Sports Medicine Protocols: Hernia and Exercise


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10 Question Exam (sent via email)

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We have recently received many sports injury questions relating to sharp burning pain in the lower stomach area during exercises. The most recent question stated the pain was occurring during a deadlift.

It is difficult to know precisely what’s going wrong from a distance and brief description of the questions we have been receiving. The symptoms described could be many things, but the first thing that comes to mind is a Hernia or the development of a Hernia.

If there is not a lump in the area, you may not need to go to an emergency room yet, but you will need to go see your doctor as soon possible. Yesterday would not be soon enough!

All newly discovered or suspected hernia symptoms are cause for an urgent need to visit your doctor. Hernias are not by necessity a medical emergency, even if they are tender or ache or are easily reduced. They do not become medical emergencies until the hernia can not be reduced or becomes strangulated.

When the hernia becomes tender, painful and/or irreducible lump, you should go to your hospital’s emergency room. Strangulation of organ, fatty tissue or intestine within the hernia sac can quickly lead to gangrenous (dead) bowel in as little as six hours. The good news is that not all irreducible hernias are strangulated, and therefore do not present as medical-surgical emergencies, but they DO NEED to be evaluated by a physician. Asking your work-out buddies what they think does not qualify as expert physician care… One of the many reasons why we have laws penalizing people for “Practicing Medicine without a license!”

There are many different types of hernias, but since they all need medical expertise to diagnosis correctly, I am going to avoid an unnecessary discussion and focus on the problem at hand. The problem is a misunderstanding of the “No Pain-No Gain, if it doesn’t hurt, you aren’t doing it right!” MANTRA!!!

I want you to recall all the exercise science principles you learned in your IFPA Personal Training Certification Course and use them… ALWAYS:  The S.A.I.D Principle: Specific Adaptations to Imposed Demands. Initially for all your beginner clients, the program should be moderately hard, not taking any muscles to failure for the first 2 or 3 Workouts and cardio/endurance exercise only slightly to moderately hard. Then using the G.P.O. Principle: Gradual Progressive Overload, you GRADUALLY increase the load on your selected exercises. You control the GPO Principle through the F.I.T.T. Principle: Frequency, Intensity, Time and Type.

If you have given yourself a hernia, you have violated ALL 3 Principles.

You violated the SAID Principle since your CORE, including your abdominals is inadequately conditioned for the loads you were trying to pull from the floor in your Deadlifts.

You violated the GPO Principle by neglecting the “Gradual” part of the Progressive course you should have navigated toward SAFE and EFFECTIVE training. You are not alone in this error since many “Would Be Great” athletes tolerate the “PAIN” to their detriment.

You violated the F.I.T.T. Principle by rushing to a higher Intensity and Volume and possibly TYPE of exercise that your body was capable of executing without sustaining severe damage.

When you choose the ‘No Pain-No Gain” Mantra over these exercise science principles, the result is an injured body. The correct, healthy, intelligent version of “No Pain-No Gain” should be injury free!

Here is how it works:

You start at a manageable, healthy level within the F.I.T.T. Principle. Then, using the GPO Principle, you gradually increase the F.I.T.T. Factors to make your exercise workouts more demanding, more tedious and YES… more painful as you experience the burning sensation of a 15 RM (Repetition Maximum) Set.

In a 15 RM set: At 15 Repetitions, your exercising muscle will fail and you will feel the “Pain” of the “Burns.” Later, as your body becomes more conditioned, you can incorporate H.I.T., High Intensity Training, such as “Forced REPS,” where another IFPA Certified Trainer watches you do a 15RM Set, achieve failure after the 15th Rep, and then provide you just enough help to do 3, 4, or 5 Reps past your 15RM failure to work more muscle fiber, take you deeper into the Lactic Acid Energy System to build more muscular hypertrophy and endurance, and of course, to take you for deeper into PAIN!

You can achieve some of the same PAIN, even without your own Personal Trainer by utilizing some of the other H.I.T. Programs you learned in your IFPA Certified Personal Trainer Certification Course such as: Cheat Sets, Stripping, or Drop Sets, etc.

Pain from going deeper and deeper into the Lactic Acid Energy System is a good pain and a necessity if your personal fitness goals are to compete at an elevated level. What is also tedious and painful are advanced H.I.T. Programs required to increase Volume of Training and/or decrease Rest Intervals.

Short Rest Intervals between Sets can become very Tedious and PAINFUL. Care must be taken to adhere to the strictest FORM! This is an absolute necessity since shortening of your Rest Internals between Intense Sets places a great deal of stress and overload on both your Central and Peripheral Nervous Systems (CNS/PNS). Loss of correct form is your indicator that the CNS and PNS Systems are failing. Trying to continue into deeper “PAIN” of a failing CNS/PNS only results in injuries.

The “burns” and painful fatigue of the CNS/PNS from H.I.T. Programs can be described as the “Good Pain.” For optimal advances in your training, you may have to spend a lot of time with “Good Pain.”

You also need to know how to avoid the “Bad Pain.” What is “Bad Pain?”

Any PAIN that occurs outside the muscles is BAD PAIN. Pain in the joint capsule, fascia, tendon, ligament, bone, etc. is an indication that you are about to have an injury. The WORST thing you can do is to keep exercising!

The patient walks into the doctor’s office and says “Doctor, it hurts when I do this.” And the doctor says: “well then, stop doing that.” It’s an old joke, but 100% accurate when it comes to exercising.

When you feel a pain, even a temporary pain, follow the Injury Management Protocols you learned in your IFPA Personal Training Certification Course, and start with PRICE: Protect, Rest, Ice, Compression, Elevation. If you do that you can be 100% Good-To-Go in short order. If you fail to do it, it could mean a trip to an Emergency Room and your athletic career off track for an extended period or completely destroyed.

Think of the “BIG PICTURE.” When I ask someone why they did not stop when they felt the first “twinge” of pain, the typical answer is “I did not want to miss a Workout!” And when I ask them how many Workouts they have missed due to their surgery the answer is usually around 6 months worth… give or take another 6 months for rehabilitation and recovery.

In the future, when you feel that first little twinge of pain in your abdomen, you will Stop! You will not continue with that exercise or any other exercise that causes you pain. You will not stretch the area either! Think about it, since you must at least suspect the twinge of pain is a pulled(strained) muscle, why would you risk tearing the fibers further by stretching them? No! The correct answer to stop and employ PRICE. This will prevent what is right now only a minor injury not become a major injury!

Good Luck,

Dr. Jim Bell



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