Demystifying Return to Lifting
“When will I be able to get back to squatting?”
“When will I finally be able to get back into deadlifting?”
“I’ve been trying to get back into CrossFit for months, how do I know if I’m ready?”
These are just a handful of questions that I hear from strength athletes on a daily basis. There is a tremendous amount of confusion and misinformation related to returning to lifting following an injury.
The answers to these questions are not so clearly defined with black and white answers. The beauty of returning to any form of resistance training is that there will always be some variation or modifications that can be used to reintroduce and build back up to desired activities.
We have discussed return to run falling across a continuum… and guess what? Return to lifting is no different! Many of the strategies and criteria follow similar thought processes and trajectory during reconditioning.
What criteria should be met before re-introduction of lifting activities?
Ah, if only this were a simple answer! Unfortunately, the criteria that should be met will be highly variable based on the desired lift, the intensity, and the training history and goals of the individual. Imagine the necessary prerequisites for return to strength training for basic health goals (bone density, improved ADL’s, improved force output) versus those for a competitive powerlifter.
Returning to performing strength training on machines at the gym will have a much lower barrier of entry as compared to returning to maximal effort squatting, benching, and deadlifting at a highly competitive level. Relevant demands and expectations will guide which criteria and checkpoints become vital to initiating return to lifting programs. In many cases, the initial strategies and interventions will bear a lot of similarities between the two, but will progressively diverge as specificity of training increases.
Some quick and easy benchmarks to consider for all return to lifting progressions could be:
“Do they have enough _____ range of motion?”
“Can they tolerate external loads in _____ position?”
“What is the individual’s subjective level of confidence returning to ____?”
“Can they tolerate speed and impact with loading?”
“How much volume of _____ lift can they currently perform?”
Graded Exposures with tolerable movements vs. Non-Specific Training methods
Considering the specificity of a client’s goals will aid in the selection of appropriate interventions and return to lifting plans and processes.
If we know from the onset that this individual needs to get back to benching twice their body weight to be competitive in their sport, we can safely assume that a good portion of their reconditioning process will revolve around improving the strength and tolerance to this specific movement, even if other strategies must be used early on.
Utilizing variations of a given movement is a great place to start as the underlying movement (bench in this case) should remain very similar to the intended movement. If a client cannot tolerate traditional bench pressing initially, a simple early strategy could be to utilize dumbbell floor presses, barbell floor presses, or even specialty bar bench pressing. This can help to maintain a degree of external loading with a relevant movement pattern, while slightly altering the specific stressors that may not be well tolerated (example could be wrist position with straight bar versus specialty bar).
Keeping a high degree of movement relevance while altering the specific loading strategy allows the client to build further resilience while mitigating undesirable or provocative positions.
Tempo and Partial Range Training:
Altering the tempo (or speed) and the range of motion of movements are my favorite starting points for return to lifting interventions.
Say an individual has low back pain in the very bottom of a back squat?
Here’s one simple strategy! Let’s alter the depth of the squat such that they either have to stop above their max depth or have them squat to a box of a height that they can tolerate.
A second strategy that could be used would be to alter the tempo of the movement. If the pain occurs when “bouncing” out of the bottom of the squat, we can attempt to mitigate this by adding a brief pause in the bottom of the squat to ensure desirable positions and maintenance of tension. From there, we could focus on a slow and controlled transition into and out of the bottom position prior to incorporating a more rapid drop into the bottom.
“Testing The Waters”
We can take out a lot of the confusion of return to lifting by considering that every individual can serve as their own case study.
This is no different than the scientific method: we test the waters of tolerance to movements and positions by consistently providing a stimulus, assessing the response, adapting, and re-testing.
This process allows for small adjustments to training and dosage that can result in huge changes and progress over time.
- Mike Reinhardt, DPT, PT
FUEL UP!
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Social Media Follow: Brett Birnbaum @total_performance_pt
Our guy Brett is a physical therapist with a private practice working out in Keego Harbor, Michigan. He is an extremely passionate young clinician with a strength and conditioning background and has spent time at both Rehab 2 Perform and Resilient PT in NJ. Be sure to check out his page!
