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Weight loss, improved cardiovascular/respiratory function, increased metabolic rate, and increase in lean muscle mass are all parameters that entice gym goers from the outset. But what are the risks ? Many exercises that are performed within a gym environment can be performed incorrectly, and hence contribute to musculo-skeletal injury. I am consistently seeing novice gym goers hinge there spine to lift that extra 10kg on a bicep curl, or worse yet bend there spine during a heavy max weight dead lift. Although there are small group of gym exercises that I consider to be forbidden for all humans, most are safe, and actually very beneficial if performed correctly.

Upper Body

An upper body strengthening regime can involve a combination of machine and free weight exercises, and are generally aimed at increasing muscle size and or definition. It is a general notion that free weights can increase stability and thereby protect joints from injury. Thus for most people it is advisable to perform dumbbell/barbell exercises as opposed to machines. Machines however can be an option for those who are lifting much lighter loads at higher reps to achieve more of a toning/endurance effect. The absolute forbidden exercise for the upper limb is dips, either the arm behind or bar style. It is common to see the average middle aged woman doing these in attempts to lose the ‘tuck shop arms’. These exercises place a massive stretch on the front of the shoulder joint potentially irritating the biceps tendon and front of the rotator cuff. Hence I tell all my patients to avoid dips at all costs! Press exercises, especially incline are in the category proceed with caution. Care should be taken not to go too deep with the down phase, as this can also place pressure on the front of the shoulder, due to a restriction in scapula mobility levering the humeral head forward. Majority of other exercises can be effective if performed correctly and there is no presence of shoulder pathology or abnormal biomechanics. 

Lower Body

Due to the size of most of the lower limb muscles, a strength/muscle building program aimed at the legs can be a very effective way of boosting metabolism. With this benefit, comes the risk of injury due to these muscles needing a fairly large stimulus (ie high resistance) to gain condition. Exercises like squats and deadlifts can be detrimental if performed incorrectly, and can be equally dangerous if resistance is progressed to rapidly. Maintaining a neutral spine through the movement is the primary challenge faced by strength trainers. Collapsing into spinal flexion (bend) and over-arching into extension can place stress on discs and facet joints respectively. It is advised to control these movement patterns through the gluteals and hamstrings. Similarly, leg press/45 degree leg press can be harmful for people with a pre-existing lumbar disc injury. Anybody with a pre-existing lumbar condition must take this into account and consult your physio prior to embarking on a program.

Pre-existing Conditions

Pre-existing pathology, biomechanical abnormalities and joint instabilities can dramatically increase the spectrum of exercises that can be a problem. For example a severe shoulder instability may cause pain with most upper limb machine and free weight exercises. It may therefore be a prerequisite that the individual partake in a full scapula/rotator cuff control program prior to getting into the heavy weights and working the outer global musculature. Similarly, someone with lower back/pelvic pain might progress through a lower level inner unit (see previous months article) and gluteal activation and control program prior to moving into dead lifts. The other area of concern within a gym setting is the cardio circuit, especially the treadmill. Although high intensity interval running is an excellent fat burning tool, it can lead to knee problems given the individual is overweight, and/or has poor hip knee control. It may be worthwhile for the trainer to assess the knee control while running and if warranted, referral onto a physiotherapist for a hip/knee control program. Provided that a graduated program is adhered to, correct technique is adopted and normal joint control/mechanics are apparent, a gym based program is an excellent way to get fit, build muscle and stay away from the doctor.

Shane O’Sullivan
Sports Physiotherapist
Prahran Sports Medicine Centre