Periodization is a great thing when it comes to a workout program. It gives you the chance to plan a training program around a specific goal, whether that goal is losing the last 10 pounds, the first 100 pounds, winning the gold medal or getting a PR in a deadlift. The downside is that the typical training program is designed for someone who isn’t recovering from an injury and is considered “healthy.” We hear about it all the time in pro sports where someone coming off the injured reserve talks about “getting healthy” and being able to get back on track with their training.

But let’s say you aren’t a professional athlete, or you don’t work with a professional athlete. Let’s say you’re just someone looking to get stronger and leaner and you have a few nagging injuries that have never resolved. You give an undulating program a try for a couple of weeks and right around the fourth cycle, when intensity and volume are at their peak, those old injuries rear their ugly heads again and make life a living hell. Sound familiar? I’ve been there, and I can testify to the fact tha it sucks more than 24/7 news coverage of Kim Kardashian’s divorce. Seriously, why do people report this crap??? Reggie Bush would be laughing his ass off at this if it wasn’t for his crippling depression for being completely useless in the NFL.

Now before you run away and say “Well I’m not injured, I feel great!!” Fantastic, but the bad news is you’re probably worse off than you think you are. Consider the fact that in 1995 Jensen et al (New England Journal of Medicine) MRI’d 98 asymptomatic spines and found 52% of them had a bulge in at least one level, and 38% had more than one disc issue, with the incidence increasing with age. Just because you feel fine doesn’t mean there isn’t something potentially wrong.

Here’s a simple fact when it comes to training injuries. There is only one type of training program proven to be successful in long-term resolution of symptoms and causative factors for most musculoskeletal problems, and that is linear periodization. The most boring, non-variable and straight ahead program that does nothing for fat loss, muscle gain, maximal strength gain, power gain, or any other facet of human performance and all-out sexification, and the one with the highest incidence of overtraining, chronic injury and pattern adaptation is the best for making the body adapt to a painful stimulus and make it a non-painful one.

The biggest issue with periodizing a program for someone recovering from an injury or currently in pain comes down to recovery. Most conventional program rely on training frequently throughout the week, programming rest days as body weight squats instead of 90% max weight. With injured tissue, the ability to recover is reduced, which means the time between stressors tends to be longer and the inflammation of the workout has a much more pronounced effect. It’s very easy to “spill over” and work the area too hard and make someone go from one workout that was pain-free to one that caused a lot of discomfort and reduced function.

The hardest part of developing a program for someone in pain is knowing how hard to push them. I’ve had a lot of clients come through feeling great on Monday and wanting to push harder, only to not be able to walk for the rest of the week once they cooled down. The tipping point could have been as simple as a couple extra reps, an extra set, or a small increase in weight, and that small increase was enough to tip the cascade of inflammation. Inflammation leads to swelling, which has been shown to reduce neural input into associated muscles relatively quickly. Simply pumping 20 CC’s of fluid into the knee-joint through a syringe was enough to get Torry et al to make the quadriceps shut off on EMG analysis, essentially screwing up knee-joint mechanics. So a joint that has swelling won’t respond to conventional training, and could actually be injured further pretty easily.

Now I’ve been fortunate enough to work with about 3 dozen meniscal repair clients over the years, not to mention those with meniscal injuries not repaired and osteoarthritis clients, and the protocol is pretty consistent: keep the range of motion limited and only progress if they have no swelling or pain. What this means is mini squats and we only increase anything if they go three days post-workout without pain or swelling. Progress will only be mad in 10% increments, meaning if on Monday they did 10 reps, on Friday they would do 11. If they lifted 100 pounds, they would then lift 110, even if they could lift a hell of a lot more. The goal is preventing pain and swelling, and nothing will get them there faster than pushing to failure or fatigue.

Conventional strength training programs work on the premise that fatiguing the nerve complex will increase the amount of signal being sent to the muscles and increase the strength of the person performing the lift. There’s also the breakdown of tissue that leads to hypertrophy and getting all jacked and stuff. These are both great things in healthy tissue, but as mentioned before, in the presence of inflammation or swelling, the nerve innervating the area may be down-regulated, meaning it literally can’t send more signal to the muscle. It’s sort of like turning the knob on your garden hose to get more water but there’s a kink in the line somewhere preventing water from flowing freely. Also the threshold for stimulating the nerve complex will be lower in an injured area, meaning you can’t work it as much before the muscle packs its’ bags and hits the bricks.

Hypertrophy is pretty difficult to train when an area is injured, as the process of degrading the tissue enough to provide adaptation means the forces acting on the area may cause more harm than good. Bodybuilders see this all the time with shoulder injuries and knee pain, and try to train through or around the issues in order to keep their symmetry and muscle size.

So we’ve already decided that training for strength gains and hypertrophy are pretty hard to do. They aren’t impossible, though.

Let’s say someone has a repetitive strain injury from poor posture in their job. Their upper back and shoulders are rounded forward and they complain fo getting low back pain after sitting for a long time. instead of getting them started right away on deadlifts to strengthen the low back, they may have some other issues that would prevent them from doing the movement well in the first place, which means doing the lift would probably make them worse in the short term. You could work on different patterns and movements, like antirotation movements in order to train core stability without compromising the movement pattern that’s causing the issue (namely flexion bias degeneration).

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Along with this, you could work on mobility drills for the hips and thoracic spine to take some of the loading off the low back and to consciously train the individuals posture to reduce the strain while at their desk.

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Once they can do these kinds of things easily enough, we can get them training the movements that may help build strength through their low back, but regressing the movement as far as necessary so the movement itself doesn’t cause pain, and the recovery period has no pain, swelling or loss of function. I’ve taken some amateur powerlifters with back pain right back to half-range deadlifts with a doweling to get them to a stage of pain-free training, and then began to increase the range of motion slowly, then get them doing it with an olympic barbell, etc.

Compensation patterns will happen when an area of the body lacks the specific range of motion, strength or endurance to complete a task, which leads to other areas of the body subconsciously picking up the slack and eventually burning out as a result of being overworked. Technical correction is stupidly important when working with someone who has pain, and ANY exercise not done with absolutely perfect movement and zero pain has to be regressed to the point where they are doing exactly what they are supposed to do. The set will also have tos top at the point where the quality of movement declines, or where they start to lose the ability to control the movement, otherwise you start training a compensation pattern instead of a corrective exercise. There is no reason to “train through the pain,” because that inevitably will always result in an epic training fail. Sort of like this guy.

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Way to use drywall screws to secure the shower rod you call a chinup bar, guys.

While it may not be sexy, linear periodization proves to have the best results with a lot of my injured clientele, and the whole name of the game is getting people to move better and be in less pain so that when they are ready to use more advanced systems of training, they don’t wind up pooping a spleen or something like that.