This is a guest post by my good friend Patrick McGrann, a Physiotherapist in Belfast, Ireland. Paddy says…
I am delighted to be asked to write a guest blog for MuscleHack. As a Physiotherapist I have a great interest in all things exercise and lifting. And as a lifter myself, I have been a big fan of Mark’s message for years. When he asked me to write a piece on weight lifting injuries, I jumped at the chance.
Good Pain vs Bad Pain
As a bodybuilder it is essential that you are in tune with your body. To help prevent or avoid injuries you need to know the difference between pain caused through exertion during a lifting session and the pain caused by an injury.
By understanding what the difference is, you will be able to stop pushing the bad pain, preventing a full blown injury, and allowing you get back to the gym sooner.
1. Lower Back Pain
90% of the population will experience lower back pain (LBP) at some point in their lives. There are varying degrees of back pain, the most common being mechanical LBP, which can be treated conservatively (not needing surgery).
Our lower back is involved in most things you do in weight lifting. It is involved during standing bicep curls as well as when you are dead lifting. When you experience LBP it can affect most of the exercises you do in the gym preventing you from training, not good!
What are the causes of Lower Back Pain
- Not warming up:
- It’s crazy the amount of times I see people walk into the gym (after a day of sitting on their bums), go straight over to the squat rack, fire out 10 reps and then load the bar up and go for it. Then they wonder why they have back pain. A good warm up is essential to preventing back pain. Your glutes are the foundation your back sits on and they should be primed and ready for action. If your on legs day you should carry out this Glute Warm Up
- Poor technique: There are 2 ways to hurt your back through poor technique.
- The first one is the most obvious, if your lifting technique is poor your going to hurt your back. It doesn’t have to be a rubbish deadlift technique with 200kg on the bar! It can be as simple as swinging your back during bicep curls. You do this over a few sets and your back will give out.
- The second way is through poor manual handling technique. Your lower back is at its most vulnerable when you are bent over and twisting to the side. This is exactly the same position I see lifters picking up dumbbells or plates and moving them from rack to bench or floor to rack. You need to slow down and essentially dead lift each weight to where you want it to go. Nothing worse than having to tell someone you hurt you back lifting a 45lb plate.
- Lifting too heavy:
- Trying to lift a weight, which is too heavy, will load forces on your lower back that it’s not ready to take. It will also cause you to adapt your technique (most likely for the worst), which will increase the stress on the back and cause you pain.
Treating Lower Back Pain
- When you have acute back pain you should:
- Rest from aggravating activities
- Take pain medication as needed
- Walk – try to go for a walk every day. Start with 10 minutes and increase as able
- Do not stay in the same position for more than 20 minutes
- Use a lumber support for your lower back. You can make one by rolling up a towel and taping it in place
- Use heat to reduce muscle spasm
- Go and see you local Chartered Physiotherapist
- Learn to Hip Hinge
- Work on your core to prevent recurrence of pain and aid recovery after injury.
- Modify your training and slowly re-introduce your body to lifting again
- If you have pins and needles, numbness or weakness in your leg(s) go and see your doctor
2. Muscle Tear
For bodybuilders and lifters muscle growth is the reason that you push the boundaries of discomfort, tiredness and pain (remember good pain). When you injury or tear a muscle, scar tissue will develop, which can reduce the effectiveness of the muscle and increase the chances of recurrence in the future.
What are the causes of a Muscle Tear
Potential causes of muscle tears in the gym include:
- Lifting too heavy:
- When a muscle is overloaded it reaches breaking point and the excessive force causes the muscle fibres to tear.
- This can occur when you exercise the muscle too much with out proper recovery time. The muscle becomes fatigued, resulting in a tear
- This comes back to poor technique. Lifting weights the wrong way will cause the muscle to tear, doing a job it’s not designed to carry out.
- Not warming up sufficiently:
- Muscle is like an elastic band. The warmer it is, the more efficient the contractile fibres become. A cold muscle is a quick way to increase the risk of a tear.
Treating a Muscle Tear
When it is an acute tear follow the M.C.E. Protocol.
There are 3 grades of muscle tear, which need to be consider when treating it.
- Grade I:
- Minor damage to the muscle fibres. There maybe mild pain (bad pain) with little to no swelling and no bruising present. Your muscle will still have full strength. Follow the M.C.E Protocol.
- Grade II:
- There is a partial tear in the muscle. There will be moderate pain, bruising and swelling present. There will be a reduction in strength output of the muscle. It is essential to go and see a chartered Physiotherapist to reduce scare tissue formation and improve your rehabilitation.
- Grade III:
- This is a full tear/rupture. There will be extreme pain, swelling and bruising. You will need to seek medical advice immediately with surgery a likely outcome.
This is a degenerative condition affecting tendons. It is a chronic condition caused by overuse or repetitive movements (similar to a repetitive strain injury). Microinjuries to the tendon accumulate faster than it takes to heal, resulting in the breakdown exceeding the repair. Common areas affected in bodybuilding include:
- Tennis Elbow:
- This involves the extensor muscle group in the forearms
- Pain is located on the outside of the elbow
- It is caused by heavy lifting, forceful forearm pronation and supination or lack of internal rotation at the shoulder joint
- Pain occurs when gripping a weight
- Bodybuilders complain of a lose of grip strength or difficulty carrying weights
- Supraspinatus tendinosis:
- This involves one of the Rotator Cuff muscles, which is involved in abduction and stability
- Pain is located at the front of the shoulder
- It can be caused by increased loading during weight lifting (too much too soon) and muscle imbalance at the shoulder blade-rotator cuff area
- Pain will be experienced during over head movements for example a military press and sleeping on the side of injury
- This is rest from the aggravating factors/movement. By the time you are experiencing pain from this injury it may have been building for a few weeks. Tendon injuries take time to heal and when you carry out the painful movement you only set the healing time back. So if it’s sore doing military/dumbbell press, then stop this movement.
- Eccentric loading
- Eccentric loading has been shown to be very effective for healing tendinosis injuries. Loading the tendon this way allows for the collagen fibres of the tendon to grow in a more parallel alignment, speeding up the recovery process.
- Soft tissue work:
- Going to your local chartered Physiotherapist to get some deep tissue frictions or soft tissue mobilisation can improve your recovery from injury
- These can be used if you really want to perform an exercise/lift without pain. They provide support and stability while off loading the tendon
- Weight Lifting technique:
- Make sure that your technique is correct during the aggravating lift. Tennis elbow can be caused by lack of internal rotation of the shoulder. An example of this is developing tennis elbow from face pulls due to lack of internal rotation at the shoulder. Possibly think of changing the type of equipment you use for example switching from Barbell to dumbbells for overhead press. The dumbbells allow your shoulders to move in the path most suitable for your pattern of movement therefore protecting your tendons and muscles.
I hope you guys found this useful. Please leave any comments or questions you may have, we would love to hear from you.
Thanks again to Mark for asking me to do this. It was an honour and a pleasure.
Physio Evolution: New Physio in Belfast
We are a new Chartered Physiotherapy service provider in Belfast, Northern Ireland. Our mission is to provide professional high quality physiotherapy service, excellent customer service, accessibility and convenience.
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Great article Patrick!
I’ve been lucky I guess, or no pushed hard enough 🙂 I do some barbell work on my own at home, and apart from what felt like a soft tissue impingement in the shoulder, and an occasional bit of aching in the lumbar area after heavy deadlifts, touch wood, I’ve not hurt myself.
On the warmup front, I hate warming up. I tend to do a few sets of kettlebell swings, and then go through some warmup sets for each exercise, empty bar to start, and working up. Is this adequate in your opinion?
any suggestion on myofascial syndrome which i guess occurred to me when i tried lifting heavy bench press?the whole left lower limb seems to show severe symptoms occasionally. thanks
What good timing, One day I felt this pain on my forearm and could not do revers curls. had to stop. (programs that weeks was 10×10) weird feeling I ever got. Did not know what it was. That was March 25, 2014. But I did continue (Mistake #1) with my other exercise. Then 4 weeks (Program that week High Reps 20-15-12) Could not do Hammer curls at all and reverse curls and also feel pain in forearm when I did wide grip Pull-Ups. Oh No. Start researching and find out I had Golfers elbow and still Continued with my weight program (Mistake #2). Today could not do Preachers curl. 🙁 . I should of stopped, but I love pumping weights. I will need to stop for a while now (which sucks).
Anymore advise brotha would really help how to cope with this.
Stephen: I’m glad you found the article useful. Depending on what you are doing for your session will depend how you warm up. If your doing a leg day then you need to fire up your glutes before you get into the movements. Use a tennis ball on the glutes, 2 minutes each side and then get into a low intensity circuit of bridging, clam, mule kicks and fire hydrants 2×10 then into into joint specific mobilisation. For legs you need to make sure you open up the hips, work on ankles and get the foam roller on the mid back. Then get into your KB swings and warm up sets. If it is upper body then you need to get the shoulders and mid back warmed up
Dr Sunil: you probably would need to go to a Physio/Physical therapist to see whats going on there
Dan: You all ready know what mistakes you are making. Plus for such a small muscle group 10×10 is very extreme which would cause that type of an overuse injury. You need to rest from those movements and seek out Physio. The more you continue to push it the longer it’s going to take to rehab
Listen to this Article and don’t make the same mistake I did! Been out of the gym for 9 months. Last thing i did was overhead presses trying to compete with friends. Ever since then I’ve had sharp pain in the shoulder joints, really sore Supraspinatus the day after the most moderate of activities involving the shoulder, and painful cracking just by laterally raising my arms. I’ve been unable to afford MRI scans to see if my shoulder labrum is okay. I’ve had my chiropractor diagnosing it as a labral tear, physiotherapists on the NHS saying its not a labral injury and I have apparently caused a shoulder impingement on both sides… combined with ingraining incorrect motor patterns or something causing my scapular muscles to literally stop working correctly. Finally after 9 months of rehab i’m starting to get some stability back in my shoulders. Whats worse is I got injured right as i got qualified as a personal trainer. So i had to go back and work in a retail shop again as I couldn’t even lift a 2kg weight above my head let alone train clients!
Don’t make the same mistakes I did guys. Learn about mobility and stability and take note of articles like this, don’t be an idiot like me lol
Very helpful article, Patrick. Thank you for highlighting this important element of bodybuilding. I’ve had my fair share of injuries, though fortunately none were very serious. However, I’ve known many who have had their enthusiasm damped because of muscle tear and worse – which could have been avoided/prevented by heeding your advise. Thanks again!
Great information and ever lifter needs to follow it.
Dan: You have a combination of medial and lateral elbow pain – these are due to inproper exercise technique and imbalance in your tendons. Tendon injuires take MONTHS to heal!
Here is a linh that provides and excellent and very detail information as to these injuries. The review also provides basic infomation and guidleines for re-hab. Hope this helps! https://www.precisionnutrition.com/fixing-elbow-pain
Mobility and stability is one of the main areas that we overlook during our training, YEt is the most important and crucial aspect of training – these mobility execersies and assessments are what keep us healthy and injury free. I am glad to hear that you learn fron this very common mistakes – trying to lift heavy weights with either por technique, poor form, and/or not being ready to to the exercise… For example, Is a traineed ready for overhead pressing movement? Is scapular location is not proper – you are asking for injuries. People need to assess there mobily and work on stabilizing the muscles before performing any exercise – as a future trainer/coach – rememeber this injury and help future trainees avoid injurines by teachin and assessing their mobility – Do the have shoulder protraction? retraction? anterior tilt? posterior tilt? poor ranege of motion/ etc…
As an intern at a physical therapy student I’ve noticed most people have a tendency to NOT STRETCH! Most of our patients, and most people are, have terribly right muscles. I nice warmup is essential, and I would also recommend post workout stretching. A good stretch will increase flexibility, as well as stretching the muscles out (which also may increase growth according to various studies) allowing for an overall better lift/workout. Basically better flexibility=more potential for size/strength gains. Lifts and stretching/warmup exercises are the same in that form is key!! Poor form will reduce the effect of the stretch and limit your warmup, causing an increase in the chance that you can become injured and none if us wants that! Thumbs should sit at seam in your pants without a conscious effort and if you can’t put a 90 degree angle or better in a hamstring stretch while laying down with knees straight(locked) then you should stretch more often. To many people neglect lower body stretching and stretching overall thereby limiting strength gains.
Great article. Wish I had read this way back. I was diagnosed with bulging and herniated discs on my lower back over 10-months now. I was walking to work and all of a sudden I had this really bad pain that ran from my right lower back all the way to my knee, no symptoms prior to this. Couldn’t sit, lay down or barely walk (took me about 20 minutes just to walk one block and it was painful). And, about 2 weeks before I could even return to work. Also diagnosed with pinched nerves on my neck, back and entire legs. Not sure how all this happen since I am told I am too young for all this, except for one time about 10 years ago when I was using one of those stability balls and it kind of slipped back as I was doing abs and I fell down on my back and can still recall the terrible pain I was in but never wen to the doctor. But then again, I do admit I lifted really heavy specially when performing deadlifts.
Just started training again, 2 week now but taking it easy. What exercised do you recommend I should stay away from? I’m sure dead-lifts and squats are out of the question, also seem to have an issue when performing seated rows, so I know that’s out of the question. I’m doing physical therapy but that doesn’t seem to help at all. Any suggestions.
Good article Patrick. Suffering from tennis elbow the last month and a half.