You’ve resolved to get in shape, you’re going to the gym regularly, you’re on a roll — and then:
Rotator cuff tears! Ankle sprains! Herniated discs!
These are among the gym-related injuries that doctors, trainers and physical therapists see regularly.
“A lot of the time, soft tissue injuries happen when you progress too quickly — load too much, too soon,” says Justin Mullner, a sports medicine doctor and team physician for the soccer team D.C. United.
Adds Chris Estafanous, a physical therapist in Washington: “It’s great when people are excited about getting in shape — they want to get ripped or big fast. But it takes time to progress safely.”
Along with safe progressions (the most important aspect of staying healthy), an injury-free workout routine should include a warm-up and postural control drills as well as exercises that create a balance between strength and mobility.
Some gym-goers might forsake the warm-up because, well, they don’t have much time and warm-ups aren’t really a workout. True, but the body has a hard time adjusting when it goes from zero to 60, and on a muscular level, warming up is kind of like lubricating an engine. In other words, the soft tissue gets primed when the blood starts flowing, Mullner says.
He adds that as we age, our muscles and tendons become less responsive — meaning they might need longer warm-ups.
The warm-up doesn’t need to be anything fancy, just about 10 minutes of gradually increasing the heart rate and gently doing some dynamic stretching and range of motion exercises.
“Just get the blood flowing,” Mullner says.
Hand in hand: postural control and mobility are key
Another key component to staying injury-free is paying attention to postural control and developing enough body awareness that once an external load is added, you don’t change your posture, Estafanous said. So if the back needs to stay straight, you should know what that feels and looks like.
“Body mechanics are key in staying injury-free,” he adds.
For example, without the proper form in a hip hinge movement such as a deadlift — a very popular drill these days — gym-goers can suffer injuries such as herniated discs.
In other words, you have to develop good core strength (strong back muscles are essential in deadlifts) but also be cognizant of your form (maintaining a straight back) throughout the drill.
And maintaining that straight back in a hip hinge movement also entails open hamstrings, which most people, especially sedentary office workers, don’t have. Sitting keeps your hamstrings in a prolonged shortened state, your shoulders hunched and weak, your chest tight.
“Mobility can be just as important as stability and strength when it comes to maintaining good form,”
Estafanous said. “It’s all connected.”
American Council on Exercise Senior Adviser Sabrena Jo agrees and said that finding and maintaining good form takes a lot of body awareness — something that doesn’t happen easily for most people.
“What does it mean to have a neutral spine? What does full range of motion look like? What does it feel like to have the posture fixed in a certain position?,” Jo said. “It can really help to have a coach or trainer even just for a few sessions to help start things off the right way.”
In other words, you might have to spend a good deal of time working on opening up your hamstrings — more than you want or thought necessary. But it is only with the right mobility that you eventually will be able to load safely, Estafanous said.
Progressions: safe conditioning and strengthening
A common condition Mullner and Estafanous see is rotator cuff injuries, which can involve partial or full tears in one or more tendons (the soft tissue that connects muscles to bones) in the shoulder joint.
This condition is often caused by overhead presses with too much external load, said Estafanous.
Generally, when out-of-shape clients come in, they need one to two months to get back into basic fitness — meaning they will work at least three times a week on body-weight exercises, light resistance, high repetitions, conditioning of core and other stabilizing muscles, as well as some cardio fitness.
“It can take up to six months to a year to lift heavy,” Jo says. “Deadlifts, pull-ups, lat pull-downs — these are things that have to be earned.”
Estafanous cautions, though, that it’s not just lifting heavy that can put injury-inducing stress on the body.
Popular classes such as barre and body pump in which relatively light weights are used and high repetitions are performed can also cause problems, he said.
“If you’re doing 3,000 reps of something and you are doing it inappropriately, that can definitely cause problems,” he said.
Another benefit of having a trainer — especially if you are moving into heavier free weights — is to have someone with knowledge spot you, Jo said.
For example, if you are unable to control the barbell in a bench press and you don’t have a spotter, that weight might be headed right into your face.
“That would be an example of an acute gym-related injury. They are not as common as the overuse injuries, but they do happen,” Jo said.
Also among top gym-related injuries are ankle sprains and, to a lesser degree, Achilles’ injuries (more common in runners than general gym-goers), Mullner said.
Both injuries are excellent examples of how everything is connected in the body, he said.
A weak back and you can get rotator cuff issues, a weak core/hip section and you can get Achilles’ tendonopathy (tearing and inflammation of the Achilles’ tendon) and weak/sprained ankles, Mullner said. Tight IT (iliotibial) bands (soft tissue that runs down the outside of the thigh and helps stabilize the knee) can lead to knee pain.
To protect the ankles, “strengthening the glute medius and other muscles involved in hip abduction is one thing we can do,” Mullner said.
So when it comes to injury prevention, remember the big picture: warm-up, postural control, mobility, gradual progressions and balance among muscle groups. We have to connect the dots (hip to ankle, back to shoulder, outer thigh to knee) even though they might not always be readily apparent.