Injuries suck, but don’t let them keep you from training for too long. Some athletes find that injuries completely dull their motivation to compete in their sport altogether, especially if they’re required to be out of action. Other athletes may look on the bright side and see injuries as an opportunity to learn more about the sport as they prepare to come back stronger than ever. To find out what some of the most common weightlifting and running injuries are and how to best heal them, we enlisted the help of J. Christopher Mendler, M.D., a board-certified sports medicine physician and Medical Director for Holy Name Sports Medicine located in Oradell, NJ, and David Potach, P.T., C.S.C.S., CEO & Founder of Quest, and Board Certified Sports Physical Therapist.
“In general, while some injuries may require a period of complete rest or avoidance of the inciting activity, many injuries can be actively managed with appropriate modifications to the program, allowing athletes to continue to train, albeit differently than they may have been prior to injury,” says Mendler. “Common themes leading to injury include high training volumes, intensity, and frequency, but also subtle changes in form or technique that occur in a given set due to fatigue or a rushed super set.”
Avoid these eight workout injuries, and learn the best plan to heal them, with this essential guide to injury prevention and rehabilitation.
Mendler’s medical disclaimer: Any suggestions or general recommendations given below should be understood to come with the following basic disclaimer: “If you are not getting better or feel it is a bad situation, get it checked by a qualified health care provider.”
Potach’s general guidelines: For all identified exercises, ice is indicated for the early inflammatory phase (after 3-5 days, until the end of the second week) for pain, swelling, and active inflammation. Inflammation is important, so it shouldn’t be interfered with early on, but it eventually needs to go away. During later phases, ice only for pain and if swelling continues.
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Low Back Pain
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What is it?
Low back pain can result from a strain of the muscles surrounding the spine due to overuse, bulging or severely damages spinal discs, or a macrotraumatic injury to the disc. Mender says spinal fractures from weightlifting are uncommon but not unheard of, including a chronic form of stress fracture called spondylolysis, as well as an acute compression fracture of one of the vertebral bodies.
“A few of the risk factors for back injuries include position of the back during a weightlifting exercise, the amount the lifter can (or can’t) engage the entire core to support the back, pre-existing back issues, and daily habits unrelated to the gym,” says Mendler. “Jobs with prolonged sitting as well as jobs with heavy lifting can both pose risks to the lumbar spine.”
During a lift, if you’re using too much weight and your back rounds, you might’ve injured your back. Severe, unrelenting pain, inability to move the muscles of the legs, and trouble controlling bowel/bladder function, are indicators of an injury, Mender says. Pain running down the back of the thigh toward the lower leg often indicates irritation of the sciatic nerve, but could also be caused by a muscle spasm in the low back or glutes.
Recommendations: The inflammation phase (injury is stabilized) of all musculoskeletal injuries is 5-7 days, and during this time Potach suggests avoiding Romanian deadlifts (RDL), overhead squats, weighted squats, and all twisting motions. The repair (tissue formation begins) phase starts up to seven after the injury and can last up to two months. RDLs with light weight are OK during this phase, but avoid good mornings and Olympic lifts such as the hang/power clean. The remodeling phase (type 1 collagen production) can last anywhere from 2-4 months to a year, and Potach recommends adding the good morning exercise and slowly increasing weight with squats and integrating Olympic movements.
“Lifting with a well-positioned, neutral-posture spine goes a long way to minize the risks of low back injury,” Mendler adds.
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What is it?
The rotator cuff is often the problem in shoulder injuries, including impingement syndrome and glenoid labrum tears. Rotator cuff tendinopathy is a microtrauma/overuse injury which is typically caused by training programming errors, excessive weight progression, and improper form.
“If the rotator cuff is weak, fatigued, or simply not properly engaged, the upward pull of the deltoid will often pinch the supraspinatus (top portion of the cuff) up against the underside of the acromion (top part of the shoulder blade that meets up with the collar bone,” says Mendler. “This will often result in some swelling and inflammation of the tendon, possibly some swelling and inflammation of the subacromial bursa (little cushion-like structure between the cuff and acromion), and thereby put the squeeze on the supraspinatus while the shoulder is in motion, thus driving continued discomfort.”
For some lifters, the cuff may eventually begin to fray by this pinch and rub cycle, leading to degenerative tears or partial tears of the cuff, Mender adds.
Risk factors: “Consider the barbell overhead press: Though not recommended, it can be performed with the bar behind the head,” says Potach. “When this form is used, excessive stress is placed on anterior structures, like the supraspinatus.”
Mendler agrees to be careful while performing behind-the-neck military presses and other exercises where the arm is abducted and externally rotated.
Mendler suggests training the rotator cuff itself to minimize injury risk.
“The key is generally to train the rotator cuff with resistance below the level that will elicit too much work from the deltoid and pectoralis muscles,” Mendler says. “Also, don’t forget to work the scapular stabilizers: the trapezius and rhomboids.”
Potach’s plan to recovery
Inflammation phase: no pressing motions, upright row, or lateral raises. Lat pulldowns (to front of head) are usually OK.
Repair phase: begin pressing motions, but use underhand (supinated) grip and low weight. Avoid fly-type exercises.
Remodeling: no explosive exercises, begin non-pressing motions (e.g., lateral raise), transition to pressing motions. Upright row might still be problematic as it places the shoulder in an unnatural, impinged position at the top of the motion.
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KNEE PAIN/PATELLOFEMORAL SYNDROME
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What is it?
Knee patellofemoral syndrome is defined as generalized vague discomfort about the knee cap, says Mendler, and it’s often related to poor tracking of the patella in the trochlear groove (space between the two knuckles of the lower thigh bone).
“Patellofemoral pain can be further exacerbated by muscle imbalances, most frequently a relatively weak vastus medialis muscle, or notable imbalances (strength or flexibility) between the quadriceps and hamstrings,” Mendler says. “Patellar tendinitis, or more often patellar tendinosis, can be a plague for a weight-lifting athlete. The term tendinosis indicates chronicity and some degree of degenerative change within the tendon substance. The term tendinitis would imply inflammation, and a relatively short duration of symptoms (days to a few weeks).”
Tendinitis is an inflammation of a tension, and if left uncorrected can cause tendinosis or tendinopathy which are chronic/long-lasting conditions.
Using too heavy of a weight during compound barbell movements or doing too many reps during bodybuilding training is often a culprit for knee injuries. Improper knee position using moderate weight can also damage the knee extensors.
For runners, Potach says it can be course-related for example, too many downhill runs cause increased stress to the patellar tendon. It can also be a gait issue; if running with excessive crossover (i.e., feet cross the midline of your body when first contacting the ground), the IT Band can be overly stressed. Potach adds that hip weakness can also be a cause because if the hip abductors are too weak, the knees can move inward, stressing the anterior knee structures.
Potach’s recovery plan for runners
Inflammation phase: no running and no deep squatting (shallow, 1/4 squats are often OK). Focus on hip abductor and quadriceps strengthening.
Repair: no plyometrics and minimize hills (up and down), but introduce impact with walking on flat ground. Continue hip and quad strengthening, but increase complexity of those movement.
Remodeling: Begin plyometric exercises, increase volume and complexity of exercises. Transition to return to running.
For weightlifters, Mendler shares how to best position the knee during a lift.
“Knees should generally be in a neutral position, roughly a straight line from hip joint, through the knee and on to the second metatarsal (foot bone of the second toe),” Mendler says.
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AzmanL / Getty Images
What is it?
Elbow pain can manifest for a variety of reasons, but the common injury is lateral epicondylitis, or “tennis elbow,” which is a microtrauma injury, specifically, tendinosis.
For a weightlifter, elbow pain can occur by lifting too heavy, performing the same exact exercises every time you work out, and improper exercise technique.
“Elbow pain is typically caused by frequent grasping, holding, twisting of equipment, tools, or even a computer mouse,” Mender says. “For weightlifters, a common training error is to perform an exaggerated wrist flexion at the end of a lift such as a biceps curl, seated row, or lat pulldown. Keeping the wrist in a neutral position throughout a lift will go a long way to minimize the risk.”
Mendler adds that treatments can include using a modified grip on equipment (provided this will not pose a threat of dropping said equipment), local ice, cross-friction massage, stretching, and gradual strengthening of the wrist extensors.
Avoid overly fast reps, especially on the eccentric portion, decrease the weight you’re using, and try not to do exercises with a concentric portion that requires a full elbow lockout.
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What is it?
This is not a medical term, and can actually mean a number of things including posterior tibialis tendinopathy, periosteal irritation of the tibia, or anterior tibialis tendinopathy. Potach explains that these injuries are microtraumas as those muscles are required to help support initial contact with the ground while running and the bone experience a lot of impact forces. The posterior tibialis connects the calf muscles to the bones of the foot, an important little muscle to keep healthy for any athlete. With that said, shin splints are overstressed muscles at the front of the lower leg which result in pain in the shin area.
“The tibialis injuries are overuse injuries, typically caused by training errors (e.g., too much volume or speed too soon),” says Potach. “Improper shoe wear is often sited as a cause, but the research would suggest simply combining proper training with shoes that are comfortable is safe.”
Shin splits are common in running and jumping, so runners, basketball players, football players, track and field athletes, CrossFit, and obstacle course athletes that do too much ground pounding are at risk.
Potach’s recovery plan
Inflammation phase: avoid impact; modify weight bearing as well. Biking and swimming are good choices.
Repair: avoid plyometrics, but weight bearing is OK.
Remodeling: Begin plyometric exercises and gradually return to running.
If you have pain in your shins, try walking on your heels for 5-10 minutes a day, as part of your normal work/gym routine. This may help you recover faster because it’ll reduce the impact on your shins that you typically absorb.
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What is it?
The main hip issue for athletes is gluteal tendinopathy, although piriformis syndrome, hip impingement, and hip flexor strains also occur. Hip problems are typically due to excessive training volume, too much uphill running, tightness, and muscular imbalances.
The iliotibial (IT) band is the tendon that extends from your hip bone to the outside of your tibia, a lower leg bone. When the IT band is tight, you may feel tightness outside of the knee, hip, and glutes. Tight IT bands can put you at risk for IT band syndrome, which is persistent, significant pain outside of the knee.
Also, worn-out lifting and running shoes can cause your body to absorb a lot of the impact, placing your IT band at risk of injury. So, be sure to replace your shoes at a scheduled interval.
Potach’s Plan for Recovery
Inflammation phase: no running or plyometrics and minimize stepups.
Repair: no plyometrics or running, but increase complexity of weight bearing. Incorporate Bulgarian split squats.
Remodeling: begin plyometric exercises, increase volume, and complexity of exercises. Incorporate uphill/up stair movements. Transition to return to running.
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What is it?
A pectoralis major rupture is a macrotrauma, meaning it’s a sudden episode of overload injury to a given tissue, resulting in disrupted tissue integrity.
“This injury is caused by excessive load on specific exercises, usually bench press and flye-type motions,” says Potach. “This was seen a lot in recent regional CrossFit Games.”
Potach’s recovery plan
Inflammation phase: no chest stretching, presses, front raises, lateral raises, or pushups.
Repair: active motion is OK, still no presses or pectoralis stretching.
Remodeling: if you’re experiencing a remarkable loss of flexibility, painless stretching is OK. Begin pushup progression which will transition to bench press.
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What is it?
Plantar fasciitis is the inflammation of connective tissue that connects the heel bone to the toes. The bottom of the foot exhibits pain, swelling, and extreme tightness.
Any athlete that spends a lot of time on their feet can be affected by plantar fasciitis. Tight and weak calf muscles are often associated with the condition.
Use a tennis ball, lacrosse ball, or golf ball to roll out your plantar fascia (bottom of foot). Your plantar fascia are very tight, start with a tennis ball and work up to a lacrosse and golf ball. There are also several stretching devices, such as fabric strips with handles or bands, designed to help stretch out and warm up the soles of your feet. Do these warmups prior to a lower body workout to prevent the plantar fasciitis.