Bill Starr Rehab Protocol for Muscle Pulls

muscle-strain-rehabLet’s say you went a little too heavy on the bench. Maybe you were feeling strong, wanting to hit that new PR. Whatever the reason, you over-reached and hurt yourself. I’m not talking the DOMS (delayed onset muscle soreness) from a hard workout, I’m talking about a tweak to the muscle or tendon that indicates a real injury.

Now what?

First thing: take time off. Wait until the pain diminishes until it down to a 1 or 2 on the 10 scale.  You want to be able to move through a normal range of motion without any increase in pain. Once you’re to that point, you can start to look at rehabbing. It might take a week or even longer to reach that point.

You want to do an exercise that directly works the injury, in this case the bench press. Start with the empty bar and do 3 sets of 20 with perfect form and at a steady pace. Do NOT favor the injury. Pay attention to your level of pain. If pain increases, then it’s not ready to be rehabbed. If it stays the same or actually feels a little better as you keep going, it’s ready to work.

Do the same thing again the next day, only this time add a small amount of weight, like 5 pounds on each side. Same three sets for 20 reps. Keep up this routine, continuing to add a small amount of weight every day.

It will hurt, but it shouldn’t hurt too much. There’s a difference between rehab pain and re-injury. If you can’t tell the difference, you will soon enough if you keep going.

This purpose of this rehab method is to flush blood through the injury while forcing the tissue to reorganize in its normal pattern of contractile architecture and it’s normal range of motion.

After 10 days of this, go up in weight and down in reps to 15s, the 10s, then finally to fives. Same three sets. During this time do no other heavy work so that your resources can focus on the injury. You should be healed up and back at you original weight in about 2 – 3 weeks.

This method can prevent scar formation since the muscle is forced to heal in the context of work and normal contraction and through the movement pattern it normally uses. The important points are:

  • perfect form with light weights that can be handled for high reps
  • every day for two to three weeks
  • no other heavy work that will interfere with the system-wide processes of healing

It is important to use ice through the whole process, immediately after the workouts. Start with 20 minutes on/20 minutes off 5 times a day or more initially, slowly tapering to after the workout and before bed. Ice inhibits inflammation and swelling while at the same time increasing blood flow.

Scar Formation

Here’s an article in Medical News Today about scar formation:

  • When the body is injured it sends fibroblasts to the area.
  • Initially it grows within the clot to help stop the bleeding and connect the two sides of the tear
  • The fibroblasts grow stiffer over time, and eventually contract to pull the sides together

Referenced Paper: Pierre-Jean Wipff, Daniel B. Rifkin, Jean-Jacques Meister and Boris Hinz, “Myofibroblast contraction activates latent TGF-b from the extracellular matrix“, Journal of Cell Biology, December 17, 2007.

The Bill Star Rehab Protocol

Knowing that:

  • scar tissue is formed through natural healing processes using the fibroblasts
  • that full range of motion in the injured area helps the fibroblasts do its job more efficiently
  • blood flow though the area flushes out inflammation, fluids, and repair byproducts and
  • provides fresh oxygen, blood, etc. to the area

The combination of the mechanical motion of the light weight reps and increased blood flow provides favorable conditions for minimizing scar tissue.

The important aspect is to do the rehab protocol and no other work.

Scale the weight to match to your strength levels. You don’t have to go up every workout, but there should be a steady increase in resistance over time.

The best way to judge when you are ready for rehab is when there is no increase in pain when competing the motion/exercise that caused the injury.


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