The Prehab Deload

Admit it... you aren't as young and healthy as you used to
be. Hell, I'm only 26 and I'm considered a corrective exercise
guy and even I get banged up from time to time while lifting heavy
stuff.

Lifting weights spans a tremendously broad continuum. On one
hand, resistance training is largely the basis for modern physical
therapy. Plenty of tension and plenty of reps can really help to
iron out muscular imbalances and strengthen previously injured
tissues.

On the other hand, putting hundreds of pounds on your back and
in your hands on a regular basis can take its toll, no matter how
structurally balanced you are. It's why deloading periods are
so important for long-term training success.

A deload week doesn't just mean more reverse band
work.

In "The Injury Prevention Roundtable," I alluded
to a deloading strategy I call the "prehab week." In a
nutshell, I take a lifter's injury history into account and
program accordingly during the deload week rather than just
considering volume and intensity. We still drop volume and/or
intensity, but we do so with a more critical eye to exercise
selection.

Featured below are my top five prehab week deloading strategies.
For most of you, this will be week 4 of every four-week cycle. You
don't have to adhere to this strategy year-round, but rather
once every two to three deloads you take.

Injury History: Primary External Impingement

Layman's Description: Your shoulder used to hurt with
overhead activity, bench pressing, lateral raises, and maybe
pull-ups. It was a diffuse pain more than it was a sharp pain and
you couldn't reproduce it just by digging your finger into
your shoulder.

By "you," I mean all you geeks who are hunched over
your computer screen right now, demonstrating the exact posture
that increased your likelihood of this problem.

Deloading Strategy: First, you'll want to drop straight bar
benching, overhead pressing, and vertical pulling. Instead, you can
go to push-up variations, dumbbell bench pressing, and a ton of
horizontal pulling (rows).

You'll also want to extend your warm-up so that it focuses
on more thoracic extension and rotation range of motion, along with
serratus anterior and lower trap activations. You can find video
examples of each in Shoulder Savers Part I and Part II. I also love
the Inside-Out DVD from Mike
Robertson and Bill Hartman for this very reason.

Additionally, you should foam roll your pecs, lats, and
posterior shoulder girdle (back of your armpit). When you're
done, toss in some stretching for all three as well.

To be honest, these are things that you should already be doing
all the time, but they still warrant mention, since very few people
do them enough.

Injury History: AC Joint Problems

Layman's Description: You may have had a traumatic shoulder
injury like an AC separation, or maybe it's just something that
gradually appeared over time.

Either way, it was a sharp pain that you could elicit by
reaching across your chest, going into the bottom position of a dip
or bench press, or simply by digging your finger in to the front of
your shoulder. You might also have it starred on the calendar as
the day of your first and last judo class.

Deloading Strategy: First off, if you've had AC joint problems,
you should never do another dip again. If you are, take a permanent
deload from them.

It's best to drop benching variations every 12 weeks or so,
and instead replace it with – believe it or not – overhead
pressing. Yes, Cressey really said it! AC joint issues
traditionally handle overhead pressing variations much better than
benching.

All of the warm-up strategies still apply, though, with the
possible exception of stretching the pecs. If you have any sort of
shoulder problems, chances are that you have weak lower traps and
serratus anterior, so adding in some extra attention there
won't hurt the cause.

Injury History: Anterior Knee Pain

Layman's Description: You had pain in the front of the
knees, usually accompanied by some lateral knee pain as well. There
are a lot of problems at the ankles and hips (and, less commonly,
the knees themselves) that can lead to these issues.

In most cases, it's worse with going up and down stairs,
quad-dominant squatting, and prolonged holds in awkward sexual
positions.

If you went to a typical physical therapist for it, they
probably talked about "vastus medialis" this and
"inner quad" that, and then they gave you a few quad
stretches and a recommendation to do leg extensions while those of
us in the know wept silently thousands of miles
away.

Deloading Strategy: You're likely going to have the most
problems with quad-dominant squatting and forward lunge variations.
Forward lunging is more decelerative and stressful to the knee.

In place of these movements, you can easily maintain a solid
training effect by substituting deadlift and good morning
variations, reverse lunges (stepping back takes away much of the
deceleration problems), and possibly wider stance squatting. Box
squats tend to be a good option because they promote sitting back
with very limited knee breaking.

Basically, your goal is to train more posterior chain and less
quads, although you'll still be getting a sufficient quad
stimulus to maintain a training effect.

As with our shoulder issues, we have a series of mobility and
soft tissue items to address. You'll want to take the foam
roller or lacrosse ball to the glutes, IT band, tensor fascia
latae, quads, adductors, calves, and peroneals.

In your warm-ups, focus on movements that increase hip internal
and external rotation, as well as extension. Some people may need
to improve hip flexion range of motion (via psoas strengthening),
too. Be sure to also work on optimizing dorsiflexion range of
motion with ankle mobilizations.

Interestingly, a lot of these recommendations parallel the tips
Mike Robertson and Geoff Neupert provided in Olympic vs.
Powerlifting Squats when they were
helping you to improve squatting depth. Isn't it interesting
how efficiency, health, and performance all go
hand-in-hand?

Mel Gibson is Mike Robertson. Julia Roberts is Geoff Neupert.

Injury History: Lower Back Tightness

Layman's Description: Admittedly, this isn't usually
as much an "injury" as it is a problem that comes about
because lifters have crappy form that has led to overuse of the
lumbar erectors because they A) lack hip extension range of motion,
B) just aren't strong enough in the glutes and hamstrings, or
more likely C) a combination A and B.

Believe it or not, relatively speaking, this might actually be
more common in female lifters, who are generally more
anterior-weight-bearing than male lifters. Especially when you have
a female who is rocking the muffin top.

Muffin tops. Hard on the eyes in the biomechanics lab and on the
street.

Deloading Strategy: With these individuals, I usually drop
"traditional" squats and deadlifts and replace them with
a lot of single-leg exercises. Or we might do deadlifts with a
prolonged isometric hold at lockout.

Many individuals get into trouble because they use lumbar
hyperextension to finish the lift when they should really be
finishing hip extension by firing the glutes. With these folks, we
just have them complete the lift and pull their butt cheeks
together for a count of 5 or 6 at the top of each
rep.

Of course, there's a ton of extra "core" work we do.
And all of it's aimed at promoting stability, not mobility,
at the lumbar spine. From side bridges to single-leg prone bridges
to birddogs to landmines, and beyond, these exercises can provide a
challenge while giving the lower back a week to
recover.

Injury History: The Supinated Foot

Layman's Description: As with the lower back tightness,
this isn't an injury... or even a "condition"
really. It's a structural thing that affects a small portion
of the population. I just so happen to be one guy in this
delightful 2%.

And given that some athletes (baseball pitchers and tennis
players, for example) can force their foot into a pseudo-supinated
structure by continuously making it the propulsion leg, it seems
worthwhile to mention.

Supinators tend to sprain ankles more frequently and have a
higher incidence of stress fractures. Here is the two-sentence
synopsis of subtalar joint function you need to
know:

Pronation is for deceleration and supination is for propulsion.
It's bad to propel off an excessively pronated foot, and it's
bad to decelerate on an excessively supinated foot.

One easy, but not 100% perfect, way to check to see if you have
supinated feet is to look at your callus patterns. In a supinator,
you'll see calluses at the base of the first and fifth
metatarsals (big and little toes).

My right foot is really supinated; check out the different
texture on the big toe and slightly below it in the photo on the
right. You can also look at toenail quality to see the difference.
My right big toenail is really beaten up.

These photos were taken when I'm coaching athletes on a hard
floor for 10 to 13 hours a day. You can see small cuts on my second
and third toes, where I shifted some of the burden.

Supination does not make your feet hairy. I'm just
half-Irish, half-chimpanzee.

Lastly, the wear on your actual shoes will tell you quite a bit.
Check out the logo, or lack thereof, on my sandals. I don't
even wear them all the time!

Deloading Strategy: In supinators, our goal during the prehab
deload is to minimize the amount of ground reaction forces they
encounter with lifting. A personal favorite strategy is to increase
volume of plyos and sprinting in week 3 of a program, a type of
intentional overreaching, and then drop them altogether in week 4
for the prehab deload.

Additionally, we remove all forward lunging variations and go
with lower impact modalities in the deload week. Things like
slideboard reverse lunges, Bulgarian split squats, and single-leg
squat and RDLs.

If an athlete needs to continue with regular energy systems
work, in place of sprinting, we incorporate low-impact modalities
like the elliptical, rower, swimming, or cycling.

In terms of supplemental mobility and soft tissue work,
I've found that supinators tend to be very restricted in the
adductors, and often need to get work done on their hip joint
capsules every so often. Many of them need solid manual therapy on
the foot itself before you can really be effective with ankle
mobilizations.

Above all else, supinators need good footwear. Asics tend to
work well, especially those with soft, white bottoms (not the
firmer gray material). I've seen good results by sliding a
thick insole into my Nike Frees, too.

In fact, simply adding a $2 insole is a great option for many
people in this situation. You just want cushioning, not the change
in contour that an orthotic provides. I wear through one every
three to four weeks.

Wrap-Up

Obviously, this is just the tip of the iceberg in terms of how I
approach deloading and it certainly only scratches the surface on a
wide variety of injuries and conditions you'll
encounter.

If there's enough interest (and maybe some suggestions on
what to cover), I'd be glad to address more scenarios in a
future article.