WEIGHT TRAINING INJURIES
Improper weight-training techniques can lead to weight training injuries. The most common areas to be injured are the back, shoulders, and knees.
Back sprains and strains most commonly result from improper lifting technique when performing exercises such as bench presses, deadlifts, and rows. Sprains involve stretching of ligaments while strains involve stretching of muscles or tendons. Initial treatment involves the R.I.C.E. method (i.e. Rest, Ice, Compression, and Elevation). Assessment and treatment by your physiotherapist are also valuable. At Saanich Physio your Physiotherapist can help you minimise the risk of obtaining weight training injuries.
Training Tip: The risk of back injuries can be reduced by maintaining a neutral spine and avoiding flexing or extending the lower back under heavy load.
Lifting weights overhead incorrectly can lead to injuries such as shoulder impingement syndrome and rotator cuff damage. Shoulder impingement syndrome is when swelling and inflammation of structures in, and around the shoulder results in pain in the front and side of the shoulder/upper arm. Rotator cuff damage causes pain and weakness of shoulder movement. Treatment for these conditions may include physiotherapy and anti-inflammatory medication in minor cases; and cortisone injections and potentially surgery in more serious cases.
Training Tip: The risk of shoulder injuries increases with excessive repetitions. Ensure you also train other body parts to give your shoulders adequate recovery time between training sessions.
Repetitive knee exercises such as squats, lunges, deep knee bends, jumps, knee extension and leg lifts can cause pain at the front of the knee. Injury to the patellar tendon (the tendon that connects the kneecap to the shin bone) can occur with overuse. Small tears develop in the tendon leading to pain just below the kneecap. Treatment in the form of physiotherapy and a patellar tendon strap often helps to reduce symptoms and your doctor may also recommend anti-inflammatory medications.
Training Tip: Ensure that your kneecap tracks correctly (i.e. over the outside of the foot) during squat and lunge exercises.
If you feel pain from weight lifting in the gym seek treatment and corrective strategies from us at Saanich Physio. The longer you keep training with an injury or small niggles that can turn into bigger injuries, the longer your recovery time will be. Seek help early and keep yourself in the gym – there is no need to suffer from weight training injuries.
Aasa U, Svartholm I, Andersson F, et al. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med 2017; 51:211-220.
Kerr ZY, Collins CL, Comstock RD. Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med 2010; 38(4): 765-71.
Mazur LJ, Yetman RJ, Risser WL. Weight-training injuries. Common injuries and preventative methods. Sports Med 1993; 16(1): 57-63.
Siewe J et al. Injuries and Overuse Syndromes in Competitive and Elite Bodybuilding. Int J Sports Med 2014; 35: 943-948.
Siewe J et al. Injuries and Overuse Syndromes in Powerlifting. Int J Sports Med 2011; 32: 703-711.
Weisenthal BM, Beck CA et al. Injury Rate and Patterns Among CrossFit Athletes. The Orthopaedic Journal of Sports Medicine 2014; 2(4): 1-7.
Tendinopathy TOP TEN By Jill Cook PhD
Tendon pain and dysfunction are the presenting clinical features of tendinopathy. Research has investigated many treatment options, but consistent, positive, clinical outcomes remain elusive. We know that treatment should be active (eg, exercise-based), and that a consistent and ongoing investment in rehabilitation is required. It is important to maximise this investment by understanding (and conveying to patients) treatments that do not help. The following 10 points high- light treatment approaches to avoid as they do not improve lower limb tendinopathy.
1. Don’t rest completely.
Rest decreases the load tolerance of tendon, and complete rest decreases tendon stiffness within 2 weeks.1 It also decreases strength and power in the muscle attached to the tendon and the function of the kinetic chain,2 and likely changes the motor cortex, leaving the person less able to tolerate load at multiple levels. Treatment should initially reduce painful, high tendon load (point 2) and intro- duce beneficial loads (eg, isometrics3). Once pain is low and stable (consistent on a loading test each day), load can be increased slowly to improve the capacity of the tendon.4
2. Don’t prescribe incorrect exercise.
Understanding load is essential for correct exercise prescription. High tendon load occurs when it is used like a spring, such as in jumping, changing direction and sprinting.5 Tendon springs must be loaded quickly to be effective, so slow exercises even with weights are not high tendon load and can be used early in rehabilitation. However, exercising at a longer muscle tendon length can compress the tendon at its insertion.6 This adds substantial load and should be avoided, even slowly, early in rehabilitation.
3. Don’t rely on passive treatments.
Passive treatments are not helpful in the long term as they promote the patient as a passive recipient of care and do not increase the load tolerance of tendon.Treatments like electrotherapy and ice temporarily ameliorate pain only for it to return when the tendon is loaded.7
4. Avoid injection therapies.
Injections of substances into a tendon have been shown to be no more effective than placebo in good clinical trials.8 Clinicians who support injection therapies incorrectly suggest they will return a pathological tendon to normal. There is little need to intervene in the pathology as
there is evidence that the tendonadapts to the pathology and has plenty of tendon tissue capable of tolerating high load.9 Injections may change pain in the short term as they may affect the nerves, but should only be considered if the tendon has not responded to a good exercise-based programme.
5. Don’t ignore tendon pain. Pain usually increases 24 hours afterexcess tendon load. An increase in pain of 2 or more (out of 10) on a daily loading test should initiate a reduction in the aspects of training that are overloading the tendon (point 2). The overload is likely to be due to excessive spring-like movements such as jumping, running and changing direction.
6. Don’t stretch the tendon.
Aside from the load on a tendon in sport, there are compressive loads on the bone-tendon junction when it is at its longest length. Stretching only serves to add compressive loads that are detrimental to the tendon.10
7. Don’t use friction massage.
A painful tendon is overloaded and irritated (reactive tendon pathology). Massaging or frictioning the tendon can increase pain and will not help pathology.7 An effect on local nerves may reduce pain in the short term only for it to return with high tendon loads.
8. Don’t use tendon images for diagnosis, prognosis or as an outcome measure.
Abnormal tendon images (ultrasound and MRI) in isolation do not support a diagnosis of tendon pain as asymptom- atic pathology is prevalent. There are also no aspects of imaging, such as vascu- larity and ‘tears’, that allow a clinician to determine outcome.11 Pathology on imaging is usually very stable and does not change with treatment and reductionin pain, so images are not a good outcome measure.12
9. Don’t be worried about rupture.
Pain is protective as it causes unloading of a tendon. In fact most people who rupture a tendon have never had pain and do not present clinically, despite the tendon having substantial pathology.13
10. Don’t rush rehabilitation.
Tendon needs time to build its strength and capacity. So does the muscle, the kinetic chain and the brain. Although this can be a substantial time (3 months or more), the long-term outcomes are good if the correct rehabilitation is completed.14
The above 10 treatment approaches take valuable resources and focus away from the best treatment for tendon pain—exer- cise-based rehabilitation. A progressive programme that starts with a muscle strength programme and then progresses through to more spring-like exercises and including endurance aspects will load the tendon correctly and give the best long- term results.
By Vanessa Service, Physiotherapist
What does my vestibular system do?
Your vestibular system’s job is to process sensory information that is required to control balance and eye movements. This means that information from the inner ear, the visual system, and from the muscles and joints is analysed by the brain. Integrating this information allows you to1:
– Maintain clear sight while you move your head,
– Figure out the orientation of your head in space in relation to gravity,
– Identify how fast and in which direction your are moving, and
– Make fast and automatic adjustments to your posture so you can maintain balance (stay in your desired position).
In other words, your vestibular system coordinates your movement with your balance, allowing you to navigate through and adapt to the world. It is this process that allows you to walk down the sidewalk, to step off a curb, to sit down and stand up again and to turn your head while walking. Anytime your head moves through space you’re depending on your vestibular system.
What are vestibular disorders and what are the symptoms?
If the vestibular system encounters disease or injury, such as a viral infection or head trauma, the result may be a vestibular disorder. However, aging, some medications, and genetic or environmental factors may also cause vestibular conditions.
Symptoms of damage to the vestibular system may include:
– Vertigo (a sense of the world spinning around you)
– Dizziness (feeling lightheaded or floating/rocking in space)
– Imbalance and special disorientation (stumbling, staggering, drifting to one side while walking)
– Difficulty with changes in walking surfaces
– Tinnitus (ringing or buzzing in the ears)
– Discomfort in busy visual environments (such as the grocery store) or when looking at screens/television
Examples of vestibular disorders include:
- Benign paroxysmal positional vertigo or BPPV (a common condition where loose debris or “crystals” collect in a part of the inner ear)
- Vestibular neuritis or labyrinthitis.
- Migraine associated vertigo
- Endolymphatic hydrops
- Acoustic neuroma
- Meniere’s disease
How can a vestibular physiotherapist help?
The effect of a vestibular condition on a person’s life can be profound. Dizziness and balance problems are often a barrier to activities of daily living, to independence, and to engaging with the community. This negative impact on daily function and socialization may also contribute to anxiety and depression. As such, appropriate management of vestibular conditions is an essential component to improving quality of life for individuals and families affected by vestibular disorders.
A vestibular therapist will interview you about the history of your symptoms and perform a series of vestibular, balance, and visual tests. Treatment will depend on what is found in the assessment. For example, if you are diagnosed with BPPV, your therapist will perform a manoeuvre to reposition the associated crystals. Other vestibular disorders are treated with specific exercises and strategies that your vestibular therapist will teach you and help you progress through to reach your specific goals.
Although for most people a vestibular disorder is permanent, an exercise based plan can be designed to reduce dizziness, vertigo, and balance and gaze stability problems1. This is made possible by your brain’s incredible ability to adapt its other systems in order to effectively compensate for an improperly functioning vestibular system. Vestibular rehabilitation is a non-invasive and drug free intervention that helps to promote and maximize the amount of compensation that occurs. Current research supports the use of vestibular rehabilitation in the management of vestibular conditions2, demonstrating reduced dizziness, balance issues, and increased independence with regard to activities of daily living 3. Additionally, no adverse effects associated with vestibular rehabilitation have been reported2. As such, vestibular rehabilitation can provide a pathway to improved quality of life for those living with a vestibular condition.
1. About Vestibular Disorders (n.d) Retrieved from https://vestibular.org/understanding-vestibular-disorder
2. Hillier SL et al., Vestibular rehabilitation for unilateral peripheral vestibular dysfunction, Cochrane Database of Systematic Reviews 3, 2011.
3. Cohen HS, Kimball KT Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 2003 Jan;128(1):60-70
Physical Therapist’s Guide to Knee Pain
Knee pain can be caused by disease or injury. The most common disease affecting the knee is osteoarthritis. Knee injuries can occur as the result of a direct blow or sudden movement that strains the knee beyond its normal range of movement. Knee pain caused by an injury is most often associated with knee cartilage tears, such as meniscal tears, or ligament tears, such as anterior cruciate ligament tears.
What is Knee Pain?
Knee pain can be caused by disease or injury. Knee pain can restrict movement, affect muscle control in the sore leg, and reduce the strength and endurance of the muscles that support the knee.
The most common disease affecting the knee is osteoarthritis, which is caused by the cartilage in the knee gradually wearing away, resulting in pain and swelling.
Knee injuries can occur as the result of a direct blow or sudden movement that strains the knee beyond its normal range of motion, as can happen in sports, recreational activities, a fall, or a motor vehicle accident. Knee pain caused by an injury often is associated with tears in the knee cartilage or ligaments. Knee pain also can be the result of repeated stress, as often occurs with the kneecap, also known as patellofemoral pain syndrome. Very rarely, with extreme trauma, a bone may break at the knee.
How Does it Feel?
You may feel knee pain in different parts of your knee joint, depending on the problem affecting you. Identifying the location of your pain can help your physical therapist determine its cause.
How Is It Diagnosed?
Your physical therapist will make a diagnosis based on your symptoms, medical history, and a thorough examination. X-ray and magnetic resonance imaging (MRI) results may also be used to complete the diagnosis.
To help diagnose your condition, your physical therapist may ask you questions like these:
•Where exactly on your knee is the pain?
•Did you twist your knee?
•Did you feel a “tearing” sensation at the time of injury?
•Do you notice swelling?
•Have you ever felt like your knee joint is “catching,” or “locking,” or will give way?
•Do you have difficulty walking up and down stairs?
•Do you have difficulty sitting with your knee bent for long periods, as on an airplane or at the movies?
•Does your pain increase when you straighten or bend your knee?
•Does your knee hurt if you have to twist or turn quickly?
The physical therapist will perform tests to find out whether you have:
•Pain or discomfort with bending or straightening your knee
•Tenderness at the knee joint
•Limited motion in your knee
•Weakness in the muscles around your knee
•Difficulty putting weight on your knee when standing or walking
The physical therapist also is concerned about how well you are able to use your injured knee in daily life. To assess this, the therapist may use such tests as a single-limb hop test, a 6-minute walk test, or a timed up and go test.
How Can a Physical Therapist Help?
Based on the evaluation, your physical therapist will develop a customized rehabilitation program, including a specific set of knee exercises, for you.
If you already have knee problems, your physical therapist can help with a plan of exercise that will strengthen your knee without increasing the risk of injury or further damage. As a general rule, you should choose gentle exercises such as swimming, aquatic exercise, or walking rather than jarring exercises such as jogging or high-impact aerobics.
Consult your physical therapist about specific ways to maintain your knee health following injury or surgery. Your physical therapist has the relevant educational background and expertise to evaluate your knee health and to refer you to another health care provider if necessary.
Depending on the severity of your knee problem, your age, and your lifestyle, the therapist may select such treatments as:
Strength training and functional exercises, which are designed to increase strength, endurance, and function of your leg muscles (quadriceps and hamstrings). This in turn helps support the knee and reduce stress to the knee joint.
Your physical therapist can determine just how much you may need to limit physical activity involving the affected knee. He or she also can gauge your knee’s progress in function during your rehabilitation.
How Can a Physical Therapist Help Before & After Surgery?
Your physical therapist, in consultation with your surgeon, will be able to tell you how much activity you can do depending on the type of knee surgery (such as total knee replacement) you undergo. Your therapist and surgeon also might have you participate in physical therapy prior to surgery to increase your strength and motion. This can sometimes help with recovery after surgery.
Following surgery, your physical therapist will design a personalized rehabilitation program for you and help you gain the strength, movement, and endurance you need to return to performing the daily activities you did before.
Can this Injury or Condition be Prevented?
Ideally, everyone should regularly get 3 types of exercise to prevent injury to all parts of the body, including the knees:
•Range-of-motion exercises to help maintain normal joint movement and relieve stiffness.
•Strengthening exercises to keep or increase muscle strength.
•Aerobic or endurance exercises (such as walking or swimming) to improve function of the heart and circulation and to help control weight. Weight control can be important to people who have arthritis because extra weight puts pressure on many joints, including the knee.
To keep knee pain and other musculoskeletal pain at bay, it’s important to maintain an overall healthy lifestyle, exercise, get adequate rest, and eat healthy foods. It’s also important for runners and other athletes to perform physical therapist-approved stretching and warm-up exercises on a daily basis—especially before beginning physical activity.
Real Life Experiences
At age 56, Monica was in very good health—eating right, maintaining her weight, and exercising daily at home. One day she fell off her exercise equipment and twisted her knee. The pain was excruciating. Even though she could walk short distances, using her sore leg during her daily activities soon became impossible. Monica made an appointment with her physical therapist. The therapist reviewed her medical history, conducted a thorough examination, and consulted with Monica’s physician regarding the need for a series of X-rays to ensure no bones were broken in the fall.
Consultation with an orthopedic surgeon confirmed that there were no broken bones and no need for surgery. Monica’s physical therapist developed a program of strength training and functional exercises to increase her hip, knee, and ankle muscle strength and endurance. The physical therapist also recommended electrical stimulation of the knee to increase her quadriceps (thigh) muscle strength.
By following the physical therapist’s regimen, Monica decreased her knee pain, and her mobility improved dramatically. Regular ongoing strength-training knee exercises—and more careful use of her exercise equipment—have helped Monica remain free of knee pain.
What Kind of Physical Therapist Do I Need?
Although all physical therapists are prepared through education and experience to treat people with knee pain, you may want to consider:
•A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems
•A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship FCAMPT in orthopedic physical therapy, giving the therapist advanced knowledge, experience, and skills that may apply to your condition
General tips when you’re looking for a physiotherapist:
•Get recommendations from family and friends or from other health care providers.
•When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people with TKR.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.