From youth athletes to the elderly, resistance training, RT, is an integral component of health, fitness, aesthetics and athletic performance. It even increases longevity in men! However, RT can lead to injuries, with the shoulder being affected most, followed by the lower back, elbow, and knee – primarily due to improper exercise selection, technique, and overuse.
Obviously, prevention of injuries is paramount to enable patients to stay active, hold their adjustments better and embrace a wellness paradigm.
Resistance training applies to a broad range of exercise styles. Traditional weight training, as in bodybuilding, comes to mind initially. However, Olympic lifting, CrossFit, circuit training, TRX, bodyweight calisthenics, powerlifting and Strongman training all involve various types of RT.
Although patients may train differently based on their individual goals, there are commonalities in injury prevention that they all share.
Consider the Patient
The starting point to limit the risk of injury in evaluating or prescribing an RT program is to consider the patient’s age, health/fitness level, genetics, and morphology (posture and joint alignment). These variables drive exercise selection, frequency and intensity. Beyond that, make note of the following injury prevention caveats:
Finally, it is also important to determine if your patients are taking ergogenic compounds, either nutraceutical or pharmacologic agents, to boost muscle gains. These agents can predispose patients to musculoskeletal, neurologic and vascular injuries.
Mechanisms of Injury and Prevention Strategies
Injuries related to exercise can be spontaneous and prevent additional activity until recovered, and thus, they would be considered severe injuries. Moderate injuries can also be spontaneous or related to insidious microtrauma. These injuries will prevent certain exercises or activities, yet the patient is still able to exercise if they avoid the injured part.
Perhaps the most common presentation in our offices is recurring pain that waxes and wanes, which the patient “works around” when they exercise. This would be considered mild, as the symptoms resolve greatly between workouts.
Proper instruction is the first step to injury prevention, as most injuries are related to poor technique. Technique issues can occur in a single repetition or as the patient fatigues during a workout. The latter underscores the importance of a training partner or exercise professional working with the patient during workouts.
Injury rates for RT are found to be the lowest in traditional strength training as in bodybuilding, followed closely by powerlifting. Both require excellent technique, and traditional strength training emphasizes isolated muscle activation with single-plane movements. Higher injury rates are found in CrossFit, high-intensity interval training (HIIT) and strength & tone classes because they focus on performing complex movements at high intensities and faster speeds. The highest injury rates are found in Strongman RT, in which high loads and multiplanar movements are combined.
Exercise selection will also impact the rate of injury. Bonilla recommends performing the most demanding, challenging exercises early in a training session to avoid tiredness, fatigue, technical errors, and excessive overload.
This contrasts with the NASM corrective exercise paradigm, which starts with isolated strengthening and muscle activation and is then followed by global movement patterns. The latter is more in line with a rehabilitative exercise program.
Shoulder injuries are the most common across all RT sports and are thought to be related to prior injury and/or an imbalance in the scapulothoracic musculature. Good stability and movement patterns of the scapulothoracic complex are critical to prevent overload on the glenohumeral joint and its related soft tissues. Strengthening and activation of the middle and lower trapezius, external rotators and serratus anterior are needed to maintain scapulothoracic rhythm. In addition, lengthening of the pectoralis group and upper trapezius further prevents subacromial anterior impingement syndromes.
Lower extremity injuries are most often related to running and jumping. Core strength training reduces ACL injury risk and improves athletic performance. However, unstable positions or postural malalignments during RT put the lower extremity and spine at risk for acute injury.
Posture and Movement Optimization
This brings us back to posture and movement mechanics. To prevent lower extremity injuries, it is essential to maintain the lower extremity in strong anatomical alignment and with a powerful hip hinge.
The feet, knees and hips need to be aligned directly forward in the sagittal plane, both statically and with motion. The feet need to maintain all three arches to allow adequate shock absorption and reinforce the knee to track over the first and second toes. In addition, a good pedal foundation prevents excessive pronation and serial distortion of the kinetic chain.
Custom, flexible orthotics are a good choice to stimulate proprioception and maintain strong mechanics of the lower extremity with all dynamic activities, including RT.
The importance of maintaining joint centration (alignment) as an injury prevention strategy in RT is well-established. As doctors of chiropractic, we need to use this evidence-based recommendation to educate our patients on the chiropractic rehabilitative model of exercise: grooving spine-sparing positions and strong posture.
This requires adjustments to restore and maintain full joint ROM, assessment of the entire kinetic chain from the feet through to the atlas, and developing body awareness to maintain joint centration with exercise. Teach patients that their posture while exercising translates directly to everyday posture!
For example, doing a seated biceps concentration curl with forward head posture and thoracic kyphosis trains that position outside the gym; whereas a seated preacher curl hits the biceps, but also trains spinal alignment and strong posture, and reinforces the chiropractic spine connection.
The Chiropractic Advantage
Prevention of musculoskeletal injuries in RT requires a multimodal approach. Most often, injuries are caused by overuse, short recovery periods between sessions, improper technique, poor conditioning, and the frequent use of high loads.
Bonilla believes “the key to the prevention of injuries in recreational weightlifters and bodybuilders is having professional supervision and adhering to proper lifting techniques and training habits that might positively impact the allostatic (exercise-induced) load and adaptations.”
In other words, a chiropractic-centered exercise model that reinforces strong posture, management of the entire kinetic chain, adequate recovery, spine-sparing exercises and alignment from the feet up is the key.
Resources
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