PTP – Strength Training Injuries
Treatment strategies for injuries sustained through poor training techniques
October 27, 2011As trends emerge in the world of health and fitness, more people get involved in new methods of exercise. As we know, exercise participants can range from the highly trained athlete to the couch potato with a new year’s resolution. No matter the participant’s experience level, injury can occur during any part of an exercise routine, and can often occur while incorrectly performing strength or resistance training. Strength training is an important part of an exercise regimen; it promotes fat burning, improves core stability, and reduces bone loss and risk for osteoporosis. However, proper precautions must be taken and modifications must be made to reduce the chance of injury.
COMMON INJURIES
Common injuries sustained during strength training include muscle strains or tears, disk herniations, tendinitis, and tendinosis, to name a few. These injuries can result from poor form, overtraining, muscle imbalances, and core weakness. A muscle strain usually involves an abnormal movement pattern such as a quick, unexpected movement, heavy lifting, or straining during daily activity. Small blood vessels are also injured in addition to the muscle, and bleeding (appears as bruising) under the skin occurs. Once strengthening is appropriate, the patient should begin with gentle isometric exercises and progress as needed.
Disk herniations can happen anywhere along the spine. A disk herniation is a protrusion of the nucleus (inner, gelatinous portion) through a tear in the annulus (the tough outer layer of the disk). Common symptoms are back and/or leg pain, weakness, and limited range of motion. In addition to pain-management techniques, core and lower-extremity strengthening should be done within the pain-free range.
Tendinitis involves inflammation and pain along the attachment of a muscle to the bone. It is usually due to repetitive stress of a muscle. This pathology is common for “weekend warriors,” those who are relatively inactive during the week and participate in sports and exercise over the weekend, overloading the body. Tendinosis is a chronic form of tendinitis. If an injury is left untreated, a failed healing response occurs and collagen fibers lay down as scar tissue and adhesions. The scar tissue is leathery and weak.
Tendinitis and tendinosis require strengthening in order to rehabilitate, but they should be addressed differently. When a muscle contracts during a concentric movement, shortening of the muscle belly and tendon occurs. This type of strengthening is appropriate for tendinitis once the patient is able to tolerate it. Tendinosis should be addressed differently. Due to the scar tissue and adhesions, lengthening should occur throughout the strengthening process, and this is done through eccentric loading of the muscle and tendon.
Most soft tissue injuries can benefit from a physical therapy regimen that includes stretching/range of motion, manual treatment, and strengthening. A vast amount of equipment can be used in all forms and price ranges that can be beneficial in rehabilitating soft tissue injuries. A rehab program does not need to utilize large and expensive equipment to be effective. A variety of portable and inexpensive equipment can be useful in rehabilitating an injury sustained through poor training techniques. If soft tissue restrictions are present, the patient should address this problem initially in order to allow them to complete their exercises without compensating.
MASSAGE
A common piece of equipment used in the clinic is a foam roller. Foam rollers come in multiple sizes and densities. A common use for the foam roller is as a self-massage technique. Depending on patient tolerance and/or acuteness of the injury, the density of the foam should be considered to allow for maximal therapeutic benefit as well as patient comfort. It can be used to improve soft tissue extensibility in commonly tight muscles such as hamstrings, hip flexors, and ilio-tibial bands. Gentle foam roller massage can be used to assist with healing and bringing blood flow to an acute soft tissue injury.
A firmer, more aggressive approach can be used to break down scar tissue that forms in the muscle or tendon, especially in areas that have become more fibrotic, in the case of tendinosis or muscle tears left to heal without proper treatment. Spending 5 to 10 minutes massaging a fibrotic hamstring or gluteus medius tendon can be a great self-treatment technique. It can also help reduce trigger points following an injury or delayed onset of muscle soreness (DOMS) after a challenging workout. Using a foam roller is helpful for a patient who has limited time in the clinic but needs manual treatment.
“The foam roller is a great tool to assist in gaining flexibility. It is simple, cost-effective, and user friendly,” says Valerie Brill, PT, OCS, of Excel Physical Therapy and Fitness, Villanova, Pa. Foam rollers are relatively inexpensive, and self-massage can be an effective adjunct to other therapeutic modalities.
STRETCHING
Another simple tool to assist with flexibility and stretching of tight or adaptively shortened soft tissue is the Stretch Out Strap from MF Athletic/Perform Better. The Stretch Out Strap is seventy-two inches long and has 10 loops along its length. The loops are large enough to place around a shoe to stretch the lower body but can also be used to stretch the upper extremities. This simple device is perfect for those who have difficulty relaxing when performing self stretches, and it allows the patient to be more passive for a deeper stretch without compromising form. The strap can also assist with improving range of motion following surgery or acute injury to a joint. In addition to addressing range of motion loss, inflexibility, and scar tissue, the patient must learn how to strength train while using proper technique.
CORE STABILIZATION
Having strong core musculature can assist with proper movement patterns and reduce the risk for injury during strength training of extremities. There are multiple ways to improve core strength to allow for improved control during functional movements. A fun and easy way to train the core is by creating instability. The BOSU trainer is relatively inexpensive equipment that has a sturdy plastic base, creating a flat surface, and a rounded top, which allows for a more challenging surface. Patients can sit, stand, or balance on the BOSU as an exercise in itself, or they can perform their strengthening exercises on its surface.
BOSU stands for “both sides up,” which means that either side of the apparatus can be used during an exercise. Squatting, lunging, and even performing upper body strengthening can allow for improvements in core stability while making the exercise fun and interesting. Other affordable tools to improve core strength and stability through an unstable surface include DynaDisc balance disk cushions from Exertools, Airex foam pads available from Fitterfirst, stability balls, and the previously mentioned foam roller, which comes in a 1/2-diameter option, allowing a patient to stand on the flat or rounded side.
FUNCTIONAL MOVEMENT SCREENING
If a patient appears to have issues in multiple areas, such as weakness, tightness, and poor posture, the Functional Movement Screen can be used. We have all had the patient who is well known to the outpatient clinical setting and can be considered a PT “veteran” due to multiple injuries over time. The FMS can help highlight any problems with these patients in order to keep them well rounded and less prone to injury.
The FMS kit is a simple apparatus that is light, portable, and easy to set up. The screening process strictly analyzes seven gross movement patterns and scores the patient based on form, flexibility, and stability. These movements include squatting, lunging, and single-leg balance activities. This tool can be used with someone who would like to begin a strength training program or for a patient who is on the mend and about to return to their exercise regimen or sport. The FMS can draw attention to major deficits with movement patterns and address them prior to resulting in injury. Once a score is obtained, corrective exercises are given to improve the flawed movements.
Desirae Gaspero, PT, DPT, explains that, “The benefit of the FMS for our patients is how well it detects asymmetries and muscle imbalances. We then utilize the corrective exercises with the goals of improving their score and reducing the risk for reinjury.”
A portion of the FMS that is often scored low is the deep squat. In order to perform a deep squat, the patient must have the leg and core strength in order to do the first half of the movement, as well as the power to stand from a squat position. They also must have the available range of motion and/or flexibility in the hips and trunk. Core strength and the ability to maintain upright posture is also necessary to perform a proper squat.
MULTIDIRECTIONAL STRENGTH TRAINING
The functional movement screen can highlight many issues that the patient may or may not be aware of, including strength deficits of the abdominals as well as the extremities. A diverse, multidimensional tool to train both the trunk and extremities is the cable column. The cable column system provides a PT with an adjustable weight stack (ranging from very light to moderately heavy), adjustable height of the cable system, and multiple attachments. The system has the ability to attach to one or two of the pulley systems. Using one of the pulley systems allows for a slower, lighter progression of resistance, while using both pulleys doubles the available level of resistance. Attachments include handles, ropes, and bars for the upper extremities, ankle/thigh straps, and waist belts.
The free motion of a cable column system allows the patient to perform exercises in a multitude of angles. They can mimic a throwing motion, restore control during their golf swing, and improve body mechanics during lifting techniques. It is also easy to incorporate PNF patterns (such as chops and lifts) with a cable column system, taking the body through diagonal patterns in order to strengthen throughout the available range of motion of the extremities. While the initial cost of a cable column system can be very expensive, they are long-lasting pieces of equipment that can train the entire muscular system.
The ability to be creative with a cable column system is helpful in the clinic, but it does not provide the patient the ability to perform the exercises at home. Many of the exercises performed on the cable column can be recreated using resistance bands. Known to nearly every PT is the Thera-Band resistance system. Thera-Band has both latex and nonlatex resistance bands in five different resistance levels. They are packaged as large rolls that allow the clinician to cut a piece of resistance band at any length. Other examples of portable resistance bands include Superbands (for heavier resistance), Corebands (to promote stability and core activation), and the Lateral Resistor (for lateral movement patterns).
Using more portable exercise and less expensive equipment can help with those patients who often have difficulty adhering to their home exercise program, whether due to busy work schedules, frequent traveling, or lack of resources. Many of the previously mentioned physical therapy products can assist with adherence to home exercises and reduce time required to rehabilitate an injury.
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