The 4 Worst Ways to Heal From Lifting Injuries

by Dr. John Rusin

Foam Rolling, Stretching, Taping, and Icing

Some of these rehab methods are just misused. Some of them are flat-out useless for lifting injuries. Luckily, there are better alternatives.


Lifting Injuries: What Helps You Heal, What Doesn’t

People trying to heal their lifting injuries using self-administered rehabilitation and regeneration techniques often do more harm than good. It’s time to set the record straight.

Here are the four most useless rehab methods that not only have limited carryover in performance and health but can actually come back around to bite you in the butt. Don’t worry, though; there are some alternatives that actually work.

1. Rice: Rest, Ice, Compression, Elevation

Icing Sports Injuries

In 1978, The Sports Medicine Book, authored by Dr. Gabe Mirkin, introduced the concept of RICE for treating athletic injuries. It makes sense to ice down an injury as soon as possible to limit swelling and maintain function, right?

Not quite.

In 2014, Dr. Mirkin went on record debunking his own work pertaining to the ice portion of the RICE acronym for acute musculoskeletal injury management. It takes a special man to admit that countless research articles and reviews had disproved his life’s work, but we’re all glad he did.

Not only did cryotherapy not aid in healing, it actually delayed the healing process altogether.

And while he was at it, Dr. Mirkin also shed some light on his recommendation for complete rest after sustaining an injury. “With minor injuries, you can usually begin rehabilitation the next day,” said Mirkin.

Hey, if the guy who literally wrote the book on injury management is saying don’t restrict movement or ice an acutely injured area, we damn well better listen!

Do This Instead

It’s a good thing there were a few more letters in the RICE acronym that stood the test of time.

Compression and elevation of acutely injured areas are still highly effective and should be prioritized after sustaining a low to moderate-level injury. Along the same lines, you might want to experiment with “floss” bands, like these.

But as far as rest and ice (R and I), it’s best to rethink those letters.

2. Foam Rolling

The foam roller may be the single biggest time waster in the fitness industry.

Soft tissue work, including foam rolling, trigger point work, and even my hands-on self myofascial-release (SMR) techniques needs to be focused and goal-oriented processes. If you find yourself rolling the same muscles every single day, it’s safe to say that your “practice” isn’t yielding any notable results.

Worse yet, flailing around on the foam roller with a smile on your face isn’t the way it’s done. Just the term itself, “foam rolling,” sets you up for failure. It sounds soft, fluffy, and enjoyable. It should be none of those when executed correctly.

You know who has the right idea with self-sufficient soft-tissue work? Mobility expert Kelly Starrett. He doesn’t call this practice foam rolling. Instead, it’s referred to as “smashing,” and he uses specific tools on select regions of the body.

Putting yourself into some serious pain in hopes of tissue deformation (and subsequent remodeling) and muscle tone reduction is what you need to create long-lasting results.

Do This Instead

There are a few key things you can do to manage your soft tissues and enhance your health and performance. Prioritize your foam rolling on just a few targeted areas per day until these areas are resolved. Big, superficial muscles like the quads and lats can be worked very well with the roller, so don’t throw the tube away quite yet.

If you think foam rolling is going to enhance your athletic performance, the research doesn’t support you.

What multiple studies do show, though, is the ability for self-myofascial release to significantly alleviate muscle soreness and increase muscle flexibility for short periods and potentially long-term periods when used on specific areas for more than two weeks. In other words, the roller can potentially expedite the recovery process.

When dealing with pinpointed soft tissue restrictions and dysfunction, there’s nothing better than getting your hands dirty and literally working on yourself. Your fingertips provide a much smaller surface area that match the size of small structures (like the rotator cuff tendons) while also allowing a sensory-rich environment for you to explore your body. Try some of these out:

The more you learn and discover in terms of muscles and structure, the better you can apply that knowledge to your training by enhancing a mind-muscle connection.

3. Kinesio Tape

Since when has wrapping yourself up like a brightly-colored mummy become a prerequisite for being an athlete?

Though kinesio tape has been in use in the therapy industry for a while now, everything went into overdrive after the 2008 Beijing Summer Olympic Games. You probably remember seeing the Americans kick some major ass on the beach volleyball sand, and the athletes were covered in that mysterious tape.

The initial hypothesis was that the tape was administered to cover up Misty May Treanor’s tramp stamp to keep relations civil with communist China. This hypothesis was quickly debunked and replaced with a statement from the American team saying that the tape was a therapeutic aid for pain and dysfunction.

But was it really? Since that time, there have been countless research articles published looking into the efficacy of kinesio tape for both pain modulation and performance enhancement. Unfortunately, a majority of studies show that the tape is of no more help to an athlete’s performance than any other faddist trend we’ve seen sputter through the industry.

White athletic tape has been around for almost 100 years, but too bad it didn’t sport a logo. Johnson and Johnson really missed out on that mega-opportunity.

The thought is that tape can be strategically placed over the skin in areas that can either inhibit or facilitate muscular tone, thus enhancing joint positions and the production of muscular force.

There are rehab experts out there that swear K-tape is the most game-changing tool they’ve used for enhancing the performances of their athletes, but the chances of it working when an amateur with no experience administrates the tape are about as likely as an ice cube’s chance in hell.

Do This Instead

If you’re going to go down that rabbit hole just because those jacked and conditioned athletes throwing around absurd weights in the CrossFit Games are showing more Rock Tape logos than they are skin, at least do it right.

Look, there’s a reason why practitioners and movement specialists get certified in this stuff. There’s indeed a science and skill set to properly administrating a theoretically sound K-tape treatment.

Go see one of those people. They paid thousands of dollars to be a certified tape specialist and may actually know what they’re doing.

That said, you can tape yourself up using nothing but plain athletic tape. It’s not a cure-all, but the treatment can be useful in some circumstances.

4. Stretching

Do you have tight hamstrings? You must start stretching! Lower back pain and discomfort? I bet you aren’t stretching! Sustained an injury to your hips or spine? Better do yoga!

These are the kind of insane misconceptions about stretching I deal with on a daily basis with my clients, some of whom, I may add, are world-class athletes pushing the limits of physical achievement. If world-class athletes are this confused about stretching, the layperson must be monumentally screwed when it comes to the subject.

What we have to ask is, what exactly does static stretching do to the human body, and does it have a place in athletic performance and reducing injury rates?

It’s important to mention that physiologically speaking, it’s extremely difficult, if not impossible, to actually add length to a contractile tissue such as a muscle. What’s essentially happening with any type of mobilization of an area is the relaxation of that muscle and the reduction of its tone, which are largely neuromuscular properties, not mechanical.

Now that we got that straight, here’s the deal. Static stretching of a tissue over 45-seconds increases muscular flexibility that may last more than 24 hours in certain muscle groups. That increased range of motion may be a double-edged sword, especially when executed right before an athletic event or workout.

If you’re stretching with the intent of reducing the likelihood of sustaining an injury during athletic participation, the verdict is still out. What we do know is stretching can reduce muscular force and power output in certain muscle groups, which can potentially decrease the level of performance.

Not exactly what you were thinking when you went down to touch your toes, is it?

Do This Instead

Static stretching done for long durations has its place in a select population of people who are literally so tonic (shortened and tightened) that administering a stretch is the only way to prevent serious and debilitating contractures.

For the rest of us, the use of dynamic stretching and oscillating protocols can get the job done without adding to the traditional problems posed by stretching.

Dynamic warm-ups are nothing new and should be programmed before every type of exercise, training, or athletic event to increase local blood flow to active tissues, lubricate joints, increase core temperature, and prime the neural system.

As for adding functional length to problematic tissues, the use of oscillations – moving in and out of near end-range of motion – for specific tissues can lead to marked improvements in the tone of tissues without overstressing the musculotendinous junctions that notoriously take the brunt of a static stretch hit.

Simply put the muscle you’re targeting into an end-range stretched position. Move back and forth, in and out of an end-range stretch, nice and easy with an oscillating motion.

This stretch-on, stretch-off range of motion may only be an inch or two, but it will be far easier on the tendons and non-contractile tissues.

Do this back and forth like a pumping motion, attempting to get just a little more range of motion through those tissues each time. Stick to 60-120 seconds per tissue to start with. Work your way up to 5 minutes at a time if you can stomach the tension.

Want more? Replace most of your stretching with accentuated eccentrics.

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6 Likes

@Mods Any chance Dr. Rusin has a handle I can tag?
RE: Soft Tissue Work/Myofafascial-Release

There are a number of methods that can be used for this which go above and beyond using your hands, but I can’t help but notice a lack of information regarding how effective they are.

  • The Graston Technique always looks good, and I want to believe that bruising up your injured area this badly has science/data to support the claims it makes… but it seems these claims are based on either bad studies (with a sample size of 17 subjects and varying techniques - which weren’t recorded) or anecdotal claims.
    It makes me suspicious when any company makes bold claims the way Graston™ does, but then they also trademark their methods and data too.
  • Cupping is another one of these techniques. You’ll see videos of athletes with symmetrical octopus circles on their bodies, and because they are their sports’ elites, it makes you want to trust that it works… but it begs the question of “why?”.
    If you click the hyperlink in this bullet-point, you’ll find a meta-analysis that basically says “There is growing evidence that cupping works, but we don’t know why… here’s some theories though”.

Where this applies to this article… Soft tissue work/myofacial release is known to help with soreness and short-term flexibility (which this article points to as well), but does it help with actual injury recovery? The above methods have very strong claims to working, but little non-anecdotal evidence to show for it; I’m interested to know if there is any more evidence to these claims that is perhaps behind a paywall.

If Dr. John Rusin is able to comment, that would be awesome; if anyone else wishes to comment - please do (particularly if you are Graston-Certified).
Also going to tag @Dr_Grove_Higgins as he is our resident Pain & Movement Specialist

Great article, by the way!

3 Likes

I mean, who DOESN’T feel better after getting a good hickey?!? Am I right?!?

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This is an excellent article with many practical things to do for lifting injuries. I know John, and he always presents terrific stuff.

@Andrewgen_Receptors, your question is a good one.

When I was going through school, I quickly learned EVERYTHING works. There are so many techniques and systems. Some definitely work better than others, for sure. But at some level, everything works.

I had the great fortune of doing several years of research in a biomechanics lab. One of our projects was researching different systems for detecting and fixing specific biomechanic issues. But unfortunately, the inter-examiner reliability was very poor among the many different techniques and practitioners. But, when you look at the individual practitioners, they had great clinical outcomes with reduced pain and increased performance.

The problem with researching techniques like the ones found in this article, especially regarding injury, is that many variables exist. Each injury is unique, and there are multiple factors influencing a person’s experience of pain, disability, and recovery. Then there is inter-examiner and practitioner reliability in the application of technique. Because of this, doing large-scale, much less double-blind placebo studies is near impossible. Also, there are many subjective variables to consider.

Even with observable injuries, the subject’s response to them can be highly inconstant from person to person. Example: I can have an individual with a mild lumbar disk bulge who can barely walk. And yet another whose disk is nearly flattened and protruding into the spinal canal, and they have an inconvenient stiffness. Likewise, I can barely touch someone executing the least effort. They get great relief and another, with a seemingly similar issue and nothing touches them.

So then the question is what works best for the person in front of me, be it manual therapy I apply or the drills I have them perform for themselves. I practice passive modalities (done to a client) such as Active Release Techniques, some Graston/IASTM, Kinesio-tapping, Chiro, and many others in the clinic. Actively we use exercise-based therapies, sensory training (vision, vestibular, etc.), and teach people how to treat themselves.

But I am constantly using my experience to apply the right tool to the right problem in the right person. Thankfully there are some consistent “go-to” things we can do for most people to get a result. But I try hard not to be so personally invested in any technique or approach that I can’t see my way to abandon it for the sake of what is best for the client and what works for that unique individual.

And, of course, if you are talking about a technique… the people pushing the technique and those invested in using it will emphasize the “strong claims” even without the “little non-anecdotal evidence” to show.

So, here is what I recommend, and this is what I do with every one of my athletes and patients:

#1. Test it – Test everything! Learn to evaluate what you are doing or what is done to you. Come up with reliable movement tests and activities to detect noticeable changes in performance. Be objective in assessing, did the thing I just did make a difference – anywhere? Did it change the level of pain, where it occurs in a range of motion, etc? Test it.

#2. Be consistent - When you are doing something you think may help, try to apply it in a consistent manner. Even though things like foam rolling and stretching have transient effects, cumulative use, along with other training that helps “set” the changes into your neuromuscular system, will pay off. Doing something only when you have pain or even just a couple of times a week is likely just a waste of time.

#3. Be Honest – When you have done your analysis and are not finding efficacy… change it or abandon it. Don’t let your ego drive your perception of results.

#4. Get Coaching – of course, that is why you are here and interested in learning how to help yourself. But getting eyes-on or hands-on help will save you a ton of money and frustration.

3 Likes

Long a fan of Starrett’s work; and I totally agree that most “rolling” you see in the gym isn’t doing much. But that could apply to most everything else one sees in the gym haha.

For hard to reach places, I use a Rumble Roller. It is knobby and u can use your whole body weight to target areas.

I don’t need data to show me it “works”; I know it helps with adhesion/etc points.

So, static stretching essentially inhibits tissue neurologically. Correct?

But will the oscillating motions described increase range of motion? Without inhibiting the tissue?

The Accentuated Eccentrics (an indie rock band?) looks very interesting. Thanks!

1 Like

I cant recommend the book Trigger Point Therapy Workbook by Clair Davies highly enough.
The number of “injuries” (muscle knots that often refer pain elsewhere) Ive fixed with this. Amazing that sometimes a single session of minute or 2 to the roght trigger point can get rid 90% of pain. Its always my first call when i get inured or somethings starting to feel off.

Its similar, if not the same as myofascial release, but often using a small ball or some other cheap tool rather than just hands as shown in the vids.
Packing more muscle can make it harder on the fingers to get the pressure needed so a ball against a wall if often best for back, glutes etc.
I own a hard copy but the best the kindle version viewed on the kindle app on a laptop/ tablet so you can search, save, highlight. One of the best £10 ive ever spent.

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Thank you Dr. Rusin! Great, USEFUL information in this article. Much appreciated.

Have had 3 shoulder surgery’s form lifting in 5 years. Last one pretty serious 5 rotator tears and severed Supra spanatious tendon in half. Rehab at pt was long but jumped leaps and bounds when they started cupping 3 days per week. Therapist thought us was the increase in blood flow to area. I am back in gym but have become wiser. Strength has not returned to previous levels 2 years ago.

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Yup, that book has saved me a LOT of trouble: doctors, $, worry, operations, etc.

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A few tools I’ve found invaluable (and I agree, hands are tough, especially no leverage in many areas)

Rumble Rollers
The Wave Tool
Thera Canes

Serious question, why does stretching my groin before any leg exercise feel soooo good then? Assuming there is something better I can do to mobilise the area?

This blows up a lot of what PTs have had me do over the past 5 years. I need to try the dynamic stretch next workout.

I’d say because you’ve done it and believe it feels better.

I’d say a slow 5 - 10 minute jog or time on a stationary bike to raise the body temp and get blood flowing.

Yes. I watched injury after injury occur during stretching for YEARS. We even used to joke about it. Every workday morning for five years I’d get up to do “PT” in the Army with the various Infantry Units I was in. Every week someone would seriously hurt their hamstring, calves, or abjuctors while we were static stretching in the cold dark. The solution…stretch MORE of course. Many of the junior soldiers would often observe the obvious. A lot more people get hurt stretching than while we were doing our pushups, sit-ups, calisthenics, and running. I heard it said many times…“They were just lucky it happened early near the aid station” or they didn’t do it hard enough. I wish I could say I learned to change my ways when I got out but no it wasn’t until years later that I learned the terrible truth. Thank You and please get the word out as the American Military has trained hundreds of thousands of folks to believe you should always do long slow static stretching before exercise - no matter how much it hurts!

The myofascial release is fantastic, especially with active range of motion. I will not use the term ART (active release technique), since it is a closely guarded “secret,” only to be utilized by licensed ART practitioners. The courses cover several days, and are priced in the thousands. I have had good success in restoring pain-free ROM to shoulder flexion in people that presented with anterior shoulder pain (impingement). Palpating the biceps tendon/anterior delt, then applying constant deep pressure, along with the subject performing elbow flexion, along with shoulder flexion, has often resolved the issue with sometimes one treatment. Adding a similar approach to the supraspinatus tendon right after the anterior delt region can offer even more relief.

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Just being facetious about the licensed ART people, as anyone can do the technique, especially the shoulder.