Post by Tim Wescott on Jan 20, 2005 21:00:31 GMT -5
Prevention Management:Weight Training Injuries:
By: Dr. Clay Hyght
All too often, weight training and chronic injuries go hand in hand. That doesn’t necessarily have to be the case. As a competitive bodybuilder I have suffered from most of these injuries and know how debilitating and frustrating they can be.
Fortunately, as a doctor who treats these types of injuries, I know how to alleviate and prevent the same injuries. If you’ll read the next few pages, I’ll share with you the basics of three of the most common chronic injuries that occur in the gym, how to work around them, and most importantly, how to avoid them.
Shoulder Injuries
The most common injury that I see among men around the gym is shoulder impingement syndrome.
If you’ve ever felt pain in your shoulder when pressing overhead, you may very well suffer from shoulder impingement syndrome. This malady can make bench presses, lateral raises, and shoulder presses next to impossible.
Don’t make the problem worse by ignoring it and thinking it will go away on its own. Worse yet, some lifters think that shoulder pain is just part of training. It doesn’t have to be. Whatever you do, do not ignore shoulder pain. Doing so can result in bone spurs and a torn rotator cuff. Yes, my friends, that means surgery.
Correct & Incorrect Form Of The Barbell Shoulder Press.
Impingement syndrome is defined as a compromise of the space between the head of the humerus and the acromial arch. In simple terms: the top of your upper arm bone is too high and close to your acromion (part of the shoulder blade—scapula) and your clavicle (collarbone).
This decrease in space can come from either a structural problem (usually bone) or a functional problem (usually muscular). Since a structural problem would likely show up as soon as someone begins lifting weights, we’ll focus on functional causes of impingement, which are most likely, the culprit in the gym.
When you raise your arm, a complex chain of events takes place. A group of muscles called the scapular stabilizers (serratus, trapezius, levator scapulae, rhomboids, and teres major) function in a very precise manner to ensure that the scapula is in the right place at the right time. At the same time, the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) finely coordinate the movement of the humerus to ensure proper alignment in relation to the scapula.
If these muscles do not coordinate this movement perfectly, the head of the humerus is likely to rise up and forward and bump into the bottom of the acromion. (To feel the top of your acromion, slide your fingers from the middle of your collarbone outward toward your deltoid. Just before getting to your deltoid you will feel the top of your acromion sticking up a bit.)
When this impingement occurs, the supraspinatus muscle and tendon, as well as the subacromial bursa, are trapped between the humerus and the acromion. When two soft structures are trapped between two bony structures, you can guess who loses. This results in swelling and tenderness of this bursa (bursitis) and the supraspinatus muscle and tendon (tendinitis).
Working Around Shoulder Injuries
Although I don’t feel that doing barbell bench presses is often the cause of shoulder impingement syndrome, it does seem to exacerbate the condition once you have it.
Therefore I would avoid BB benches if your shoulder is less than perfect. Dumbbell presses and incline presses, on the other hand, seem to be well tolerated among most everyone. In addition, performing lateral raises to the point where your arm is parallel to the floor (or above) can aggravate a shoulder problem.
Try taking your laterals only up to the point where your arm is about 15–30 degrees below horizontal. Better yet, try scaption instead. Scaption is essentially where you raise the dumbbells up in a plane halfway between lateral raises and front raises.
Personally, when I’m having a shoulder flare-up, my only shoulder exercise will be scaption. It feels safe, stable, and really hits both the anterior and medial heads of the deltoid very well.
Preventing Shoulder Injuries
To avoid impingement syndrome and other shoulder maladies, there are a couple of exercises that you should avoid altogether.
Exercises To Avoid:
Behind the neck pulldowns
Behind the neck shoulder presses
Both of these exercises are favorites among many bodybuilders because of the manner in which they stimulate the working muscles.
Regardless, if they lead to injury and time away from the gym, then their benefits are more than negated by their side effects. As opposed to doing pulldowns behind the neck, do them to the front. A recent EMG study shows that pulling the bar to the front actually stimulates the Latissimus Dorsi (lats) better than pulling the bar behind the neck anyway.
Correct & Incorrect Form Of The Cable Pulldown.
In addition to shoulder problems, pulling the bar behind the neck can also cause neck problems due to the amount of neck flexion that you must do to get your head out of the way of the bar.
In addition, strengthening the external rotators (infraspinatus and teres minor) and scapular retractors (rhomboids and middle traps) along with stretching the internal rotators (chest, anterior delts, and lats) will go a long way in restoring normal biomechanics to the shoulder region. In a later issue of Reform™, I will cover the specifics of doing just that.
Knee Injury
Knee problems like patellar tracking problems and patellar tendinitis seem to be the Achilles heel to women trainees much like shoulder impingement syndrome is to men. An inherent problem lies in the fact that our hip joints are farther apart than our knee joints. In other words, our legs angle in. The angle is greater in women because they have wider hips than men, generally speaking, that is. Due to this inward angle, the patella (kneecap) has a tendency to be pulled laterally, or out to the side. This creates a problem because the patella is designed to track in a very precise groove when the knee flexes and extends.
Even the slightest lateral deviation can cause premature wear and tear on the cartilage that lies on the back of the kneecap. This is called a Patellar Tracking problem. If left untreated, the cartilage could advance to what is known as Chondromalacia—excessive wear of the cartilage.
Because a squat can subject the back of the kneecap to a force seven and a half times greater than your bodyweight, it’s easy to see why even the slightest problem with the extensor mechanism can cause a lot of damage. Pain with these injuries usually begins by hurting after an exercise session, then during the exercise session, and eventually all the time.
It may even progress to the point of clicking or popping, usually as a result of cartilage damage. People with this condition usually exhibit a positive theater sign, meaning they can’t sit with their knees flexed for too long without causing some pain. More often than not, this pain is typically rather vague and described by sufferers as “inside the knee” or “behind the kneecap.”
Another common chronic knee injury is Patellar Tendinitis, also called “jumper’s knee.” Someone who has pinpoint pain right at the base of the kneecap most likely suffers from this condition.
Patellar tendinitis is frequently a result of tight quadriceps, in addition to overuse. When the quads are chronically tight, they will pull excessively on the quadriceps tendon. Over time, this extra stress on the tendon will cause it to get inflamed.
As you may know, an inflamed tendon is called tendinitis, and, as I mentioned before, it will usually rear its ugly head just below the patella. Hence the name patellar tendinitis.
By: Dr. Clay Hyght
All too often, weight training and chronic injuries go hand in hand. That doesn’t necessarily have to be the case. As a competitive bodybuilder I have suffered from most of these injuries and know how debilitating and frustrating they can be.
Fortunately, as a doctor who treats these types of injuries, I know how to alleviate and prevent the same injuries. If you’ll read the next few pages, I’ll share with you the basics of three of the most common chronic injuries that occur in the gym, how to work around them, and most importantly, how to avoid them.
Shoulder Injuries
The most common injury that I see among men around the gym is shoulder impingement syndrome.
If you’ve ever felt pain in your shoulder when pressing overhead, you may very well suffer from shoulder impingement syndrome. This malady can make bench presses, lateral raises, and shoulder presses next to impossible.
Don’t make the problem worse by ignoring it and thinking it will go away on its own. Worse yet, some lifters think that shoulder pain is just part of training. It doesn’t have to be. Whatever you do, do not ignore shoulder pain. Doing so can result in bone spurs and a torn rotator cuff. Yes, my friends, that means surgery.
Correct & Incorrect Form Of The Barbell Shoulder Press.
Impingement syndrome is defined as a compromise of the space between the head of the humerus and the acromial arch. In simple terms: the top of your upper arm bone is too high and close to your acromion (part of the shoulder blade—scapula) and your clavicle (collarbone).
This decrease in space can come from either a structural problem (usually bone) or a functional problem (usually muscular). Since a structural problem would likely show up as soon as someone begins lifting weights, we’ll focus on functional causes of impingement, which are most likely, the culprit in the gym.
When you raise your arm, a complex chain of events takes place. A group of muscles called the scapular stabilizers (serratus, trapezius, levator scapulae, rhomboids, and teres major) function in a very precise manner to ensure that the scapula is in the right place at the right time. At the same time, the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) finely coordinate the movement of the humerus to ensure proper alignment in relation to the scapula.
If these muscles do not coordinate this movement perfectly, the head of the humerus is likely to rise up and forward and bump into the bottom of the acromion. (To feel the top of your acromion, slide your fingers from the middle of your collarbone outward toward your deltoid. Just before getting to your deltoid you will feel the top of your acromion sticking up a bit.)
When this impingement occurs, the supraspinatus muscle and tendon, as well as the subacromial bursa, are trapped between the humerus and the acromion. When two soft structures are trapped between two bony structures, you can guess who loses. This results in swelling and tenderness of this bursa (bursitis) and the supraspinatus muscle and tendon (tendinitis).
Working Around Shoulder Injuries
Although I don’t feel that doing barbell bench presses is often the cause of shoulder impingement syndrome, it does seem to exacerbate the condition once you have it.
Therefore I would avoid BB benches if your shoulder is less than perfect. Dumbbell presses and incline presses, on the other hand, seem to be well tolerated among most everyone. In addition, performing lateral raises to the point where your arm is parallel to the floor (or above) can aggravate a shoulder problem.
Try taking your laterals only up to the point where your arm is about 15–30 degrees below horizontal. Better yet, try scaption instead. Scaption is essentially where you raise the dumbbells up in a plane halfway between lateral raises and front raises.
Personally, when I’m having a shoulder flare-up, my only shoulder exercise will be scaption. It feels safe, stable, and really hits both the anterior and medial heads of the deltoid very well.
Preventing Shoulder Injuries
To avoid impingement syndrome and other shoulder maladies, there are a couple of exercises that you should avoid altogether.
Exercises To Avoid:
Behind the neck pulldowns
Behind the neck shoulder presses
Both of these exercises are favorites among many bodybuilders because of the manner in which they stimulate the working muscles.
Regardless, if they lead to injury and time away from the gym, then their benefits are more than negated by their side effects. As opposed to doing pulldowns behind the neck, do them to the front. A recent EMG study shows that pulling the bar to the front actually stimulates the Latissimus Dorsi (lats) better than pulling the bar behind the neck anyway.
Correct & Incorrect Form Of The Cable Pulldown.
In addition to shoulder problems, pulling the bar behind the neck can also cause neck problems due to the amount of neck flexion that you must do to get your head out of the way of the bar.
In addition, strengthening the external rotators (infraspinatus and teres minor) and scapular retractors (rhomboids and middle traps) along with stretching the internal rotators (chest, anterior delts, and lats) will go a long way in restoring normal biomechanics to the shoulder region. In a later issue of Reform™, I will cover the specifics of doing just that.
Knee Injury
Knee problems like patellar tracking problems and patellar tendinitis seem to be the Achilles heel to women trainees much like shoulder impingement syndrome is to men. An inherent problem lies in the fact that our hip joints are farther apart than our knee joints. In other words, our legs angle in. The angle is greater in women because they have wider hips than men, generally speaking, that is. Due to this inward angle, the patella (kneecap) has a tendency to be pulled laterally, or out to the side. This creates a problem because the patella is designed to track in a very precise groove when the knee flexes and extends.
Even the slightest lateral deviation can cause premature wear and tear on the cartilage that lies on the back of the kneecap. This is called a Patellar Tracking problem. If left untreated, the cartilage could advance to what is known as Chondromalacia—excessive wear of the cartilage.
Because a squat can subject the back of the kneecap to a force seven and a half times greater than your bodyweight, it’s easy to see why even the slightest problem with the extensor mechanism can cause a lot of damage. Pain with these injuries usually begins by hurting after an exercise session, then during the exercise session, and eventually all the time.
It may even progress to the point of clicking or popping, usually as a result of cartilage damage. People with this condition usually exhibit a positive theater sign, meaning they can’t sit with their knees flexed for too long without causing some pain. More often than not, this pain is typically rather vague and described by sufferers as “inside the knee” or “behind the kneecap.”
Another common chronic knee injury is Patellar Tendinitis, also called “jumper’s knee.” Someone who has pinpoint pain right at the base of the kneecap most likely suffers from this condition.
Patellar tendinitis is frequently a result of tight quadriceps, in addition to overuse. When the quads are chronically tight, they will pull excessively on the quadriceps tendon. Over time, this extra stress on the tendon will cause it to get inflamed.
As you may know, an inflamed tendon is called tendinitis, and, as I mentioned before, it will usually rear its ugly head just below the patella. Hence the name patellar tendinitis.
