One of the most common injuries in the gym is shoulder injuries; there’s just a lot of moving parts including ligaments, joints, and muscle groups and, this part of the body does an enormous about of work continually whether you workout or not.

Statistics indicate the two most injuries lifts to the shoulders are sitting presses both in front of and behind the neck. People just tend to overdo it in terms of overall weight load for these exercises. Because both exercises are static, the initial push creates lots of stress on the shoulders. We are not recommending you do not perform these exercises, but you must use caution.

To reduce the stress of injuries to the shoulders the advice is for you to:

1. Lessen the amount of weight you use in static positions involving shoulder workouts. If you do use heavy weights, do so more when standing and, to get those weight moving into that overhead press, dip you knees a little and use them to propel your body and weight upward. While many may consider this cheating, you’re not in a competition for the amount of weight you lift and, sparing yourself an injury means you’ll be back to workout again tomorrow instead of in a few days, next week or next month. Trust me, experiences shows this to be true.

2. Reinforce your shoulders and strengthen them to help reduce the chance of injury during shoulder exercises. Adding additional exercises specifically for this will help. Those recommended include Balance Trainer Pushups, One-Arm Bar, Ring Pushups, and Chair or Straight-leg Pull-ups.

Balance Trainer Pushups
Using a balance trainer, place it on the floor and assume a pushup position. Using a wider or narrower hand placement, do 3 sets of 6-8 reps of push ups. Because the balance trainer is flexible, it will help to strengthen the interconnected muscle and sinew groups in the shoulders.

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One-Arm Bar
This exercise begins like a Turkish Get Up. Start the exercise like a get up. Lay flat on your back and assuming you are right handed, place a small weight dumbbell or kettlebell in your right hand. Your left leg is straight and your right leg is bent far enough so the foot is flat on the floor. The weight is straight up in the air, arm extended, pressed over your shoulder. Throughout the exercise you will maintain this position with the weight. Slowly roll left, keeping your right leg bent at the knee, until the right knee touches the floor on your left side then, return to start. All the while you keep the weight in the same position pressed above the shoulder. Switch positions and hand and do repetitions on the opposite side. Perform 3 sets of 6-8 reps.

Ring Pushup
Using either rings or TRX handles positioned about 6-12 inches above the floor, assume a pushup position and perform your pushups with your body perfectly straight. If you have particular issues or sore areas that do not seem to go away, raise the rings to lessen the work load, just as if doing incline pushups.

Straight or Chair Pull-up
Hang from a pullup bar and either keep your legs straight or bend them 90 degrees from waist so that your legs form a chair where your thigh would be the seat, i.e., thighs are parallel to the floor. From this position, execute your pull up and then, slowly lower yourself. The chair pull up is recommended because it will give induce greater shoulder reinforcement among interdependent muscle groups. Perform 4 sets for as many times as you can, but not to complete failure, perhaps 1-2 reps short of that.

You can switch these with some of your upper body warmups or warmdowns in your program and, you do not need to do all of them, just one each workout day a few times per week. Alternate for best results.

The muscles being worked with these exercises are usually the primary muscle groups in each exercise. However, suppose you get an injury in the delt area, particularly the anterior delt that just doesn’t seem to go away. How can you help heal it? Try adding some upright rows, Olympic hammer curls, and light weight front raises to your routine. Doing so will work muscles around the delts that, while involving the delt, will do so in a gradual manner and thus, allow sore areas to heal quickly. There are many variations of this, but it is not possible to discuss them all. The important thing is to work around injured areas and to train with balance between muscle groups.

As an example of the above, let’s comment on the importance of creating a balance of strength between the triceps and biceps? (i.e. why it’s not good to overdo biceps while neglecting tri’s, as many of our readers unfortunately do).

It is extremely important to balance strength training between biceps and triceps exercises. The primary reasoning for this is joint stabilization. The joints stabilized by strengthening the biceps and triceps are both the shoulder and elbow joints. Failure to train each group properly and in balance can result in either a weak elbow or shoulder joint or both, which may not be apparent until you get injured from a related exercise or movement. To understand what is not as easy to see with these muscle groups, visualize a person who does lots of bench presses but little back work such as T-bar rows, etc. to balance the chest work.

The person appears hunched forward at the shoulders. The reason is because the back muscles are overpowered by the more worked chest muscles. The result can be an overtired back that hurts while sitting at a desk, vertebrae misalignment and a host of other problems.

What happens when we train the biceps more than the triceps? Without a complete anatomy lesson and mentioning only a few of the muscles involved, the lower part of the triceps attaches to the proximal end of the elbow, while the biceps tie in from the shoulder to the front of the radius, i.e., both muscles stabilize the elbow.

On the other end at the shoulder joint, where the humerus is attached in the rotator cup, the long head of the triceps attaches at the end of the scapula and the short head attaches to the humerus behind. Also, the brachialis, which is worked by biceps curls, attaches from mid humerus to the ulna, while the caracobrachialis attaches to the clavicle and then, to mid humerus. While there are many muscles involved in the process such as the extensor carpi in the forearm that also help stabilize the elbow joint, one can quickly see the importance of strengthening both groups.

Furthermore, you would have to ask what is of most importance? Is it purposely isolating and strengthening specific muscles such as the biceps or is it total strength of the body overall for better mobility, flexibility, etc.?

To increase total strength and body conditioning, it is better to perform compound exercises such as the Olympic Hammer Curl that works many of these muscles in unison. Workout intensity is increased while time spent exercising is made more efficient. I would be happy to write an article for you regarding these types of exercises that would include a three month training schedule, fat loss, etc. Mainly because some of these exercises are shown in various magazines, but very poorly and with little explanation of what they can really do for the average person or even competitive athlete.

Also, remember that each exercise you do usually has varying positions in stance, grip, etc. So, simply by changing the width of grip or stance, you strengthen other muscle groups and help avoid injury. Using the example above concerning biceps and triceps, this leads to a question: For full development, how necessary is it to employ different grips in triceps and biceps exercises? (pronated, hammer, underhand…)

It’s important to vary your grip and width when performing these exercises. Not only these exercises, but all others. Generally, those who workout are unaware that there are usually three different positions/grips for most strength-training exercises. Why should one worry about grip position or width? Let’s look at the biceps curl as an example.

If you use a close or narrow grip with a barbell, the biceps long head will be most worked. To work the short head of the biceps, which is on the inside of the arm, you must use a wide grip. I’ve noticed that most people tend to use a wider grip that works the short head and when you see them place his or her hands on their hips, the biceps muscle, at least the long head part on the outside, is very small and disproportionate, even though he or she may feel a good strength level. The end result is that by using the same grip or width all the time, you create an imbalance in both size and strength and also in joint stabilization as mentioned above. Like a program, vary the grip and width of these exercises for best, long-term results.

What are the keys to training and strengthening additional muscle groups in lieu of a main muscle? Often, I am asked about which muscles should be trained first in a superset or other training regimen. This is a common question: In a triceps/biceps superset, is there any benefit to doing either the biceps or triceps first in the set? Or, is it best to switch up from set-to-set or workout-to-workout?

This is a question that you may find disagreement on among many trainers and thus, many may disagree with my answer. In my opinion, it does not matter which exercise you perform first in a superset with these exercises.

The keys of knowledge here are to realize that smaller muscles warm up faster than larger muscles and in this respect you may want to perform the biceps exercise first. But more importantly, you must change up or vary your routine by workout day. This means that you should not use the same supersets all the time and that the exercises used to work these muscle groups should vary each workout. For example, on the first day you may perform supersets of alternate dumbbell curls with standing triceps press then, on the next day change it to something like barbell curls followed by weighted or non weighted dips, which is a compound exercise that compliments the biceps curls much more effectively for overall strength and also joint stabilization. There are many variations you can use so, plan a little ahead to vary your routine for best results.

Question: What should I do for an acute injury?

Answer: If you feel that you have “pulled a muscle” or have an inexplicable pain after exercising, the immediate treatment is RICE (rest, ice, compression, elevation). Icing for 48 hours, every 2 hours for about 10-15 minutes, should help the injured area. You can pair the RICE treatment with taking an over the counter ibuprofen medication to decrease inflammation. However, if you’ve got an injury that doesn’t respond to RICE in a couple of days, you should see your physician.

Question: What should I do for a chronic injury?

Answer: You must see your physician or other qualified person to find out what you should do if an injury persists.

Question: What should I do or look for when working out in extreme weather or exercise conditions?

Answer: Extremes of temperature and humidity pose special problems for the exerciser. In hot weather, care must be taken to wear clothing that is light, breathes well, and allows for the evaporation of sweat.

On extremely humid days care must be taken to exercise at an appropriately lowered intensity, out of the high heat/humidity, or even to postpone exercise until the heat/humidity diminish. As exercise intensity increases and more heat is and must be dissipated, evaporation of sweat becomes the principal means for cooling the body. In a high-humidity environment, evaporation becomes less effective at cooling, and the risk of heat-related injury is greater.

Adequate hydration is also key to safe exercise in hot weather, as the body will produce large quantities of sweat. Drinking 1-2 cups of water before exercise and 1/2-1 cup of water during exercise are recommended, though more can be ingested dependent on workout conditions.

It is important to remember that the thirst mechanism lags behind the body’s need for fluid, i.e., by the time you are thirsty you may already substantially dehydrated. Even small amounts of dehydration can affect performance, and severe dehydration can be life-threatening.

Contrary to popular belief, water consumed during exercise will not contribute to cramping, so rather than merely rinsing your mouth and discarding it, you should consume small amounts of water steadily during the exercise session, especially during periods of prolonged exercise.

In the cold, care must be taken as well. Dress in layers that will wick sweat away from the body such as Gore Tex and many other “high-tech” fabrics that are now available. Outer layers can be used to keep the body warm during warm-up, and removed as exercise progresses to allow the body to cool. If you get too cold, replace layers during cool-down to avoid excessive chill.

Garments made of fabrics such as wool, which will insulate even when wet, are superior to garments made of materials such as cotton that will absorb sweat and can contribute to heat lost by evaporation and conduction as physical activity level decreases.

Heat and Cold Related Illnesses and Injuries:

Question: Who is at risk for heat-related illness?

Answer: People at risk for heat-related illnesses include those who work or exercise outdoors, elderly people, young children, and those with health problems. Also at risk are those who have had a heat-related illness in the past people with medical conditions that cause poor blood circulation, and those taking medications to get rid of water (diuretics).

Question: What are heat related illnesses?

Answer: Heat cramps, heat exhaustion, and heat stroke are conditions caused by overexposure to heat. Heat cramps are the least severe, and often are the first signals that the body is having trouble with the heat. Heat cramps are painful muscle spasms. The usually occur in the legs and abdomen. These constitute a possible heat- related emergency.

HEAT EXHAUSTION is a more severe condition than heat cramps. It often affects athletes, fire fighters, construction workers, and factory workers, as well as those who wear heavy clothing in hot, humid environments. It manifests itself as cool, moist, pale or flushed skin, headache, nausea, dizziness, weakness, and exhaustion. HEAT STROKE is the least common but most severe heat emergency and most often occurs when people ignore the signals of heat exhaustion. HEAT STROKE develops when the body systems are overwhelmed by heat and begin to stop functioning. HEAT STROKE is a critical medical emergency. The signals of heat stroke include red, hot, dry skin; changes in consciousness; rapid, weak pulse; and rapid, shallow breathing.

Question: How do you treat heat cramps?

Answer: If you believe you or someone else has heat cramps, place the victim in a cool resting place. Give him or her cool water or an electrolyte drink, i.e., a sports drink. Generally, rest and fluids are all one needs to recover. The victim should NOT take salt tablets or salt water. This can make the situation worse. Also, gently massaging the cramp area can sometimes help relieve symptoms.

When cramps stop, you can usually start activity again if there are no other danger signals of illness. The person should keep drinking plenty of fluids and be watched carefully for further signals of heat-related illness. Perhaps the best treatment is to cease exercise and proceed at a later date and time.

Question: How do you treat other heat-related illnesses?

Answer: First, get the victim out of the heat. Second, loosen any tight clothing. Third, apply cool, wet cloths. If the victim is conscious, give him or her cool water to sip, do not let the person gulp it.

Give about 4 ounces of water every 15 minutes. Let the victim rest in a comfortable position and watch carefully for changes in condition. The victim should not resume normal activities the same day.

Question: Is it an Emergency? Should I call 911?

Answer: Refusing water, vomiting, and changes in consciousness mean that the victim’s condition is worsening. In this case, call 911 (or other emergency services). If the victim vomits, stop giving fluids and position him or her on their side. Watch for signals of breathing problems.

Keep the victim lying prone and continue to cool the body any way you can. If ice packs or cold packs are available, place them on each of the victim’s wrists, ankles, groin, armpit, and neck (these are considered the pulse points). Do NOT apply rubbing alcohol or other possible coolants.

Question: At what temperatures and humidity are heat-related illnesses likely?

Answer: These are the basic temperature ranges you should monitor.

• HOT: {93F (34 C), 20% humidity}, {87 F(31 C), 50%}, {82 F(28 C),100%}. Sunstroke, heat cramps, or heat exhaustion possible with prolonged exposure/exercise
• VERY HOT: {105F(41C), 20%}, {92F(34C), 60%}, {87F(31C), 100%}. Heat cramps or heat exhaustion likely
• EXTREMELY HOT: {120F (49C), 20%}, {108F(43C), 40%}, {91F(33C), 100%}. Heat Stroke or sun stroke imminent (Reference, American Red Cross Standard First Aid Manual)

Question: What is frostbite?

Answer: Frostbite involves the freezing of tissue, and can range from mild to severe. The skin will generally look yellowish, and be cold to the touch. First aid involves warming the affected area using moderately warm water. However, remember that sensation will be reduced in the affected area thus, the temperature of the water should be checked by running it on unaffected skin! Do NOT rub the area; This can cause further tissue damage!

Frostbite should be examined by a doctor to assess the extent of skin damage. Frostbite is best prevented by proper clothing and limited exposure to cold.

Question: What is hypothermia?

Answer: Hypothermia is a life-threatening condition in which the core body temperature has become dangerously low. Many of the same symptoms as heat exhaustion, including dizziness, nausea, loss of appetite, vision problems, etc., can be present. For hypothermia, it is important to call 911 immediately. Use any means possible to warm the victim, such as removing excess clothing and putting them in a sleeping bag with an unaffected person who can provide body warmth until help arrives.

An exercise warm-up of 5-12 minutes is highly recommended prior to your exercise program. While one will often skip the warm down, it is absolutely critical that you never skip a warm-up! The warm-up can consist of any type of aerobic or strength exercise but should be practiced at a much lower intensity and should feel easy. Remember, the purpose of the warm-up is to prepare the body for more strenuous work. The warm-up should focus on the three major sections of the body. These include the lower chest and upward, i.e., the arms and shoulders; the mid section from the lower chest to the mid buttocks area (the abs and lower back); and the lower body, i.e., the legs. Warm-up each of these body parts prior to the start of your exercise program.

The exercise cool-down is essentially identical to the warm-up but is incorporated at the end of your program. Once again, the cool-down should consist of at least 5 minutes and be completed at a lower intensity level than your previous exercise intensity. The cool-down should feel easy.

Proper stretching technique is the third component that is crucial to a healthy and well-developed exercise program. Muscle stretching should be completed after your 5-minute warm-up and at the end of your exercise session to increase muscle flexibility. The key is to practice proper stretching technique. In order to obtain proper instruction with stretching exercises, please consult an exercise therapist or a physician. Either one of these professionals can guide you with the correct technique.

Who gets injured more?

Hard-charging fitness buffs or plain recreation-seekers? According to research, very enthusiastic individuals have a higher incidence of injury. These individuals tend to ignore early warning signs of micro-trauma, and stoically continue to train through pain.

Listen to the body. By listening to the body and making proper activity adjustments based on the symptoms, minor problems will often be addressed at an early stage and never have the chance to become an obstacle to continued training. This means that if you are feeling pain, work around it. If the pain persists, see a physician, trainer, or therapist.

Injuries also can cause psychological pain. Those who exercise regularly can become depressed, angry and experience and energy level decrease when they are unable to train. Additionally, this depression is typically more pronounced the longer the layoff.

Hydrotherapy

Hydrotherapy involves the use of water as a means of restoration by removing toxins, lactic acids, and improving metabolism. Water has 30 times the capability of air, which makes it a very useful tool for recovery. Warm water will penetrate muscle tissue, increase blood flow, aid in exchange of nutrients, reduce soreness, increase heart rate, etc. Cool water will take heat from the body acting as a tonic or stimulant. Mineral salts can be added to a bath or whirlpool to improve the effect of the hydro means.

The most important factor in hydrotherapy is the time which you use it and the ratio spent in hot versus cool water. For most, a good regimen is a 10-15 minute hot shower followed by a 1-2 minute cold shower (as cold as the faucet will yield). To aid this process, a shower head that rotates water pressure may be purchased. Along with the pressure head, you can perform hot-cold switching every 30 seconds, i.e., 30 seconds hot shower followed by 30 seconds cold shower. Always begin with hot water followed by cold; this interval shower should last for 5-8 minutes; finish the shower with cold water. This is commonly called an “Interval” or “Swedish” shower. These types of restorative processes should be used directly after the workout, especially if you train twice per day.

Another method to use in hydro-recovery is the whirlpool or a hot bath with the temperature set at 100-106 deg F. The primary purpose of the whirlpool is to relax the athlete. The duration in the whirlpool should not exceed 20 minutes and should be done directly after a workout or just prior to bedtime. Another means of recovery with water is the use of a swimming pool with a temperature of 80-85 deg F. Swim at a slow, relaxed pace for 10-20 minutes; this will have restorative effects.

These techniques should be used quite frequently. By doing so, one will allow the body to repair itself much faster, preventing injury; this is a small detail which should not be overlooked. You may or may not have a whirlpool bath, but almost everyone can use an interval shower after a workout.

Dry Sauna

A dry sauna can be used for many restorative processes in the body. Be sure its a dry sauna and not a steam room because steam rooms do not get hot enough to penetrate muscles and can be detrimental to some due to sinus and lung ailments. A dry sauna should be set at a temperature of 175-205 deg F with a 10-15 percent humidity. When set up properly, a dry sauna will increase chemical exchanges, nervous system functioning, increase blood flow, induce sweat gland activity, help heal muscle injuries, and open skin pores. Follow these simple guidelines for using a dry sauna:

1. Use no more than twice per week.
2. Take a warm shower beforehand (keep the hair dry).
3. Dry off before entering the sauna.
4. Wrap your head with a cool towel before entering.
5. Sit on the lowest level for 2-3 minutes on a dry towel; afterwards, move to a higher level.
6. Do not exceed 6-10 minutes and take a contrast shower (cold for the first five minutes followed by hot (100 deg F) then cold (50 deg F).
7. Dry off and repeat steps 5-7 for a total of three times.
8. Never exercise in a sauna or enter while drinking alcohol.
9. Allow 10 minutes for cool down, drinking adequate amounts of water for the next two hours.
10. Younger athletes (< 16 years old) should never proceed to the higher levels where the temperature is higher. The duration for a young athlete is 4-5 minutes.

Massage

Sports massage for the elite athlete has become a necessity during the last decade. In certain instances, massage can prove more beneficial than supplementation as a means of recovery. Massage is used primarily to keep athletes from injury and over training and can increase flow of nutrients to muscles, reduce tension and stress, increase flexibility, enhance nervous system functions, induce sleep, and increase appetite. How much and how often depends on your size and training variables. However, as a rule of thumb, an active person should seek this service at least once every 3-4 weeks.

There are two types of massage for athletes; local and full body. For high training loads, a full body massage is advisable (twice per week). These massages should not be deep, but relaxing with rubbing and kneading techniques. If training loads are light or medium, a massage once every two weeks is sufficient. Local massage is used to treat special areas. An example of a local massage is for someone that may need extra attention to the hamstrings because of performing heavy leg curls. When speed-strength training, special attention should be given the lower back, glutes, and hamstrings. A massage should be given only by a qualified sports massage therapist. To prevent injury and increase skills requires that proper care be taken with the body. Top athletes succeed because they do this, shouldn’t you?

Active Release Techniques©

This is only one type of physical therapy as an example to the reader. The goal of ART© is to restore optimal texture, motion, and function of the soft tissue and release any entrapped nerves or blood vessels. This is accomplished through the removal of adhesions or fibrosis in the soft tissues via the application of specific protocols. Adhesions can occur as a result of acute injury, repetitive motion , and constant pressure or tension. ART© eliminates the pain and dysfunction associated with these adhesions.

Dr. P. Michael Leahy first began teaching his innovative technique in 1991 using the name myofascial release. Later in 1995, he trademarked the name Active Release Techniques© .

This was done for several reasons:

• This technique was dealing with more than just muscle and fascia;
• There are many other techniques which utilize the name myofascial release and many practitioners that utilize myofascial release techniques which are not similar in any way or form to ART© to standardize the treatment a patient receives and duplicate the high rate of success achieved with ART©, a proficiency level was developed for ART© providers.

The types of conditions successfully treated with ART are very diverse.

Some of the more common conditions are:

• Carpal tunnel and other peripheral nerve entrapments
• Spinal pain and dysfuntion
• Tendonitis and other soft tissue inflammatory disorders of the hand, wrist, elbow, shoulder, hip, knee, ankle, and foot
• Sciatica, TMJ, recurrent sprains and strains

Only a credentialed ART provider can ascertain whether ART might prove beneficial for your condition. Providers must attend annual update seminars to maintain their credentialed status and keep current of any new protocols and research.

Why wasn’t I getting better with traditional treatments?

• Past soft tissue therapies of heat, cold, electrical stimulation, anti-inflammatory drugs, massage, rest, joint manipulation, and exercise failed due to a lack of permanent changes in the source of the injury.
• None of these treatments solved the underlying cause of the pain and resulting tissue malfunction.

What is ART© Soft-Tissue Management?

• ART© is a type of manual hands-on therapy that corrects muscular and soft-tissue problems caused by adhesion formation as a result of acute injury, repetitive trauma, or constant pressure and tension.
• There are nearly 300 ART© diagnostic and treatment protocols for the spine and upper and lower extremities.
• ART© was developed over the last decade by Dr. Michael Leahy, a world renowned chiropractor, graduate of the United States Air Force Academy, and former Air Force fighter test pilot.

What should I expect during an ART© treatment?

• ART finds the tissue that is injured and physically works it back to its normal texture, tension, and length using various hand positions and manipulation methods.
• Breaking up the adhesion’s can be uncomfortable at times
  Once the muscle is returned to its normal state, then the joint is manipulated into alignment.
• It is important to reproduce the symptoms during the treatment to ensure that the correct muscles are being addressed.
• The muscles then must be strengthened using the prescribed exercises in order to keep the joint in the correct position.
• Unlike most therapies, it does not require extended periods of rest before you notice results. You can expect to see significant improvements in the injury after 1-2 sessions.
  The normal treatment course is 6-8 visits, lasting 10-30 minutes each.
• The average patient is treated two times per week, but more complex cases may require 5-6 weeks of treatment.

What are Adhesion’s and how do they affect soft-tissue performance?

• Our bodies protect us from further damage by sending out pain signals and repair those damaged areas with scar tissue, otherwise known as adhesion’s.
•  Adhesion’s are caused by acute trauma, repetitive motion, or constant tension.
• They normally begin to form within 2 days of the initial acute injury.
• If adhesion’s are attached to muscles, they decrease the muscles ability to work properly. If attached to nerves, they cause abnormal sensations like numbness, tingling, or pain.
• Adhesion’s also cause drag and tension which requires an additional expenditure of energy and effort to accomplish a desired movement.
• Adhesion’s heal but also weaken the tissue and if left untreated can expedite the beginning of the Cumulative Injury Cycle (CIC), also discovered by Dr. Michael Leahy

Is ART© a permanent cure?

The immediate changes to the adhesion’s are permanent, but the real answer lies with the prescribed stretching, strengthening exercises, and periodic joint manipulation. Also, if it is a repetitive motion or tension injury, then the adhesion’s could eventually build-up again if the activity itself is not modified.

• Results from ART:
  There is over 90% success rate of permanent relief from the pain and resulting problems in movement and performance.
• Immediate treatment to an acute injury will generally speed up recovery by 50%
• Restoring proper muscle function and movement enables the body to perform at its most efficient level.
• ART© helps eliminate trigger points, because it treats the source of the pain. sometimes the path of treatment may not be obvious due to either radiating or referring pain symptoms.
• ART© improves performance by increasing range of motion, strength, endurance, and reaction times. It also increases circulation causing a positive change in carbon dioxide, oxygen, and nutrition and facilitates tissue repair.

Chiropractics and Acupuncture

Chiropractics and acupuncture are specialized restorative processes that can be very beneficial. Chiropractors can fix subluxations or minor misalignment’s of vertebrae that occur. Acupuncturists can stimulate blood flow in areas that may be blocked or muscles and ligaments that might be damaged. A visit to the chiropractor or acupuncturist every 2-3 months could be beneficial. The major problem with these methods of recovery is that a good acupuncturist or chiropractor is difficult to find, especially those that have experience with athletes. Talk to other athletes for referral to a good one in your area. However, for most, it is quite likely that hydro and sauna restorative techniques will be more available and safer.

A single symptom (such as lower back pain) can have a variety of causes, which are not immediately obvious and can require diagnosis by a physician or certified therapist that can prescribe treatment.

Do not to use the information below to “self-diagnose;” use it only as guidelines for appropriate first aid or symptomatic relief or, to see a physician.

Exercise professionals are admonished to refrain from the process of diagnosis and/or prescription of treatment or rehabilitative exercise. We encourage such to use RICE and for the affected person to visit their doctor. (RICE is an acronym for Rest, Ice, Compression, and Elevation.)

Statements such as “that sounds like chondromalacia – why don’t you try strengthening the medial quad to help out” or “you’ve got low back syndrome” involve a judgment that can be construed in a court of law as a diagnosis and/or prescription of rehabilitative exercise.

Common exercise injuries

Overuse Injuries

The heading of overuse injuries is generally broad. It can include a vast majority of exercise-related injuries. Generally overuse injuries are chronic ones, meaning that no single event causes them (as with a sprained ankle or a broken leg), but repetitive motion with time, i.e., months or years of training, gradually weaken or irritate the area in question until exercise becomes difficult or impossible or other symptoms appear.

The vast majority of overuse injuries can be avoided by proper attention to form and technique, appropriate rest, proper equipment (especially footwear), and gradual increase of exercise frequency, intensity, or duration. Rest is critical during training, when feeling any irritation other than muscle soreness.

The best cure for overuse injuries are: rest followed by a gradual return to activity, coupled with an awareness of the problem activity, and appropriate corrective measures. This could a gradual return to exercise, appropriate strengthening, or avoiding specific activities or exercises.

Patellofemoral Syndrome (“Runner’s Knee”) / Chondromalacia

Chondromalacia literally refers to the wearing away of the cartilage on the back surface of the kneecap, which might be first exhibited as a “clicking” or “grating” sound, and knee pain under the patella (kneecap).

Chondromalacia refers to the condition, and not a specific disease state, as a great many possible causes exists for damage to the cartilage.

Patellofemoral syndrome, likewise, refers to generalized knee pain, often associated with runners, but not limited to runners alone. In this context, the cause is usually improper running mechanics over a period of time and in many cases, the cause is unknown. The precursor to patellofemeral syndrome can be patella maltracking that can occur from several different causes.

Once chondromalacia has occurred, the process is irreversible, and attention is paid to achieving the maximal amount of pain-free activity, and avoiding activities which will cause further damage to the joint. Keeping the muscles surrounding the knee strong becomes crucial as it relieves the demand off or from as lay persons like to say it, the knee joint.

Note that patellofemoral pain is of a more general nature, and may or may not be due to the pathological condition of chondromalacia.

It is best to consult a physician or a physical therapist when any sort of knee pain is encountered.

Plantar Fasciitis and Neuromas

Plantar fasciitis is literally an inflammation of the plantar fascia, a web of tough, fibrous connective tissue on the bottom of the foot. Neuromas are irritated nerve endings, but can cause pain in the foot (or other places, depending on the nerve in question). Distance runners and walkers are often affected by Plantar Fascitis.

Either of these conditions should be examined by a doctor. While both are commonly caused by overuse, the question of whether the condition is due to poor technique, simple overuse, or an orthopedic problem should be determined. In this way, you can address the problem and avoid a reoccurance.

In the case of the latter, orthotics (inserts for shoes designed to help maintain proper impact cushioning and support for the foot) can play a major role in the prevention of future episodes.

Lateral Epicondylitis (“Tennis elbow”) and the more general Tendonitis/Arthritis/Bursitis

Any “-itis” condition refers to inflammation or irritation. In the cases of tendonitis, arthritis, and bursitis, sites of inflammation include the tendons, joints, and bursae (fluid-filled sacs provided cushioning between tendons and bones), respectively.

These conditions should involve a referral to your physician. Tendonitis and bursitis are common overuse injuries, andoften go hand in hand. Rehabilitation will generally include rest and enhancing flexibility and strength of all muscles surrounding the joints near the area in question.

Arthritis can be caused by two distinct disease processes – osteoarthritis is essentially “wear and tear” on joints, in which the cartilage covering the articulating surfaces of the bones becomes worn, and the joint reacts, often by swelling and filling with fluid. It can become quite tender, and motion can become difficult.

Rheumatoid arthritis is an autoimmune disorder in which the body launches an attack on its own joint tissues. While much less common than osteoarthritis, it can be severely debilitating.

Rehabilitation for arthritis generally involves activities that are low-impact in nature, and strengthening exercises. Activities are carried out through a “pain-free range of motion” (ROM limited by the onset of discomfort), and no activity is recommended during periods of active inflammation.

Shin Splints and Compartment Syndromes

Shin splints are a common name for pain felt in the anterior portion of the calf, which can be due to a variety of causes, from muscle imbalances to something as serious as a compartment syndrome.

General treatment for shin splints involves RICE, strengthening exercises for supporting muscles surrounding the ankle joint, soft tissue mobilization of the anterior shin muscles, and flexibility exercises. Implementing a calf stretching program may offer relief of symptoms. Orthotics may also be indicated to prevent reoccurance.

Compartment syndromes are a much less common, but more serious problem. This is a condition in which one of the compartments between muscles that contains blood vessels and/or nerves becomes swollen, compressing the blood vessels and/or nerves. It can lead to pain, swelling, and discomfort, and in severe situations, may be an emergency situation requiring surgical intervention.

Common exercise reactions

Some people experience reactions to exercise, ranging from uticaria, a harmless red blotchiness on the neck, face, or arms, to exercise induced asthma or bronchospasm, to anaphylaxis.

Exercise-induced asthma (EIA) is most likely to strike individuals exercising in cold, dusty, or excessively humid environments, and can range in severity from mild coughing to severe discomfort. Individuals who suspect that they have exercise-induced asthma are encouraged to see a doctor and to ensure the best possible treatment for the condition.

There is a rare condition, due to allergic reaction, called exercise-induced anaphylaxis. This is a life-threatening situation, and requires immediate medical attention. Any person suspecting that they are prone to EIA should consult with their physician before resuming exercise.

General recommendations for persons with EIA include an extended warm-up, avoidance of cold, dusty, or extremely humid environments for exercise, pursed-lip breathing, and keeping an inhaler handy for use during exercise (if recommended by physician). You may consider wearing a dust or surgeons mask in some situtations.

Physical Therapy

• How Often?
  While there are multiple factors, the frequency of physical therapy/massage primarily depends upon the persons size, training intensity, and training frequency.
• Massage is used primarily to keep you from injury and over training and can increase flow of nutrients to muscles, reduce tension and stress, increase flexibility, enhance nervous system functions, induce sleep, and increase appetite.
• As a general rule of thumb, the average fitness buff should have a physical therapist check and massage them based on the therapists judgement at least once every 6-8 weeks. Depending on your individual uniqueness, scheduled visits will vary.
• Before seeking a massage, you should first try to combat over training (see Table 1). If you still find slow recovery from soreness and other exercise pains, you should visit your therapist.
• There are two types of massage; local and full body. For high training loads, a full body massage is advisable (twice per week). These massages should not be deep, but relaxing with rubbing and kneading techniques. If training loads are light or medium, a massage once every two weeks is sufficient.
• Local massage is used to treat special areas. An example of a local massage is when you may need extra attention to the hamstrings because of a particular activity that exerts constant work on a specific muscle such as the hamstrings or upper back. When speed-strength training, special attention should be given the lower back, glutes, and hamstrings. A massage should be given only by a qualified sports massage therapist.
• For most athletes, either a local or full massage should be obtained at least once every 3-4 weeks. The harder you train, the more frequent you will need them. Talk to your therapist or ask one of our experts.
• To prevent injury and increase skills requires that proper care be taken with the body. While times of massage can vary, see Tables 2 & 3 for suggested times.

Techniques to combat over training:

• Stop training for one week, a light warm-up and stretching, do not exceed 30 min/day.
• Reduce protein intake to 15% of total calories.
• Increase complex carbohydrates to 70% of total calories.
• Increase antioxidants to 200% of recommended dosage.
• Sleep requirements: minimum of 9 hours/night.

Full body massage time requirements:

Body Weight (lbs) Time Requirement (min.)
135 or less, 40
136-150, 50
151-200, 60
200+, 60+

Local massage time requirements:

Light (5-10 minutes)

Medium (10-25 minutes)

Hard (20-25 minutes)

A recent study by Johns Hopkins University School of Medicine in Baltimore, Maryland, studied 38 men and 46 women who were generally healthy, although participants blood pressure was at the high end of the normal range or mildly high. None of the participants exercised regularly. In the study, neither overall aerobic fitness nor participation in mild physical activity had a significant effect on increasing bone mineral density.

Although some activity may be better than none at all for certain aspects of health, like heart health, milder forms of activity may not be sufficient to hold off or attenuate the age-related decline in bone with aging. More vigorous exercise may be needed.

While neither mild activity nor aerobic fitness affected bone density in the study, having greater muscle strength and carrying extra pounds around the middle were related to stronger bones. McAlpine and Tindall found that overloading strength exercises built stronger bone and muscle density in their research to increase these densities during long-term space travel while designing a NASA long-term space travel exercise protocol system.

But, don’t get your hopes up, despite the apparent link between abdominal obesity and stronger bones, research does not give the green light to pig out.

Although being fat may be good for bone density due to overloading of bones and muscles, gaining weight is not the answer due to the harmful effects of obesity on many other aspects of health.