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A Guide to Working Out When Something Really Hurts

Three sports medicine physicians gave us a plan.
Stocksy/Rob and Julia Campbell

"I'm hurt, so I'm on a break."

We've all said it to ourselves at one time or another as we've nursed sprained wrists and pinched nerves. Then, when we finally get back into the swing of things, we've grown soft. Muscles atrophy in as little as two weeks. Tendons and ligaments can lose flexibility fast. That's why, in many circumstances, some experts agree that it's okay to keep exercising when you're hurt—as long as you do it intelligently. The key is creating a temporary workout around your injury so you're not losing the progress you've already made, and so you're not prolonging the injury. We spoke with three sports medicine physicians to come up with a plan for a few of the most commonly cited pain points.


Avoid These: overhead (i.e. military) press, flat-bench press, behind-the-back lat pull-downs
Do These Instead: cable rows, bent-over dumbbell rows, decline bench press, flys and reverse flys on a flat or decline bench, in-front-of-the-chest lat pull-downs Avoiding any pain while overhead lifting is key. Our recommended exercises put you in proper posture and let your shoulder sit back in the joint, reducing further irritation as your work out, says Snehal Patel, a shoulder and knee specialist at the Hospital for Special Surgery in New York City. Start your exercising with some range-of-motion warm-ups, such as pendulum swings or windmills, and modify your routine or take a break from working your shoulders if it doesn't feel right. Shoulders, unlike other muscle groups, won't loosen up and feel better as your progress through your exercise routine, says Ryan Lingor, former team physician for the New York Jets and attending physician at the Hospital for Special Surgery. If it hurts at the start, it'll hurt at least as much by the end.

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Avoid These: leg extension machine, running
Do These Instead: squats, lunges
If your knee is swelling or if it has any instability or loss of motion, lay off it. How can you tell? If it's any worse than your other knee, unless you injured both. Start off with joint rotations or diver's stretches to warm up, and then progress to bodyweight exercises. If all's still going well, you can begin slowly incorporating weights into your squats and lunges, but back off if it starts to hurt at all. “With your knee, let pain be your guide,” Lingor says. “If it doesn't bother you while you're doing it, afterwards, or the next day, then it's perfectly fine to keep doing it.”


Upper Back/Lower Back/Neck
Avoid These: swimming, bicycling, sit-ups (if nerve injury)
Do These Instead: cable rows, planks, deadlifts

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Every doctor we consulted said the treatment for both upper and lower back injuries is the same. In either case—and for the neck—the red flags are pain shooting into the fingers from the neck or pain shooting into the toes from the lower back because that's more likely to be nerve pain due to something like a bulging disc, says Jordan Metzl, a sports medicine physician at the Hospital for Special Surgery. Metzl, who himself is a 29-time marathoner and 10-time Ironman competitor, often encourages people to work through muscular injuries, such as muscle spasms in the back or neck. Exercise may hurt right away, but taking it lightly and easing into it can alleviate some of your pain afterward. Just avoid anything with a lot of twisting motions, such as swimming (neck rotation) and bicycling (hunching down).

Avoid These: box jumps, burpees
Do These Instead: balancing exercises
Anything that forces you to stop and start repeatedly, such as basketball or sprinting, is going to aggravate your injury, but Lingor says distance running may be fine. If you're limping, you shouldn't be working the ankle or foot, because you're going to throw off all your lower-body mechanics by compensating for the busted ankle or foot, and potentially aggravate your knees, hips, and back. Do joint rotations before you get out of bed in the morning to loosen everything up. Spell letters in the air with your big toe, move your foot around in a circle, press your toes up and down, and see how you feel later on when it's time to exercise.

Avoid These: lifting too heavy, free weights
Do These Instead: wrist extensions, machine exercises (i.e. chest press)
What we love about free weights when we're healthy—that they simultaneously call upon many muscles to stabilize the weights—is a negative when you're injured. Switch them for machine exercises, which isolate muscles more so than free weights and give your injured joints less stabilizing to do. Elbows, wrists, and hands are one area in particular where you can quickly make a bad problem into a worse problem if you try to push through the pain, Metzl says.

Abdominal Muscles
Avoid These: anything with rotation (i.e. Russian twists)
Do These instead: planks, lunges, curls, crunches
Pain that radiates into your groin is a sign to back off exercising and go find a doctor, but if your pain is limited to your abdominal muscles, then you might want to try some linear exercises. Twisting motions are fine for warm-ups and for cooling down, but for the actual workout, you'll want to limit yourself to linear exercises that don't involve rotating. And strengthen the abdominal muscles, Lingor says, adding that people who have stronger abdominal muscles have a lower frequency of back pain.

Avoid These: bicycling (including the stationary bike), anything with rotation
Do These Instead: lunges, squats, single-leg squats, swimming
Pain that gets worse the day after a workout is a sign that you need to rest your hip or groin. Swimming can be helpful for hip or groins injuries that don't seem to be getting better, Lingor says. “Getting in the pool to loosen up can be a really effective treatment, and allow you to get your workout in,” he says. Give sports a rest, too. Everything from soccer to hockey to basketball to baseball involves a lot of waist rotation that can keep your injury from healing, but Lingor adds that often people with groin injuries can do straight-line running without much of a problem. As always, though, monitor yourself: Pain that just won't go away is your body's signal that it craves rest and recovery.

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