Part of my evaluation process when working with new physical therapy patients is to take a look at their workout program. Essentially, I am looking for gaps in training. What are you training too much? And what are you training not enough?

Over the years, I have noticed that there are commonly a few things missing from most workout programs. These gaps can lead to overuse injuries, muscle imbalances, and weak links.

In this article, I will share with you the 4 things that I commonly see under trained in most workout programs. I will also suggest ideas to help you fill those gaps. 

1. Unilateral strength AKA training each arm/leg separately

 Most people have side-to-side strength imbalances, but it's difficult to pick up on them when doing bilateral movements where both extremities move at the same time-such as squats, deadlifts, bench press, pushups etc.. 

For this reason, I like to see at least some supplemental unilateral movements integrated into every workout program. 

When we train each side separately, a few good things happen.

First of all, we can pick up on deficits and then adjust the weight appropriately for each side. Perhaps your right leg is stronger than your left. You may not notice it during a deadlift, but when we do a single leg hamstring curl you notice that you need different weight to appropriately challenge each side. 

Additionally, unilateral training improves proprioreception which is how your joints and brain communicate. Improved proprioreception means your brain and brain can more easily sense movement, position, and muscle force. This all results in decreased risk for injury because your body and brain are more in tune with one another. 

How to implement: pick a couple unilateral movements to perform supplementally towards the end of your workout. These can be lighter weight but higher volume than your traditional squat, hinge type of lifts. Focus on squeezing and isolating the targeted muscle group, and pay close attention to side-to-side deficits. 

 2. Train in a variety of movement directions

Most exercises typically performed at the gym are linear movements where our joints flex and extend (think squats, lunge, run, walk, shoulder press, lat pulldown etc.. 

What is missing is often lateral or side-to-side movements and then rotational movement. 

I always say- 'linear movements make you strong, lateral movement makes you more athletic, but rotation is what keeps you young!'

Rotational movement is particular important for our joints. Every joint is surrounded by a joint capsule and rotation is what keeps that joint capsule healthy, mobile, and in good communication with our brain. 

While most all the joints in the body love rotation, the hips and shoulders have the greatest need. To hit this mark, I make sure that every leg day incorporates hip rotational work and then every upper body day incorporates shoulder rotational work.  

3. Plyometrics

These are exercises that involve rapid and repeated stretching and shortening of muscles (jumping). And while they can improve your speed and power, I use them primarily because they also make tendons stronger and more resilient. They also train the body to both produce and absorb force. 

Sadly, many people stop plyometric training as they get older. Without this regular stress to the tendons, the tendons because weak and lose elasticity. All of this is a recipe for injury.

Incorporating plyometrics into a training program doesn't have to be as daunting as you may be think. In fact, I usually have physical therapy patients start scaled plyometrics within a couple months of surgery. Sometimes this starts as just really soft bounces where the feet barely leave the ground. 

You can start bouncing in place on both legs and over time progress to bouncing forward and backward and then side-to-side. And eventually you can transition to 1 leg. 

For athletes that are capable of tolerating it- jump rope is the easiest way to implement this into your training. Jump rope, skip rope, jump on both legs, jump on 1 leg...do it all! Start with a few sets of 50 jumps and gradually progress. 

PS. This is a great warm-up for running, lifting weights, sports etc... Get your heart rate up, get blood flowing, and train your tendons all at the same time!

 4. Training your weaknesses

It is human nature to focus on the things we are good at. When we excel at something, we get a rush of dopamine and feel happy. BUT only doing the fitness things you are good at, leaves a huge vulnerability for injury. 

I always laugh when I have this conversation with rehab clients. I tell them 'your XYZ is weak, let me show you some things to work on it.' More often than not they reply with something along the lines of 'I know I should do these things but I hate doing them because I suck at it'. 

It's so hard to choose the suck. But from an inury prevention standpoint, it is worth it! 

If you have been to physical therapy before and already have some supplemental things to work on an easy implementation is to incorporate them into a movement prep prior to your main workout. Let's say your rotator cuff muscles need more strength- I would recommend you pick 2-3 rehab/prehab exercises to do prior to your main upper body lifts at the gym. 

Bottom line- chase down those weaknesses until they become strengths. 

This is how I may program a lower body gym session incorporating these 4 undertrained fitness components:

Warm up: Jump rope 3-5 minutes. Alternate between double leg jump, single leg jump, and skip

Movement prep: Hip CARs, Hip Airplanes (rotational work), single leg bridge isometric holds (unilateral and weakness work) 

Primary lift: Back squat 4x8

Accessory work: weighted step-ups (single leg work) 3x8, single leg quad extensions (single leg work) 3x15, side plank with hip abduction lifts (weakness work) 3x5

Hope this article was helpful. If you have any questions feel free to shoot me an email at [email protected]. 

Yours in health, 

-Doc Mraz