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 deficiencies 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 a 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?
Although certain movements should not be performed by those
with a current injury or even those with certain 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 effects of range
of motion restrictions:
- Avoiding knee lockout during squat, leg presses, etc.
- Avoiding full extension or abduction during shoulder presses
- Avoiding spinal extension under load
- Erector Spinae Weakness
- Degeneration of joint structures in spine (Nelson 1993)
- Greater venerability to low back injury (Nelson 1995)
So what is an exercise instructor to do when working with
a group? Instead of announcing to the class that a certain movement
is 'bad', educate your class. 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 for 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 Deficiencies (below) and Dangerous
Exercises Essay and Squat
Both extrinsic and intrinsic factors
can increase the risk of injury. Extrinsic factors include training
errors, faulty technique, poor environmental conditions, incorrect
equipment and surfaces. Intrinsic factors include biomechanical
deficiencies, including malignant of limbs, muscular imbalances,
degenerative processes, and other anatomical factors (Crown LA,
et. al., 1997).
Biomechanical deficiencies (as those referenced
below) may contribute to orthopedic injury when combined
with other factors than may negatively effect joint integrity
(e.g. hyper-mobility, structural weakness, insufficient adaptation
of joint or muscular structures, acute or chronic overtraining,
etc). See Adaptation
are always at risk of injury, whether it be during practice,
in the weight room, or on the playing field. The reasons of injury
vary and often happen unnecessarily. The failure to understand
and implement fundamental training
principles and adaptation
criteria is largely to blame. A program that does not adequately
prepare the athlete for the specific types of forces and stresses
experienced on during the sport place athletes at risk. See Training Specificity
Training for the Reduction of Sports Injury. Programs that
fail to incorporate movements that condition stabilizing muscles
(joint stabilizers such as hamstrings and rotator cuff muscles),
maintain ideal muscular
balance, and correct biomechanical
deficiencies unique to each athlete increase the risk of
injury on and off the playing field. Using too much resistance
or perform too many sets when athletes are first introduced to
new movements or exercise variations are common training errors
greatly increasing the risk of injury. Injuries can also be caused
by poorly designed split and cross training programs (e.g. speed,
agility, and strength training) as well as the over emphasis
of higher-volume training programs. See Overtraining.
The coach can introduce methods in which athlete's can customized
a 'group program' to each athlete's unique abilities, results,
and needs. Coaches must allow for proper adaptation to 'new'
exercises, understand the benefits periodization
techniques, implement program customization, and schedule
adequate recovery periods for optimal recovery and progress.
Also see Training Mistakes.
The biomechanical deficiencies are listed for precautionary
measures only so they may be identified and possibly corrected
in attempt to prevent athletic injuries during exercise or physical
activity. A physician may need to establish if a biomechanical
deficiency is structural, muscular, neuromuscular, or due to
some other pathology. The corrective exercises assume a muscular
imbalance (flexibility and strength). Only a qualified physician
should diagnose and give prescription for an existing injury.
In some circumstances, an attempt to correct a biomechanical
deficiency may irritate the injury and prolong recovery, particularly
if certain exercises are initiated too soon after an injury has
occurred. Even after the underlying biomechanical deficiencies
have been improved, the injury may require the attention of a
physical therapist under the advise of a physician to restore
total functionality. See Injury
Prevention Tidbits and Sports
Injury First Aid.
Crown LA, Hizon JW, Rodney WM, (1997) Musculoskeletal Injuries
in Sports, The Team Physician's Handbook, Mosby, 2: 361-370.
Livingston S (2004). Contra-indicated People Versus Contra-indicated
Exercise, Society of Weight Training Injury Specialists (SWIS)