Built from Broken: A Science-Based Guide to Healing Painful Joints, Preventing Injuries, and Rebuilding Your Body

by Scott H Hogan

Education: Learn about your tendinopathy causes, outcome expectations, and best practices for recovery. Unloading: For a brief time period, reduce training load and repetitive activities that cause painful flare-ups. Reloading: Build up load capacity gradually, starting with light resistance exercise and extremely slow repetitions that do not trigger a pain response (e.g. 3–5 full seconds to lift the weight and 3–5 seconds to lower the weight). Start by performing 3 sets of 10–15 repetitions on two nonconsecutive days per week. When you’re able to complete the exercises with minimal pain (3 or less on a scale of 1–10: 0 = no pain, 10 = unbearable pain) and recover fully in between sessions, then increase the resistance by 10%–20%. Continue with this progression until you reach a threshold of resistance that only allows you to complete 5 or 6 repetitions with good form. By this point, you will have significantly increased your load tolerance and joint integrity. As long as your pain levels stay at a 3 out of 10 or less as a subjective pain score, keep increasing the resistance each week. Prevention: Continue corrective exercise training for at least 8–12 weeks after symptoms resolve and take steps to prevent the underlying tendinopathy.

The take-home message is that activity is the driving force behind joint lubrication.

Try supplements that increase joint lubrication: Collagen, hyaluronic acid, glucosamine, and chondroitin are components of the extracellular matrix—the fluidlike mix of compounds that provides structural support for your cells.

While the medical world is still divided on the best ways to address chronic joint pain and tendinopathy, taking a four-pronged approach to pain management is your best bet for short-term relief and long-term health. Focus on modulating inflammation, resolving tendinopathy, improving synovial fluid health, and protecting your collagen.

There are five primary types of joint connective tissue: Tendons: Tendons connect muscles to bones. They’re more compliant (stretchy) than ligaments but more rigid than muscles. Tendons are responsible for much of the force transfer through the body during movement. Ligaments: Ligaments connect bones to other bones. Their primary purpose is joint stabilization. Cartilage: Cartilage acts as a cushioning barrier within joints and between bones. Unlike tendons and ligaments, cartilage lacks blood vessels and nerves, making it a problematic connective tissue for the body to repair. Intramuscular: This is connective tissue that runs directly through and between muscle fibers. It helps transfer force from muscles to tendons and vice versa. Fascia: Fascia is the thin sheath of connective tissue that surrounds muscles. It plays a pivotal role in force transfer between parts of the kinetic chain. Fascia is dense with nerve endings, making it almost as sensitive as skin. This is part of the reason why manual therapy methods like foam rolling and massage have so much support for pain and tension relief.

This is why using slow, deliberate motions while lifting weights helps activate collagen remodeling—breaking

When normal exercise hurts, isometric exercise is a good way to stimulate muscles and tendons without aggravating the injury. In my experience, it’s the most underutilized therapeutic fitness strategy.

Heavy Slow Resistance Training (HSR) HSR utilizes both eccentric and concentric contractions, heavy resistance, and slow repetition speeds. The reason “heavy” is in the name is not necessarily because you’re supposed to use heavy weights. It is because the goal of HSR is to progressively increase the resistance with each training session while lowering the number of repetitions performed. Generally, you should start with a light training load that does not trigger a pain response (e.g. 3 sets of 15 repetitions), then progressively increase the weight and reduce repetitions. This gradually builds the load tolerance of the tendon, encourages increased collagen turnover, and relieves pain.

Now you can see the problem: light, “safe” training with easy weights and high volume could theoretically produce the same muscular growth results as heavier weights. But your tendons won’t adapt to the same degree. This gap combined with repetitive use and chronic joint under-recovery leaves your tendons vulnerable to gradual degeneration.

While you will benefit from focusing primarily on slow, deliberate movements, you should incorporate a variety of movement tempos into your training schedule.

Your ability to prevent injury during quick movements comes down to how effectively your muscles and tendons perform during the stretch-shortening cycle (SSC).

Collagen protein supplements and type II collagen supplements are both good for your joints, but they have different mechanisms of action. Collagen protein benefits your joints by kick-starting collagen production and supplying the building blocks of healthy joints. Type II collagen supplements have a novel “oral vaccine” effect that builds immune cell tolerance, reduces autoimmune reactions, and relieves inflammation-based pain.162 Think of collagen protein as a joint builder and type II collagen as an anti-inflammatory pain reliever.

Preworkout recommendation: To increase collagen synthesis, tissue regeneration, and joint recovery, supplement with 5–10 grams of collagen protein 30–60 minutes before exercise. Choose a supplement that lists “hydrolyzed collagen,” “collagen hydrolysate,” or “collagen peptides” to mirror the supplements proven effective in studies. Adding 100–200 mg of vitamin C to your preworkout routine further supports tissue repair and healing rates. Type II collagen supplements appear to be preferentially effective at reducing cartilage inflammation in dosages as low as 10 mg per day.161 For added joint inflammation support, you could also supplement with type II collagen immediately before training.

On a cellular level, varied movement is what creates, maintains, and reinforces physiological health.

This is the most important injury-prevention lesson in the book: being sedentary all week and then playing golf or tennis on the weekend is the easiest way to get injured and develop joint pain. Even within daily time periods, being sedentary all day and then exercising intensely for one hour will lead to injury. It might show up as tendinopathy, or it might be an acute tear or sprain. But it will happen.

The more you use a particular joint, the more important it is that you expose it to a variety of stressors

When you start any new exercise modality—be it weight training, running, bike riding, or a sport—start slow. Train the new modality no more than twice per week for at least four to six weeks (ideally with two to three days of rest between). This will give your connective tissue time to heal between sessions and increase load tolerance. (Remember, collagen synthesis levels within joints stay elevated for three full days postexercise.)128 You can then bump up the training frequency to three days per week for another four to six weeks. This rule applies whether you’re a couch potato or dedicated fitness junky.

There is no more underrated and research-backed therapeutic tool than walking.

A 2016 study published in BMJ Open Sport & Exercise Medicine found no relationship between mobility and injury risk, and that “strength asymmetry was statistically significant in predicting injury.”190 This is not to say that it’s OK to be so tight that you can’t bend over to tie your shoelaces. Limited mobility is a problem. But it’s only one piece of a larger puzzle.

We’ve all heard that stretching helps lengthen muscles, reduce joint pain, and prevent injuries. But the science behind stretching doesn’t hold up.

Standing Quick Mental Cue List Feet: pointed forward. Knees: directly above heels. Hips: on top of knees—squeeze your glutes and activate your TVA. Shoulders: pack the scapula back and down. Head: pull up toward ceiling, tuck chin slightly.

Cat-Cow World’s Greatest Stretch Glute Bridge Hinge to Squat Cossack Squat Band Pass Through Cat-Cow World’s Greatest Stretch Glute Bridge Hinge to Squat Cossack Squat Band Pass Through

Perform 10 repetitions of each exercise listed below: Dumbbell Zottman Curl Standing Dumbell Pullover Bent Over Dumbbell Row Dumbbell Romanian Deadlift Dumbbell Goblet Squat Dumbbell Pronation/Supination

This is known as the joint by joint concept.216 Here’s how the kinetic chain of joints in your body is set up from your feet to your shoulders. Notice how the primary function alternates between stability and mobility as you move up the chain: Feet: stability Ankles: mobility Knees: stability Hips: mobility Lumbar spine (low back): stability Thoracic spine (upper back): mobility Scapulothoracic (scapula): stability Glenohumeral (shoulder): mobility Knowing the primary function of each joint helps provide context for establishing preventative goals. For example, your hips are primarily designed for mobility, indicating that maintaining range of motion is paramount. Conversely, your low back is designed mainly for stability, indicating that building stabilizing strength should be the focus—along with mobilizing the joints above and below it to prevent unnecessary movement compensations.

If you have a history of low back pain, you should always warm up your glutes with activation exercises before working out. If nothing else, this will remind your body that your glutes are the primary movers during lower body squatting and hinging and that the small muscles of your low back should only act as synergistic supporters. Even if you don’t have low back pain, performing glute activation exercises is a great way to improve motor control and muscular power during lower body movements. Activate your glutes, and your low back will thank you.

Key exercises Fire Hydrant Glute Bridge with Hip Band

Follow this three-step bracing sequence before heavy lifting, picking up furniture, or any other exertion event. Take a deep inhale and hold it, focusing on expanding your belly outward and preventing your chest from rising. This method creates more intra-abdominal pressure and spinal stability than allowing your chest to rise and expand as you breathe in.221 Tighten your stomach while continuing to hold in the breath, like you are preparing to be punched in the stomach. This cue creates more tension in your core than the popular “suck in your belly” cue (try both now and you’ll see what I mean). Bracing for a punch activates your TVA and surrounding core muscles such as the obliques, further reinforcing core stability. Squeeze your butt muscles. This should create a sense of horizontal pressure between your butt and lower abdomen.

Back muscle endurance is more important than strength or mobility when it comes to preventing pain.

There are dozens of muscles involved in low back muscle endurance, but one muscle in particular is vital for developing endurance along the entire length of your back. Running vertically along each side of your spinal column is a thin yet powerful muscle called the multifidus. This underrated muscle group runs from your tailbone all the way to the top of your upper back. A well-developed multifidus bolsters the stability of your entire back, helping to reduce joint degeneration and prevent low back pain.226 But it’s not just about mechanical support. The multifidus, along with the TVA, is chiefly responsible for sending messages through your spine to your brain about your core’s current stability status.227 These two are the dynamic duo of core stability.

While you could build endurance with high-repetition sets of squats and deadlifts, the Bird Dog exercise targets the multifidus.

Best Exercises for Low Back Pain 10–20 minute walk Cat-Cow World’s Greatest Stretch Supine Drawing In Core Bracing Sequence Bird Dog Fire Hydrant Glute Bridge Cable Pull Through

By definition, shoulders are among the least stable of human joints because of their hypermobility.

The only way to bulletproof your knees is to increase their load capacity. That is not accomplished by stretching or mobility work but with slow, controlled repetitions of exercises that progressively challenge the load-bearing capabilities of connective tissue structures around your knees.

If you’ve been around organized sports or fitness, you have probably heard the acronym RICE, which stands for rest, ice, compression, and elevation. For the last 50 years, this was the gold standard of acute injury care. But new research casts doubt on this technique, and forward-thinking therapists and doctors are using a new method for postinjury care.

soft-tissue injuries simply need PEACE and LOVE. I’m not kidding. The title of the article is “Soft-Tissue Injuries Simply Need PEACE and LOVE.”256 The acronym is a bit excessive. But it covers all the bases. And it’s grounded in good science: P for PROTECTION: Protect the injury during the first few days by avoiding movements that cause pain or stress the injured area. E for ELEVATION: Raise the injured limb (if applicable) higher than the level of your heart to minimize swelling and allow fluid to drain from the area. Follow this for the first day or two postinjury as needed. A for AVOID ANTI-INFLAMMATORIES: Avoid NSAIDs, ice, and other anti-inflammatories during the first few days postinjury. C for COMPRESSION: Use elastic bandages, tape, or wraps to reduce swelling so you can continue pain-free movements (but don’t become dependent on compression devices that provide stability to your joints—you need to keep those stabilizer muscles strong). E for EDUCATION: Understand the injury recovery process, let your body do its job, and avoid unnecessary medical interventions that may limit long-term healing outcomes. L for LOAD: Use pain as your guide for returning to activities. Pain (or lack thereof) will also tell you when it’s OK to start adding more resistance and intensity to your movements. O for OPTIMISM: Injuries take a toll psychologically. Expect it and know that it’s normal. Then, work on maintaining a positive, long-term mindset for getting back to full function. V...

Understanding that injuries have lasting psychological and neurological effects is important so you know what to expect and maintain faith that you’ll eventually get past it.

If all the training methods described so far seem contradictory, it’s because they are. Strictly speaking in terms of joint health, you need heavy weights to increase tendon stiffness, slow repetitions for optimal collagen formations, and sustained contractions to induce the greatest adaptive responses. You need all of them. But you can’t train all of them at once. In the next section, I’ll show you how to layer all these concepts into a training program that optimizes performance now without sacrificing your joints later.

There are three primary types of periodization: linear, undulating, and block.

Instead of trying to do maximum damage to your body each session, optimize for consistent incremental gains. Instead of trying to pack in as much training as possible, aim for the minimum effective dose (MED) of training that will allow you to make progress from week to week—at least while you follow the program I’ve outlined in the next chapter.

I recommend a four-day training week consisting of two upper body focused days and two lower body focused days. This schedule is a winning combination of enough mechanical stimulus for muscles to grow and frequency of movement to see positive neural adaptations. It also provides a full three days between targeted exercise sessions so your joints have time to repair.

Week 1: Connective Tissue Remodeling Use prolonged repetition speeds (e.g. five seconds down, five seconds up) for maximum connective tissue adaptation. Because each set demands sustained contractions of over a minute, you’ll use lighter weights and only complete two sets per exercise. This is your “joint reset” week. Week 2: Hypertrophy with Heavy Slow Resistance Training Use slow to moderate repetition speeds (e.g. three seconds down, three seconds up), moderate resistance, and higher volume to maximize muscle growth. Complete three sets of 8–12 repetitions on each exercise. Week 3: Strength Training Perform three sets of fewer repetitions, with controlled repetition speeds during the eccentric phase (e.g. three seconds down) and maximum power production during the concentric phase (i.e. lift the weight with as much force as you can). The goal here is to maximize motor unit recruitment and increase strength. Week 4: Endurance + Energy Loading (Deload Week) Use light weights that allow you to comfortably perform sets of 15 repetitions or more. While still under control, you will not pause at the start or end of each repetition. Instead, you’ll keep the weight in constant motion. This week gives your joints and muscles a reprieve from high intensity but still stimulates neuromuscular endurance adaptations.

If you currently do no weight training, here’s how I suggest you ramp up to four days per week: Step 1: Full body weight training: 2 nonconsecutive days per week—follow for 4 to 8 weeks, then progress to 3 days per week. Step 2: Full body weight training: 3 nonconsecutive days per week—follow for 4 to 8 weeks, then progress to 4 days per week. Step 3: Weight training 4 days per week (alternate between upper and lower body strength training days)—follow for 8 weeks, then assess progress, joint health, injury status, etc.

Like we covered in the chapters on movement and mobility, even your “off” days from working out should be filled with varied movement.

For the sake of time management, I’m a big fan of keeping rest periods as short as possible without sacrificing movement quality.

One of the most important reasons to use a dynamic warm-up is the least talked about—it serves as a diagnostic ritual to see what is going on with your body that day. What joints are extra stiff, what muscles are tight, and what movement patterns just aren’t working. This awareness allows you to address any potential problems early, which can prevent a minor tweak from developing into a full-blown injury.

To rebuild your body from the ground up, you have to start at the ground. While it may seem painstaking to use lighter weights and go back to mastering basic movement patterns like the row and lunge, you’ll quickly see that this creates an opportunity for exponential progress. Building core stability, mobility, and connective tissue resilience will translate to more strength, a better body, and pain-free movement faster than you might think. It just takes a little vision, and enough discipline to do the first thing first. Then the next thing, then the next. Do this long enough to see your first substantial leap in progress, and you’ll be hooked.