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Why And How to Maintain Cardio Fitness During Rehab

Why And How to Maintain Cardio Fitness During Rehab

“All you do is slow me down and I’m tryin’ to get on the other side of town”
Photo by Kyle Lin on Unsplash

The best predictor of an injury is a previous injury. This validates a thorough rehab before getting the green light to return to your sport. Yet this green light is often one-dimensional and rarely covers the assessment of our cardio fitness. 

Returning to sport with low levels of cardio fitness elevates the risk of re-injury.

Are the heart and lungs and everything that comes with it ready for the return? Low cardio fitness means you’ll get tired quicker. And the more tired you’ll get, the harder it becomes to move well. Hence the reason for frequent re-injuries.

One way to improve the odds of staying healthy is to spend time re-building cardio fitness between rehab and the return to sport. The downside is that thus further prolongs the time away from doing the sport you enjoy. But there is a better option.

Maintaining fitness during rehab allows a quicker return to outdoor sports.

A more efficient way is to do whatever possible to maintain cardio fitness during rehab. This could mean not having to go through a long and tedious re-conditioning phase before returning to running, hiking, climbing, wrestling with polar bears and whatever else you decide to do. 

And here’s how you can get it done safely.

Test cardio fitness at the start of the rehab

This test establishes a clear goal to aim for at the end of the rehab. It’s a cardio fitness green light for returning to your sport. 

During the early stages of rehab you probably can’t test your fitness by doing what you normally do for conditioning. Those who adapt win. 

For low body injuries you might be able to test your fitness with a rower, or a bike. But a skierg (or more likely a DIY banded alternative) or battle ropes are probably the safer alternatives. Especially if done seated or kneeling.

For upper body injuries, a bike might work the best.

Checking conditioning before and after rehab

  1. At the start of the rehab do a fitness test that mimics, as closely as possible, the conditioning demands of what you do in your outdoor sport. Be it long distance or intervals. Use equipment that allows you to do this without exploding.
  2. At the end of the rehab repeat this same test to see how much, if any, conditioning you need before returning to your sport. What’s the difference between the first test and the second test?

If your second test spits out lower results compared to the first one you need to spend some time re-conditioning. But hopefully the gap is small, or even non-existent. Because of the hard work you put in to maintain your cardio fitness during the rehab.

Maintaining fitness with low body injuries

Most people associate conditioning with lower body work. Whether it’s running, hill sprints, hiking, biking, kettlebell swings or doing a lightweight low body strength medley. And all of that makes sense. Using the big muscles of the low body is a sure way to drive up the heart rate. 

So it’s no wonder why we so often decide to do nothing because we can’t do the things we are so used to. But unless we want to dive into the dark abyss of poor conditioning, we need to find a way to keep elevating the heart rate. 

Eliminate the injured area

Doing hill sprints with an injured ankle doesn’t fly. Unless the goal is to do single leg hill hops. Which in itself only makes sense until you are about to fall and need to catch yourself with the injured leg. Don’t get me wrong, it’s great for us others watching the replay of it on YouTube. Not so much for your rehab efforts.

Instead, let’s look for upper body options for conditioning where we can rest the injured area. Depending on the injury, it’s possible to do these by kneeling on the ground or sitting on the ground or on an elevated surface. You know, a box, chair, guitar amp…

These might even work in standing as long as they don’t aggravate the injury. But let’s acknowledge that this can be difficult to do in the heat of the moment.

Med ball throw variations against a wall 

Think presses, overhead throws, side throws and so on. If you have a ball that doesn’t bounce a whole lot you might get away with slams as well.

Rope work

Waves, both alternating or synchronized, and slams work quite well in both kneeling and standing.

Skierg machine

If you are lucky to have access to one of these, you can really crank the heart rate. A DIY alternative is to attach one or two resistance bands to a chin up bar and use them to do the same thing. Err on the side of lighter bands.

Spin bike

This next one might sound unfeasible, but can actually work. As long as you are able to rest the injured leg safely on the frame. Or perhaps on a box or a stool next to the bike. Just use the healthy leg to do all the work. Again, go lighter on the resistance. You have to cycle the wheel 360 degrees with one leg. Six to twelve o’clock is tough on the quads.

Maintaining fitness with upper body injuries

As with low body injuries, it should go without saying to eliminate the injured area. You might actually still get away with your typical conditioning options, but I would reduce impact on low body activities. Even if you think that you can run, the bouncing and impact are probably not the best things for a joint that’s trying to heal.

Single arm work

Kettlebell swings, low body conditioning circuit (kettlebell rack squat, lunge variations etc), rope work. I am hesitant to include kettlebell cleans unless you’re a master at them. There is a chance that an occasional catch is not a soft one. Just adds an unnecessary risk of impact.

Weight vest

Can work for a low body conditioning circuit and an uphill walk.


You can try using the prowler if it is possible to grip it with a one hand and push without going around in circles. Otherwise you might get dizzy, that’s all.

Spin bike

Out of all the typical conditioning options, this is the safest to do with upper body injuries. Idiot proof, really. More the reason I’ve used it for myself in the past.

Single arm rowing

You might get away with this as well. If so, you win in the convenience department.

Tying it together

Getting a green light from an allied health professional is one thing. But as movement quality deteriorates when tired, we still need high levels of cardio fitness to return to sports as safely as possible. 

Test your fitness at the start of the rehab and again at the end. Make up the difference before returning to your sport at your usual intensity.

Finding alternative ways to maintain, or even improve fitness during rehab helps you to bounce back quicker to your usual wickedly awesome self. From a purely conditioning point it means that you might be able to skip the re-conditioning phase after rehab and go straight into doing what you enjoy.

Maintaining conditioning during rehab often requires you to find alternative ways to crank up the heart rate. And those ways might not be what you would normally choose or enjoy doing.

But they’re well worth the effort.

And by the way, all of this applies to strength training during rehab as well.

Why You Should Keep Training When Injured (and How to Do It Without Exploding)

Why You Should Keep Training When Injured (and How to Do It Without Exploding)

“This is how we found it. I swear.”

Like so many times before, Captain Skip Brown Jr. is flying a scheduled morning flight from Sydney to LAX. He’s done this exact same flight, with this four engine Airbus A340 plane a hundred times, and counting. As with the previous flights everything’s going as expected, smooth. If you don’t count the shitty weak coffee, the cabin crew is serving this morning.

Four hours into the flight though things take a rather upsetting turn. Without a warning one of the plane’s four engines shuts down with a bang.

He reaches for the CAB button on the audio control panel to share the disappointing news with the passengers as well as the cabin crew who are busy problem solving what the fuck went wrong with the coffee today. Miguel, the chief of cabin crew on today’s flight, is adamant that it’s the beans.

The captain clears his throat, “Good afternoon ladies and gentlemen. It’s a bit unpleasant, but we’ve just super recently lost one of our four engines. Not sure what happened, but it’s annoying. Anyway, a plane with only three working engines is not worth flying with. I just want to go home and sit on my couch and watch Netflix. And definitely not fly this plane anymore. A piece of shit that it is.”

Captain Skip Brown then does the only reasonable thing he can think of, he turns off the remaining three engines and starts a gentle descend with the goal of gliding the A340 into the Pacific Ocean. “Only three working engines left,” he mutters to himself. “No point flying now. Can’t wait to get home and watch Narcos Mexico.”

Ok, so besides the weak coffee and Narcos Mexico, none of that makes any logical sense. Captain Skip Brown’s A340 still has three perfectly working engines. The plane would fly as normal with two, perhaps only one engine. 

Skip Brown Jr.’s approach to flying is on par with how people look at training when injured. “I can’t do it 100 percent so why do it at all”. Here’s why ditching your body into the Pacific, aka your couch, when injured is not smart.

Training while injured will help you to maintain your strength levels

You might lose some strength, but training will definitely slow the speed that you’ll lose it. If your right shoulder is injured, you still have three limbs and the trunk to train. That’s over 80% of the body. What’s more, you might actually speed up the healing.. 

But before diving into the details of how and what to do, there are two important points to remember.

1. Injuries in this article means stuff to do with limbs

There are certain areas of the body that might be tough to find ways around when injured. Low back is one of them. Depending on what’s going on with the back it might be better to take a step back from intense training and focus on less straining activities. 

It really depends on what’s going on with the back whether you need to stop training, or if modifying the program is enough. Backs are tricky, especially online.

2. If it hurts don’t do it

Regardless of the information on training around injuries, don’t do something if it aggravates the symptoms. Simple rule, but ignored way too often. 

Three ways to train when injured

1. Train one side only
2. Progress by increasing time under tension instead of adding resistance
3. Find an alternative exercise with the same, or similar, movement pattern

Let’s tackle them one by one.

Train one side only

While letting the injured side to recover, you should keep training the uninjured side as normal. Not only will this help you to maintain the results you’ve gotten so far, but it will aid the healing. 

A process called cross transfer takes place when training the uninjured side. It’s a neurological health-loaded roundhouse kick to the injury. The body transfers some neurological training benefits from the uninjured side to the injured one which is pretty much candy for your injury.

There’s a study somewhere about how hip replacement patients who kept training their uninjured side where able to heal quicker from their operation compared to those who stopped altogether. Candy.

If you can’t hold a weight increase time under tension

When one arm is injured, it can get complicated to load up the lower body heavy enough to get the training effect. Any two legged squatting movement becomes difficult because you can’t hold enough weight (if any) to provide sufficient training stimulus for the legs.

That’s when time under tension and single leg work become your friends. Do single leg squats (one leg needs less loading than two) with a 3-5 second eccentric phase (lowering). Here’s how a brutal set of ten would look:

5 second lower – 1 second up x 10. Finish all the reps before taking a break.

You can also use the time under tension trick when doing upper body exercises, such as a single arm dumbbell press. It means you don’t have to go as heavy and worry about how to get a big dumbbell up in the first place without helping with the injured arm.

Or worse, you might have to ask a gym “friend”. You know, the guy in the skinny singlet with a double nipple piercings who likes to talk about the unquantifiable energy of the universe. Meh.

Find an alternative exercise with the same, or similar, movement pattern

Sometimes you can’t do the original movements in your program. This could be, as mentioned earlier, a struggle to load a two legged squat, not being able to set up the landmine press exercise without aggravating the injured side, or unable to hold the trapbar. You’ll need an alternative that has a similar benefit as the original exercise. 

Here are a few examples

Squat is predominantly a knee dominant lower body strength exercise. We want a similar benefit without having to load as heavy (or at all) → single leg squat with 5 second eccentric phase on each rep.

Landmine press is an upper body pushing strength exercise → single arm dumbbell press with a slight incline will give a similar training effect.

Trapbar deadlift is a lot of things, but mostly a hip dominant lower body exercise → single leg skater squat is the closest we can get.

The purpose is to keep training, even progressing, without making your program one dimensional. One exception is upper body push pull ratio. Everyone and their mum needs more upper body pulling exercises. So if you can’t press, you’ll be fine doing any form of pulling instead.

Most folks initially struggle with the idea of only training one side 

They’re afraid the uninjured side will become too strong or too big. Like Quagmire walking out of the house after he discovers the internet. I understand the fear, but once you think about how much work it takes to build strength and size, this fear should become a moot point. Let’s rephrase the question.

Why would you let a perfectly healthy limb lose its hard earned strength and muscle and weaken it to the levels similar to your injured side? 

If it really gets that much stronger and bigger than the uninjured side (it won’t) you can do double the work for the injured side once it’s healed. You have a strong limb, use it to your advantage.

Real example of a client with an upper body injury

Here’s what we did with a guy who had injured his right shoulder/chest in an indoor soccer match.

A1) kettlebell front Squats single leg squats
A2) chin up single arm TRX row, left arm only

B1) split stance deadlift same, but loading the left arm only
B2) dumbbell bench press dumbbell single arms bench press, left arm only

C1) single arm bottom up carry → same, left only
C2) dumbbell single arm row same, left only

Real example of a client with a lower body injury

Here’s what we often do with a client who’s knee doesn’t love the eccentric part of squatting, or knee flexion in general. Kneeling is also often problematic.

Most of the hip dominant movement are fine though. Her programs are built around aggressively training the hinging while using the limited choices we have for training the knee flexion. Needless to say she swings a heavy kettlebell like a boss.

A1) suitcase carry
A2) med ball shot put

B1) kettlebell swings
B2) cable press with a forward step this is our opportunity to get in low level knee work

C1) Skillmill* – her knee tolerates this well so we use it almost every session. The lack of eccentric work (you’re only moving forward) makes it money for the knee.
C2) TRX Row


Find ways to train the healthy parts of the body. Don’t let them regress to the level of the injured side. You will not only maintain more of the strength on the injured side but also speed up the recovery with neurological cross body transfer magic.

Injured limbs are usually simple to train around. Train the uninjured side as normal and increase tension when struggling to add resistance. When swapping exercises try to stick with the same or similar movement patterns. And no, you won’t end up like Quagmire by only training one side.

Things take a complicated left turn up the hill when you’re dealing with a trunk or low back injury.

Captain Skip Brown Jr. realises he’s being silly

One minute into the descent an overwhelming quantity of positive warmth rushes over the captains body. “A340 with three engines is still a beauty to fly. It’s like riding an arctic fox on marshmallows.”

Miguel solves the weak coffee riddle (it was the beans), and brews a new batch. He hand delivers it to the cockpit, placing it in the firm, warm, but cool and calm hands of Captain Brown.

The captain pushes a button on the audio control panel to contact LAX air traffic control. “Captain Skip Brown Jr’s eagle is LAX bound. Stop. Light up the runway like a Christmas tree, Santa’s coming home. Stop. And for Christ’s sake someone get Miguel a raise. Stop.”

“Also, nobody tell me what happens in Narcos Mexico. Full stop.”**

*a machine mimicking prowler/sledge. Small gym no turf space.
**I am somewhat confident this is how pilots talk.


What Did I Learn From a Recent Failure?

What Did I Learn From a Recent Failure?

What Did I Learn From a Recent Failure
Few posts ago I mentioned about my 60 day pull up challenge. I started with 10 pull ups on Day One, adding a rep each day and aiming to finish with 70 reps on the last day. It’s a cool little challenge and definitely doable if you have a bit of a base on doing pull ups. I’ve done it in the past and the biggest obstacle always seemed to be to find the extra time to do it all.

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