Controversial Exercises

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Controversial Exercises

Although specific exercises are often cited as the cause of acute injury, the etiology of many chronic injuries remains elusive. The ability of clinicians and strength and conditioning professionals to recognize training patterns which may increase risk of injury requires an awareness of documented injury trends and risk factors. (Kolber 2010)

When introducing any new exercise, particularly exercise associated with higher risk, strict progressive adaption and caution should be practiced. For healthy individuals with no biomechanical impairments and sound training practices, many exercises considered controversial are in fact relatively safe when performed correctly and may actually decrease the risk of injury (see Squats as an example). This is particularly true when an even greater stress from daily activity, sports, other conditioning exercises will be encountered.

Sample Exercise Questioned Position Considerations
  • Conditioning of neck reduces risk of injury in certain sports.
  • Neck structures are typically deconditioned in most people.
  • Begin with less intense movements before progressing to advanced movements.
  • Are Resistive Neck Exercises Dangerous?
  • Compression of Spine
  • Inverted position
  • Risk of serious head or neck injury during fall
  • Ballistic movements

Over Generalizations

It is easy to denounce an exercise or movement as 'dangerous', particularly if an injury has occurred during its execution. When someone sustains an injury while performing a particular exercise, we should not assume that a particular exercise is necessarily a 'bad' exercise. Likewise, we should not judge a particular exercise or movement as 'bad' if an exerciser experiences pain during its execution before an injury has healed, allowing for proper rehabilitation to be administered.

Trainers often tell their clients not to perform a particular exercise through full range of motion. Take for example, allowing the elbow to travel behind the shoulders during a bench press or chest press. These guidelines may be appropriate for those with a Shoulder Transverse Adduction / Flexor Inflexibility and/or an Infraspinatus Weakness. However, this same advice is inappropriate for those with no biomechanical impairments relating to the structures in question.

Perhaps, a trainer was told by their client that their physician ordered them to avoid a particular exercise or a specific range of motion due to an orthopedic problem. More commonly, trainers offer these over-generalizations because their 'Cracker Jack' certification recommend such practices despite the ability of most people to safely perform these movements. Certainly, some individuals should not perform a particular movement due to a recent injury or an orthopedic issue, but to suggest a movement is inappropriate for all people is an erroneous assumption.

Livingston, CSCS (2004) explains, "The justification of contraindication is derived from the philosophy of training at the level of the lowest common denominator. There are very few exercises that should be contraindicated. There are lots of people who should not be doing certain exercises."

Take for example, sprinting, or even running. These modes of exercise could be considered contraindicative for many people, yet we understand there are those individuals that are certainly capable of performing these activities relatively safely. We also can understand the need to prescribe these forms of exercise for those with particular fitness or sports performance goals. For this reason, we should not dismiss other exercises or activities as dangerous for all individuals. Certainly, one can find numerous studies supporting the injurious effects of running or sprinting. One could even make the argument than nearly all runners or athletes that run have occurred an injury sometime in their careers. But are we to deem running contraindicative for these reasons?

Even swimming, generally considered one of the safest forms of exercise, has a surprisingly high rate of injury at the competitive level. The reasons for injury are multifaceted, but they can often be attributed factors other than the activity per se. See Swimming Injuries.

Its interesting to note that many individuals apparently perform certain exercises thought to be dangerous without incident. It is certainly plausible that factors other than a particular questionable exercise play a concomitant, if not a dominate role in the risk of injury. See Weight Training Risk Factors. We know of no studies that explain or even explore how certain individuals who regularly use these so called contra-indicative exercises experience few if any injuries. Perhaps there are specific anti-risk or protective factors at play offering a certain degree of immunity to the unaffected.

Although certain movements should not be performed by those with a current injury or even those with particular predispositions to certain orthopedic complications, for those with relatively healthy joints, these movements may actually decrease the occurrence of injury, particularly when the joint is moving through this particular range of motion, perhaps, even inadvertently or subtly. Conversely, avoiding a movement or a particular range of motion during exercise may actually increase the risk of injury, particularly if the joint ever experiences greater load than what it is accustomed to, through these particular ranges of motion, either in real world situations or in training. See example of effects of range of motion restrictions:

  • Avoiding knee lockout during squat, leg presses, etc.
  • Avoiding full shoulder extension / abduction (lower range) during shoulder presses
  • Avoiding full shoulder extension / transverse extension (lower range) during chest press or bench press
  • Avoiding spinal extension under load
    • Erector Spinae Weakness
    • Degeneration of joint structures in spine (Nelson 1993)
    • Greater vulnerability to low back injury (Nelson 1995)

Weighted Roman Chair with Balllistic HyperextensionSo what does an exercise instructor do when working with a group? Instead of announcing to the class that a certain movement is 'bad', educate your class why certain movements may not be ideal for some but might be OK for others. With certain 'higher risk' movements, instruct those who have had certain knee or shoulder problems to do it one way (having them follow the advice of their physician) and have the remaining participants perform the movement through the fuller range.

Typically, restrictive guidelines given to injured individuals or those with biomechanical deficiencies are commonly misconstrued and unnecessarily recommended for orthopedically healthy individuals. Ironically, an injury-free individual may be more likely to injure themselves avoiding a movement they believe to be dangerous (full range of motion, locking out, etc.) when they inadvertently perform that movement, as compared to someone that implements that movement following sound training principles and adaptation criteria. The appropriateness of an exercise should be assessed on an individual case-by-case basis. See Common Biomechanical Impairments and Dangerous Exercises Essay and Squat Safety.

References

Kolber MJ, Beekhuizen KS, Cheng MS, Hellman MA (2010). Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Res. 24(6):1696-704.

Livingston S (2004). Contra-indicated People Versus Contra-indicated Exercise, Society of Weight Training Injury Specialists (SWIS) Symposium.

Nelson, B.W., O'Reilly, E., Miller, M., Hogan, M. Wegner, J.A., Kelly, C., (1995). The clinical effects of intensive, specific exercise on chronic low back pain: a controlled study of 895 consecutive patients with 1-year follow up. Orthopedics, 18(10), 971-981.

Nelson, B.W. (1993). A rational approach to the treatment of low back pain. J Musculoskel Med, 10(5), 67-82.


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