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Andrew Coates is an Edmonton based trainer, online coach, writer, public speaker, and host of The Lift Free and Diet Hard Podcast. Follow Andrew on Instagram here: @andrewcoatesfitness

Train and coach long enough and you’ll work with people with broken or otherwise immobilized limbs. I’ve coached clients with broken wrists, surgically repaired shoulders, ruptured bicep tendons, sprained ankles, broken tibias, and more. The answer isn’t sitting at home getting weak and depressed. 

You might intuitively believe training your “good” arm or leg will create one exaggerated Popeye limb while the other withers. Years of studies suggest otherwise. When we continue to train the opposing limb, we better resist muscle atrophy and strength loss of the injured limb. This phenomenon, called “cross-education” has been demonstrated to at least spare muscle and strength loss, if not create a small increase in muscle strength, even when the limb is immobilized. While the mechanisms behind cross-education are not perfectly understood, it’s believed to be the product of neural activation of the immobilized limb and, according to a literature review by Hendy and Lamon(2017), increased neural drive originating from the “untrained” motor cortex. Regardless of how it works, we know it works and we shouldn’t ignore its benefits. 

 

In a study by Andrushko et al. (2018), researchers immobilized the forearms of 16 participants for four weeks and randomly assigned them to a training or control group. The training group performed eccentric wrist flexion exercises three times a week with their free arm while the control group didn't train at all. After four weeks, the trained group preserved the strength and muscle thickness of the forearm flexors on the immobilized arm. The control group lost strength and muscle thickness. This same outcome was found in several other studies including Farthing et al. (2009).

A study by Perez and Cohen (2008) also points to the magnitude of the force used by the good limb affects the degree of cross activation. This suggests training with more load, volume, and intensity, should enhance the results for the immobilized limb. Don’t just go through the motions, hit your training as you would normally for strength progression and muscle growth, though it’s wise to be mindful of nutrition and sleep to maximize recovery and not compete with resources for healing, 

Studies have also demonstrated the same effect on lower limbs. Martinez et al., (2021) randomly split 36 participants into control and experimental groups, having the experimental group perform decline squats on one leg for 6 weeks. The experimental group showed an increase in structural and strength adaptations in the untrained limb. 

 

Staying in the gym means more than just avoiding muscle and strength loss. For lifters whose physical and mental health are dependent on regular workouts, losing weeks or months of training would be catastrophic. Finding strategies to train with an immobilized limb may be essential for our well being. For a young athlete it could mean avoiding months of lost progress. For an older adult fighting sarcopenia and bone mineral density loss, the consequences may be more severe. 

Even if there were no cross education effect on the injured limb, the normal physical and mental health benefits of physical activity and the risks associated with being sedentary make staying active non-negotiable. A recent headline in the Washington Post read: “Regular exercise protects against fatal covid, a new study shows”. “The study (Young et al., 2022) found that exercise, in almost any amount, reduced people’s risks for a severe coronavirus infection.” Something the fitness industry had been saying all along is now backed by research and only now becoming more widely accepted. 

Another comforting point: if you have a history of resistance training and had previously built muscle, then return to training after a period of training cessation, muscle returns more quickly than in untrained individuals. This is muscle memory at work, shown by Moberg et al., (2020) and Seaborne et al., (2018). Though these studies weren’t done on people who lost training time due to injury, they demonstrate the power of previous resistance training adaptations to restore lost muscle upon returning to training. This is likely from satellite cells donating myonuclei to muscle cells as muscles grow. The presence of more myonuclei in muscle cells has a relationship with regaining muscle faster. According to a review by Gundersen (2016) “Fibres that have acquired a higher number of myonuclei grow faster when subjected to overload exercise, thus the nuclei represent a functionally important 'memory' of previous strength.”

What Does This All Mean?

This means you can choose a normal array of single arm or leg exercises and continue to train them normally, while otherwise resting the injured limb and progressing through prescribed physical therapy. 

Push Pull Legs Program For Immobilized Arm

With an immobilized arm, often in a cast, you’ll rely mainly on single arm dumbbell and cable exercises. You’ll train near or at failure to maximize the muscle building effect of the workout. Be mindful of getting dumbbells and other implements into position with heavier loads. The assigned set ranges assume intermediate to advanced lifters. Beginners should reduce all exercises by 1 set. RIR means reps in reserve, noting the target number of reps before you would hit failure.

This program is meant to be a general illustration of the principles behind cross-education to preserve strength and muscle. The individual exercises or overall theme and strategy can be merged with specialized athletic or strength programs to optimize for these populations. An elite powerlifter or professional athlete probably won’t be gunning for new records while recovering from a broken leg, merely hoping to avoid atrophy and being significantly set back. All this being said, the powerlifter recovering from a lower body injury can shift most training volume to bench press to break new ground and the bodybuilders nursing injuries routinely use this time to bring up healthy but lagging body parts. Feel free to add more advanced or specialized training tactics to this program to suit your needs, such as accommodating resistance or top sets and backoff sets.

Top sets and backoff sets offer the advantage of being more aggressive with training while managing recovery. By introducing backoff sets, we can develop or maintain big lifting skills(as long as they aren’t the ones directly impaired by the injury) without stealing recovery resources from those needed to heal or worrying about overreaching. Backoff sets are appropriate for any major barbell or dumbbell exercise like safety bar squats, safety bar bulgarian squats, or bench press. 

To execute top sets and backoff sets, choose the 1-2 exercises across the program most appropriate to your performance goals and perform 1 set at 90% of your 1 rep max for 1-2 reps. Rest for 3-5 minutes then perform 1-3 backoff sets at 80% of your 1RM for sets of 4-5 reps. Use 2-5 minutes rest between backoff sets. To tailor more toward progressive hypertrophy goals, lower the % of both top and backoff sets by 5-10% and increase reps to 6-10. 

Be mindful so that the overall volume and intensity doesn’t cross the bleeding edge of your body’s resources to both recover from the injury and make training adaptations. 

Push Day 1 

Single Arm Dumbbell Bench Press

  • 4-5 sets of 8-12 reps to 1-2 RIR
  • 60-90 seconds rest for warm-up sets
  • 90-120 seconds rest for working sets
  • /superset

 

Single Arm Cable Facepulls

  • 3 sets of 10-12 to 1-2 RIR
  • 60-90 seconds rest

 

Single Arm Seated Dumbbell Shoulder Press

  • 3-4 sets of 8-12 reps to 1-2 RIR
  • 90-120 seconds rest 

 

Landmine Press

  • 3-4 sets of 10-12 reps to 1-2 RIR
  • 90-120 seconds rest

 

Single Arm Side Cable Raise

  • 3 sets of 10-15 reps to failure
  • /superset

 

Single Arm Overhead Cable Extensions

  • 3 sets of 10-12 reps to failure
  • 60-90 seconds rest

 

Single Arm Cross Body Rope Cable Pressdowns

  • 3 sets of 12-15 reps to failure
  • 60-90 seconds rest

 

Suitcase Carry

  • 3 sets of 40 meters
  • 90-120 seconds rest

 

Pull Day 2

 

Single Arm Seated Cable Rows

  • 4 sets of 10-12 reps to failure
  • 60-90 seconds rest

 

Landmine Meadows Row 

  • 4 sets of 10-12 reps to 0-1 RIR
  • 60-120 seconds rest

 

Single Arm Neutral Grip Cable Pulldowns

  • 4 sets of 10-12 reps to failure
  • 60-90 seconds rest

 

Single Arm Bent Over DB Laterals

  • 3 sets of 10-12 reps to 1-2 RIR
  • /superset

 

Dumbbell Curls

  • 4 sets of 10-12 reps to failure
  • 60-90 seconds rest

 

Leg Day Day 3 

Safety Bar Squats

  • 4-6 sets of 5-10 reps to 1-2 RIR
  • 90-120 seconds rest warm-up sets
  • 120-180 seconds rest working sets

 

Single Leg Romanian Deadlifts

  • -DB held in the “good” hand for both sides
  • 3-4 sets of 6-10 reps to 1-2 RIR
  • 90-120 seconds rest

 

Safety Bar Bulgarian Squats or Safety Bar Reverse Lunges

  • 3-4 sets of 5-8 reps per leg to 2 RIR
  • 120-180 seconds rest

 

Leg Press

  • 3-4 sets of 10-15 reps to 1-2 RIR
  • 60-120 seconds rest

 

Seated Hamstring Curls

  • 3 sets of 8-12 reps to failure
  • /superset

 

Leg Extensions

  • 3 sets of 10-15 reps to failure
  • 60-90 seconds rest

 

Conditioning with an Immobilized Arm

Cardio durations and intensities will vary depending on someone’s goals, training age, and cardiovascular capacity. If you have a broken or otherwise immobilized arm you still have a lot of options to do cardio. Bilateral rower or skierg are out, and you shouldn’t be hanging on for dear life with both hands on a steep incline treadmill walk anyway, almost everything else is fair game. There’s no reason why you can’t walk on a treadmill or outside, hit the stairclimber, or use spin or assault bikes. Looking for more anaerobic intense methods? Single arm kettlebell swings or pulling a sled backwards both work. Barring more system wide trauma, you have tons of cardio options to sustain your cardiovascular health and stamina while your arm heals. 

Push Pull Legs Program for an Immobilized Leg

An injured leg may present challenges getting around a gym, on and off benches, or into some machines like a leg press. Bias toward exercises where you can sit and avoid load or pressure on your injured leg, even if wearing a cast. In later stages of recovery, moving around and loading the leg, within the parameters assigned by a doctor or physical therapist, is important for restoring mobility of the injured limb. This program isn’t meant to replace the direction of a rehabilitation professional, only to enhance the process. The assigned set ranges assume intermediate to advanced lifters. Beginners should reduce all exercises by 1 set.

Day 1 Push

Bench Press

  • 4-6 sets of 6-12 reps to 1-2 RIR
  • 60-90 seconds rest for warm-up sets
  • 90-180 seconds rest for working sets

 

Seated Dumbbell Shoulder Press 

  • 4 sets of 15-20 reps to 0-1 RIR
  • 90-120 seconds rest 

 

Incline Machine Press

  • 4 sets of 12-15 reps to failure
  • 60-120 seconds rest

 

Seated Side Dumbbell Laterals 

  • 3-4 sets of 12-15 reps to failure
  • /superset

 

Skullcrushers 

  • 3-4 sets of 10-12 reps to 1-2 RIR
  • 60-120 seconds rest

 

Day 2 Pull 

Chin-ups

  • 3-4 sets to 0-1 RIR (reps will vary based on ability)

 

Or Assisted Chin-ups 

  • 3-4 sets of 8-10 reps to 1 RIR
  • 90-150 seconds rest

 

Dumbbell Rows 

  • 3-4 sets of 8-12 reps to 0-1 RIR
  • 90-120 seconds rest

 

Seated Cable Rows

  • 3-4 sets of 10-12 reps to failure
  • 90-120 seconds rest

 

Seated Bent Over Dumbbell Laterals 

  • 3 sets of 12 reps to failure
  • /superset 

 

Seated Bent Over Dumbbell Rear Delt Rows 

  • 3 sets of 8-10 reps to failure
  • /superset

 

Seated Dumbbell Curls

  • 3-4 sets of 10-12 reps to failure
  • 90-150 seconds rest

 

Day 3 Legs

 

Supported Single Leg Romanian Deadlifts

  • 3-4 sets of 6-10 reps to 1-2 RIR
  • -can hold the DB ipsilateral or contralateral, holding support with the opposing hand
  • 90-120 seconds rest

 

Single Leg Squats to a Box

  • 3 sets of 8-10 reps to 2+ RIR
  • 90-120 seconds rest

 

Leg Press - Single Leg

  • 3-4 sets of 10-12 reps to 1-2 RIR
  • 90-120 seconds rest

 

Single Leg - Leg Extensions*

  • 3-4 sets of 12-15 reps to failure
  • 60-90 seconds rest

 

Seated Hamstring Curls*

  • 3-4 sets of 10-12 reps to failure 
  • 60-90 seconds rest

 

*Avoid supersetting here due to the impracticality of moving between stations quickly with an immobilized leg. 

Conditioning with an Immobilized Leg

Being unable to load or stress a leg requires a little more thought for cardiovascular training. Much of the traditional stuff won’t work, but we have a few options. An assault bike done with arms only solves the problem, so does a skierg done seated. Even battle ropes work seated, or standing if you’re able to stand in a cast. Conditioning with an immobilized leg requires more creativity, but it’s possible.

A broken arm or leg feels like a massive setback. Misguided medical professionals may tell you to avoid lifting or activity as bones set and surgeries heal. But this only applies to the injured limb. Not only can you train the rest of your body, you should to prevent loss of strength and muscle, while supporting your cardiovascular and mental health. 

References:

 

  • Hendy, Lamon, “The Cross-Education Phenomenon: Brain and Beyond,” Front. Physiol, 2017 

  • Andrushko, et al., "Unilateral strength training leads to muscle-specific sparing effects during opposite homologous limb immobilization," Journal of Applied Physiology, 2018

  • Farthing, et al., “Strength training the free limb attenuates strength loss during unilateral immobilization,” Journal of Applied Physiology, 2009

  • Perez, Cohen, “Mechanisms Underlying Functional Changes in the Primary Motor Cortex Ipsilateral to an Active Hand,” Journal of Neuroscience, 2008

  • Young, et al., “Associations of Physical Inactivity and Covid-19 Outcomes Among Subgroups,” American Journal of Preventative Medicine, 2022

  • Moberg, et al., “Exercise Induces Different Molecular Response in Trained and Untrained Human Muscle,” Medicine and Science in Sports and Exercise, 2020

  • Seaborne, et al., “Human Skeletal Muscle Possesses an Epigenetic Memory of Hypertrophy,” Scientific Reports, 2018

  • Martinez, et al., “Effects Of Cross-Education After 6 Weeks off Eccentric Single-Leg Decline Squats Performed With Different Execution Times: A Randomized Controlled Trial,” American Orthopaedic Society for Sports Medicine, 2021

  • Gundersen, “Muscle Memory and the New Cellular Model for Muscle Atrophy and Hypertrophy,” J Exp Biol., 2016

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