Training vs a Rehab Exercise???

Have you ever thought that the distinction between rehab and performance is black and white? For example, if you’re experiencing pain during activities like weightlifting or running, it seems logical that rehab exercises are specifically designed to alleviate pain, and are independent of the performance activities themselves, right? 

Well… let me challenge you this... If the rehabilitative process only incorporated exercises targeted at one body region, to achieve a goal of reducing pain… then completely stopped there… how would someone successfully re-integrate to the activities that were causing pain in the first place?

Do you have pain with training, including squats, deadlifts, presses, or Olympic Weightlifting? Furthermore, are you having pain with a variety of CrossFit activities, including single arm overhead movements, impact activities, or gymnastics?? Well, if your goal is to overcome pain + progress back into consistent training, don’t forget that there is a middle ground here… a progressive approach that applies your newfound strength and movement to the specific exercises you want to resume.

If rehab exercises are designed to target movement, motor control, and strength issues that lead to pain, then there is a WIDE RANGE of what this can entail! Sure, in the early stages of rehab, we might focus on lower-level, isolated drills to alleviate symptoms and restore movement and muscle activation; However, rehab can certainly evolve into training and performance exercises — I'm here to show you how.

 So when does a rehab exercise become a training/performance exercise? Well, sometimes the lines can be heavily blurred — and for a good reason! 

1.  Once a patient starts feeling better in the early stages of working together, I would be doing them a disservice if I stopped their rehab process altogether. The goal isn’t to become pain-free, but to stay pain-free, with the activities they love to do. Therefore, we’ll start incorporating pieces of their activities INTO their rehab program with a restorative purpose. 

2.  Let’s use Deadlifting for example. If this is a training exercise, with which an athlete has pain, we can turn it into a rehabilitative exercise by altering certain variables that change the outcome and training goal of the movement. What we manipulate here is the volume, load, range of motion, or even the variation OF the deadlift (i.e. an exercise that still targets the hinge pattern and posterior chain loading). This is based on the needs of the patient, tissue loading capacities, their training experience, equipment access, and so many other contextual factors.

3.  Here’s an example of how we can transform a standard Deadlift, a training exercise, into a rehab exercise:
1.  Weeks 1-3:
1.  Strength: Wall hinges, low back isometric loading, hip thrusts. Volume and load where symptoms are well controlled at 3/10 or below. 
2.  Workout: EMOM x 12mins 
1.  Seated Rows 
2.  Wall Hinges (with or without weight based on their capacity, add weight as weeks go on)
3.  Ski Erg
2.  Weeks 3-6:
1.  Strength: Elevated Deadlifts, from the knee-height. The weight is one where pain remains a 3/10 or below, with an RPE of 6-7/10, and symptoms don’t last longer than 24-48hrs. 
2.  Workout: EMOM x 12 mins
1.  Bike, or other cardio they enjoy
2.  Deadlifts 95/65lb 
3.  Bent Over Sled Push / KB Farmers Carries 
3.  Weeks 6+: 
1.  Strength: Deadlifts from the floor, emphasizing core and lat engagement cues, or any other cues specific to them. The weight progresses through the weeks by 5-10%, with the same principles of symptoms 3/10 or below, not lasting longer than 24-48hrs. 
2.  Workout: EMOM x 12 mins
1.  Bike
2.  6-8 Deadlifts at 60-70%
3.  10-20 Pull Ups/ variant of this
4.  Past this, the athlete might find they are able to incorporate deadlifting more regularly into their CrossFit program. 

As you can see, the Deadlift has been modified by the weight and volume to give it a rehabilitative focus. Wherever the athlete needs to start, based on symptoms and load tolerance, we will start. But we can incorporate it still into a strength program with a progressive nature, still manipulating load/volume/range of motion variables, with symptom management.

I LOVE helping athletes still do a movement pattern in other ways (hinge work = ski erg, sled push, bent over rows). :)

I am not here to say Deadlift is ONLY a training movement — it’s how it’s programmed based on the target outcomes that turns it into a rehab exercise, or gives it rehabilitative purpose. ALSO, that person can still participate in their training, and call it training!!!

 But let me make myself clear: I am NOT downplaying the role of the more simple, targeted exercises. Those have a HUGE place in the strength program as well! These are still important AND effective for sport specificity!! For example, if you have a strength or Weightlifting program that already incorporates Accessory work for the lifts, we can take those away and incorporate some more locally-targeted rehab exercises you’re doing to help address the movement and motor control factors that contribute to pain. Are we trying to improve scapular and RTC stabilization in the receiving position of the snatch? Okay, let’s take away the current Accessories, and add in our Windmills, Turkish Get Ups, Sott’s Presses, Bamboo Holds, etc that will actively be specific to our goals, 

In summary: it’s all about how you PROGRAM a training exercise — to still target a specific stimulus of a workout or strength training outcome — which is what gives it rehabilitative purpose. 

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If you have PAIN with when trying to return from a pain issue into regular training, well, that’s the whole reason I am here today — to help you transform your training and rehab to restore pain free activity. Reach out to me and let’s assess the issue together!

Ready to learn more? Have specific pain problems that are limiting your performance goals? Czarbell is here to help. Reach out at [email protected], or schedule an appointment with me through the main page of this website, to learn more!