Prehab Basics

Prehab Basics

The idea of reducing injury risk through intentional exercise, strengthening, and preparation is a long-standing one.

The ideas you have about preventing injury probably could do with brushing up, however. It’s a practice that should play a significant part in your training: nothing ruins progress like an injury.

This is a brief guide, so let’s get straight into what ‘prehab’ and joint conditioning are, and how you can make them work for you.

Idea and principles of good prehab

The prehab process is aimed at rehabilitation before the injury. The point is to train in anticipation of injury risk. This is a valuable approach but also requires patience and forward-thinking that is hard to use. If you invest now, you’re going to experience significant long-term benefits.

The intention is a simple one: strengthen the joints and muscles in all ranges, produce controlled movement in opposing directions, and conditioning of joint tissues.

The principles that are required are relatively simple:

  • Control and Speed: a well-controlled exercise is going to be important. Dynamic training is good but for prehab you should try and be intentional with your positions, whatever you’re doing. Never let the weight/movement control you.
  • Range focus: you need to get strong in all ranges, so be sure to keep in mind what range you’re training and how. The variety and focus on comprehensive training should guide your prehab – especially if you have a portion of a joint’s range you’re not usually training.
  • Both directions: if you’re weak in one direction, you need to ensure proper mobility/strength in both directions. Joints are never affected in just one direction – focus on opposites.
  • Sub-maximal exercise: you need to stay sub-maximal and rack up reps. This is the essence of joint conditioning and improves recovery and blood flow as well as proper control, movement, and positional familiarity (even in positions you’re trying not to lift in.

If you’re following these principles, you’re not going to go too far wrong. It’s an easy enough concept to grasp, and we’ll be providing tons of examples of how it should work and how you can get the most out of it. Let’s look at some examples of what to do…

Practice and implementation (joint by joint)

Let’s take a joint-by-joint tour of the body and look at how to prehab each piece in some brief detail.

GH/Shoulder Joint

The glenohumeral or shoulder joint is one with a huge amount of range in a number of directions. It’s a mobile joint in 3 dimensions: it’s a significant consideration. You need to work on the positional strength in all of them.

Start with the proper movement, mobility, and control of the muscles surrounding the shoulder joint. The weighted shoulder dislocate is a great place to start for maximal range in the chain between the pec and the bicep tendon.

https://www.youtube.com/watch?v=Xq509Hqe5bw

After ‘opening’, it’s time to strengthen. Proper internal/external rotation is one of the biggest problems, and control in both directions is key. Prepare for both directions in a strong, controlled fashion: internal and external rotations, face pulls, overhead shoulder rotations, and across-the-body rotations.

Overhead training should also be paired with proper directional raises and their opposite ‘closing’ exercises. Front and lateral raises (to full overhead position) with the traps tucked down is key for proper shoulder recruitment and health, and can be super-setted easily.

Shoulder extension exercises can provide a rare and important stimulus, and swimmer’s holds and scaption are key for moving the shoulder joint through complete ranges. If you’re missing any movement of the shoulder joint, you’re going to risk injury around that position.

Scap

The scap has 2 dimensions: it moves up and down, or back and forward. There are some significant movement restrictions in most people, and you need to get strong in each of these combinations.

One way of doing this is to simply take a weight and work high-rep, low-weight movement in each direction. This can be performed with intentional overhead shrugs and depressions, as well as their opposites with single-arm lat pulldowns and wall slides.

https://www.youtube.com/watch?v=hyfb9x7VJWE

The retraction and protraction of the scap are also used here. Wall slides are a great example of protraction, as are scapular push-ups. The opposite movements, such as face pulls and reverse cable flyes, offer direct improvements to control.

Core

The core is a clear part of the body where significant investment is needed and likely to pay off. We’ve discussed core training extensively in the past, so we’re just going to recap quickly with a quick-start guide to core prehab:

  1. Rotate: most injuries occur in rotation, or as a result of some form of obliquity in the core/hips. Rotational and anti-rotational work (wood chops, side planks with rotations, etc.) can prevent significant rotational bias.
  2. Lateral: move sideways and avoid sideways movement. Side bends with a pause are a great way of doing this, but side planks always do this by default. Equally, you should be performing some lying heel-touches for a high-rep oblique pump/conditioning.
  3. Arching and curling: move through full ranges in both directions and just use light loads where necessary. This means training to arch the back, or curl up into a strong core flexion. Think cat-cows and
  4. Dynamism: don’t just stay controlled and slow and predictable. The core needs to be trained reactively and statically; with static and dynamic training.
  5. Variety: everything about your core is going to be complicated and the best solution is to train it with a wide variety of exercises and intentions. This can add up rapidly if you just vary your core exercises so you’re never just performing one exercise per session: alternate and superset to get in more, easy variety.

Follow these simple guides and check out our piece on core training in more detail!

Hip

The hip is the shoulder of the lower body – and it is always loaded. We’re probably going to cover the hip itself at some point, but for now it’s important to treat it the same way.

The internal and external rotation of the hip needs to be trained. Hip swivels with a slow and controlled approach is the place to start. This should be paired with Kosack squats (the assisted kind where necessary) to improve full-range control and familiarity.

https://www.youtube.com/watch?v=tpczTeSkHz0

The flexion and extension of the hip are also more common movements under load than in the shoulder – especially in strength training. The psoas march is one way of training flexion, while controlled knee raises can provide a similar emphasis.

Hip extension is more than just the kind you’d do in a deadlift. It’s factored into a ton of lower body exercise (such as Kosack squats or Bulgarian split squats). You should be performing single-leg glute bridges, frog pumps, and full-range back extensions if you have the equipment for it.

https://www.youtube.com/watch?v=HyCiZVMMDW4

The abduction and abduction of the hip is also chronically overlooked in strength enthusiasts. The lateral leg raise or clam (especially with a band) can be a simple finisher for this, while the abduction/adduction machines are always a solid choice.

Isometric strengthening exercises in each of these direction can also help. Isometric exercise against terminal band resistance is a great way to strengthen the knee and hip together. It can be a great way of feeling the proper contraction of core, hip, and leg muscles together.

Developing better hip control means strength in various positions, as well as a development in the stability and strength of the back. These add up over time, on top of just preventing injury to the most important and commonly-injured part of the body!

Knee

The proper preparation of the knee joint is largely dependent on the hip. The movements listed in the previous section will really add up. Most of the hip muscles determine knee position or cross the knee-hip in interactive ways.

Prehab for the knees takes two shapes: extension and flexion. They’re simple but not easy.

If you’re familiar with heavy squatting, you’re going to want to practice knee extension with light, unilateral exercise such as reverse lunges. You could also perform conditioning in the knees with unloaded squats or cyclist squats. These are great for lighter days and recovery.

The opposite is also important: consistent and lightly-loaded high rep knee flexion. The hamstring is often undertrained in weightlifters and other athletes where max-weight hip hinging is not a concern. Often, powerlifters don’t have such a problem.

Hamstring curls are pretty good for this; especially if you can alternate lying and sitting. Equally, good mornings or death marches can be useful for blood flow and submaximal strength in the knee joint.

https://www.youtube.com/watch?v=NMIx-S_8VEY

Finally, you should try and incorporate some light, painfully-high-rep single leg hamstring work. This is going to be a great opportunity to develop balance around the joint: contralateral single-leg deadlifts, stagger stance deadlifts, and single leg front-loaded good mornings are all great for this.

Final Thoughts

There are a dozen ways you could incorporate each of these exercises, and a dozen alternative exercises for each one we’ve discussed. We can offer you examples and principles, but you need to decide for yourself what you’re going to use – and how.

We recommend using 2-4 exercises toward the end of your workout – and especially ones that cover more than one joint. The Kosack squat or side plank with rotation are excellent examples of this kind of efficiency.

Focus on what is most vulnerable – or weakest – in your own training and strengths. This is the best place to start for significant long-term change and it provides a great training effect with relatively little time-investment compared to the squat, bench, deadlift, or Olympic lifts.

 

 


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