Training without Injury by Timothy Fritz - Men's Fitness
Author/s: Timothy C. Fritz
Training smart is more than building the most muscle in the least time.
It's eating right, hydrating properly and getting enough rest. Most
important, and most often overlooked, training smart means protecting
yourself from injuries that can compromise your ability to work out
or sideline you completely.
You're probably careful to avoid acute injuries at the gym--dropping
weights on your foot, walking into mirrors, etc.--but you may be unaware
of the potential for chronic injuries. Bothered by a sore shoulder that's
gradually deteriorating or a weak knee that gets a little better only
to get a little worse? Chronic injuries tend to develop slowly. This
makes them harder to anticipate, but it also makes them easier to prevent.
With a little preparation, you can significantly reduce their likelihood
as well as their severity.
Chronic injuries typically develop from overuse and recurrence. The
initial stress is insufficient to cause detectable harm, but over time
the damage builds to the point of pain and discomfort. Overuse injuries
go by a number of names, including repetitive stress injury, repetitive
stress syndrome or cumulative trauma disorder.
"Those are all terms for overload injuries to tissue, whether it's
overload to muscle or overload to bone or some connective tissue around
the muscle or joint," says Edward R. Laskowski, M.D., co-director
of the Mayo Clinic Sports Medicine Center in Rochester, Minn. Such problems
are a common hazard of the workplace, especially among typists, factory
workers and others forced to repeat the same task for hours on end.
Carpal tunnel syndrome is the most familiar example.
In their simplest form, repetitive stress injuries in the gym are caused
by a drastic increase in exercise intensity, duration or frequency.
This is often seen in weekend warriors or in newbies just starting a
sport or training regimen. Despite good intentions, they risk eventually
getting up close and personal with an ice bag, an orthopedist or both.
When beginning a new workout, follow these guidelines:
* Start slow and gradually add extra weight, reps or time.
* Never increase intensity or duration more than 10 percent from one
week to the next.
* Allow at least a 24-hour break between activities involving the same
* Depending on the intensity, up to 72 hours' rest may be needed.
OVERUSED AND ABUSED
As many as half of all exercise injuries result from overuse, reports
Clinics in Medical Science. But it's not always an overly ambitious
workout that gets you into trouble. The difference between pushing yourself
and pushing yourself too far may lie in other factors, such as technique,
muscle imbalance, anatomical factors, or equipment.
* "Technique is so key--I can't overemphasize it," Laskowski
says. "One of the most common reasons for [injury] in the gym is
faulty technique. That's when you get a buildup of microtrauma and strain
over time, which can lead to a problem. If you're doing moves the right
way, that's going to alleviate most of the problem."
* Imbalance occurs in joints when opposing muscles--the quads and hamstrings
for the knee, the triceps and biceps for the elbow--aren't developed
evenly. When one group gets trained significantly more than its antagonist,
the resulting imbalance can cause undue joint strain.
* The same is true of a muscle that is too tight or too lax. Either
condition changes the mechanics of the joint and the way the muscles
move it. Tight muscles are more prevalent, underscoring the importance
of warming up, cooling down and stretching daily.
* Outerwear has a big impact on inner wear and tear. The right running
shoe, for example, provides support for flat feet or high arches, while
the wrong shoe only exacerbates existing problems.
To minimize injuries, check out "Avoiding the Danger Zone"
on page 82 (also read Fast Track's "Perfect Form" in every
issue of MEN'S FITNESS). If you're still uncertain--or if you need special
instruction or equipment due to your body's proportions or alignment--consider
hiring a certified personal trainer to individualize your workout program.
GET SOME RELIEF
Be sure to warm up, progress slowly and use strict form. You can avoid
potential trouble in the early stages by paying close attention to any
signs of fatigue or distress. If you detect an unfamiliar ache or pain,
rest is the best cure. Ice and anti-inflammatory medications (e.g.,
ibuprofen) will reduce swelling and pain.
If an injury is unresponsive or lingers, visit a sports-medicine specialist.
"If the problem persists more than two months, go to an orthopedic
doctor and get checked out," says Marc J. Friedman, M.D., a founding
partner of the Southern California Orthopedic Institute in Van Nuys,
Calif. "You may want to get an MRI to make sure you don't have
a full-thickness tear."
A minor tear will heal over time given adequate rest, but a full tear
will only get worse, causing a decrease in performance and degradation
of the injured tendon. "More often than not, an injury can be addressed
nonoperatively," says Laskowski. "But if the tissue's been
compromised to the point that you've torn your rotator cuff or something
like that, then surgery may be necessary."
Assuming surgery is not required, your physician will likely prescribe
some combination of rest, ice, drugs and therapy. Medication normally
consists of anti-inflammatories but may include steroids, such as a
cortisone injection. Therapy generally entails exercises for flexibility
as well as muscle strength and balance, and often involves ultrasound
or similar modalities. Physical therapists may recommend elbow or knee
braces, shoe orthotics, heel lifts or other devices to speed recovery
and correct mechanical deficiencies.
AN OUNCE OF PREVENTION
A little common sense goes a long way toward reining in repetitive strain.
If your muscles are tired or sore, chances are your body needs rest.
A short break or a decrease in training volume can help fend off many
injuries. If problems persist, seek the appropriate medical attention.
Laskowski believes that the foundation for injury prevention happens
in the gym, not on the court or playing field. "Take the time beforehand
to do the appropriate flexibility and strength-training exercises specific
to your activity, rather than using your sport to get you in shape,"
he advises. "In other words, you shouldn't play your sport to be
in shape; you should be in shape to play your sport."
AVOIDING THE DANGER ZONE
If you want to train without injury, you have to be methodical and attentive.
"Be intelligent; be scientific," urges Van Nuys, Calif., orthopedist
Marc J. Friedman, M.D. "If it hurts every time you're on a machine,
guess what. You're using the machine wrong. Either you're doing too
many reps, or adding too much weight, or the angle of the treadmill
is not right, or your body position is off--something is wrong. So you've
got to analyze what's causing that."
If a particular exercise or movement causes pain, stop doing it. Find
out what the problem is so you can continue the activity minus the pain.
You may have to alter your training slightly or find a different exercise
to work the same muscle group, but it's worth the effort to be able
to train pain-free.
The following exercises can cause problems for some individuals. If
you're one of them, try the suggested modification.
1. Bench Press A common bench-press mistake is lowering the bar all
the way to the chest. A lot depends on your chest size and the length
of your arms, but as a general rule, you should stop when your elbows
reach the level of the bench. Going any farther puts too much stress
on your shoulder joint.
2. Cable Fly By itself, elbow movement away from the body puts a lot
of stress on the shoulder, so avoid dramatic jumps in reps or weight.
Doing flyes with too much weight or allowing your hands to pass behind
the front of your body can cause injury to a poorly trained shoulder
3. Lat Pull-Down To play it safe, perform lat pull-downs to the front.
Bringing the bar behind your head places additional stress on the shoulder
and cervical spine. When performing pull-downs to the front, keep your
head and chest up and focus on bringing the bar to your upper chest
and squeezing your shoulder blades together.
4. Overhead Press This exercise can overstress the shoulder, so if you
already have shoulder problems avoid overhead presses. If you choose
to perform overhead movements, keep the weights in line with your body,
never behind the head, and stop when your arms reach 90 degrees in the
5. Biceps Curl To protect yourself, and to work the right body part,
keep your wrists rigid when doing any curling movements. Excessive movement
at the wrist in either direction (flexion or extension) puts extreme
pressure on the tendons that attach near the elbow. In time, tendinitis
will likely develop.
6. Squat There's probably no better whole-body exercise than the squat,
but it can put a lot of stress on the knees. To reduce the forces at
the knee, your feet should be shoulder-width apart, toes painting straight
ahead; stop when your thighs are parallel to the floor. For most people,
the risks of going lower outweigh the benefits.
7. Knee Extension There are two potential causes of knee pain during
knee extensions: 1) foot movement and 2) hyperextension. Rotation of
the foot changes the position of the knee, leading to undue stress.
Make sure your feet are painting straight up, and don't rotate during
the exercise. If you experience pain at the end of the move, try stopping
just short of lockout.
8. Treadmill Running puts a lot of stress on your feet, ankles, knees
and back. The better treadmills absorb some of the impact, but big changes
in incline can cause ankle and knee pain. Keep elevation increases to
no more than a few degrees per week.
WHERE DOES IT HURT?
Overuse injuries present themselves in different ways. Broken bones,
torn tendons, ruptured muscles and the like are possible, but repetitive
strain tends to show up as less severe but equally disruptive ailments,
such as tendinitis, bursitis and stress fractures.
A sore, achy feeling is a common first indicator. The joint may be swollen,
tender or feel hot. Discomfort usually occurs during or immediately
after a particular movement, but as the condition worsens, pain may
arise at any time, even when you're asleep. The severity and frequency
of pain escalates as the injury progresses.
Other signs of injury include decreased strength, fatigue, tingling
or numbness; loss of joint mobility; and reduced coordination. In the
case of a stress fracture, pain is usually limited to the fractured
area and brought on by stress or impact to that region. In some cases,
sophisticated testing may be necessary for a proper diagnosis.
Tendinitis is the inflammation of the tendons, the tough, elastic bands
of connective tissue that attach muscle to bone. Repetitive trauma is
typically the cause.
Tendinitis of the shoulder, particularly the rotator cuff, is prevalent
among swimmers and athletes who perform repeated overhead motions. "Tennis
elbow" refers to tendinitis of the posterior (outside) elbow, typically
caused by bending the wrist backward (think backhand shots), while "golfer's
elbow" affects the anterior (inside) elbow, often as a result of
bending the wrist forward (think follow-through).
Runners often experience tendinitis of the knee (when overuse causes
the patella to move up and down outside its normal groove), the Achilles
tendon (due to uphill or downhill running, inadequate shoes, or biomechanical
errors) or the plantar fascia (caused by repetitive heel striking).
Bursitis is the inflammation of the bursae, which are fluid-filled sacs
strategically positioned to reduce friction throughout the body, particularly
in the joints. Bursitis is attributable to overuse, infection or arthritis.
"It's impossible to make the distinction between bursitis and tendinitis
without getting an MRI or doing an arthroscopy," says orthopedist
Marc J. Friedman, M.D. "Unless you can see the inflammation in
the bursae and/or the damage to the tendon, you can't really tell."
Stress fractures are partial fractures, often hairline cracks in the
bone, caused by repeated stress. They occur throughout the body, but
are most common in the lower extremities, mainly the tibia and fibula
bones of the ankle. Pain in the lower leg, especially from running,
can also be attributed to shinsplints.
"You have to make a distinction between shinsplints, that is, inflammation
of the muscles that attach to the inner aspect of the tibia, and an
actual fracture--a little crack," says Friedman. "You probably
can't see the stress fracture on an X-ray, so you have to get a bone
scan. The key is that stress fractures are usually unilateral, shinsplints
bilateral." (For more information, see the Prehab Workout, page
Tim Fritz is a freelance writer and certified strength and conditioning
specialist in southeast Florida.