Musculoskeletal

THEME IV Injuries

CHAPTER OUTLINE

MUSCULOSQUELETAL INJURIES
ON WEIGHT TRAINING

Injury Types

The three stages of injury

Equipment Risks

Prevention of Injuries

Recommendations

Factor afecting recovery

Recommendations

Key Terms

Injury
Pain
Prevention
Stress
Disorders
Rehabilitation
 Theme IV Objectives
After the study of this theme, the reader should be
able:

To Describe

1- The main Injuries of the human skeleton during weight

training.
2- The Risk Factors Associated with Weight Training Inju-
ries.
3- The Types of Musculoskeletal Injuries with Weight Train-
ing.

To Define

1- The three stages of injury.

2- General recommendations to prevent musculoskeletal
injury.
3- The four levels of pain for each injury.

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MUSCULOSQUELETAL INJURIES ON
WEIGHT TRAINING
T
The increasing use of weight training over the
last four decades has played an important role in im-
proving athletic performance in high-level competitive
sports. Currently, weight training has become more
than merely part of the training for specific sports. It
has become a popular physical fitness activity in it-
self.
Whether weight machines or free weights are
used, weight training has become a common compo-
nent of recreational exercise for many active people.
As competitive athletes and their coaches discovered
many years ago, weight training can enhance sports
performance and may prevent musculoskeletal inju-
ries.
Prior to the popularity of weight training for
sports like football and wrestling in the 1960s and
1970s, many team sport coaches, especially in bas-
ketball and baseball, believed that weightlifting made
an athlete tight and could compromise the fine mus-
cle control needed to perform optimally.
Efforts have been and are still being made to
disseminate scientific information to educate coach-
es and athletes about the benefits of an intelligent
weight training program, but the success stories of
well-known coaches using weight training have prob-
ably had greater influence on its acceptance. In addi-
tion to increasing performance from adding strength
and endurance, weight training is believed to en-
hance and increase the strength of connective tissue
sheaths within the muscle, joint cartilage, tendons
and ligaments.
The mechanical strain and loading of weights
also contribute to increasing bone mineral content.
Also, weight training is becoming more common
among children, adolescents, and to some degree
the elderly.
Most of the documented information on weight-
lifting injuries arises from those injuries sustained
while training for or participating in an Olympic-style
weightlifting or powerlifting competition. This type of
training involves performing a maximal lift one or two
times. In contrast, a majority of the weight training
programs for enhancing sport performance is aimed
at improving conditioning and often are designed to
enhance strength to do specific tasks involving com-
plex motor movements.
Weight training as a recreational activity may
have elements of a sports-specific training program.
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In todays fitness environment, weight training
is generally a solitary endeavor, which does not in-
clude a team roster, coach or athletic trainer, physical
preparticipation or signing of a waiver consent form.
No medical records are kept, injuries are not docu-
mented, and there is no way of knowing the total time
of participation to calculate injury rates.
Injury Types
Recreational Weight Training
Recreational weight training is generally not
competitive and usually not considered a sport in it-
self nor practiced as a primary activity. Instead it may
be a part of a general fitness program or used to im-
prove performance in another activity. Clearly, some
of the interest in it has arisen from the desire to ap-
pear physically fit and healthy.
For a variety of reasons, there has been a
growing participation in recreational weightlifting over
the past two decades. In this population the upper-
extremity injuries predominate, accounting for about
two-thirds of the injuries.
The shoulder is most often injured (29.6%l,
followed by the upper arm (around 13%), knee
(12%), and back (11%). Gradual onset injuries are
most common with only few reports of acute injuries.
Women report similar or slightly lower injury rates
compared with men for most weight training activity
(free weights and weight machines).
The injury rates for weight training were low-
er than for competitive team sports but higher than
for noncompetitive, noncontact activities like hiking,
walking, and exercise bicycling.
The most prevalent injuries in recreational
weightlifters documented in other sources are muscle
strains and ligament sprains, which account for 40%
of all reported injuries. Contusions and abrasions ac-
count for 20%. The highest percentage of fractures in
weight training occurs in recreational lifters.
Olympic-Style Lifting
Weightlifting is part of the modern Olympic
Games. There are two events: the snatch and the
clean-and-jerk. Today, these two events are referred
to as Olympic-style weightlifting.
The most prevalent injuries in Olympic-style
lifting are ligament sprains, which account for 30-45%
of the total. Muscle strains are the next most preva-
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lent injury, constituting approximately 30%. There is a
lower percentage of fractures, perhaps attributable to
good technique and musculoskeletal development.
Powerlifting
Distinct from Olympic-style weightlifting,
which is a highly technical sport where weight is lifted
over ones head, powerlifting involves brute strength.
Powerlifting consists of three lifts: the squat, bench
press, and deadlift.
Muscle strains make up about 60% of the to-
tal injuries in adolescent male powerlifters, 11% in
women, and 6% in males. Arthritis and, degenerative
joint changes are more common, as are chronic and
overuse injuries, among the adult athletes.
Bodybuilding
Bodybuilding refers to weightlifting for the
purpose of developing skeletal muscle mass and
definition. It is characterized by high-volume weight
training accompanied by strict dietary regimens to
minimize body fat.
In female lifters the most common diagnosis
is tendinitis, accounting for one-third of the problems.
Male lifters report chronic overuse injuries such as
degenerative joint disease, arthritis, and tendinitis.
Prevention
Regular weight training may trigger injuries
which, although seldom serious, can be avoided or
managed more efficiently with experience.
Problem generally arises due to ignorance,
excess, lack of focus or carelessness all causes
that can be easily remedied. Injuries can be avoided
through skills, fitness, nutrition, warm-ups, equip-
ment, environment and treatment.
Levels of pain due to Injury
There are four levels of pain for each injury.
When the pain reaches the next level, it means that
the injury is getting worse and will require more pro-
longed treatment.
Level 1 Pain in the affected area after the
activity.
Level 2 Pain during and after the activity,
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but which does not impede performance.
Level 3 Pain and difficulty performing the
activity.
Level 4 Pain during the activity and during
other activities (sports or other).
The three stages of injury
The Acute Stage (0 to 24 hours)
This stage is defined as the time immediately follow-
ing the injury and lasts until all bleeding has stopped,
usually up to 24 hours. Proper management can sig-
nificantly reduce this time period.
The Middle Stage (24 to 48 hours)
This is the stage when bleeding has ceased
and the acute stage has ended. Bleeding may start
again, usually 24 to 48 hours after the injury. If proper
procedures are not followed, there is a risk that the
injury could return to the acute stage.
The Final Stage (48 hours and more)
This occurs when all bleeding has stopped
and there is little chance of it starting again, usually
from 48 hours on. At this time therapeutic care can
greatly enhance recovery. Healing occurs gradually
during this stage, in the form of soft scar tissue.
Risk Factors Associated with Weight Train-
ing Injuries
There is very little published information on
risk factors for weight training injuries. However,
steroid abuse (ergogenic aids), skeletal immaturity,
improper technique, and equipment itself have been
implicated as contributing factors, along with genetic
predisposition for injury, lack of supervision, exercise
intensity, and training sessions.
Steroids
Steroid usage has been associated with many
acute musculoskeletal injuries as well as medical con-
ditions. The physiologic changes in muscle, tendon,
and ligaments that may make them more susceptible
to failure and rupture are usually associated with the
performance of heavy demands.
Among the medical side effects include testic-
ular atrophy, liver function abnormalities and hepato-
mas, myocardial ischemia, gynecomastia, hyperten-
sion, strokes, aggressive behavior, baldness, acne,
and death.
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Skeletal Immaturity
Growth plate injuries have been reported with
weightlifting. Therefore, the American Academy of
Pediatrics has issued guidelines for weight training
in children. These guidelines recommend a qualified
trainer and medical clearance before a child begins
weightlifting and advise that an adolescent should
have reached the Tanner 5 stage (well-developed
secondary sex characteristics) before performing
strenuous weightlifting.
Improper Technique
Lifting with poor mechanics, or too quickly,
may place sudden loads on a vulnerable orthopedic
system. All athletes or individuals that are starting
a weight training program should go through a for-
mal instruction session on utilization of free weights
or weight machines. They should then be monitored
periodically until they become more experienced at
weight training programs.
The use of too many repetitions, excessive
weight, lack of concentration and ballistic exercise
routines predispose an athlete to injuries. Frequently,
conditioning programs are not balanced and appro-
priate for the individual.
Equipment Risks
There are a few risk factors associated with
different pieces of equipment. In the free-weight
bench press, the most common complication is drop-
ping the weight on extremities or on the chest or
neck, thought to occur when there is no lifting partner
to act as a spotter. Other problems have to do with
appropriate upkeep and maintenance of equipment
in workout gyms. It is not uncommon for a cable to
break, a chain to stick, or a weight stack to fall. Also,
the most styles and brands of weight machines in the
market do not adapt to all the anthropometric charac-
teristics of all the participants in weight training pro-
grams, increasing the possibility of injury during the
training.
Acute Fractures: There are few reported fractures
Types of Musculoskeletal Injuries with Weight caused by weightlifting. Most are upper-extremity
Training fractures.
Injuries can be categorized as acute and
overuse (gradual onset) injuries. Chronic injuries are
often confused with overuse injuries. Acute injuries
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often result from weight room accidents, improper
warm-up techniques, or being overzealous. A chronic
injury is best defined as an acute injury that doesnt
get better within a reasonable period of time. This is
different from overuse injuries, which have a gradual
onset, though it can also become chronic.
Acute Injuries
The most commonly reported acute injuries
are sprains and strains. Sprain is defined as the
stretching or tearing of ligaments and may result per-
manent laxity and decreased joint stability. Strain re-
fers to a stretching or tearing of a muscle or tendon
and may result from an active contraction against a
resistance or passive stretching.
Ligaments Sprains: may be divided into different
degrees of severity from pain without ligament laxity
to a complete ligament tear. Medial and lateral col-
lateral ligament sprains of the knee can occur during
squats, lunges and leg presses or with improper low-
er extremity placement. Meniscus or cartilage tears,
associated with rotational movements and stress,
can occur with squat and dead lifts.
Muscle Strains and Ruptures: are painful and
present with limited range of motion, loss of strength
and tenderness. The tendons that frequently rupture
include the hamstrings, biceps, patellar, pectoralis
major and triceps. The most common strain involves
the paraspinous musculature.
Pelvic avulsion: Excessive tension placed on a
tendon insertion into bone can cause an avulsion
fracture. The most common is the avulsion from the
anterior superior iliac spine (ASIS), the ischial apo-
physis and hamstring origin. Most of the apophyseal
avulsions occur in people with immature skeletal.
Biceps Tendon Rupture: usually occurs when an
individual is lifting a heavy object. In the past these
injuries were frequently work related. Currently,
most such reported injuries occur with weightlifting
activities, most commonly biceps curls.
Overuse Injuries: Chronic injuries often result from
overuse injuries, particularly if the injury is ignored. In
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weightlifting, the body is required to put heavy stress
on the ligaments, tendons, and musculature. Tendini-
tis is probably the most common overuse injury seen
in weight training (3.5-12%). Often overuse injuries
occur because of incorrect exercise technique or ex-
cessive repetition of movements performed against
weight.
Rotator Cuff Injury: are often the result of muscle
imbalances, weakness, and repetitive loading activi-
ties. The rotator cuff stabilizes the humerus so the
larger muscles can lift heavier weights. The rotator
cuff strain is often the result of the weight attempted
posing too much stress for the small cuff muscles
used to stabilize the joint. Weight training activities as-
sociated with these injuries include the military press,
rowing, bench press, and pectoralis machines.
Therefore, it is important to access the
strength of all the musculature in the shoulder (es-
pecially the posterior shoulder and external rotators).
Rehabilitation of these weak muscles is often the key
to resolving pain. Secondly, the range of motion in
the shoulder needs to be tested and corrected. Of-
ten the external and internal rotator muscles become
tight and limit the range.
Anterior Shoulder Instability: An athlete with an-
terior shoulder instability will report looseness, tran-
sient numbness, and apprehension about the shoul-
der going out of joint. The bench press produces
hyperextension of the shoulder musculature and can
cause repetitive shoulder capsule trauma and may
also disrupt the AC (acromioclavicu-lar) joint. An of-
ten problematic exercise is the reverse behind-the-
neck military pull-down. This exercise often causes
shoulder capsule loading and inferior glenohumeral
ligament sprain.
Neuropathies: Nerve injuries, often the result of
constriction from muscle hypertrophy, present with
pain or parasthesias as well as muscle weakness.
Repetitive traction on the nerve can also produce
similar symptoms. These injuries occur over months
of repetitive stress or increase in muscle size. The
most commonly reported injuries of this type include
suprascapular and musculocutaneous neuropathy,
long thoracic nerve injury, thoracic outlet syndrome,
lateral plantar nerve entrapment, and ulnar nerve
neuritis.
Suprascapular Neuropathy: Compression of the
suprascapular nerve within the suprascapular notch
produces shoulder pain, muscle weakness, and at-
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rophy. Often this diagnosis is missed. The etiology
for this disorder includes impingement of the supras-
capular nerve, brachial plexus injuries, direct trauma
to the scapular region, dislocation of the shoulder, or
fracture of the scapula.
Musculocutaneous Neuropathy:may be
brought on by repetitive biceps curls. The pain and
weakness are thought to be caused by impingement
of the musculocutaneous nerve from the coracobra-
chialis muscle hypertrophy.
Bony Disorders
A variety of bony disorders have been report-
ed in weightlifters. The most common are stress frac-
tures, osteoarthritis, osteolysis, and back disorders
such as spondylolysis and spondylolisthesis.
Stress Fractures
Stress fractures of the humerus, sternum, and lumbar
ring apophysis have all been associated with weight
training. The presenting symptoms include progres-
sive focal or point tenderness and exacerbation of lo-
cal pain with deep pressure, or increased pain with
loading the bone.
Osteoarthritis: Many competitive weightlifters
have patellofemoral osteoarthritis. Re-searchers
have documented the fact that this disorder is found
more in lifters than in runners or soccer players. This
is thought to be due in part to suboptimal technique if
the squats are done with heavy loads with the thighs
descending below 90 degrees, placing stress on the
articular cartilage.
Back Disorders: The use of weightlifting equipment
was initially thought to cause back pain or herniated
disk problems but some epidemiological studies have
showed that there is a very small risk of herniated
disk in lifting weights when proper technique is used.
In fact, lifting weights is a means of strengthening the
back and decreasing the stress on the back.
Spondylolysis is a defect (stress fracture) or con-
genital defect in the pars interarticularis that probably
arises from repeated back extensions in the pres-
ence of a predisposing bony weakness.
Spondylolisthesis
Spondylolisthesis is the anterior subluxation of one
vertebral body relative to the adjacent below. This in-
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jury is seen in weightlifters that do squats and clean-
and-jerk lifts.
Prevention of Injuries
Scientific research indicates that weight train-
ing can play an important role in injury prevention.
The physiological mechanisms that aid in injury pre-
vention include increased strength of tendons, liga-
ments, joint cartilage, connective tissue, and tendon-
to-bone and ligament-to-bone junction.
Losing control of free weights or abruptly in-
creasing either the number of repetitions or amount
of weight are the frequently cited causes of problems.
Joint pain, swelling, or loss of motion are often indi-
cations of impending injuries and should not be ig-
nored.
Recommendations
General recommendations to prevent muscu-
loskeletal injury include the following:
Warming up
Good technique
Assess imbalances/preexisting conditions
and deal with them
Use of weight belt when lifting heavy loads
Alternate upper-extremity and lower-extrem-
ity workout days
Proper shoe wear while lifting
Equipment orientation
Adequate sleep and diet
If injured acutely, seek medical attention be-
fore the condition causes compensation injuries.
Free weights generally take more time to set
up and require awareness of good technique and
body mechanics; some exercises require a spotter.
Free weights, unlike weight machines, are not con-
tained and can present hazards to both the exerciser
and others nearby if control is not maintained. Injuries
have been reported, some quite serious, from loss of
control of free weights.
Free weights have an advantage in that they
allow one to move in three planes and simulate per-
forming sport-specific movements. Weight machines,
on the other hand, generally do not require a spotter,
are already set up and ready to use, and are more
forgiving of poor technique and body mechanics.
Good supervision is particularly important with free
weights, but weight machines can also be used im-
properly, subjecting their users to potential injury.
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Supervision may be even more important for groups
who are at potentially risk, such as adolescents and
the elderly.
The American College of Sport Medicine rec-
ommended since 1990 that moderate weight training
be included in fitness programs as an integral com-
ponent.
Weight training has shown beneficial effects
in fitness programs by improving muscle strength,
neuromuscular pathways, and cardiovascular en-
durance, and decreasing the percent body fat. The
multiple benefits physical and mental include
strengthening of musculature and bones and de-
creased symptoms of depressions and arthritis. The
elderly even benefit by counteracting muscle weak-
ness and physical frailty, which improves quality of
life by maintaining strength to carry out daily living
activities and achieving more independence in daily
living. Thus, if well prescribed according to the indi-
viduals biologic characteristics weight training pro-
grams, besides of being very safe, can help prevent
or diminish the risk of potential injury during recrea-
tional or sport activities.
Factors affecting recovery
The four following factors will determine how
fast an athlete will recover from a sports injury.
The type and severity of the injury: Major injuries will
take longer to heal then minor ones.
Early management: quick and proper first-aid
will shorten the recovery time.
The type and frequency of the therapy: Select the
correct therapy and applying it conscientiously will
promote healing.
Individual differences: Young athletes heal
faster. Athletes differ in their physical and psychologi-
cal make up and this affects the healing time.
Rehabilitation of Sport Injuries
Before returning to action, you must be totally
rehabilitated if you want to avoid another injury. The
requirements for proper rehabilitation include:
Full flexibility (100% range of motion);
Return of full strength in the injured part;
Absence of pain;
Psychological readiness; absence of fear.
If you doubtful about when you are able to re-
turn to training, you should consult your physician to
ensure that your rehabilitation has been effective.
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 STUDY QUESTIONS

1- What are the injury types on recreational weight training?

2- Describe the three stages of an injury.

3- List and describe the levels of pain due to injury.

4- What are the main risk factors associated with Injuries on Weight Training

Exercises?

5- What are the most commonly reported acute injuries on Weight Training?

6- Describe Spondylolisthesis.

7- What is the role of Weight Training on injury prevention?

8- List some General recommendations to prevent musculoskeletal injury when

Training with weights.

9- Describe the four factors that affect the recovering process from an injury.

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