You’ve had an injury.

Maybe you tore your ham­strings.  Or pulled a low back mus­cle, strained your fore­arm with the repet­i­tive stress of key­board­ing, or threw out your shoul­der get­ting jerked by your dog on a leash.

Exer­cise is an essen­tial part of rehab.

In the ear­li­est phase after an injury, you may have to avoid move­ment of the injured area alto­gether.  Soon though, you’ll be ready for step two: easy lim­ber­ing exer­cises to main­tain range of motion.

It’s the third phase of heal­ing that presents a chal­lenge – how do you retrain your injured mus­cles to rebuild strength?

Start with the wrong exer­cise, at the wrong time, or per­formed too enthu­si­as­ti­cally, and you could eas­ily set back your recov­ery.  On the other hand, if you do too lit­tle, you’ve need­lessly pro­longed your rehab and left your­self (and your weak­ened mus­cles) vul­ner­a­ble to re-injury.

For­tu­nately, reha­bil­i­ta­tion spe­cial­ists have now reached gen­eral agree­ment on the way to avoid these pit­falls and begin to rebuild your mus­cle power after sprains, sprains, ten­dini­tis, and the like.

Accen­tu­ate the Negative

The most benign form of mus­cle exer­cise – with the least chance of re-injuring the area and the best chance of enhanc­ing the heal­ing process – is slow move­ment acti­vat­ing the mus­cle dur­ing the neg­a­tive work phase.

Here’s what I mean.

Pic­ture to your­self the well-known exer­cise of a biceps curl.  Your arm hangs at your side.  You hold a dumb­bell in your hand and bend your elbow, lift­ing the weight.  You’ve acti­vated your biceps mus­cle to per­form the pos­i­tive work of rais­ing the dumb­bell against the down­ward pull of gravity.

If your biceps mus­cle went com­pletely limp, the dumb­bell you’ve just lifted would plummet.

If instead you lower the weight slowly, your biceps mus­cle is now doing the neg­a­tive work of con­trol­ling and coun­ter­act­ing the down­ward action of grav­ity.  The biceps is fir­ing while it’s being length­ened by an out­side force (grav­ity, in this case).

Same Rose, Dif­fer­ent Name

They also call mus­cle acti­va­tion as the mus­cle length­ens dur­ing the neg­a­tive work phase eccen­tric mus­cle con­trac­tion.  When the mus­cle acti­vates and short­ens, doing pos­i­tive work, that can be called con­cen­tric con­trac­tion.

The secret to healthy reha­bil­i­ta­tion of an injured mus­cle is to post­pone chal­leng­ing the mus­cle with heavy con­cen­tric con­trac­tion and instead per­form eccen­tric con­trac­tion: acti­vat­ing the mus­cle to do the neg­a­tive work of coun­ter­act­ing gravity.

In other words — don’t lift, but lower slowly.

Eccen­tric Work­outs Applied to Your Recovery

It can take a lit­tle cre­ativ­ity to apply the neg­a­tive work prin­ci­ple to your rehab.  But once you under­stand the mechan­ics of the sit­u­a­tion, it shouldn’t be too hard to cre­ate an exer­cise that works for your injury.

For exam­ple, if you have a biceps strain on the right side, here’s how you’d exercise:

• Hold the dumb­bell with both hands.
• Bend both elbows to lift the weight.  This is the pos­i­tive work phase, but you’re not over­work­ing the right biceps because the load is shared by both arms.
• Let go with your left hand.
• Slowly lower the weight using the right arm only.  This is the pay­off – the neg­a­tive work phase.

(By the way, did I men­tion that you should acti­vate your core abdom­i­nal sup­port­ing mus­cles while per­form­ing this exercise?)

Here’s another exam­ple for some­one with a left-sided calf strain or Achilles tendinitis:

• Stand on the edge of a stair, with your weight on the balls of your feet and your heels hang­ing over the edge.
• With your weight on both feet, per­form a toe rise.  This is the pos­i­tive work phase, but you’re using both legs.
• Lift your right foot, so your weight is entirely sup­ported by your left.
• Slowly lower your body weight to a posi­tion slightly below hor­i­zon­tal.  You’ll feel a mild stretch of the left calf.  This is the neg­a­tive work phase.

Warn­ing Warning

It’s not sup­posed to hurt.  If it does, don’t do these exer­cises.  Your injury is still too del­i­cate.   Back up one step in your rehab.

Design­ing Your Rehab

Regard­less of what area you’ve injured, you should be able to design a sim­ple reha­bil­i­ta­tion exer­cise using the neg­a­tive work principle.

You could also con­sult your phys­i­cal ther­a­pist, doc­tor of chi­ro­prac­tic, or sports trainer.

Or con­tact Dr. Lavine at 212–400-9663.  Or by e-mail drlavine@askdrlavine.com

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Deepen Your Body of Knowledge

Self-Care Secrets for Mus­cle and Joint Pain