Coaching Injury Prone Athletes
Coaching the Injury-Prone Athlete
One of the things I've been thinking about lately is how to manage the injury prone athlete. I think about this as an athlete who has historically had a hard time staying healthy, not one who got unlucky once.
I have some personal experience here. Between eight seasons of competitive baseball in high school and college and four years of competitive CrossFit, I went through a single season fully healthy exactly one time in eleven or twelve years of competitive sport. When I found running, I was, for whatever reason, a lot more resilient to it. A few tweaks here and there, but no real injuries. That was a profound experience for me, because it meant I could finally explore a capacity sport where I was able to lean in and do appropriate volume and appropriate intensity without something breaking down underneath me. Even now, working into HYROX, I'm still modifying things when I do mixed modal work. I have injury dispositions I'm managing, and I have to trade optimal training for good enough training that still creates progression. That trade-off is the entire subject of this post.
Assessment First, Always
Whenever I have an injury prone athlete, the first thing I'm doing is assessing them. Some of that is through questions, some of it is through a movement assessment. The questions are always some version of: what movements cause you the most issues? Deadlift, vertical pressing, horizontal pressing, high volume kipping, pulling, whatever the case may be. I'm trying to identify what has historically caused problems for that athlete.
Then I watch them move. I take a global approach, narrow into an isolation approach, and come back out to global, and that sequence tells me how to proceed.
If I see that someone has an issue with high volume hinging, and I watch them do a hinge assessment, and they can't send their hips back without immediately going into spinal flexion, that's a pretty obvious fix. But if I'm working with someone who has anterior shoulder pain on high volume chest to bar pull-ups, and I watch them, and the movement looks smooth, their shoulder flexion mechanics look clean, the shoulder extension mechanics check out, and everything seems fine on paper, then we have a different problem. That athlete requires me to dig into what might be happening technically, or think much more carefully about how we layer the progression so they can safely handle the volume they need to be competitive.
The Offseason Is for Raising the Ceiling
This is the time of year to make the biggest change in what an athlete can handle from a volume and intensity tolerance standpoint. I have several athletes on very basic increasing volume accumulation progressions right now. We might start with five chest to bar pull-ups on the minute for eight minutes and plan to increase by 1 minute each week. Maybe we've had to progress three weeks and pull back, progress three weeks and pull back again. But if we can get to 75 chest to bar pull-ups in a session without pain over the course of 12 weeks, that is a massive improvement and one that gives us a bigger platform to approach out competition season from.
The other piece of this is supplementing the problematic pattern with low threshold movement and accessory work. If I have an athlete who isn't particularly squat resilient and they're doing a bunch of thrusters on Monday, I'm not stacking another dense squat session on top of that later in the week. Instead, Wednesday might be single leg work like lunges or split squats. Friday might be a dumbbell foam roller hack squat, or I'll send them to a globo gym to hit leg press, just accumulating volume that's relatively easy on the joints they're struggling with. We're building tolerance in the joints, the tendons, the ligaments, and the muscles to continue to raise the ceiling of what that athlete can handle.
Alongside that, I'm increasing the accessory work specific to their problem area. Going back to the squat example, we'd be doing a lot more hip rotation work, hip flexion work, short range hamstring strength work. We're trying to make the athlete strong in their end ranges, and most of the time that starts as accessory-based work before we integrate it into more isolated work and eventually back into the full compound movement.
Erg Buy-Ins Are Doing More Than You Think
Once I think it's acceptable to bring an injury prone athlete back into MetCons, I lean heavily into erg buy-ins. This applies across pretty much any movement where that athlete tends to be at risk. Rowing, skiing, biking, and running if they happen to be resilient to it.
We're not creating the same mechanical fatigue we'd get elsewhere, but we are creating the internal physiological environment. We're teaching the body how to execute skills under stress and stay composed while it's happening. We're making the skill more resilient to a specific type of fatigue, in this case heart rate and metabolic fatigue, not just mechanical breakdown. And we can choose which erg to use based on the movement we're building toward and how that erg is likely to interact with it.
This also gives us a built-in stopping point. We can terminate a set before technical failure sets in, and technical failure under fatigue is exactly when injury risk spikes. We're trying to manage all of these variables at once, not just program around a movement pattern.
Deload Before You Have To
The last piece of this, and maybe the one I'm most dug in on, is deloading injury prone athletes more frequently and more proactively than I would with anyone else.
For most of my athletes, I like to deload based on observation. This occurs when their language changes, performance drops for multiple days in a row or their mood shifts. Those are the indicators that it's time to back off. With an injury prone athlete, I try to never let it get that far. I try to stay three to five days or more ahead of any indicators so that we can keep the athlete on a more consistent upward trajectory.
Part of the reason is neurological, not just structural. Once an athlete has been in pain, the pain receptors in that area become more efficient at doing their job. My threshold for elbow pain, after years of throwing a baseball, is far lower than someone who has never experienced pain in their elbow. It takes far less stress on my elbow to trigger that signal than it would for someone who's never been through that cycle. The same is true for my back and hinging patterns. My body has gotten efficient, in the wrong way, at telling me something's wrong. We can improve this but the moment we trigger the pain cycle, we are setting ourselves back again.
So for me to actually progress, I have to be conservative on purpose. I'm in a deadlift progression right now where, as someone who can probably still pull in the mid 400s, I started at 135 pounds. Slow eccentric, built very conservatively. I could be far more aggressive and get stronger faster, but I'd also be far more likely to end up hurt again. And since I don't need a big deadlift number anytime soon, there's no reason to rush it.
The Bottom Line
The offseason is the window where this kind of patient rebuilding is possible, because you're not competing according to the CrossFit HQ season and there's no external clock forcing your hand. If you take advantage of that time, you're setting an injury prone athlete up for real, sustainable improvement instead of another cycle of pushing through until something gives out again.
That's ultimately what individual coaching is for, for any athlete, but especially for the one who has a history of getting hurt. You need to be working with your coach well before it's time to compete, because once competition starts, you just have to compete. At that point there's only so much anyone can do to manage risk while the clock is running.
— Ryne Sullivan
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