I get a ton of questions each week, and most of them I just respond to in a simple email. This was one, I believe, is worth addressing publicly, and I hope it helps you figure out what to do with your training and diet if you ever find yourself in such a situation.
Our reader wrote in the following:
“I’m currently dealing with a bum left knee, achey lumbar spine, achey right rotator cuff, stiff neck with some occasional pins and needles down the arm. I’ve lost about 70lbs doing Intermittent Fasting, and I’m going super slow lately.
My macros probably need adjusting and I probably need to refocus, but I feel like lately I just keep getting injured more and more.
Do I take a weight loss break and do a little maintenance or bulk?”
Wow. There’s a lot here, but it’s not too uncommon for those pounding the pavement, and making lots of progress to incur some injuries, wether they be from overuse, too little rest, or just bad form/exercise habits.
In the last article, I touched on some points about not needing to chase strength gains, if your goal is fat loss and/or to be more fit/aesthetic.
Here’s a perfect example of someone that doesn’t need to be under a heavy bar going for a 5-rep squat max.
They also shouldn’t be pulling heavy from the floor, and any straight bar benching is out, due to their rotator cuff soreness.
Disclaimer: Before I go any further, I want you to know I am not a physical therapist, or doctor of any kind. I’m giving some general advice based on this email as I don’t know what’s exactly wrong with this person’s shoulder, knee, or lower back. If this were you, it’s probably best to consult a rehab professional.
Exercise Options and Ideas
So let’s first address his physical ailments. I have a strange feeling that our friend’s previous plan was a combination of major strength goals and a pretty aggressive fat loss diet.
Nothing super wrong with this approach, but we often get caught up in the notion we must add weight/reps every single workout, and if we don’t, then we’re not gaining/preserving muscle as we’d hoped.
Along the way, form starts to get sloppy for that extra rep.
We justify the idea of throwing on a few extra pounds, even if we barely hit the bottom of the prescribed rep range from the last workout. This is common for the most driven trainees.
But it’s hardly a good idea to be chasing strength gains so aggressively, all the while putting yourself in an energy deficit with the hopes of shedding some body fat.
What if you get hurt? What then?
Do you find a way to work around it, or just let yourself go altogether?
What if, and I hope this never happens to you, the injury is so bad that is sidelines you for months – to the point of not being able to exercise in the slightest just to heal properly?
All your hard work from the previous weeks, months, and even years for some, could quickly slip through your fingers. You’ll slowly watch your body atrophy, and return to it’s former state. This is especially true if you’re prone to getting emotional during these low times, and resorting to food as comfort.
I’m not saying this to be a judgmental jerk, but it happens… a lot. We’re human, and it’s easy to get completely wrapped up in a goal, and once things take a turn south, we find comfort in activities that can sabotage our efforts.
Many of us are mostly governed by our emotions, but again we’re human, and it’s okay (sometimes).
So what happens in the case you have a bum knee, achey hips and lower back? First, you should probably see a specialist to make sure you’re clear and you’re not incurring more damage by training through the pain. If you’re feeling ‘pins and needles’ or any numbness, you might get checked for nerve damage, too.
But let’s say you’re clear to exercise.
There are many exercises one could focus on outside of the major, most-bang-for-your-buck, movements.
Let’s start with this guy’s knees. It’s likely squatting is out of the picture due to pain, bad form, and the possibility of further complication. We’re going to assume he’s been cleared by the doctor with no actual joint injuries, and some slight tendinitis.
The pain could be stemming from a poor movement pattern, or the lack of mobility in his hips, and ankles. It could also be a combination of all above.
So what are some movements likely to reinforce better patterns, and also create enough stimulus to maintain muscle?
A few of my favorites are goblet-style reverse dumbbell lunges, and single-leg presses with a focus on keeping the knee from moving over the toes, which means you’ll have to place your feet higher than usual on the platform.
Another movement I like requires a good amount of balance, but when done correctly can take a lot of strain off the knee. Those are Bulgarian split squats. See the video below:
As you’ll notice, her knee is tracking right over her toe. To make this a bit more knee friendly, you would place your foot slightly further out in front of you, and make sure your shin remains mostly vertical.
So there are a few load-bearing movements (to build muscle, and strength) you can try if you need to take a break from heavy squatting, or jumping movements.
Now, let’s talk about the lower back issues. Again, we’re assuming the doctor has cleared them to lift, and ruled it out as nothing severe. We’ll take caution by assuming that direct spinal loading is out, as well as heavy hingeing.
So what do we do?
We load the muscles using dumbbells, or machines and apply no direct pressure on the spine.
So instead of heavy squats, we’ll opt for goblet squats to a box, or split squats while holding dumbbells. As I mentioned above, leg presses (single or regular) are probably fine as well.
To hit the backside, we want to forgo any heavy pulling such as deadlifts from the floor, or RDL’s in the 1-8 rep ranges. Instead, we can focus on light hingeing using a hyperextension, or even a very light RDL (imagine reps of 12-15 here). Single leg RDL’s with DB’s in the higher rep ranges (12-15) might be a good option too, and they’ll help with core stability.
Here’s a video demonstration I did showing proper form for RDL’s and hyperextensions.
If those are giving you problems, fear not. There’s always single-leg glute bridges (one of my favorite exercises for glute and hamstring development), as well as loaded glute bridges and hip thrusts.
Here’s a good example of single-leg bridges/thrusts.
Here’s a good example of loaded hip thrusts.
And finally, let’s talk about shoulder movements. I’ve had my fair share of shoulder issues, so I don’t need to write a book about this one. If it hurts, don’t do it.
If you need a good shoulder resource, I wrote this all about saving your shoulders few years back.
As for movements, just about any neutral grip variations are good. Dumbbell presses, band-resisted push-ups, and neutral grip machine presses seem sufficient. To be safe, neutral grip vertical/horizontal pulling is a good idea to keep the shoulders healthy and safe, too.
Of course, all of this is assuming the rotator cuff is merely weak or strained, and not severely injured.
Don’t forget lots of internal and external rotation, and plenty of band pull aparts, as well as face pulls. This article is all you need, seriously.
What about rep ranges?
Since the main focus here should be movement quality, correcting form, and even improving mobility (if that’s what’s causing tightness or pain), we’re going to stick with the 8-20 rep range. I don’t see much of a reason to go below 8 reps for 2 reasons:
Allows for enough practice, which instills proper movement patterns and allows you to focus on the overall contraction quality.
Helps keep you honest by checking your ego at the door. No going into the gym with an aim to hit a 5-rep maximum, which also preserves your ability to recover.
Also, if your main goal is to maintain muscle, and maybe even build some while you’re dieting, the mid-higher rep ranges are probably better all around anyway, especially when nursing/preventing injury.
And for his last question….
What about the diet?
Honestly, if fat loss is that much of a concern (health reasons, or just being fed up with a certain aesthetic), then sure, continuing with the fat loss diet is probably okay.
Personally, I’d like to see someone eating plenty of carbohydrate and protein around their maintenance levels to promote recovery, and healing, but we all have our priorities.
Bulking is hardly a good idea in most cases, but strategic overeating could be beneficial in this sense, especially if he ended up doing some heavy volume work. It’d promote recovery, which could lead to some more muscle.
Of course, if you ever have questions, submit them to us here. (please read the email policy)
I’ll write you back, and possibly write about it on the site.