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.
A Physiotherapist’s Guide to Osteoarthritis
“Arthritis” is a term used to describe inflammation of the joints. Osteoarthritis (OA) is the most common form of arthritis and usually is caused by the deterioration of a joint. Typically, the weight-bearing joints are affected, with the knee and the hip being the most common.
An estimated 27 million Americans have some form of OA. According to the Centers for Disease Control and Prevention, 1 in 2 people in the United States may develop knee OA by age 85, and 1 in 4 may develop hip OA in their lifetime. Until age 50, men and women are equally affected by OA; after age 50, women are affected more than men. Over their lifetimes, 21% of overweight and 31% of obese adults are diagnosed with arthritis.
OA affects daily activity and is the most common cause of disability in the US adult population. Although OA does not always require surgery, such as a joint replacement, it has been estimated that the use of total joint replacement in the United States will increase 174% for hips and 673% for knees by 2030.
Physical therapists can help patients understand OA and its complications, and provide treatments to lessen pain and improve movement. Additionally, physical therapists can provide information about healthy lifestyle choices and obesity education. This is important because some research shows that weight loss can reduce the chance of getting OA. One study showed that an 11-pound weight loss reduced the risk of OA in women.
What is Osteoarthritis?
Your bones are connected at joints such as the hip and knee. A rubbery substance called cartilage coats the bones at these joints and helps reduce friction when you move. A protective oily substance called synovial fluid is also contained within the joint, helping to ease movement. When these protective coverings break down, the bones begin to rub together during movement. This can cause pain, and the process itself can lead to more damage in the remaining cartilage and the bones themselves.
The cause of OA is unknown. Current research points to aging as the main cause. Factors that may increase your risk for OA include:
•Age. Growing older increases your risk for developing OA because of the amount of time you’ve used your joints.
•Genetics. Research indicates that some people’s bodies have difficulty forming cartilage. Individuals can pass this problem on to their children.
•Past Injury. Individuals with prior injury to a specific joint, especially a weight-bearing joint (such as the hip or knee), are at increased risk for developing OA.
•Occupation. Jobs that require repetitive squatting, bending, and twisting are risk factors for OA. People who perform jobs that require prolonged kneeling (miners, flooring specialists) are at high risk for developing OA.
•Sports. Athletes who repeatedly use a specific joint in extreme ways (pitchers, football linemen, ballet dancers) may increase their risk for developing OA later in life.
•Obesity. Being overweight causes increased stress to the weight-bearing joints (such as knees), increasing the risk for development of OA.
How Does it Feel?
Typically, OA causes pain and stiffness in the joint. Common symptoms include:
•Stiffness in the joint, especially in the morning, which eases in less than 30 minutes
•Stiffness in the joint after sitting or lying down for long periods
•Pain during activity that is relieved by rest
•Cracking, creaking, crunching, or other types of joint noise
•Pain when you press on the joint
•Increased bone growth around the joint that you may be able to feel
Caution: Swelling and warmth around the joint is not usually seen with OA and may indicate a different condition or signs of an inflammation. Please consult with your doctor if you have swelling, redness, and warmth in the joint.
How Is It Diagnosed?
Osteoarthritis is typically diagnosed by your doctor using an x-ray, but there are signs that may lead your physical therapist to suspect you have OA. Joint stiffness, difficulty moving, joint creaking or cracking, and pain that is relieved with rest are typical symptoms.
How Can a Physical Therapist Help?
Your physical therapist can effectively treat OA. Depending on how severe the OA is, physical therapy may help you avoid surgery. Although the symptoms and progression of OA are different for each person, starting an individualized exercise program and addressing risk factors can help relieve your symptoms and slow the condition’s advance. Here are a few ways your physical therapist can help:
•Your therapist will do a thorough examination to determine your symptoms and what activities are difficult for you. He or she will design an exercise program to address those activities and improve your movement.
•Your therapist may use manual (hands-on) therapy to improve movement of the affected joint.
•Your physical therapist may offer suggestions for adjusting your work area to lessen the strain on your joints.
•Your physical therapist can teach you an aerobic exercise program to improve your movement and overall health, and offer instructions for continuing the program at home.
•If you are overweight, your physical therapist can teach you an exercise program for safe weight loss, and recommend simple lifestyle changes that will help keep the weight off.
In cases of severe OA that are not helped by physical therapy alone, surgery, such as a knee or hip replacement, may be necessary. Your physical therapist will refer you to an orthopedic surgeon to discuss the possibility of surgery.
Can this Injury or Condition be Prevented?
The best way to prevent or slow the onset of OA is to choose a healthy lifestyle, avoid obesity, and participate in regular exercise.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of hip osteoarthritis and hip replacement. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Centers for Disease Control and Prevention. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation: United States, 2007-2009. Published October 8, 2010. Accessed March 11, 2013. Free Article.
Murphy LB, Helmick CG, Schwartz TA, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage. 2010;18:1372–1379. Free Article.
Cibulka MT, White DM, Woehrle J, et al. Hip pain and mobility deficits—hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2009;39:A1–A25. Free Article.
Murphy L, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59:1207–1213. Free Article.
Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785. Article Summary in PubMed.
Deyle GD, Allison SC, Matekel RL, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005;85:1301–1317. Free Article.
Authored by Christopher Bise, PT, MS, DPT. Reviewed by the MoveForwardPT.com editorial board.
The Role of Physical Therapy
Physical therapy with a trained professional may be useful if pain has not improved after 3 – 4 weeks. It is important for any person who has chronic low back pain to have an exercise program. Professionals who understand the limitations and special needs of back pain, and can address individual health conditions, should guide this program. One study indicated that patients who planned their own exercise program did worse than those in physical therapy or doctor-directed programs.
Physical therapy typically includes the following:
Education and training the patient in correct movement.
Exercises to help the patient keep the spine in neutral positions during all daily activities.
Incorrect movements or long-term high-impact exercise is often a cause of back pain in the first place. People vulnerable to back pain should avoid activities that put undue stress on the lower back or require sudden twisting movements, such as football, golf, ballet, and weight lifting.
Exercises performed after a simple diskectomy do not seem to provide much added benefit over time.
Specific and regular exercise under the guidance of a trained professional is important for reducing pain and improving function, although patients often find it difficult to maintain therapy.
Exercise and Acute or Subacute Back Pain
Exercise does not help acute back pain. In fact, overexertion may cause further harm. Beginning after 4 – 8 weeks of pain, however, a rehabilitation program may benefit the patient.
An incremental aerobic exercise program (such as walking, stationary biking, and swimming) may begin within 2 weeks of symptoms. Jogging is usually not recommended, at least not until the pain is gone and muscles are stronger.
Patients should avoid exercises that put the lower back under pressure until the back muscles are well toned. Such exercises include leg lifts done in a facedown position, straight leg sit-ups, and leg curls using exercise equipment.
In all cases, patients should never force themselves to exercise if, by doing so, the pain increases.
Exercise and Chronic Back Pain
Exercise plays a very beneficial role in chronic back pain. Repetition is the key to increasing flexibility, building endurance, and strengthening the specific muscles needed to support and neutralize the spine. Exercise should be considered as part of a broader program to return to normal home, work, and social activities. In this way, the positive benefits of exercise not only affect strength and flexibility but also alter and improve patients’ attitudes toward their disability and pain. Exercise may also be effective when combined with a psychological and motivational program, such as cognitive-behavioral therapy.
There are different types of back pain exercises. Stretching exercises work best for reducing pain, while strengthening exercises are best for improving function.
Exercises for back pain include:
Low Impact Aerobic Exercises. Low-impact aerobic exercises, such as swimming, bicycling, and walking can strengthen muscles in the abdomen and back without over-straining the back. Programs that use strengthening exercises while swimming may be a particularly beneficial approach for many patients with back pain. Medical research has shown that pregnant women who engaged in a water gymnastics program have less back pain and are able to continue working longer.
Spine Stabilization and Strength Training. Exercises called lumbar extension strength training are proving to be effective. Generally, these exercises attempt to strengthen the abdomen, improve lower back mobility, strength, and endurance, and enhance flexibility in the hip, the hamstring muscles, and the tendons at the back of the thigh.
Yoga, Tai Chi, Chi Kung. Practices originating in Asia that combine low-impact physical movements and meditation may be very helpful. They are designed to achieve a physical and mental balance and can be very helpful in preventing recurrences of low back pain.
Flexibility Exercises. Flexibility exercises may help reduce pain. A stretching program may work best when combined with strengthening exercises.
Specific Exercises for Low Back Strength
Perform the following exercises at least three times a week:
Partial Sit-ups. Partial sit-ups or crunches strengthen the abdominal muscles.
Keep the knees bent and the lower back flat on the floor while raising the shoulders up 3 – 6 inches.
Exhale on the way up, and inhale on the way down.
Perform this exercise slowly 8 – 10 times with the arms across the chest.
Pelvic Tilt. The pelvic tilt alleviates tight or fatigued lower back muscles.
Lie on the back with the knees bent and feet flat on the floor.
Tighten the buttocks and abdomen so that they tip up slightly.
Press the lower back to the floor, hold for one second, and then relax.
Be sure to breathe evenly.
Over time increase this exercise until it is held for 5 seconds. Then, extend the legs a little more so that the feet are further away from the body and try it again.
Stretching Lower-Back Muscles. The following are three exercises for stretching the lower back:
Lie on the back with knees bent and legs together. Keeping arms at the sides, slowly roll the knees over to one side until totally relaxed. Hold this position for about 20 seconds (while breathing evenly) and then repeat on the other side.
Lying on the back, hold one knee and pull it gently toward the chest. Hold for 20 seconds. Repeat with the other knee.
While supported on hands and knees, lift and straighten right hand and left leg at the same time. Hold for 3 seconds while tightening the abdominal muscles. The back should be straight. Alternate with the other arm and leg and repeat on each side 8 – 20 times.
Note: No one with low back pain should perform exercises that require bending over right after getting up in the morning. At that time, the disks are more fluid-filled and more vulnerable to pressure from this movement.
Some common spinal injuries and conditions we treat:
Acute lower back (lumbar) pain due to spinal disc and/or facet joint injuries
Chronic low back (lumbar) pain
Sciatica – referred pain and symptoms into the lower limb
Pelvic dysfunction syndromes . Often diagnosed in patients who feel ‘out’.
Childbirth related instability and acute pain syndromes of the lower back and pelvis.
Spondylolisthesis (forward slip of one vertebrae on the vertebrae directly below it)
Spondylosis (disc space narrowing combined with degenerative changes in the facet joints common with age)
Acute neck pain due to facet joint and/or spinal disc injury
Chronic neck pain
Brachialgia-referred pain and symptoms into the arm, ‘pinched nerve’ pain and/or pins and needles/numbness (known as paraesthesia)
Mid-back (thoracic) and rib (costovertebral joint) pain (which, in some cases, refer pain around the chest wall)
Acute/chronic (myofascial) trigger point conditions. (These are tender and hypersensitive coin sized zones within the muscle tissue that can cause local pain and tightness and can also refer to distant sites.)
Muscle and joint stiffness
Causes of Spinal Pain
Acute and chronic spinal pain is experienced due to the stimulation, via mechanical or chemical irritation, of small nerve endings, nerve root or spinal cord sheaths, nerve cords, complex pain mechanisms in the central nervous system or a combination of the above.
Acute Spinal Pain
This can involve findings of bulging disc, disc protrusion or disc prolapse/rupture. Disc problems are very common in the lower back (lumbar spine). They are often associated with episodes of bending, bend with twist or prolonged sitting /driving which distorts the rim of the disc causing acute pain. In addition it can produce pressure on the spinal nerves in the lower back which produce symptoms known as sciatica. This is felt as pain, pins and needles sensation, numbness and/or weakness in the leg(s). In the neck (cervical spine), disc injuries can cause debilitating pain into the neck and commonly severe pain into the arm called brachialgia due to compression of the spinal nerves in the neck. This is commonly referred to as ‘pinched nerve’.
These joints are small joints which flank the disc on either side and behind the spinal discs. They are like a finger joint in their structure and when injured swell and inflame and cause acute pain and restriction of movement. They can be sprained in an injury or activities involving twisting, arching and reaching upward movements. In the neck they can become overstrained by an awkward night’s sleep leading to a condition known as ‘Acute Wry Neck’. They can cause local pain and also refer pain to neighbouring and even distant sites.
The joints of the pelvis can suffer acute injuries through high force trauma such as motor vehicle/bicycle accidents, contact sports, slips and falls on to the ground/floor, landing from a height, or when the female pelvis is vulnerable before and after childbirth. Injury and acute instability syndromes can occur which involve the sacroiliac and pubic joints. Lumbo-pelvic dysfunction conditions are common in the sporting population. Muscle imbalance, asymmetrical posture and structural alignment, as well as poor activation and stabilising strength (core control) can create syndromes such as chronic back pain, Osteitis Pubis (OP), recurrent hamstring strains, and contribute to a range of soft tissue injuries/conditions in the lower body.
This refers to the soft tissue layer involving the muscles, tendons and fascial tissues. This can be injured acutely and cause local pain at the site of injury but can also be responsible for ache and pain at distant sites. Myofascial pain is often associated with damage to deeper joint structures, namely disc and facet joints as either a primary (injured tissue) and/or secondary (protective spasm) component of the acute injury.