Programming and Rehab Based on Contraction Type

Using different modes of contraction typically happens naturally throughout training, but for those looking to get more nuanced in their programming, attention to detail surrounding contraction type can be a valuable way to spice up your training. So how do we ensure that we encompass the full envelope of athletic and rehab potential when manipulating contraction type? Let’s look at a couple examples. 

Athlete A: Knee Pain with Squatting

Let’s say an athlete is looking to increase their 1 RM back squat (We LOVE PR’s!). But this athlete also struggles with a nagging knee pain that comes on with higher loads and volumes.

At Made 2 Move, one way we can help this athlete is to adjust their programming by utilizing different contraction types, in order to work around pain and still evoke adaptation. With this athlete, we could run a squat cycle where the first few weeks are centered around isometrics (finding the most provocative + painful position and holding just above this threshold). This allows the athlete to work around their pain, as “isometric training allows for a tightly controlled application of force within pain‐free joint angles in rehabilitative settings” (Oranchuk et al. 2019). Not only can isometrics help you work around pain, they can also strengthen and promote greater motor learning as you spend more time in these challenging positions.

The next phase could be centered around eccentrics, where you lower into the squat for a 3-5 second descent (eccentric), then stand the bar up quickly during the ascent (concentric). People tend to be able to load heavier eccentrically than concentrically, and this is one of the reasons the “bail” on a back squat is often on the way UP. However, eccentrics are often more taxing due to increased loads, muscle damage, and DOMS. For this reason, heavy eccentrics often aren’t a top choice for in-season athletes or in the few weeks leading up to competition.  

Oscillations (1 ¼ squats, oscillating accessory work) can be added throughout the cycle as well. Once positions are mastered and foundational strength is gained, oscillatory exercises can be mixed in. Variations can be implemented in the speed of oscillations, ranges of movement, and external load (holding DBs, BBs, bands).

The last phase: putting it all together by doing your normal squats! Because you’ve had so much time under tension and exposure to these loaded, challenging positions, you’re likely stronger and experiencing less pain than you were at week 1 of the cycle. Thus, squatting a normal rep without the additional isometric hold or eccentric descent typically makes for an EASSYYY feeling rep. 

Athlete B: Wrist Pain in the Front Rack

Let’s take an example from a recent patient at Made 2 Move in which isometrics were used to reintroduce previously threatening movements. A recent patient had wrist pain she’d been struggling with for months after a Crossfit competition. One of her biggest complaints? She couldn’t clean, front squat, push-up, snatch, etc. because of pain in the wrist when getting into these positions. 

One of her exercises in rehab was simply a front rack hold with the barbell. Utilizing isometrics in this way helped us to expose her to the painful position without further aggravating the injury. The stimulus was introduced in a tolerable manner, at low (no) velocity, low intensity (only the barbell), so that we could calm down the system and work on reincorporating the speed and positions needed to get back to loading through the movements she was missing.

We then worked back to slow, eccentric front squats with the barbell. Once these became tolerable, we could introduce the speed component in the form of cleans or wallballs.

Overhead positions in the form of pressing, overhead squats, and snatches were also provocative movements for this athlete. And since this is often more pressure through the wrist joint, we waited to incorporate these until after the front rack position became more tolerable. We started with isometric holds overhead and once these became tolerable, we introduced the overhead squat back into the equation. And eventually, snatches!

What about push-ups? (She wasn’t too bummed about this one, as she got out of doing any sort of burpees.) Day 1, this athlete couldn’t tolerate any pressure through the wrist, even during a plank on the knees. No problem- we regressed to a plank on the wall. As this became more tolerable, we went to a plank on the knees, full plank, and then eventually were able to start reintroducing handstands (higher loads through the wrist) and burpees (higher speeds through the wrist). 

Here at Made 2 Move…

An important note: the choice of contraction type doesn't have to be done in any specific order. Rather, the key to deciding how and when to progress what contraction type is based off preferences, pain levels, and goals so will be specific to each individual and corresponding injury. 

This is just an example of TWO of many ways contraction type can be manipulated to work around pain in the rehab setting while still making steady progress towards long term goals. Interested in working with a PT who considers the nuances of movement and incorporates these concepts into your rehab? Reach out to frontdesk@made2movept.com today to set up a consultation with one of our PTs at any of our 4 locations.