Crac! Boum! Aiee! How not to bust yourself up

I’ve always loved the above quaint Quebecois notation for disaster, the onomatopoeic yet distinctively Gallic words that make catastrophes fun to discuss. To me, it’s become an all-purpose expression for any kind of unpleasant event involving personal injury, and a way to make light of an otherwise nasty occurrence.

People often ask me how I know so much about sports injuries. Well, I’ve been weight training seriously since the mid-1990s. And during that time I gave myself just about every major injury there is. (Oh, the joys of learning through experience.) I’d like to say my gym injuries happened as a result of a spectacular accident involving humourous Leslie Nielsen-esque pratfalls, 45-lb plates, rubber chickens, and/or general laff-a-minit antics. I’d like to say they were from rescuing babies stuck up in trees or kittens from a burning building. I’d like to say stuff like “You should see the other girl!”

But no, my problems came about in the same rather mediocre and uninteresting way that so many other physical misadventures in the gym do — overuse, fatigue, and biomechanical mismatch.

where do gym injuries come from?

While weight training has a reputation for being dangerous, it has a much lower incidence of acute injury than many other sports. In other words, it’s very unlikely that you will break a bone, sprain something badly, cut yourself, get a concussion, or tear a muscle or connective tissue. Sports such as football, hockey, skiing, and running have far greater rates of injury than weight training. In fact, weight training is generally used as part of an injury rehab program.

The source of most injuries in the gym, particularly those which are chronic, generally stem from a mundane source: bad gym practice. It is very important to make sure that you use correct technique, you vary your exercises occasionally, that you work your stabilizers with free weights, you keep your ego in check, and that you don’t concentrate your efforts in one area to the exclusion and detriment of others (you know who I’m talking to, chest boys).

Overuse injuries tend to emerge when you’ve been doing the same thing with too much frequency, and/or too much intensity, especially if you’re not conditioned for it yet. Overuse injuries often include common complaints such as achey joints and tendonitis (an inflammation of the tendon). Overuse injuries are particularly nasty because they don’t always result from big heavy movements. Rather, like carpal tunnel syndrome or Blackberry thumb, they come from tiny things done over and over and over. They may feel worse after you do the offending exercise, ache between workouts, and be restricted to a particular area. Overuse injuries generally respond to rest and reduction of the problem activity, icing, aggressive supplementation (see below) and if necessary, physiotherapy.

Overuse injuries also tend to pop up in smaller joints: wrists, shoulders, ankles, etc. This tells you that you may not be distributing the loading properly. A good example is the preacher bench biceps curl. In my opinion, this exercise is an easy path to elbow tendonitis. The upper arm is fixed in place, and there’s only one moving joint — the elbow. Because biceps curls are an ego exercise, folks love to load up the barbell and grind out the reps. When a lot of weight is hanging on one joint, that’s an E-Z-Bake recipe for trouble.

Fatigue-based injuries are often more serious, because you’re tired and maybe not using good form. Or, maybe you are using good form but you’re pushing your body past the limits of what it can comfortably do. Many years ago, I sprained my back. I was at the end of a long workout and decided to add weight to my last set of stiff-legged deadlifts. Because safe execution of this particular lift depends so much on perfect control of the spine, and because back injuries can result even from small deviations in vertebral position, this was a Very Dumb Idea. This back sprain stayed with me for many years, and even now I have to be careful lest I piss it off again. So, don’t go like that.

Wherever possible, don’t attempt difficult movements and/or movements that require a lot of careful technique, when you’re fatigued, because it increases your chances of injury. If you’re trying for a one-rep max, warm up well but don’t overtire yourself. Use a power cage and/or a spotter where possible and appropriate. Fatigue-based injuries tend to be things like minor sprains and strains.

Finally, there are injuries I call “biomechanical mismatch“. What this means is that the mechanics of some people’s bodies just don’t work with some forms of certain exercises. Frinstance, many people experience shoulder pain and eventual dysfunction from exercises such as the barbell bench press, upright rows, and dips. But yet they keep on doing them instead of finding substitutes. I see a lot of guys in my gym doing what I call the “chicken wing”. They do the bench press, then get up and crank one of their arms around while holding that shoulder with the other hand. They’re clearly in pain from it. But they continue to do it. For most recreational lifters, there’s no reason why you have to do a certain exercise if it causes you pain. You may need a temporary layoff, you may need to check your form and fix your technique, you may need to use less weight, you may need to modify the exercise slightly (e.g. bench press with dumbbells, or change the grip), you may need to find a substitute, or just junk the thing entirely. Don’t continue to do something if it’s hurting, no matter how good you think the exercise is.

uh oh. i think i hurt myself…

Here’s some general advice.

Learn to distinguish between good pain and bad pain. Good pain, which indicates that your muscles are being productively worked, manifests itself largely as delayed onset muscle soreness (DOMS), and is a general muscle ache or stiffness in the region that you exercised 24-36 hours before. Good pain can also be the “burn” that you feel at the end of a hard set. Good pain is diffuse, not overly localized to one spot. It often comes on slowly, rep by rep or hour by hour.

Bad pain, which can indicate injury or possible conditions for injury:

  • tends to be acute and/or sudden
  • usually occurs at a precise moment while exercising
  • is more likely to be felt in a specific area like a joint
  • may be accompanied by an audible sound like a crack or snap
  • may feel like you’ve been suddenly struck in that area, or that something has torn
  • may bruise and/or swell later

immediate treatment

OK, so you’ve got bad pain. Now what? The first thing to do is to take charge of the immediate situation. Remember the acronym RICE: rest, ice, compression, and elevation. Rest is obvious: STOP what you are doing that’s causing the pain. Don’t be an ass and try to “work through the pain”. I prefer to junk the slogan, “No pain, no gain” in favour of, “No pain, no pain” (yeah, it’s stupid, but it kinda makes sense).

Second, apply ice as soon as possible to the affected area for 10 minutes or so. Ice has both an analgesic and anti-inflammatory effect; in other words, it helps control pain and swelling. Wrap the ice in a towel; do not apply ice directly to the skin if you can help it. However, most healthy people with adequate circulation do not need to worry unduly about skin damage from brief cold application. A bag of frozen peas works well for injury icing, since you can mold it to the bumps and lumps of all your 2000 parts. It’s also handy to buy one of those gel packs and just keep it in the freezer for emergencies. At first you may feel a burning sensation on the skin as the nerves respond to the sensation of cold, but shortly a nice numbness will set in.

Never, NEVER heat an injury for the first 24-48 hours after it occurs, even if it feels good. You’ll get swelling and inflammation like you won’t believe. If your GI tract can tolerate it, take some ibuprofen, 200-400 mg every 4 hours. (Be smart with this stuff. Save it for when you really need it, as it’s hard on your insides.) This will control the pain and inflammation for the time being. Keep icing for 10-15 minutes every hour or two.

Third, compression. This will also help control swelling. If you can do so, wrap the affected area up snugly with an ace bandage (but not so snugly that you cut off circulation; you want compression, not a tourniquet… unless you’ve just severed your arm, then you probably do want a tourniquet). In a pinch, any piece of cloth will do. On a soccer field I’ve stolen someone’s head bandana to tie an ice pack to a player’s knee injury. Bad hair is a small price to pay!

Finally, elevate the affected part if you can. This might mean, for example, putting a sprained foot up on a chair while you sit with your ice pack.

long-term treatment

See a doctor if the injury is serious and/or persists for longer than a few days. The only way to take charge of your injury is to know what the heck it is. Is it the ligament, is it the bursae, is it the hard mass of the joint itself, etc.? Sometimes the symptoms for each can mimic one another, so it’s best to be sure. Try to find a doctor that understands a bit about sports medicine. If that’s not possible, ask your GP to refer you to someone who works with athletes and understands what their concerns are. Often GPs can be a little in the dark about what strength training involves, and don’t tailor their solutions to your problem.

Educate yourself. Learn some anatomy, see how the joint/muscle works, and understand what the problem is. Ask your doctor to explain exactly what’s wrong, and what you might have been doing to cause it. Try to suck in as much information as you possibly can. Critically evaluate your routine to see what you may have been doing. Were you working one group too hard without working the other (for example, were you working chest too often without regard to back?), or were you training on a machine that allowed your stabilizers to weaken, or that forced you into an unnatural movement pattern? Were you using improper form and uncontrolled movements? Did you just do too much of a good thing? Be ruthless in your critique. (If you fell down the stairs or got the snot beaten out of you in a title fight, you probably know what caused your problem, so you can likely omit this step.)

Investigate such things as supplementation to aid the healing process.

  • Glucosamine sulfate is well-documented as a supplement for regenerating cartilage. 1500 to 2000 mg in divided doses is usually recommended for the hardcore weight trainer, and 500-1000 mg in divided doses for the average person concerned about connective tissue problems. Because of the relatively poor blood supply to connective tissues, glucosamine sulfate supplementation will take a while to show effects (and connective tissue injuries will take a while to heal).
  • Fish oil, taken in therapeutic doses of 5-10 g daily, is also a good anti-inflammatory that can be taken long term.
  • Daily intake of vitamin E and C (in food, not supplement form) can boost your body’s natural defenses.
  • Judicious application of ice and/or heat (experiment to find what works best for your particular problem) can work to keep things under control enough so that you can work out. You can use heat once the initial swelling has gone down. Use your judgement here; if your foot still looks like a purple basketball with toes, keep icing. Alternating hot-cold treatments works well: place a heating pad on the affected area or immerse it in very warm water for a few minutes; then immediately switch to ice or cold water immersion for a few minutes. Go back and forth a few times, finishing with ice.

Allow yourself time to recover. Don’t try to work through an injury until it’s fully healed. Your body will not appreciate you re-injuring yourself and will reward your pigheadedness with a longer recovery time. Try not to let an injury destroy your enthusiasm for working out.

My injuries have made me wiser, and now I approach the weights with a new reverence, caring less about how much weight I do and more about how I do it. While injuries force some humility upon you, they can be an opportunity for you to re-evaluate your goals and motives for working out.