One of the most frustrating things to do when it comes to health and fitness is trying to fully rehabilitate an injury, especially a chronic injury. There are endless mistakes made in the process of restoring movements and injured joints back to normal and it it is usually a very bumpy journey for most people. This bumpy journey is a normal process and if you are not making mistakes then it is safe to say you are not going to change much either. Often the movement that sets off your pain is the same one you have to figure out how to change but there can be many things that get in the way of doing this. It sounds quite simple however, it is anything but simple and it may take several different exercises to even get to the point where you consider changing the dysfunctional movement responsible for your pain. During this process of trial and error and endless mistakes it is VITAL you know what to do when things go wrong. This is one of the first things I like to teach people when they come to see me for help for I am anticipating that we will most likely aggravate something along the way of trying to change things. This is where I like to find a "relief exercise" or "relief workout". In this article, I share with you some ideas of how to do this and also the most critical change you need to make when this happens.

During the assessment process and in the very early stages of trying to correct an injury problem it is important to identify the pain trigger, or source of the pain. To do this often requires me to deliberately provoke pain to reveal the weakness or movement we need to work on. If we identify early on it means the person will not aggravate their injury, but it also means we know where the problem long term really is.

As you can imagine this process comes with the obvious risk and chance of setting off more pain. This is why it is so important to know what to regress back to when things go bad. Now I wish I could give you a set of exercises that works for everyone, every time. Unfortunately, that is a fantasy and you have to find what works for you. Having said that I have found there is one change you can make that is common to all people and helps narrow down your exercise selection to the ones you need. That change is,

Moving ALL exercises to HORIZONTAL LOADING!

This means you work on exercises that do not require you to stand. You are either lying on your back, on your side or kneeling on all fours. Anything but a vertical position.

As I mentioned in the introduction it is never an easy process rehabilitating an injury. Even when it seems like it is straight forward and should be quite a quick process it never is as there is always something that comes up along the way that derails you.

The two exercises shown above are both great exercises to use. The Romanian deadlift is a superior exercise in many ways for it does several things the horse-stance exercise cannot do.

1. It enhances a movement pattern we use daily
2. It builds incredible strength in the posterior chain of the glutes and hamstrings
3. It teaches us how to protect our back during bending movements
4. It improves grip strength
5. It improves muscles mass which is great for bone density and various other health factors

However, it also comes with a huge amount of spinal compression and potential risk to the spine if performed poorly.

The horse-stance or bird-dog exercise cannot improve the overall strength that the Romanian Deadlift can do, but it does allow you to continue working on several important things.

1. You can improve the strength of the glutes
2. You can improve mobility of the hip into extension
3. You learn to improve the function of the core.

These are all key elements you need in the Romanian Deadlift. The best thing about this exercise is the horizontal position allows you to LENGTHEN YOUR SPINE and AVOID SPINAL & HIP COMPRESSION. Therefor this exercise is the perfect partner to the deadlift but also one you can regress to if things go wrong and you are in too much pain to try the standing movement. You can feel great in knowing that you are still working on your deadlift but without the potential for more pain and aggravating the injury.

It is also very important you NEVER FOLLOW A TEMPLATE!

What I mean by this is never follow a set of exercises that claims to work for everyone. I regularly post videos and articles saying "The 3 best...., or "The 6 best exercises for...., but what you will also hear me explain in every one of these articles and videos is that it can vary a lot from person to person. I may use all of the exercises, I might only use one of them. It all depends on the person. The only way I can truly know what works is to assess them and find out for sure based on the results of the tests. I cannot let my bias influence my decision making.

During this assessment process is when I am looking to provoke pain or weakness. I am looking for clues as to WHY the injury is there in the first place. As opposed to most people in the health profession who are more interested in treating symptoms and getting rid of pain. Getting rid of pain is not the same thing as solving the problem.

If I can find the underlying cause of the problem or pain trigger, we are halfway towards the goal of rehabilitating the injury for good. Unfortunately, this is often a difficult process, especially if the pain has been there for some time. By this stage the body will have created all types of compensation that can lead you off track trying to work on things that are not the source of the problem.

There is a detailed article I did a few years back showing how I complete a knee pain assessment to see how I provoke pain to expose hidden weaknesses.

In addition to this is the fact they may aggravate their pain symptoms during our pain provoking process and lose their confidence that this approach is the way to go. Many times the person may injure themselves at home or at work and it has nothing to do with the exercise program at all. Either way it slows down the process of restoring things back to normal.

By all means I try my best to minimize the risk of the assessments and corrective exercise as much as possible and using sensible ways of doing this is essential. But there is a good chance that pain may be a part of the program when we are messing around with things that the body does not want to change.

Our instincts are wired to find ways to avoid the pain and the fear of more pain can make people avoid the exercises they actually need to correct their problem. This avoidance of movement only serves to keep their problem building into a much bigger problem.

I covered this concept in great detail a few years ago in the article titled - Why good pain is needed to eliminate bad pain

The very thing that is very likely help you, is also likely to be the same thing that has potential to make things worse! For example learning how to bend correctly or perform a deadlift is a great way to rehabilitate a bulging disc back injury, if done correctly. But this same movement or exercise is also the same one that will cause severe damage if done poorly!

I love the Tony Robbins quote when it comes to this paradox.

"If you can't, you must".

This also means that there will be a certain degree of pain required during this exercise stage. For this corrective stage is never smooth sailing, and it will most likely be a very bumpy road.

Knowing that the bumps in the road are coming, and that you have a plan to address it when it happens with a "relief workout" takes a lot of the fear away with the rehabilitation process and significantly speeds things up. This brings us to the value of horizontal loaded exercises.

Horizontal Loading Is the Secret

This means you I need to use exercises that are positioned with the spine in a horizontal position to the floor.  We must remember whenever we are standing or our spine is in a vertical position gravity is trying to squash us. You may not realize it but there is a multitude of muscles instantly activated when we are upright to hold joints in place for movement. If there is a weakness present we will need other muscles to become hyperactive to hold us together and this is where stiffness and trigger points take a hold of our body.

Read these two articles to see more detail about various ways spinal compression wreaks havoc on the body

• 5 daily habits that could be ruining your spinal health
• How much compression is placed on the spine when you sit?

While the spine takes the lion share of the compressive forces, all joints are vulnerable to this problem when we stand up. When trying to recover from an injury this mechanism is on red alert and any threat the body feels coming to the affected joint or muscle activates trigger points and pain. The pain response is the body's attempt to protect itself from more harm. While this is a good thing it can limit your ability to restore weakened muscles back to full strength and eliminate compensatory movements that have crept into your brain. Exercise is vital at getting things back to normal but it can backfire on you if you are not careful. This is where horizontal loading exercises are invaluable.

Basically, you will be lying on your back, lying on your side, or kneeling on your hands and knees. Why is this so important? There are several unique things that happens to the body when you in this horizontal position.

Here is a list of benefits from working in this position.

• There is no compression on the spine allowing you to lengthen the spinal segments
• There is no compression on the hips, knees, or ankles
• There is an increase in stability for the shoulders and hips
• There is an increase in mobility due to the lack of compression on joints
• There is no need for foot stability (which in some ways is a disadvantage, more on this later)
• There is less coordination required to execute movements on the floor. (Like foot stability above this is also a disadvantage later on)

You can see why so many people rate Pilates so highly for rehabilitation as almost all of their exercises focus on floor positions. You can instantly see how this can be a great way to overcome pain when it is at its worse for your body will have much greater control over joints and various muscles acting out of balance.

Now it is important to understand that these regressed exercises WILL NOT be enough to restore things back to normal. They are merely a stepping stone to getting to the ones that will make a difference, and these movements are almost always in the standing position. This is where staying on the floor and using methods like Pilates may help reduce the overall pain initially, but it will never fully resolve the underlying problem over the long term.

This means you have to move forward in your plan to more complex methods that could send you backwards again. But this time you should have a series of exercises to quickly settle things down and allow the body to heal itself so you can try again. Before I give you some examples of these exercises it is important at this point to be very clear as to what your pain trigger is.

Finding Your Pain Trigger

Many might argue by this point that it seems too hard to find what exercise to do, and it would be much easier to simply rest and do nothing. Why bother if exercise could hurt you and send into more pain? That is a typical response I encounter as many just want the pain to go away. It seems like it is all too hard trying to figure out the right exercises to resolve the problem and many prefer to do nothing and avoid activities that hurt them and use painkillers as their way of dealing with it.

Unfortunately, rest is never a good option. In many cases it is inactivity that is the whole problem all along that led to muscles becoming weak and dysfunctional, leaving joints unstable and exposed to damage. In the short term it can be useful to allow the body to some healing, but if you do not address the reason you became injured in the first place, it means the problem will return the minute you go back to what you were doing. With regards to back pain, resting is about the worst thing you can do!

Lying in bed for too long can make matters much worse and many people will often feel extremely stiff and sore first thing in the morning. The reason this happens is the discs in the back re-hydrate overnight by filling up with a concentrated protein that is a water-like substance. This is how our discs receive their nutrition to remain in good health. When this happens they swell to a larger size which is fine for someone with good spinal mechanics and position. But it is bad news for someone whose spine is not in optimal alignment as these larger discs now pose problems and makes movement very stiff and awkward until the discs reduce back to their normal size.

Click here to see a video about this for more detail.

In almost every article I have ever published I constantly refer to finding what causes your pain, and to not solely focus on removing pain. The quote by Dr Stuart McGill sums it up perfectly.

This would be a quick summary of what I often find behind the pain trigger. This is not 100% the same with all people but pretty close to it. Take note of the movement that triggers the pain with the different injuries. This movement is the very thing that needs to be changed.

• With back pain the pain trigger is usually associated with stiff hips and thoracic spine in combination with weak glutes and core creating poor bending or twisting movement.
• With knee pain the pain trigger is usually associated with tight hips and ankles in combination with weak glutes creating poor squat or single leg movements.
• With hip pain the pain trigger is usually associated with tight hips, weak glutes and weak feet creating poor bending and single leg mechanics.
• With shoulder and neck pain the pain trigger is usually associated with dysfunctional scapula mobility and stability creating poor pushing and overhead movement.

You can read more about the specifics of each of these injuries in the articles below to see various tests and methods I might use to identify exactly what the pain trigger may be.

• What causes piriformis syndrome?
• What causes knee pain is not the knee itself
• What type of back pain do you have?
• What causes neck pain?

Now that you know your pain trigger it is time to create your relief workout to use if things go wrong.

Creating Your “Relief” Workout

What exercises should you use for relief workout? Well, there is a lot of exercises I could refer to, it just depends on the person what would be best. To help you out I will give you some of the exercises that come to my mind first when I encounter this situation breaking it up into the specific injuries.

These will be a mixture of mobility and stability exercises to enable your body to settle the inflammation and improve motor control to prepare you for the standing up stage of strengthening. Some people may require more mobility type movements whereas others will need more stability type of training.

Let's start with back pain as it is the most common of all the injuries.

Back Pain "Relief" Exercises

As I stated earlier these are not the only exercises I might use but are the most common ones I will regress to when things go bad.

1. HORSESTANCE

My "go-to" exercise with almost every case of back pain is the HORSE-STANCE or BIRD-DOG exercise. We quickly discussed this earlier but let’s look at it a bit more closely.

Why is it my go-to exercise?

This exercise not only targets the back but also the hip extensors, which in many cases is a big part of the problem. The lack of hip mobility and pelvic stability forces the spine to move too much with simple movements like bending and squatting. During this exercise the spine is saved from high compressive loads in a four point position and allows people to work on creating stability and good extension of the back. The hip and shoulder are both in a super stable position here as opposed to standing movements.

Dr Stuart McGill has found from his research that this exercise is a major contributor to desensitizing back pain!

If the person is struggling to even do this I might regress further to simple TVA activation exercises to help build up some core stability. Click here to see a video about this.

You can read more about this in the article - Is horse-stance the best exercise for back pain?

The next exercise I would focus on would be some kind of HIP MOBILITY work.

2. HIP MOBILITY

This could consist of foam rolling with the glutes and hips, stretching of the hips with a 90/90 stretch, or even a series of mobility drills. You need to experiment and find what works best for you.

Without adequate hip mobility your lumbar spine has no choice but to bend and flex during movements that it should remain stable and in neutral. Spending time doing "core" exercises is a complete waste of time if the hips remain stiff, rigid and unable to move as they are designed.

The person with incredible stiffness in the hips will often find these exercises reduce the pain almost immediately. Whereas the person who already has good mobility will find they do nothing and even make their back worse. These people will benefit more from the horse-stance shown previously. Not everyone needs more hip mobility.

For several ideas of how to do this check out this article - Top 10 hip mobility exercises to improve movement

3. SIDE PLANK

These next two exercises are more stability based and can provide great relief and more control for different types of back pain. The first one is the SIDE PLANK and the best part of this exercise is that it does not encourage flexion or extension of the spine. It also rates very highly in terms of core activation of all the abdominal stabilizers, much higher than the traditional plank or sit-up movements.

This is great for the person who cannot control these spinal positions as this enables them to work on improving their stability with little risk of moving into excessive flexion or extension. This exercise is great for people with hip instability or lateral pelvic tilt problems as it addresses the weakness of the hip and pelvic muscles.

The last exercise is the FORWARD BALL ROLL.

4. FORWARD BALL ROLL

This exercise works really well for the extension related back pain cases who are unstable to control their spine from excessively extending. While it is a great way to activate the core muscles its true purpose is much more beneficial than that. And while it definitely does work your core abdominal muscles this exercise teaches your body how to efficiently move by improving joint SEQUENCING and TIMING!

Watch the video below to see more on this.

You will also find this article great to read with other ideas to try - Why kneeling exercises are so great for core stability

Next thing to look at is hip pain.

Hip Pain "Relief" Exercises

Many of the exercises I just featured with back pain will be useful for hip pain and vice-versa. The main difference is that I am often trying to strengthen weak areas like the glutes while simultaneously trying to improve hip mobility with hip pain people. There is always a constant back and forth with progressions and regressions during this process so having some "go-to" exercises is very useful here.

1. Hip Extension Single Leg Test

This exercise is a great test to use and is one I use in my standard assessments with all new clients. It provides great information as to the stabilisation strategy the client uses with the glutes and pelvis. You will very easily see the lateral pelvic tilt if there is a weakness in the gluteal and obliques on the opposite side.

You should feel a strong contraction in the glute area in combination with your core bracing the just prior to your lifting the foot off the ground. This is where you often see the person shift to one side before they even lift the foot. This indicates poor stability. It is hard to confirm that it is only the glutes at fault here for it could be several reasons for this. But one thing is for certain is if that happens on this exercise it will be much worse on the more complex standing ones about to come.

2. Clamshell Variations

While there are many faults associated with the clamshell exercise it is not all doom and gloom. And it does not mean you it is a useless exercise for there are many people who will benefit from using it.

Firstly, this is a great way to teach someone “hip dissociation".

This is where the person learns how to move their hip without any additional movement from the lumbar spine or body as we discussed earlier in compensatory mistakes. This is a very important lesson for a person with back pain to learn for it is common for them to use their core and lower back to sacrifice stability in order to move. If this exercise is taught well they can learn that they must tighten the core and ONLY move their hip in abduction.

Sometimes I regress to the closed clam exercise shown in the video below and gradually build back up to the open clam.

You can read more about the clamshell exercise for the glutes and all the different variations of this in this article - How useful is the clamshell exercise?

3. Kneeling Deadlift

This last one is a kneeling deadlift exercise and this is great for the back pain person too. Even though this is not horizontal loading it is a fantastic regression to use to help the person learn how to hinge at the hips and learn the skill they need in a standing position. Often this is very relieving for the person to do as the standing one can instantly bring on pain when performed poorly.

Obviously the other exercises I would try to use for hip pain would involve more mobility based methods using stretches and foam rolling. Refer to the hip mobility article again to see all of these in more detail.

Next area to look at is the knee.

Knee Pain "Relief" Exercises

This joint will find great relief with hip extensions and clams as we have just seen and they would be one of my first exercises to regress to. Anything that loads the posterior chain will take considerable load off of the knee. Exercises like the horse-stance may not be a good idea here as it may hurt too much to kneel on the knee itself. This is where you may need a different approach. A big focus on hip mobility is again something you need to work on. The other area I would focus on is with the ANKLE.

Firstly let's take a look at my other "go-to" exercises for the knee.

1. Quadriceps Flexibility

The best way to stretch for someone with a lot of stiffness in the knee will be with a partner, therapist, or trainer to assist you as it is the most comfortable position to get into. Also the use of PNF stretching can be used which is by far the most effective form of stretching. To do this stretch on your own you can do this with a towel wrapped behind your foot.

For most people however the stretch shown in the video below will be superior to all forms of quadriceps stretching as it addresses the rectus-femoris muscle at the knee and hip at the same time. If it is too hard to kneel on then lie face down and wrap a long resistance band around the bottom of your foot and pull the knee into flexion.

The use of foam rolling in combination with stretching is a perfect addition too. Refer to the hip mobility article again for ideas of how to do this.

2. Ankle Mobility

As mentioned earlier it is very common to see ankle stiffness associated with knee pain. This does not mean the ankle is sore, it often has no pain at all. However, stiffness limits the body's ability to use the knee joint effectively and compromises its stability in a big way.

When I regress to the floor I will spend some time working on things like ankle mobility and even foot stability with simple drills to ensure that when we are ready to try standing movements again the body will have a better chance of executing these movements correctly.

You can see several examples of ankle mobility in the video below.

3. Romanian Deadlift

The last exercise is one where I break my rule of horizontal loading and this is where I use the Romanian Deadlift. This exercise can be very helpful to the knee pain person as it teaches them to load up the hip extensor muscles and unload the knee. This can be very relieving for a person with knee pain if performed correctly. I have seen many people with chronic knee pain and even knee replacements use this exercise as their "relief exercise" as the strengthening of the posterior chain takes the load off the knee joint.

Watch the video below of how to do this exercise correctly and an explanation of why it helps the knees so much.

Read these articles to see more about this.

• Why Romanian Deadlifts are so good for knee pain
• Best exercises for severe knee pain and osteoarthritis

The last part of the body to look at is the shoulder.

Shoulder & Neck "Relief" Exercises

This last joint is definitely the most complicated to work with as there are so many variables and things to consider. Pain in this region can easily bring on headaches, migraines, and feeling of nausea so having some exercises to give relief is vital. Resting often makes matters worse so exercise is essential but you have to be very careful that you do not aggravate anything.

Here are some of my "go-to" exercises when things go wrong here.

1. Feldenkrais Shoulder/Spine Integrator

This exercise is not a neck stretch. It is actually a great way to mobilize the thoracic spine to allow you to easily rotate your neck. We have all experienced that awful feeling when you can hardly turn your head to look behind you, and this exercise is great for carefully helping your body to get this back.

I prefer this in the early stages with neck pain as it is so gentle. The whole point of this is to be able to move your head with the least amount of effort as the rest of the body moves to allow your head to fall into position. This is usually a favourite exercise for many neck pain sufferers in the early stages as it feels so relieving.

Watch the video to see how this exercise works.

There are a ton of other mobility drills I use in addition to this that you can check out in this article - 10 best exercises to improve thoracic mobility. But this one is definitely my favourite for it is so calming and easy to do making it a perfect choice when the person is in a lot of pain.

2. Side Lying Wall Slides Drill For Serratus Anterior

In almost every case of neck pain or shoulder pain there is weakness with serratus anterior and dysfunction with the scapula providing stability for the shoulder joint. Many of the best exercises to correct this are pushing exercises. However, when there is pain present it is impossible to do these so you need some regressions to fall back to so you can continue working on these weaknesses.

Failing to address this will make the rehab process longer and the pain continue for a long time. I have found the drills shown in the video below a great way to help the person who is struggling to do much with their shoulder.

I normally prefer the standing wall slides drill but even this can aggravate the shoulder at times when things are really sore so I use a slight variation as shown in the video below.

You will find other great ideas in the articles below.

• 13 exercises to strengthen the neck
• 10 ways to strengthen serratus anterior

Do You Need More Help?

If you currently suffer with knee, back or shoulder injuries you will find our online programs shown below a great resource that take you through all of the assessments and corrective exercises to get you back to full strength and out of pain. You will find a lot of the exercises in the first phases of the rehab programs feature several of the relief exercises discussed in this article.

Summary

While it is always great to be looking to make improvements and progress your training it is unrealistic to expect there to be no setbacks or bumps in the road. If you do not have any setbacks it is fair to say you are not really challenging the body enough and will not be making any changes.

The secret to long lasting improvement is to minimize your risk of injury or setbacks by making calculated decisions with your progressions and having a fall-back plan with a relief workout as discussed in great detail in this article. We also must remember that it may not be our workout that causes a setback as it can easily happen in daily life with something that comes up.

Knowing what to do when this happens can be a great asset to have in your toolkit and take some anxiety and fear away from trying to get back to normal. I hope this article has given you some good.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.

If you live in Melbourne and feel you need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 16 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• Functional Anatomy of the Pelvis and the Sacroiliac Joint - By John Gibbons
• The Vital Glutes - By John Gibbons
• Movement - By Gray Cook
• Corrective Exercise Solutions - by Evan Osar
• Back Pain Mechanic - by Dr Stuart McGill
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Dr Stuart McGill
• Ultimate Back Fitness & Performance - by Dr Stuart McGill
• Core Stability - by Peak Performance
• Athletic Body in Balance - by Gray Cook
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek
• Knee Injuries In Athletes - by Sports Injury Bulletin
• The ACL Solution - by Robert G Marx
• Understanding & Preventing Non-Contact ACL Injuries - American Orthopaedic Society For Sports Medicine