All too often, weight training and chronic
injuries go hand in hand. That doesn't necessarihave to be the case. As a competitive
bodybuilder I have suffered from most
of these injuries and know how debilitating
and frustrating they can be.
Fortunately, as a doctor who treats
these types of injuries, I know how to alleviate and prevent the
same injuries. If you'll read the next few pages, I'll share with
you the basics of three of the most common chronic injuries that
occur in the gym, how to work around them, and most importantly,
how to avoid them.
most common injury
that I see among
men around the gym
is shoulder impingement syndrome.
If you've ever felt pain in your
shoulder when pressing overhead,
you may very well suffer from
shoulder impingement syndrome.
Click To Enlarge.
Seated Military Press.
This malady can make bench presses, lateral raises, and shoulder presses next to impossible. Don't
make the problem worse by ignoring
it and thinking it will go away on its
Worse yet, some lifters think
that shoulder pain is just part of
training. It doesn't have to be.
Whatever you do, do not ignore
shoulder pain. Doing so can result
in bone spurs and a torn rotator
cuff. Yes, my friends, that means
Impingement syndrome is
defined as a compromise of the
space between the head of the
humerus and the acromial arch.
In simple terms: the top of your
upper arm bone is too high and
close to your acromion (part of the
shoulder blade (scapula) and your
clavicle (collarbone). This
decrease in space can come from
either a structural problem (usually
bone) or a functional problem
Click To Enlarge.
Anatomy Of The Shoulders.
Since a structural
problem would likely show
up as soon as someone begins lifting
weights, we'll focus on functional
causes of impingement,
which are most likely, the culprit
in the gym.
When you raise your arm, a
complex chain of events takes
place. A group of muscles called
the scapular stabilizers (serratus,
trapezius, levator scapulae, rhomboids,
and teres major) function in
a very precise manner to ensure
that the scapula is in the right
place at the right time.
At the same time, the rotator cuff muscles
teres minor, and subscapularis)
finely coordinate the movement of
the humerus to ensure proper
alignment in relation to the
If these muscles do not coordinate
this movement perfectly, the
head of the humerus is likely to
rise up and forward and bump into
the bottom of the acromion. (To
feel the top of your acromion, slide
your fingers from the middle of your collarbone outward toward
your deltoid. Just before getting to
your deltoid you will feel the top of
your acromion sticking up a bit.)
When this impingement occurs, the
supraspinatus muscle and tendon,
as well as the subacromial bursa,
are trapped between the humerus
and the acromion. When two soft
structures are trapped between two
bony structures, you can guess who
loses. This results in swelling and
tenderness of this bursa (bursitis)
and the supraspinatus muscle andd
Working Around Shoulder Injuries
Although I don't feel that doing
barbell bench presses is often the
cause of shoulder impingement syndrome,
it does seem to exacerbate
the condition once you have it.
Therefore I would avoid BB benches
if your shoulder is less than perfect.
Dumbbell presses and incline presses,
on the other hand, seem to be
well tolerated among most everyone.
Click To Enlarge.
Dumbbell Bench Press.
In addition, performing lateral
raises to the point where your arm
is parallel to the floor (or above)
can aggravate a shoulder problem.
Try taking your laterals only up to
the point where your arm is about
15-30 degrees below horizontal.
Better yet, try scaption instead.
Scaption is essentially where you
raise the dumbbells up in a plane
halfway between lateral raises and
Personally, when I'm
having a shoulder flare-up, my only
shoulder exercise will be scaption.
It feels safe, stable, and really hits
both the anterior and medial heads
of the deltoid very well.
Preventing Shoulder Injuries
To avoid impingement syndrome
and other shoulder maladies,
there are a couple of exercises
that you should avoid altogether:
behind the neck pulldowns and especially behind the neck shoulder presses. Both of these exercises are
favorites among many bodybuilders
because of the manner in which
they stimulate the working muscles.
Click To Enlarge.
Regardless, if they lead to
injury and time away from the
gym, then their benefits are more
than negated by their side effects.
Click To Enlarge.
As opposed to doing pulldowns
behind the neck, do them to the
front. A recent EMG study shows
that pulling the bar to the front
actually stimulates the Latissimus
Dorsi (lats) better than pulling the
bar behind the neck anyway.
In addition to shoulder problems,
pulling the bar behind the neck can
also cause neck problems due to
the amount of neck flexion that
you must do to get your head out of
the way of the bar.
In addition, strengthening the
external rotators (infraspinatus
and teres minor) and scapular
retractors (rhomboids and middle
traps) along with stretching the
internal rotators (chest, anterior
delts, and lats) will go a long way in
restoring normal biomechanics to
the shoulder region. In a later
issue of Reform, I will cover the
specifics of doing just that.
Knee problems like patellar
tracking problems and patellar
tendinitis seem to be the Achilles
heel to women trainees much like
shoulder impingement syndrome is
An inherent problem lies
in the fact that our hip joints are
farther apart than our knee joints.
In other words, our legs angle in.
The angle is greater in women
because they have wider hips than
men, generally speaking, that is.
Due to this inward angle, the
patella (kneecap) has a tendency
to be pulled laterally, or out to the
side. This creates a problem because the patella is designed to
track in a very precise groove
when the knee flexes and extends.
Even the slightest lateral deviation
can cause premature wear
and tear on the cartilage that lies
on the back of the kneecap. This
is called a Patellar Tracking problem.
If left untreated, the cartilage
could advance to what is
known as Chondromalacia - excessive
wear of the cartilage.
Because a squat can subject
the back of the kneecap to a force
seven and a half times greater
than your bodyweight, it's easy to
see why even the slightest problem
with the extensor mechanism
can cause a lot of damage.
Pain with these injuries usually begins
by hurting after an exercise session,
then during the exercise session,
and eventually all the time.
It may even progress to the point
of clicking or popping, usually as a
result of cartilage damage.
with this condition usually exhibit
a positive theater sign, meaning
they can't sit with their knees
flexed for too long without causing
some pain. More often than not,
this pain is typically rather vague
and described by sufferers as
"inside the knee" or "behind the
Click To Enlarge.
Another common chronic knee
injury is Patellar Tendinitis, also
called "jumper's knee." Someone
who has pinpoint pain right at the
base of the kneecap most likely
suffers from this condition.
Patellar tendinitis is frequently a
result of tight quadriceps, in addition
to overuse. When the quads
are chronically tight, they will pull
excessively on the quadriceps tendon.
Over time, this extra stress
on the tendon will cause it to get
As you may know, an
inflamed tendon is called tendinitis,
and, as I mentioned before, it
will usually rear its ugly head just
below the patella. Hence the
name patellar tendinitis.
Click To Enlarge.
AVOID: Behind the neck pulldowns and shoulder presses.
Working Around Knee Injuries
A good rule to follow is, "if it
hurts, don't do it." I don't want to
be one of the doctors who always
says, "Oh, just stay off it for a few
weeks and take these anti-inflammatories."
I am very pro-exercise.
However, if an exercise really causes
your knee to hurt, it's probably
doing more damage to an already
injured knee. (Same goes for your
Hack squats, lunges,
and full range-of-motion leg extensions
tend to exacerbate these conditions.
Although not an exercise
per se, going down stairs tends to
be painful as well. Leg presses
with your feet fairly high on the
platform and partial leg extensions
like described before, tend to be
tolerated well by most people.
Preventing Knee Injuries
As with most overuse injuries,
pain from patellar tracking problems
and patellar tendinitis are
also a result of either a sudden
increase or change in activity.
Therefore, you want to make sure
to adhere to the GPO principal.
GPO stands for Gradual
Progressive Overload. The key
word being Gradual. If you've been
doing three sets of leg extensions
and three sets of squats once per
week for quads, then suddenly
doing five sets of each twice per
week, you're asking for knee pain.
Likewise, if you've been squatting
225lbs for ten reps, your next goal
should be 230 or 235lbs for ten
reps. Don't suddenly jump up to
275lbs. Make use of those little 2.5
pound doughnuts in your gym.
They're not there for wimps,
they're there for intelligent people
who know how to apply GPO.
Besides progressing gradually,
there is another important rule to
follow when trying to prevent knee
injuries. Avoid letting your knee go
past your toes when doing exercises
like squats and lunges.
will put a lot more stress on your
knee than if you keep your knee
behind your toes in the bottom
position of these exercises. I must
admit though, that the quads sure
get a great stretch and subsequent
stimulation when the knee exceeds
the toe line. You may know some
people who train by exceeding the
knee/toe line on a regular basis and they never have knee problems.
Likewise, some people can smoke
two packs of cigarettes a day for 50
years and never get lung cancer.
How To Reduce Stubborn Knee Injuries In All Sports!
Check out these five home-based exercises that are shown to make your knees stronger and get you off the injured reserve list in a hurry!
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Regardless, both increase your risk
Ensuring adequate strength of
the vastus medialis (teardrop of the
quads) is essential in preventing and
treating patellar tracking problems.
If the vastus medialis is weak, it
allows the patellar to drift laterally,
as is already its tendency given the
fact that our legs angle inward, and,
as I said, especially in women.
As for prevention and treatment
of patellar tendinitis, begin by
stretching the quadriceps. This
will help to provide a long-term
solution. In addition, you should
consider having some soft-tissue
work like Active or MyoFascial
Release done on your quadriceps to
help loosen them up and keep them
loose. Although not nearly as
effective, regular deep tissue massage
will also help a bit.
Good For All Your Inflammatory Ailments.
Although cryotherapy sounds
like some sort of futuristic medical
treatment in which your body is
frozen and preserved until a cure is
found for your ailment, it simply
refers to the use of ice to treat
inflammation. Both the shoulder
and knee injuries mentioned above
will respond well to this simple
procedure you can do at home. You
can also use cryotherapy on elbow
tendinitis and just about any
sprain/strain that you may incur.
To properly use cryotherapy,
begin by placing a thin, wet rag on
the affected area. Then place the
ice pack (a bag of crushed ice or
even frozen vegetables will suffice)
on top of the rag. Allow the ice
pack to sit on the area for up to
twenty minutes or until the area
goes numb, whichever comes first.
Leaving it on longer than that can
cause the body to actually bring
more blood and inflammation to
the already inflamed area. Of
course it can cause frostbite as
well, neither of which are good.
Although most people would
prefer to put heat on most injuries,
ice is usually your best choice.
Click To Enlarge.
AVOID: Letting Your Knee Go Past Your Toes.
will agree that heat temporarily feels better, but in the long run it
will simply cause more inflammation
than what already exists.
That's the exact opposite of what
you want. Avoid the instant gratification
and go with ice on any
injury that involves (or may
Don't forget the role that nutrition
plays in healing any inflammatory
ailment. First of all, make
sure to consume plenty of the
Omega 3 fatty acids (aka linolenic
acid). Omega 3's have been shown
to ultimately have an anti-inflammatory
effect within the body.
Fish oil and flax oil are two of the most
concentrated sources of this coveted
essential fatty acid. Likewise, try to
avoid excessive saturated fats which
can actually have a pro-inflammatory
effect. Lastly, try a joint support
product that contains the clinically
proven 1,500 mg of
Glucosamine along with 1,200 mg of
Chondroitin. Stick with a reputable
To close, don't do any exercise
that hurts. If you continue to add
insult to injury, your pain will never
For those of you who do
not have any knee or shoulder pain,
training intelligently will help you
to remain pain free. As the saying
goes, "an ounce of prevention is
worth a pound of cure."
What Do Other People On The Forum Think?
Discuss your problems with chondromalacia and how it had affected you. Find out what others have done to deal with it and prevent it from happening in the future!
Dr. Clay Hyght
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