Injury prehab

Injury Prehab

Most training injuries announce themselves weeks in advance - a cranky shoulder, a knee that aches on stairs - and the cheap fix is targeted resilience work done before failure, not rehab after it. This skill programs that work for the four zones where lifters and runners actually break: shoulders, knees, lower back, and hips. It prevents; it does not treat. Anything that already hurts belongs with a physiotherapist.

Operating procedure

Step 1: Gather inputs

Collect: the current training program (lifting split, running volume, sport) so prehab can attach to it; training days per week; the zones that feel tight, weak, or historically troublesome; any current pain or past injury (past injury means bias volume to that zone; current pain means stop - see Escalation); available equipment (bands cover 90% of prehab); and minutes willing to spend (default 10-15 before sessions). If the user cannot name a weak zone, treat all four as guesses and start with the balanced circuit.

Step 2: Screen before programming

Sharp pain, radiating pain, numbness or tingling, joint swelling or locking, or night pain disqualify a zone from prehab programming - those are physio referrals, not exercise-selection problems. Prehab loads are light, but loading an undiagnosed injury still makes it worse.

Step 3: Select the zone menus

• Shoulders (the rotator cuff is the most common failure point): band or cable external rotation 3×15 at light load, face pulls 3×15-20, YTW raises 2×10-12, plus serratus anterior work (wall slides, scapular push-up plus) to protect mechanics under load. Run 2-3 days per week, ideally before pressing sessions. Structural rule: keep pulling volume equal to or greater than pressing volume across the week - chronic pressing dominance is how impingement develops.
• Knees (most knee trouble originates in weak glutes and hips, not the knee): glute bridges or hip thrusts 3×15-20, lateral band walks 2×15 per side, terminal knee extensions with a band 3×15 per side; Spanish squats or sissy squats at slow tempo for the VMO; single-leg work (split squats, step-ups) to expose and correct side-to-side asymmetry - a rep or load gap above ~10% between sides is a flag to train the weak side first.
• Lower back (needs stability, not mobility - core endurance is the target): the McGill Big Three - curl-up (lumbar stays neutral; this is not a crunch), side plank, bird dog - 3 sets of 8-10 reps with 10-second holds, progressing to timed sets. Pair with hip flexor mobility (couch stretch, 90/90) because tight hip flexors load the lumbar spine directly. Rule: no heavy spinal flexion under fatigue.
• Hips (need both strength and range): Copenhagen plank for adductors, banded clamshells, single-leg RDL; mobility via 90/90 (internal and external rotation), deep squat holds with thoracic rotation, and hip flexor stretch with a posterior pelvic tilt. Five minutes daily on hips has outsized returns for lower-body longevity.

Step 4: Place it in the week

Default: 10-15 minutes before each training session, targeting the zones being trained that day (shoulder work before pressing, knee/hip work before squats or runs). On non-training days: a 10-minute full-body circuit touching all four zones. Consistency over intensity - light, frequent work outperforms occasional heavy corrective sessions.

Step 5: Progress conservatively

Prehab progresses by reps and holds first, load second. When all prescribed reps are clean, add reps or 5 seconds to holds before adding band tension or weight. Apply the 10% rule to the overall program the prehab supports: total training load (mileage, tonnage) should rise no more than about 10% per week - most "sudden" injuries are load spikes, and no prehab circuit survives a 40% mileage jump.

Step 6: Reassess at 4 weeks

Retest the flagged zones (asymmetry, tightness, how the shoulder feels after pressing). Improved: keep the doses. Unchanged: add one weekly session for that zone. Worse or newly painful: stop and refer.

Worked artifact

Example: lifter on an upper/lower 4-day split, history of shoulder crankiness, desk job.

PREHAB WEEK - attaches to existing upper/lower split (10-15 min pre-session)

Mon (upper): band ext. rotation 3x15 / face pulls 3x15 / wall slides 2x10
Tue (lower): glute bridge 3x15 / lateral band walk 2x15ea / 90-90 60s ea
Wed (off):   full-body circuit 10 min: bird dog 3x8 (10s holds), side plank
             3x20s ea, clamshells 2x15ea, couch stretch 60s ea
Thu (upper): face pulls 3x20 / YTW 2x10 / scap push-up plus 2x12
Fri (lower): TKE 3x15ea / Copenhagen plank 3x15s ea / deep squat hold 2x45s
Weekend:     hips 5 min daily (90-90 + hip flexor stretch, posterior tilt)
Rule checks: pulling >= pressing volume  |  weekly load +<=10%  |  any sharp
pain -> stop, physio

Deliverable

Produce a weekly prehab schedule containing: exercises with sets, reps, and holds per zone, placement relative to the user's actual training days, the pulling-vs-pressing volume check, the 10% load-progression cap, the 4-week reassessment plan, and the written stop-and-refer rule.

Do NOT

• Do not program prehab for a zone that currently hurts - prevention work on an active injury delays diagnosis and worsens outcomes.
• Do not turn prehab into a second workout; heavy corrective sessions defeat the light-and-frequent mechanism that makes it work.
• Do not stretch the lower back to fix lower-back tightness - the lumbar spine needs endurance and stability; the mobility work belongs at the hips.
• Do not skip single-leg work; bilateral lifts hide the asymmetries that cause injuries.
• Do not let this replace the main program or a flexibility practice - strength-training-plan owns the program, mobility-routine owns desk-worker flexibility.

Quality bar

The plan ships when: every zone has named exercises with sets/reps/holds, the schedule attaches to the user's real training days rather than floating free, pulling-vs-pressing balance is checked for shoulder work, progression is reps-and-holds-first with the 10% weekly load cap stated, and the stop-and-refer rule is written into the plan itself.

Escalation

This is general wellness education, not medical advice - a licensed physiotherapist or sports medicine physician owns anything that hurts. Refer immediately (do not program around it) for: sharp or radiating pain, numbness or tingling into a limb, joint swelling, locking, or giving way, night pain or pain at rest, pain following a specific traumatic event, or any pain persisting beyond 2 weeks of activity modification. Route neighbors: mobility-routine for general desk-worker stiffness without a training context, strength-training-plan for the main lifting program, zone-2-cardio-plan for aerobic volume the 10% rule also governs.