Rehab Fatigue

Like anyone who regularly reads™, I've struggled with injuries. Most of these injuries are solved within a few weeks and I move on. I’ve had lower back pain (fixed with more abdominal work), knee pain (fixed with foam rolling the crap out of my IT band), and golfer’s elbow (fixed with switching up my grip on rows). Right now, I'm suffering from severe elbow/forearm pain. I haven’t done a traditional push-up, bench press, or overhead press in almost a year now. It's getting better, but it wasn’t always that way.


When I first experienced my pain, I completed the usual steps—rest, ice after workouts, balms before workouts, and bottles of ibuprofen. In reality, these steps didn't solve the problem,. They just masked it. After weeks of putting off professional help, I finally went to my doctor. This was the first step in me wasting months of potential training time, not that it was my physician’s fault. I went to the doctor without any specific information. I said “My elbow hurts here (pointed to about a five-inch area) when I work out.” The doctor replied, “Sounds like elbow tendonitis” and referred me to a physical therapist.

Giving Up

After a few visits to the physical therapist trying to troubleshoot my “elbow pain,” I gave up. It was expensive, and I found out I could perform narrow grip chin-ups pain free and reverse grip bench pressing pain free. Instead of taking that information to my physical therapist as a possible diagnostic tool, I used it as a substitute for solving my pain problem. Although I never said it out loud, I thought “I can just live with this pain and still get my lifts in by working around it. Reverse grip bench presses aren’t all that bad, right?”

Looking back, it is clear I was tired of trying to solve the problem. I had given up hope that there was a solution to my pain and that I could ever do a push-up or pull-up again. I eased into the mindset of rehabilitation fatigue (my own made-up term). An uncomfortable mindset to be sure but not nearly as uncomfortable as going through the effort to rehabilitate my elbow.

Fast forward a few months later. After realizing that I had given up, I made rehabbing my elbow my number one goal. All of a sudden, I found time at the beginning of my training (now relegated to SSB squats and deadlifts) to rehab. I made stretching a priority and did it multiple times throughout the day. I actually bought a lacrosse ball and spent 30 minutes working on trigger points. I started paying attention to my posture and hand position while I was at work. Guess what? The pain is subsiding. It turns out that actively rehabbing an injury does resolve it.


So now that you know my story, how can this be avoided in the future?

1. Don’t get hurt in the first place! We all know that we're supposed to warm up. We all know that we need roughly eight hours of sleep. We all know the miracles of a foam roller and lacrosse ball. We all know that stretching is good, but do the majority of us do it? Think about it—even if you miss ten minutes of training per session to stretch/prehabilitate, isn’t that better than months or years of pain and setbacks? How hard is it to spend ten minutes an evening stretching? You are probably just watching television anyway. If you aren't paying attention to prehabilitation work and stretching, it isn't a question of if you will suffer an injury but when you will suffer an injury.

2. Always remember—there is a solution to your pain. There was a time when you didn't feel any pain, right? You can get back to that. It may take a while to undo the damage done, but it can be accomplished. If the first five methods don’t work, try five more.

3. Before trying to treat the problem, test your pain. Where exactly does it hurt? How much does it hurt? What kind of pain is it? Don’t say, “My knee hurts.” Say, “The inside of my right knee hurts approximately 20 minutes into training, usually after my second warm-up set of box squats. It's a dull, throbbing pain that increases as I add weight.” Whenever you're troubleshooting a problem, you must know exactly when and where it occurs. You usually can't fix a problem that you can’t accurately describe. This is especially important for your physical therapist. They can't feel your pain. If you walk in with a nebulous description of a problem, you're wasting your time and money.

4. Don’t let your preconceived notions get in the way of solving this problem. When I started working with my physical therapist on my elbow pain, she suggested that perhaps my pain was due to my work habits. I immediately blew this suggestion off. I was sure the problem was related to the increased volume I had recently added to my upper body training. Never mind that I train 6–8 hours a week and I sit at a desk 40–50 hours a week. In my mind, this was a problem that couldn't be resolved by a silly ergonomic keyboard and gel wrist support.

5. Don’t let the obviousness or simplicity of the solution hinder you from pursuing it. So far the therapy that has gotten me furthest on the road to recovery has been stretching and soft tissue work. You know, that thing I was supposed to be doing anyway. As soon as this was suggested by my physical therapist, I felt a twinge of embarrassment and a strong desire to try something else. This was counterproductive and has added weeks on to my recovery time.

Hopefully everyone reading this will take my first point seriously and never run into this problem. If you do run into this problem, be aware of rehabilitation fatigue. As long as you're aware of it, you're less likely to fall into its trap.