else for the time being


Once you have identified the aggravating factor for your injury, it goes without saying that you shouldn’t keep doing it. In the initial, stages of healing it is good to avoid aggravating further injury, and you can do that by doing a different exercise that does not aggravate your pain while still keeping you fit. For example if you are a runner with a recurring ankle sprain, you may find that swimming helps keep up your cardio without making your pain worse, and as you heal further cycling might become an option as well, as it will start to challenge your ankle with a small amount of weight while being gentler than running and keeping your legs strong. This way, when you do start running again your body will still be conditioned to exercise, while your ankle has had a rest and your body a chance to balance and stabilize itself.




Stabilize, strengthen and lengthen


Doing some rehabilitation exercises can help you prevent further injury. Often when an injury occurs, there is a problem with the chain of muscles or joints that are involved in the exercise. This is often due to the way your skeletal frame has been twisted over time. An example of this can be when the chain of muscles fire in the wrong order, or not the same on each side. For instance, if you lift heavy weights and your left leg takes more load than the right when you do 70 kg squats, that can cause a major problem anywhere from your feet to your spine. Another example if you are a runner with weak and underactive glutes, you may experience overactivity and pain in your hamstrings or lower back.

A way to condition your form to be perfect as you get back into exercise is to do exercises to teach these muscles to fire correctly. If you have a good side and a bad side, you should do this by doing each side individually, for example by using two dumbbells rather than a bar when bench pressing. This way you will train both sides equally without your good side taking up the slack. A very helpful tool here can be a mirror, a training buddy or a personal trainer to keep an eye on you and correct mistakes.



If your spine is the problem, waking up your core and glutes can be very helpful. Most people already have decent core and glute strength, they just need to learn how to actually switch it on and use it. For this reason weighted squats or 200 crunches a day are not usually the answer, and can worsen your pain. Pilates and yoga classes can be helpful in strengthening, stabilising and lengthening your muscles, both in your core and elsewhere. Please note that if you are doing dynamic therapy, you should avoid extensive hip twisting and stretching. You might be surprised when you realise how tough it is to do certain poses and exercises once you get this core activation right, while doing it “wrong” always seemed easy.



The reason glute and core strength is so important is that they are important parts of the dynamic stabilizing system of your hips, pelvis and spine, and the most commonly underactive. While your treatment and dynamic therapy is the effective way of correcting your hips and pelvis, conditioning the muscles that help stabilising them can be an important factor in helping the corrections hold when you put your body under load.



Don’t get ahead of yourself


When you finally find yourself out of pain and able to do your exercise again, there is a chance you are not ready to go back to your usual routine, especially if you have had a long time off. At this stage you can start doing your usual exercise, but you should not do it at the duration and intensity you used to before injury. The best thing is to start very carefully and then observe how you feel during, right after, and the day following exercise. If you experience pain during exercise, stop immediately and either extend your break or lower the intensity and duration further.


The 2 minute rule


The 2 minute rule is especially helpful for runners, cyclers, rowers and other endurance exercises. When you are able to run again after an injury, start at a small portion of what you were doing. For example if you used to run for 30 minutes, go for a 10 minute run. If you feel fine the next day, you can add 2 minutes to your next run and go for 12 minutes. Add two minutes per successful run. If you find yourself in pain during or after a run, subtract two minutes on the following run and keep running at this time until you are no longer experiencing pain. Then you can continue adding and subtracting until you have reached your goal.



The 10% rule


The 10% rule is another helpful tool to help you return to exercise. This rule adds intensity in 10% blocks. If you are returning to weights, start lifting about 30-50% of your normal weight (depending on your injury and how long you have had off you might even want to start with less or with body weight exercises). If this goes well you can ad 10% on a weekly basis. If you experience pain or symptoms of injury, subtract 10% from your next session and continue at this intensity until you no longer experience pain with it. Continue adding and subtracting 10% until you have reached your goal.




Prevent re-injury


Congratulations! You are back to exercising like you used to! But you have just been through an extensive training program to get here, so how can you stop this from happening again? Remember those stabilising exercises? Keep doing them! As mentioned earlier an injury often occurs due to bad form. Continuing your stabilizing, lengthening and strengthening exercises will help prevent your body from going back to its old faulty patterns. If you are doing everything right and you still start feeling a hint of pain again, stop what you are doing and get it looked at, your skeletal frame can also start to pull itself back into its old pattern which can slowly lead to injury. If you have been prescribed dynamic therapy, continue doing it after you are out of pain. This is when dynamic therapy is doing its best work! We recommend that our patients strap up for 2 years (give or take) as this is the normal time frame for retraining the strong and robust ligaments in your hip and pelvic joints. This does not mean you will be in pain for two years, again it is to prevent recurrence of a chronic twist of your skeletal foundation.





Talk to us


If you have any questions or concerns during your healing and recovery process please talk to one of our practitioners. We are happy to help and listen. Remember that healing is a process which will take the time it needs, stay positive and see this as an opportunity to take care of your body and improve the way you use it. This is a good time to pick up some good habits that will help your body’s wellness, balance and strength and prevent reinjury in the long term.



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