Hypertrophy/Injuries

Injury Modifications

2 injury guides

Guidelines for safely modifying workouts when dealing with common injuries. Always consult a healthcare professional for specific medical advice.

Lower Back

Lower back issues are common in lifters due to the high loads placed on the spine during squats, deadlifts, and rows. Causes range from muscle strains to disc issues to facet joint irritation. Most non-traumatic lower back pain in lifters responds well to modified training rather than complete rest. The key is identifying pain-provoking positions and loading patterns while maintaining overall training.

Warning Signs

  • ⚠Pain that worsens during workout instead of improving
  • ⚠Pain that persists more than 24 hours after training
  • ⚠Morning stiffness getting worse, not better
  • ⚠Need for pain medication to train
  • ⚠Compensating movement patterns

Red Flags - Seek Immediate Care

  • ●Numbness or tingling in legs/feet - possible nerve compression, seek immediate care
  • ●Loss of bladder/bowel control - CAUDA EQUINA EMERGENCY, go to ER immediately
  • ●Progressive leg weakness - possible nerve damage, urgent evaluation needed
  • ●Fever with back pain - possible spinal infection, seek care immediately
  • ●Pain after significant trauma (fall, car accident) - possible fracture, imaging needed
  • ●Saddle anesthesia (numbness in groin/inner thigh) - EMERGENCY

When to Seek Professional Care

  • →Any red flag symptoms (listed above)
  • →No improvement after 4-6 weeks of modification
  • →Radiating pain down leg (sciatica)
  • →Progressive weakness
  • →History of cancer, infection, or significant trauma

General Principles

  • •Movement is medicine—complete rest often prolongs recovery
  • •Find pain-free exercises and movements; train around the issue
  • •Neutral spine under load is protective
  • •Core strength (anti-extension, anti-rotation) is critical for spine health
  • •Morning is often worst; train later in day when possible
  • •Avoid repeated spinal flexion under load (the primary injury mechanism)

Contraindicated Movements

Conventional deadlift from floor (moderate-severe)Good mornings with significant loadSit-ups and crunchesSeated exercises that round the backAny exercise causing sharp or radiating pain

Recommended Exercises

Dead Bug

3 sets × 10 reps

Teaches core anti-extension while protecting spine; fundamental rehab exercise

Bird-Dog

3 sets × 10 reps

Anti-rotation and spinal stability; minimal disc pressure

McGill Curl-up

3 sets × reps

Ab strengthening without spinal flexion; protects discs

Pallof Press

3 sets × 10 reps

Anti-rotation core strength; spine-friendly

Side Plank

2 sets × reps

Quadratus lumborum and oblique strength; McGill's Big 3

Glute Bridge

3 sets × 15 reps

Hip extension pattern without spinal load; glute activation

Cat-Cow Mobility

2 sets × 10 reps

Gentle spinal mobility; good warm-up

Return to Full Training

Criteria:

  • ✓Pain-free in daily activities for 2+ weeks
  • ✓Can sit and stand without discomfort
  • ✓Morning stiffness resolved or minimal
  • ✓Core endurance tests pain-free (plank 60s, side plank 45s each)
  • ✓Successfully completed progressive return protocol

Progression:

  1. 1.Week 1-2: Core stability exercises only (McGill Big 3)
  2. 2.Week 3-4: Add supported exercises (leg press, chest-supported row)
  3. 3.Week 5-6: Add goblet squat, trap bar deadlift from elevated position
  4. 4.Week 7-8: Progress trap bar to floor, add RDL with light weight
  5. 5.Week 9-10: Gradual return to barbell squat/deadlift with 50% normal load
  6. 6.Week 11+: Progressive return to full program, maintain core work

Shoulder

Shoulder issues are common in hypertrophy training due to the high volume of pressing movements and the vulnerability of the shoulder's complex anatomy. This includes impingement, rotator cuff strains, labral issues, and biceps tendinopathy. Most shoulder problems in lifters stem from training imbalances (too much pressing, not enough pulling/external rotation) and can be managed with smart modifications.

Warning Signs

  • ⚠Pain that worsens through workout instead of warming up
  • ⚠Clicking or catching with pain
  • ⚠Weakness that doesn't improve with warm-up
  • ⚠Night pain or sleep disruption
  • ⚠Pain spreading down arm

Red Flags - Seek Immediate Care

  • ●Sudden loss of strength after traumatic event - possible rotator cuff tear
  • ●Unable to raise arm above horizontal - possible complete tear
  • ●Visible deformity after injury - possible dislocation
  • ●Numbness or tingling in arm/hand - possible nerve involvement
  • ●Fever with shoulder pain - possible infection

When to Seek Professional Care

  • →No improvement after 4-6 weeks of modification
  • →Any red flag symptoms
  • →Pain after traumatic event (fall, sudden load)
  • →Progressive weakness
  • →Sleep significantly disrupted by pain

General Principles

  • •Most shoulder issues improve with balanced programming (more pulling than pushing)
  • •Pain-free range of motion work helps healing; complete rest often makes shoulders worse
  • •External rotation strength is protective and often deficient
  • •Avoid impingement-provoking positions (behind-neck press, upright rows)
  • •Temporary exercise modification is better than complete cessation
  • •Shoulders heal slowly—expect 6-12 weeks for significant improvement

Contraindicated Movements

Behind-the-neck pressUpright rows with narrow gripWide-grip bench press (for most shoulder issues)Dips (if painful)Any exercise causing sharp pain

Recommended Exercises

Face Pulls

3 sets × 15-20 reps

Strengthens external rotators and rear delts, counters internal rotation dominance

Band Pull-Aparts

3 sets × 20 reps

Scapular retraction and external rotation; can do daily

External Rotation (side-lying or cable)

3 sets × 12-15 reps

Directly strengthens infraspinatus and teres minor

Prone Y-T-W Raises

2 sets × 10 reps

Strengthens lower traps and serratus; improves scapular control

Shoulder CARs (Controlled Articular Rotations)

2 sets × reps

Maintains joint mobility and identifies painful ranges

Return to Full Training

Criteria:

  • ✓Pain-free in daily activities for 2+ weeks
  • ✓Full range of motion restored
  • ✓Can perform modified pressing without pain
  • ✓External rotation strength symmetrical
  • ✓Successfully completed 2-week progressive return

Progression:

  1. 1.Week 1-2: Pain-free ROM exercises, prehab only
  2. 2.Week 3-4: Add pulling exercises, light machines only
  3. 3.Week 5-6: Add modified pressing (floor press, machines)
  4. 4.Week 7-8: Progress to free weight pressing with conservative load
  5. 5.Week 9+: Gradual return to full program with maintained prehab