Sports Injuries – Let’s Stop Blaming the Exercise

Recently, while both attending and presenting at a professional conference, during a particular speaker presentation a conversation (actually a debate) arose by some attendees regarding their opposition (actually condemning) of the utilization of specific weight room exercises which were a portion of the content of the speaker’s presentation.

A “pro vs. con” utilization of the exercises presented discussion evolved and continued until the next presentation was ready to begin. If not for the next scheduled presentation, I am confident the discussion would have continued for a prolonged period of time.

The “pro vs. con” weightroom exercise performance conversation resumed that evening with a number of strength and conditioning (S&C) coaches who were gathered at a local tavern where I also happened to be present. During the lengthy conversation there were yet again, some very strong opinions with regard to the performance of these same weightroom exercises, and how these specific exercises, in the opinion of some, were unsafe and to be avoided like the plague.

This certainly wasn’t the first time I had been present to such a conversation. Throughout my 30 plus year career as a Physical Therapist, Athletic Trainer and Strength and Conditioning (S&C) Coach, I have witnessed many “era’s” of athletic enhancement performance training.

For many years, the evolvement of various types of exercise machines and the theme of “the next best thing to free weights” was all too common, nutritional supplements evolved, “odd implement” equipment entered the training arena, countless pieces of new equipment, training techniques, and programming continued to emerge.

Books progressed to instructional DVD’s, and the establishment of the Internet provided an easy and accessible venue to educate, as well as to both promote and sell products. Undoubtedly many of these product developments and training progressions were beneficial to the industry.

During these decades I have also witnessed numerous claims and products that were preceded by the words “the best”, some may have been valid, some were surely unfounded, but one thing is for certain, these manifestations continue to this day. One reoccurring “theme” that has also “reared it’s head” throughout my career, and yet again at this conference, is the perpetual condemning of the performance of specific weightroom exercises that are to be avoided during the development of an athletic performance enhancement training program.

These “con” sentiments are often followed with a declaration of the type of injury that may (will) occur if these weightroom exercises are utilized for the enhancement of the various physical qualities necessary for the participation in competitive athletics.

I recall a similar experience early in my career when reading that during the early 1960’s a Dr. Karl Kline was noted for his insurgency against the utilization of the squat exercise with claims this specific exercise was detrimental to the ligaments of the knee.

Due to Dr. Klein’s efforts, the “fable” of the squat exercise performance resulting in an adverse effect to the ligaments of the knee continued to snowball for many years to come, including my initial years in practice, amongst coaches and medical professionals.

During my time at the Sports Medicine, Performance, and Research Center at Hospital for Special Surgery in New York City I successfully initiated the squat exercise as part of my ACL reconstruction rehabilitation protocol in 1986, and continue to do so to this day.

In 1994 my associates and I published our research in the American Journal of Sports Medicine that was one of many studies performed by many other researchers and professionals throughout the years to demonstrate this particular squat “myth” to be unsubstantiated.

To this day continued concern regarding the performance of weightroom exercises such as the squat, overhead press, the Olympic lifts, leg press, knee extension, and many other specific exercises placing “excessive and undue stress” upon the low back (spine), shoulders, knees, and other various anatomical structures of the body has portrayed to be the topic of conversation at many conferences, publications, Internet sites and blogs, and yes, even dialog at the local tavern.

Throughout all of these discussions I have often witnessed many a conversation of how the athlete’s injury was “due to the exercise” performed, yet I personally do not often hear, read, or witness the responsibly for the occurrence of such an unfortunate event as that of the S&C Professional.

Certainly there are times an unfortunate injury may occur due to circumstances that are not within the control of the S&C Professional. However, these circumstances are of rare incidence. The S&C professional is responsible for establishing a controlled and safe training environment, as there is research documenting the incidence of weightroom injuries to be very low in comparison to the incidence of the various types of athletic injuries that may occur during athletic team practice or especially during game day competition.

Therefore, the argument of the unfortunate occurrence of an athlete’s training injury due to a specific strength or power type exercise performance is likely lower than what is perceived. Perhaps the strong “con” opinion of specific exercise(s) performance is established due to the history of a single specific incident, experience, and/or conversations with other S&C professionals, resulting in the “blame” for the training injury to be directed upon the specific exercise of performance at the time of the injury.

The question may then be asked, “If a specific strength or power type exercise performance is dangerous and responsible for a “high” number of weightroom injuries, then why do so many athletes from various sports of participation perform these very same exercises without concern or incidence of injury?”

If these specific exercises are so dangerous, then why have they survived the stringent test of time as many of these “condemned” exercises have been utilized both safely and successfully for more than a century?

The Athlete’s Evaluation and Preparation

At the time an athlete is to initiate their participation in an athletic performance enhancement training program, an evaluation process (based on the individual coach’s preference) is necessary to determine the athlete’s strengths, deficits, needs, and establishment of goals.

A medical history should also be included in this evaluation process for awareness of the athlete’s medical, injury, and surgical history so that appropriate training adaptations, if necessary, may be incorporated into the athletic enhancement training program to avoid an exacerbation or recurrence of the athletes previous injury/surgical history.

Once the athlete’s evaluation is completed, all of the information obtained is utilized for the development of the athlete’s performance enhancement training program based on the needs and goals that have been established.

Prior to the initiation of their “primary” athletic enhancement training program, often times it is necessary to prepare the athlete for this “primary” training program via a programmed “preparation period” of training to establish and/or enhance such essential physical qualities as mobility, stability, proficiency in exercise technique, strength, and work capacity.

It certainly serves no purpose to load an athlete with a high intensity (i.e. weight, velocity, etc.) whom is not “equipped” to handle such an exercise intensity or volume of work. It also doesn’t make sense to disregard an exercise that may be beneficial for the athlete when all that is required is to simply prepare the athlete to ensure an eventual safe performance of the exercise in question.

If an athlete cannot perform an appropriate and perhaps a beneficial exercise due to an inadequacy in a physical quality and/or anatomical deficit, is it more logical to disregard the exercise entirely or to resolve the inadequacy/deficit (i.e. via the preparation period) so that this valuable exercise may be incorporated into the athlete’s training program?

If neither an evaluation, or if deemed necessary, a preparation period of training is implemented by the S&C professional, and the athlete is injured during a specific exercise performance, is that the fault of the exercise executed at the time of injury?

The Selection of “Safe” Exercises

Every exercise has a place for consideration during the athletic performance enhancement training process. Some exercises may be deemed inappropriate and not be incorporated at all, but when determined to be appropriate, will have their place for utilization based upon the athlete’s presentation as determined at the time of the athlete’s evaluation.

The evaluation will provide the information previously stated, to establish the appropriate exercise selection for the needs and goals of the athlete. The selection of some specific exercises may be employed more often than others, as there certainly are specific exercises that are considered to be the “foundation” of each S&C Professional’s training program(s).

The “foundation” of exercises may vary from coach to coach as disparities in various program philosophies including exercise selection, certainly exists. However, isn’t this one way in which we as S&C Professionals learn from each other? If there was a “perfect” training program or “perfect” exercise wouldn’t we all be coaching exactly the same way?

The work of Hans Seyle as well as the work of others, have documented the necessity for the application of stress to be applied to the body for adaptation and (physical) enhancement to take place. The stress applied to the athlete must be of a high enough stimuli to disrupt the homeostasis of the body for sufficient adaptation of the body to take place.

For this disruption to occur, the stress applied to the body must exceed the levels of stress to which the body is accustomed. Each specific exercise available for selection will place an emphasis of increased localized stress upon different anatomical regions of the body based on factors such as body posture and biomechanics of the exercise (movement) performance, the (anatomical) placement of the exercise resistance, and the velocity of exercise performance, to name a few.

As an example, some exercises considered “safe” for the lumbar spine might “unload” the lumbar spine so to speak, yet place increased stress to the sacroiliac joint. An exercise considered to “unload” the knees, may place greater stress upon the hips and low back. An exercise considered safe for the shoulders (gleno-humeral joint) may prohibit the normal and necessary scapula-thoracic motion required during exercise performance, and the list can go on and on.

Due to the necessary application of stress, all exercise performance encompasses an effect of both a risk and reward with regard to the (a) high stresses placed upon specific anatomical structures as well as (b) the diverse anatomical structures that may also be considered “unloaded” during the same exercise performance.

When exercises are appropriately selected, programmed, and applied, the stress levels placed upon the body will be suitable for the exercises performed during the training process. What is also true is that with inappropriate exercise selection, programming and stress application, some anatomical structures may receive unwarranted levels of inappropriate (excessively high) stress during exercise performance that may result in an undesirable outcome.

“Optimally safe” exercise selection for performance are those exercises that are appropriately selected based on the athlete’s medical history, evaluation, and work capacity (preparation), which also include proper technical exercise execution. Specifically with regard to the process of athletic enhancement performance exercise selection and prescription, one must also remember to address the “big picture” and not only focus on one anatomical joint, structure, or muscle group.

Exercise Intensity

The exercise intensity may arise from a variety of applications. The weight (load) placed upon a bar, the velocity of the bar, run, or throw (i.e. maximal effort vs. tempo), as well as the height and/or distance of a jump (i.e. plyometrics), to name a few.

Appropriate exercise intensity is not only important to ensure “adaptation”, but is also essential to minimize the occurrence of a possible training injury. For example, as an athlete performs the squat exercise with an inappropriately programmed (excessively high) specific intensity (weight), to compensate for this excessive load, an unwarranted flexion (posture) of the lumbar spine may occur in an attempt to achieve a successful exercise performance.

An athlete may also “arch” their back to compensate for an inappropriately prescribed heavy intensity during an overhead press or bench press performance as another postural “adaptation” in an attempt to ensure the same exercise success. As a possible consequence of this “postural compensation” during exercise performance, if an unfortunate injury happened to occur, is that the fault of the exercise performed?

Who programmed the inappropriate high intensity to be lifted by the athlete, the S&C professional or the specific exercise that was performed at the time of the injury?

Exercise Volume

The exercise volume is probably the most significant training component that is responsible for excessive fatigue. The onset of fatigue may also result in consequences during the exercise performance.

Exercise fatigue will negatively affect the body’s proprioception abilities resulting in a decrease in stability, a decrease in the proficiency of exercise technique/performance, as well as a decline in muscle force output. The undesirable effects of fatigue are well noted in athletics, i.e. there is a reason why there is a pitch count at all levels of baseball competition.

If the program design for the exercise performance volume is inappropriate (excessive) for the athlete, and at the time of an attempted specific exercise performance the athlete is overly fatigued, resulting in a change of the qualities listed above, and an ensuing injury occurs during exercise performance, is that the fault of the exercise performed at the time of injury?

Who is responsible for prescribing and applying the exercise volume to be performed by the athlete, the S&C professional or the specific exercise performed at the time of injury?

The exercise performed surely does not retain a level of intelligence (possess a brain), or the ability to comprehend, think, or reason. Table 1 is a review of the capabilities of the S&C professional when compared to the specific exercise of performance.

			S&C Professional		Specific Exercise
Ability to Evaluate the Athlete			Yes		No
Ability to Prepare the Athlete			Yes		No
Instruct in Exercise Technique			Yes		No
Program and Apply Exercise Intensity			Yes		No
Program and Apply Exercise Volume			Yes		No

Table 1. The Capabilities of the S&C Professional vs. the Exercise Performed

Is the Exercise Performed Responsible for the Athlete’s Injury?

The S&C Professional has the unique responsibility to apply high levels of stress to the athlete for adaptation resulting in the enhancement of various physical qualities, to be performed in a safe and controlled environment as possible. During specific exercise performance these high levels of applied exercise stress also place high levels of stress upon various and specific anatomical structures of the body.

If this were not true, why then would exercise performance (adaptation) improve? The “blame” for an injury that may occur during an athlete’s athletic enhancement training is often pointed to the specific exercise performed at the time of the injury. However one may be justified to inquire who prescribed and applied the (a) specific exercise to be performed at the time of injury (b) specific exercise intensity implemented, and (c) specific exercise volume executed during the actual exercise performance, the S&C professional or the exercise itself?

Throughout my career there have been countless S&C professionals whom I’ve met and as well as those of whom I have had long standing relations. My impression is that the majority of all of these professionals are very proficient in their occupation and take their responsibility very seriously.

The S&C Professional has a very large diversity of exercises available for selection to their training program. Each specific exercise selection, when deemed appropriate, has its specific contribution to the athletic enhancement training program. These “selected” exercises (as well as all exercises), place an unaccustomed stress upon the athlete, thus all exercises utilized in training have both their risk and reward.

As S&C Coaches we are the professionals who possess a level of intelligence, and unlike the specific exercise(s) performed, have the ability to contemplate, comprehend, analyze, instruct, and ultimately are the ones who are responsible for the prescription and application of the athletic performance enhancement training program to be performed.

As any other professional in any other particular professional field of occupation, the S&C Professional is also required to assume the requirements and responsibilities for their occupation, as well as the accountability for the expectations of both their occupation and position held.

When the unfortunate occurrence of an exercise performance training injury does occur, as an alternative to pointing the finger and the blame at the exercise performed at the time of the injury, perhaps the S&C Professional should leave their hand in their pocket and glance in the mirror.

References

1. Hammil B, “Relative Safety of Weightlifting and Weight Training”, Journal ofStrength and Conditioning Research, 8(1) 53-57, 1994
2. Hootman JM, Dick R, and Agel J, “Epidemiology of Collegiate Injuries for 15 Sports: Summary and Recommendation for Injury Prevention Initiatives” Journal of Athletic Training, 42(2) 311 – 319, 2007
3. Panariello RA, Backus SI, and Parker JW, “The Effect of the Squat Exercise on Anterior-Posterior Knee Translation in Professional Football Players”, The American Journal of Sports Medicine, 22(6) 768 – 773, 1994
4. Selye H, The Stress of Life, New York McGraw-Hill Book Co. Inc., 1956