Chapter 11

Preventing And Dealing With Injuries And The Use Of Restorative Methods

Injuries are the scourge of sport. At a minimum, they cause discomfort, which, apart from its obvious drawbacks, can have a negative influence on technique. More serious injuries can lead to a loss of training time. These losses of training time can greatly decrease an athlete’s chances of success. In some cases, injuries can end a career (or even a life). Avoiding injury is therefore one of the cardinal rules for achieving championship performance.

Training for high level athletic performance and competition itself present certain inherent and sport-specific risks to athletes. Risk cannot be reduced beyond this level with our current level of knowledge. In comparison with many more popular sports, weightlifting is a relatively safe sport. While statistics in this area are far from complete, the incidence of serious weightlifting injuries appears to be significantly lower than in sports like football, basketball, gymnastics and wrestling.

In all of my years in the sport of weightlifting the severest injuries I have heard of include one coronary that occurred during a competition (in a lifter in his mid-forties who had a heart condition of which he was previously unaware), one spinal cord injury that resulted in partial paralysis (which appeared to be the direct consequence of the lifter’s foot being caught on a faulty platform) and a few losses of finger tips (the latter when the fingers were positioned between a weight rack and a bar when the bar was lowered in an uncontrolled fashion to a weight rack or simply dropped on such a rack). Severe strain of major muscle-tendon units occur on occasion, as do elbow dislocations. Less serious joint and muscle injuries are much more common, but the frequency and severity of such injuries is lower than in many other sports. When you compare this list to the numerous head injuries, spinal cord injuries and compound fractures that occur in some of the more popular sports, the risk of weightlifting appears far smaller.

Despite weightlifting’s safety record, the general public, and even many of those who train with weights or coach athletes who do, regard Olympic style weightlifting as the most dangerous of the weight sports. This is a somewhat surprising view considering that deaths caused by the bench press are reported with regularity, yet few people regard bench presses as unsafe, and many practice them with little or no instruction or supervision.

The risks inherent in any sport tend to be far lower than the actual incidence of injury. Weightlifting is no exception to this rule. The percentage of weightlifting injuries that are preventable is very high. In my opinion, weightlifting’s relatively moderate injury rate could be reduced by at least two-thirds, and perhaps more than 90%, if proper precautions with regard to supervision, training, safety practices and equipment were followed. In addition, if injuries were treated properly and promptly, the entire problem of injuries would be still smaller.

The main purpose of this chapter is to teach you how to prevent injury and to minimize the severity and negative effects of injuries that do occur and to help you recuperate more effectively from training so that your risk of overtraining and injury is reduced. The reader should recognize that I am not a medical professional and I cannot give medical advice. You will find a listing of some very fine books on sports medicine in the Bibliography. If you sustain an injury, I urge you to confer with the appropriate medical professionals immediately. This chapter is not intended to substitute for their advice.

What I will attempt to do in this chapter is to tell you what I have learned about injuries through hard experience during more than thirty years of training for competitive weightlifting and a longer period of training with weights. While much of the advice that I will offer would be considered “mainstream,” I will sometimes say things that are at odds with the views of the medical establishment. These opinions are based on my own experience and are merely offered to the reader for informational purposes.

Although we will discuss many kinds of injuries, the reader should not be led to believe that these are necessarily everyday occurrences in weightlifting. If you are around any activity for more than thirty years, you see many mishaps and injuries.

Preventing Injuries

The old adage, “an ounce of prevention is worth a pound of cure,” certainly applies to sports injuries, though it might better be expressed as a gram of prevention being worth a kilo of cure. Pain, inconvenience, lack of function, loss of training time, destruction of technique and serious health risks are all reasons to avoid injuries. If these negative aspects are not enough to encourage coaches to treat this subject seriously, moral concerns over the well being of athletes and concerns over legal liabilities certainly should.

The importance of safety in teaching technique, in developing training plans and in a wide variety of other areas has been stressed throughout this book. Chapters 2 and 5 presented a number of important safety guidelines. We will not attempt to repeat those guidelines here. Instead, we will focus on other measures that can be taken to assure the safety of athletes. However, before we address some of those issues, let us look at one important preventive measure that should be taken even before an athlete enters the gym.

Having a Check-up Prior to Commencing an Activity

A check-up with a physician, preferably one who is knowledgeable regarding sports, is an important precaution before participation in any sport. A doctor can screen an athlete for any serious risk factors, answer questions and concerns that he or she may have about a particular activity and establish a “baseline” measure of the athlete’s condition before he or she undertakes an activity. If the physician fully understands the activity in which the athlete intends to participate, he or she may be able to make recommendations that will enable the athlete to avoid injury.

The prospective athlete should be aware, however, that the advice offered by a doctor may be have limited value for at least two reasons. First, the doctor may not fully understand the nature of the activity the athlete intends to undertake. This is especially true of weightlifting. Many physicians are no more aware of the nature of competitive weightlifting than the general public. They do not understand the distinctions between the various weight sports. They also do not understand the techniques of weightlifting or the adaptations that the body makes to the activity. Consequently, a very good doctor may not make sensible recommendations regarding weightlifting. This is not to say that a physician’s advice should ever be ignored; anyone does this at their own peril. But it does suggest that athletes and coaches should educate the physician about their sport and understand that the physician’s advice is based on his or her own understanding of that sport and the athlete’s condition. That advice must then be carefully judged by the athlete (or, in the case of a minor, by the athlete’s parents) and the coach.

A second consideration regarding doctors is that many of them are conservative by nature. The first rule followed by any physician is to “do no harm” (and malpractice worries make that rule even more important for physicians today than ever before). Cautious doctors may never recommend an activity of a vigorous nature for fear that if injury occurs during such an activity their patients may try to hold them responsible in some way.

The coach should encourage his or her athletes (and parents, where appropriate) to understand the sport and the risks of participation before they begin. Weightlifting may be a relatively safe sport, but participation in any vigorous sport can result in injuries, and athletes need to understand that. Once they do, they can make their own decisions regarding participation.

Some organizations which deal regularly with the issues of exercise safety, such as the American College of Sports Medicine, have developed guidelines for safe participation in moderate activity without having medical clearance. However, since competitive weightlifting is strenuous by nature, these guidelines do not apply. A check-up, or at least a discussion with your family physician about participation in weightlifting, is a prudent precaution for every fledgling weightlifter.

Safety Is Enhanced by Proper Coaching

Good coaching is one of the most important ways to prevent injury. Sensible training programs are the foundation of good coaching. Training programs must be tailored to the level of ability, condition, physical and mental limitations (if any) of each athlete. The implementation of the program should then consider the athlete’s condition and external conditions on any given day, so that appropriate modifications can be made. Training for athletic competition often involves pushing athletes to levels which exceed their previous bests. But this should not take place every training session and should never be attempted when the athlete is fatigued, impaired by injury or illness, mentally unprepared or limited in some other way. In addition, athletes should never be pushed beyond their legitimate limits.

Fatigued and overtrained athletes are prone to injury. When a coach observes signs of fatigue or overtraining, he or she should act to correct the situation, particularly when the fatigued or overtrained state is severe enough to compromise the lifter’s technique or ability to perform to a significant extent.

Another important foundation of good coaching is teaching proper technique. The coach should always emphasize sound technique first, including how to miss (see Chapter 2). Proper technique is not only efficient; it is also generally safer than poor technique.

Proper workout design is nearly as important as the proper design of the overall training plan when it comes to preventing injuries. A proper warm-up is essential. Lifters who attempt heavy lifts when they are “cold” are running an unnecessary risk of failure (if not outright injury). Exercises requiring considerable skill (such as the classic lifts) should generally be prescribed early enough in the workout so that the athlete is not in a fatigued state when they are being practiced. (This is especially important if the athlete is going heavy that day, which is one of the reasons for the guidelines for exercise order provided in Chapter 6.).

One final and very important aspect of injury avoidance is being reasonable in terms of weight selection when practicing and competing. This does not mean that the lifter must be overly cautious or afraid to attempt new personal records. A willingness to extend yourself is one of the true keys to progress in weightlifting. Being reasonable does mean that the weight attempted on any given day should be within or only slightly beyond the lifter’s capabilities. Assessing capabilities requires consideration of the lifter’s current physical and mental conditioning, his or her skill level and readiness on a given day.

The lifter’s overall condition dictates that lifter’s potential at that time. It is evaluated on the basis of the athlete’s recent performances in the classical lifts as well as the assistance exercises. For example, if the lifter can typically power clean 85% of his or her squat clean and that lifter has recently power cleaned 127.5 kg. , a 150 kg. clean is a reasonable projection. Alternatively, if the lifter always seems to lift 5% more in competition than in the gym, and he or she cleans 142.5 kg. in the gym, a 150 kg. clean in competition is again possible. Perhaps the lifter will do even better. On a day when the lifter feels really wonderful, a 155 kg. clean might be possible. But 170 kg. is surely not within the realm of possibility for that lifter at that time, and attempting such a weight would be foolish.

The lifter’s readiness on a specific day is another important consideration. Our lifter with a 150 kg. potential in the clean may well have a day on which 130 kg. presents a challenge. On another day, 140 kg. may look good but 150 kg. is simply not reachable. On still another day 150 kg. will be achieved and on a truly great day an additional 5 kg. or even 10 kg. more may be possible. The coach will get to know how an athlete looks when near maximums are being reached, and the lifter will know how he or she feels. The coach can supply valuable external feedback to the lifter, and the lifter can supply valuable internal feedback to the coach. As an example of the latter, many lifters have the ability to regulate their output of effort so that they can make a given weight, but it will not look easy. Then they can add considerable weight to the bar and lift it with the same apparent degree of effort, merely by increasing their focus and arousal level. Only the lifter knows his or her internal mental state, and it is important for the lifter to be able to monitor and judge that state. The lifter must come to know how to distinguish great courage from wishful thinking.

The final consideration with respect to judging a lifter’s readiness for a given weight is that lifter’s degree of skill. Mature and skillful lifters are able to make large increases from one attempt to another without suffering a breakdown in technique. Less experienced and less skillful lifters and those who get so excited when they attempt a heavy weight that their technique deteriorates may not be able to make large jumps in weight. For beginners and intermediate lifters, the fundamental rule is that increases should be gradual (no more than 10% at a time when the lifter is at 80% of maximum or beyond and often less than 5%). In addition, no increase in weight should be permitted unless the lifter is performing the current weight with correct technique. Moreover, if an increase results in a significant breakdown in technique, a lesser weight should be taken next and then any increases should be made more gradual than they were the first time around.

Two Major Causes of Injury Only Athletes Can Control

Regardless of what the coach does to assure safety, athletes are generally the biggest contributors to their own injuries. The two most common of these causes are fighting mis-positioned lifts and failing to concentrate on what you are doing.

Fighting A Lost or Mis-positioned Lift

One of the most common and completely preventable causes of lifting error is fighting to make a lift beyond the point where correction is reasonably possible. I have witnessed many examples of this, but I’ll offer only two.

I knew one national level lifter who suffered a severe ankle sprain when he tried to recover from the low  squat position in the clean after both knees had fallen to the platform and while the weight was still on his shoulders. He should have dropped the bar forward as soon as there was one knee touch. With two knees down, the appropriateness of “dumping” the bar was obvious. Attempting to rock back to normal squat position was ludicrous, as this athlete soon discovered. Fortunately, he recovered fully from the incident, but I am sure that he regards that incident as one of his most foolish.

Another lifter I knew had a long and outstanding career in the sport (including many national titles, a silver medal in the World Championships and three Olympic teams). This lifter effectively ended his career when he fought to press out a snatch that was guaranteed to be turned down by the referees had he been able to press the bar to arm’s length. The attempt to save the bar resulted in a torn triceps muscle that was never properly reattached. He continued in a heroic effort to resume his previous level of performance, but he was never able to accomplish this. His mistake had ended his career.

The athlete must learn when a weight can reasonably be saved and when it cannot. There is no point in fighting the latter kind of lift, especially in training. It may look impressive to bystanders when a lifter twists and turns, struggles and squirms to save a lift that is unbalanced, outside the lifter’s base of support or not cleanly lifted. But a lifter is wrong to use this kind of performance to demonstrate a fighting spirit. Struggles against maximum weights are part of the drama of weightlifting, but when the bar is grossly mis-positioned, struggling is a major mistake. A lifter who heeds this advice is likely to have a far longer and more rewarding career than one who does not.

Lapses in Concentration

Lapses in concentration are a major cause of injury. A lifter may have good technique and good equipment and follow sound safety practices, but if he or she lets his or her concentration lapse, the risk of injury rises dramatically. Concentration is a learned skill. Lifters should always be urged to cultivate this skill. Loss of concentration due to distractions or other causes can cause problems. But most problems occur when the lifter has not learned to focus on the exercise at hand for the full duration of its performance. The lift is not over until the bar is at rest on the platform or on the support from which it was removed. The majority of the accidents I have observed in the gym over the years can be attributed to the athlete permitting his or her attention to drift to something other than the safe completion of the lift. For instance, a acquaintance of mine has been lifting for approximately thirty-five years. He has trained vigorously for most of that time and is quite knowledgeable regarding the sport (having achieved the status of an international referee). This lifter has broken his foot twice in training because he was talking as he was unloading the bar and dropped a plate on his toe. He would be the first to tell you that neither accident would have occurred if he had been concentrating on what he was doing.

Understanding Injuries

There are two basic categories of injuries: acute and overuse. Acute injuries are caused by a single incident. Examples include dropping the bar on a part of the body or losing your footing on a slippery surface while lifting and spraining a knee as a result. Most acute weightlifting injuries are avoidable. Proper technique, appropriate equipment, proper supervision and safe lifting practices all serve to minimize the incidence of acute injuries.

Overuse injuries result from repetitive forces that lead to the destruction of a small number of cells (also known as “micro-trauma”). In general, the body can adapt itself at the cellular level to physical demands, but the adaptation process takes time. Any sudden change in demands imposed on the body can result in a breakdown of tissue that exceeds the body’s ability to repair itself. If the complete repair or replacement of the cells damaged by micro-trauma does not have sufficient time to take place, permanent injury can result. The destruction of even a small number of cells per incident of micro-trauma has a cumulative effect.

The causal factors of overuse injuries are generally divided into two categories: intrinsic and extrinsic. Intrinsic causes include the athlete’s anatomy and physiology. Examples of extrinsic factors include an overly ambitious training regimen, improper technique, environmental stressors or some combination of these factors. The dividing line between extrinsic and intrinsic causes is not always clear. For instance, a gradual increase in training volume may lead to an injury in one athlete and not another. What is the cause here? Intrinsic or extrinsic? The answer is that overuse injuries are caused by the interaction of intrinsic and extrinsic factors. Therefore, overuse injuries that are addressed early enough can often be overcome by altering the training, technical and/or restorative activity of the athlete.

In some cases, there is also a fine line between traumatic and overuse injuries. An athlete may take a false step and incur a back injury as a result. The immediate reaction is to blame the wrong step and classify the injury as a trauma. The reality may be that the lifter had unduly fatigued his or her back with prior overtraining and/or the use of a technique which placed an unnecessary strain on the back, predisposing it to injury. Along comes the misstep and the lifter interprets the entire incident as one of those “freak” accidents that sometimes befall athletes. While the lifter who has such an “accident” needs to analyze the reason for a technical mistake or misstep in order to assure that it does not occur again, time should also be taken to consider the possibility that prior overuse may have contributed to the injury. If that is believed to be the case, the lifter should work to correct that problem as well.

A similar mistake can be made in analyzing the cause of other injuries that have a rapid onset. A fairly typical case is one in which an athlete walks into the gym, begins to warm up and suddenly sustains a strained muscle. The easy conclusion would be to blame an inadequate warm-up or some minor technique fault in the lift during which the injury occurred. These may well have been the sole causes. However, a more likely scenario is that the lifter had actually sustained an injury in a prior workout which had thus far gone unnoticed. When new strain was placed on the body during the later workout, the full blown injury actually appeared. It is important to analyze each injury carefully, searching out all of the contributing factors. If a likely cause is discovered, the athlete can make appropriate corrections. If the lifter is fortunate, the injury will never recur. Should the injury recur despite those precautions, the lifter may need to strengthen the preventive measures that he or she took prior to the injury or to reexamine the original hypothesis regarding the cause.

Genetic and Acquired Predispositions to Certain Injuries

Two athletes can train in exactly the same way, live the same lifestyles and be exposed to the same stressors, yet one will develop an injury and the other will not. One reason is that athletes vary in their genetic makeup (one of the “intrinsic” factors alluded to earlier). Some athletes have inherited sturdier constitutions and have much more room for error. Evidence suggests genetic predisposition to certain kinds of injuries. In some cases this evidence applies to specific injuries (e.g., Achilles-tendon ruptures) and in other cases it is related to the body’s overall tendency to have degenerative reactions to stress.

Athletes also differ because of the environmental influences to which they have been exposed. Proper training strengthens the body’s reserves against injury, so an athlete who has been properly trained will have better resistance to injury than one who has not. In contrast, an athlete who has had previous injuries to a given area of the body, or one who trains improperly, may be more susceptible to injuring that area of the body in the future.

An example that might fall into either of these categories would be an athlete who had done extensive stretching. If he or she had stretched areas which were more likely to be injured due to a limited range of motion, he or she would now be more resistant to injury than an athlete with the same genetic makeup who had not practiced such stretching. In contrast, if stretching had been performed by the athlete in an improper way, it could have resulted in laxity in the athlete’s ligaments, which could actually make the athlete more susceptible to injury.

Psychological Characteristics that Can Predispose an Athlete to Injury

Athletes who emphasize mental toughness in their approach to sports can predispose themselves to injury by overestimating their invincibility and minimizing real injuries until they have worsened to a relatively severe level. While mental toughness is a characteristic of virtually all top athletes, it must be properly channeled. A healthy athlete must be determined to perform at his or her best, whatever the competitive conditions, but only as long as he or she is healthy. Minor injuries that pose no potential for serious complications need to be ignored, even if they present significant pain (i.e., pain which is disproportionate to the risk).

In contrast, an athlete who has a serious injury, or the precursor of one, must act immediately to avoid further damage. All athletes must believe in their invincibility on one level. If the risks of injury are too firmly in mind, an athlete will not be able to concentrate on performance. But false confidence must not lead to inappropriate techniques or cause the athlete to ignore reasonable safety precautions or warnings of injuries.

The Body’s Fundamental Reaction to Injury

To a certain extent, the body reacts differently to each injury. The area injured, the condition of the athlete prior to injury, the cause of the injury and a number of other factors all interact to determine the exact nature of the injury. Nevertheless, virtually all injuries which involve vascularized tissues (i.e., tissues with a blood supply) generate a fundamental kind of response called the inflammation-repair process. The body has a similar response to infection, thermal injury and chemical injury. The purpose of this response is to localize the injury, remove damaged tissue and begin the repair process.

The body’s response to trauma occurs at the cellular level. Cell necrosis, which arises out of direct damage or hypoxia (lack of oxygen to the tissue involved,) triggers the inflammatory response. Interestingly, the degree of the body’s inflammatory response is not highly correlated with the degree of damage generated by the injury.

Different kinds of tissue repair themselves in different ways. Tendons, ligaments and cartilage rely on the migration of reparative cells (e.g., fibroblasts and macrophages) to the injury site in order for the repair process to proceed. Bones and muscles, which are more amenable to repair than tendons, ligaments and cartilage, have resident pluripotential cells (called “myoblasts” in muscle and “osteoblasts” in bone) which facilitate the synthesis of new tissue.

The inflammation-repair process has three basic stages: inflammation, acute vascular inflammatory response and repair regeneration and, remodeling regeneration. The vascular response occurs immediately following the injury. There is a brief period of vasoconstriction (contraction of blood vessels) to control bleeding. Within minutes vasodilation (expansion of blood vessel’s diameter) causes blood and cellular debris to contribute to swelling and the eventual formation of a hematoma (blood clot). Virtually concomitant with this vascular response, the body activates a substance called “clotting factor XII” in the plasma. This has the effect of increasing clotting, capillary permeability and edema (swelling) and attracting inflammatory cells, such as leukocytes (white blood cells) and macrophages to the injury site. Other processes taking place in the injured area serve to increase inflammatory activity even further. (This latter stage of the inflammatory response is believed to be unnecessary, or at least exaggerated, and is the target of today’s more advanced anti-inflammatory drugs.) This additional inflammation and accompanying edema creates a zone of secondary injury which envelopes the primary injury site. Inflammation is indicated by heat, swelling, redness and pain at and near the site of the injury. However, there are conditions which generate pain without any discernible inflammation and conditions which generate inflammation unaccompanied by any significant level of pain.

From two days to six to eight weeks after soft tissue injuries, another category of cells called “fibroblasts” emerge at the injury site and aid in the repair of the wound and in the formation of collagen. Collagen is made up of large protein molecules that comprise a major share of bones, tendons and ligaments. (A similar process takes place in bony tissue, with cells called osteoblasts serving the same purpose as fibroblasts do in the soft tissues.) Capillarization (the formation of tiny new blood vessels) brings a blood supply to the new tissues. The collagen which forms in the early stages of this second phase of the inflammation-repair process is immature (e.g., quite soluble and relatively weak). Its strength increases at the latter stages of this phase of repair. In addition, substances called “myofibroblasts” cause a contraction of the wound (one reason for the reduction in soft tissue flexibility after injury).

The third and final phase of the inflammation-repair process sees the repaired tissue begin to approximate normal tissue as closely as possible. The biochemical profiles within the cells return to normal levels at this time as well.

Chronic Inflammation

There are times when inflammation does not follow normal patterns. Inflammation can be disproportionate to the magnitude of an injury or can be caused when relatively minor stresses are applied to a particular tissue, leading to atrophy and degeneration of the tissues involved and to a chronic state of inflammation.

Non-steroidal anti-inflammatory drugs (NSAIDs) are often used to interrupt the chronic inflammation pattern. However, these drugs are not meant to be long term treatments for inflammation. Some research that is beginning to appear in medical journals suggests that NSAIDs may interfere with the normal healing process. They also do not seem to positively influence it in the long term. Although, therapeutic modalities such as cryotherapy, thermotherapy, ultrasound and electrical stimulation all appear to reduce inflammation and promote healing, none of these therapies is fully understood. Exercise is by far the most powerful therapeutic modality for restoring damaged tissue to normal functioning.

Psychological Reactions to Injury

Athletes who have a serious injury generally pass through several psychological phases in reaction to that injury. At first the existence of the injury is denied or at least not fully grasped. Then the athlete becomes angry and/or frustrated over the injury. This is generally followed by a period of depression. Eventually there is acceptance. Finally, the successful athlete begins the comeback process. The length and severity of each stage varies with the athlete and the circumstances, and some stages may overlap with others. Certain stages of this typical l sequence may be virtually non-existent in some athletes or in certain cases.

A coach or other advisor who understands these phases can attempt to support the athlete as is appropriate. In addition, he or she will not be surprised by what may seem to be curious reactions to the obvious (e.g., an athlete’s denial of an obvious injury). The wise coach learns to flow with these stages, to offer help as needed at each phase and to facilitate the athlete’s movement toward the final and most productive psychological stage, the one in which dedication to come back develops.

Specific Kinds of Injuries

There are many kinds of sport injuries, but the vast majority are musculoskeletal injuries which fall into a category called “soft tissue” injuries. Soft tissues are essentially those which surround the bones (e.g., skin, muscles, tendons, nerves and blood vessels). In addition, there are other kinds of injuries or ailments that affect athletes (e.g., fractures and syncope) and we will address some of these kinds of injuries as well.

Two Soft Tissue Injury Categories

There are two general categories of soft tissue injury: closed and open. Closed injuries involve damage to soft tissues without a break in the skin. Open injuries are all of those in which the skin is damaged.

Open Injuries

The four main types of open injuries are abrasions, lacerations, avulsions and punctures. Abrasions occur when the uppermost (epidermal) layer of skin and a portion of the lower (dermal) level of skin have been scraped or rubbed away. Lacerations are cuts, many of which extend beneath the level of the skin into and blood vessels, nerves and muscles. Avulsions occur when the skin is torn rather than cut. Punctures occur when a pointed object penetrates the skin (sometimes penetrating deep into the soft tissues).

The treatment for all minor injuries of the four types described above involves cleansing with soap and water, the application of an antiseptic solution or ointment and the application of a sterile gauze. Wounds that go beyond the level of “minor” because of the pain associated with them, the depth of the wound, or the surface area affected should always be referred to a physician.

Blood vessel injuries can occur whether injuries are open or closed. Injuries to very small blood vessels (capillaries) are generally not serious and can usually be handled by the body’s natural defenses. Bleeding and swelling that result from damage to capillaries can be minimized through the application of ice and compression to the injured area. Damage to larger blood vessels, though not common in athletics, must be controlled immediately, as described in the later section on “First Aid.” Severe bleeding is life-threatening. A person in whom severe bleeding is observed or suspected must receive immediate medical attention.

Whenever an injury has caused a blood loss, it is important for the protection of others using the equipment and facilities that the blood be cleaned up immediately. This can be done with any appropriate disinfectant (a common recommendation is the use of a solution that is one part bleach to one part water).

Closed Injuries

Closed injuries fall into the following categories: sprains, strains, nerve injuries and blood vessel injuries.

A sprain occurs when a ligament is stretched or torn but the joint which the ligaments supports is not completely dislocated. A strain is a rupture in a muscle or tendon. Because strains involve the muscle-tendon unit, they are characterized by pain only when the athlete actively moves or exerts force against resistance. Sprains are painful even when the joint at which they occur is moved passively., Moving an injured joint to test for pain upon passive motion can be risky, however, and is not recommended without medical supervision.

Strains vary in severity with the extent of the damage to the tendon or muscle. Both mild and moderate strains are characterized by spasming and pain at the injury site and sometimes a loss of strength. The difference between the two is a matter of degree. Both will heal in time (the mild strain in days and the moderate strain in weeks). Severe strains involve complete avulsion of all or part of a muscle. They are generally quite painful, frequently manifesting themselves as deformities which can be observed and/or felt when the area is palpated (examined with the fingers). Severe strains often result in a loss of function This loss of function is not always visible because synergistic muscles or other muscles in the same muscle group can permit the athlete to continue to move despite a severe strain.

Sprains are also graded by their severity. Mild sprains are characterized by stretching of the ligament without an actual loss of continuity in the fibers of the ligament. Moderate sprains involve some actual tearing of the ligament, generally accompanied by some degree of abnormal laxity in the joint. Severe sprains are characterized by an abnormal range of motion and an inability to use the limb normally because of the pain and/or the position of the joint. Severe sprains involve the complete avulsion of the ligamentous fibers. In all cases in which severe strains or sprains are even suspected, the areas involved should be immobilized, and prompt medical treatment should be sought.

A delay in medical treatment for severe strains and sprains reduces or eliminates any likelihood of a full recovery. I have known a number of high level strength athletes whose careers were ended by a delay in treatment of a severe strain. In some of these cases the athlete denied the extent of the injury and did not seek treatment until surgical repair was ineffective. In other cases the athletes were so strong and the muscles that surrounded the injured areas were so well developed that the doctors who examined them pronounced the damage to be “minor” and not requiring surgery for a full recovery. Examinations of weightlifters should be performed by medical people who are used to examining and treating athletes with significant hypertrophy.

Injuries to Cartilage

Cartilage is a tough elastic and smooth substance that is generally situated between and at the ends of bones. Cartilage contains no blood, nerve or lymph supply. Synovial fluid lubricates the movement of cartilage and cancellus or soft bone tissue beneath the cartilage helps to absorb shocks that are applied to cartilage and, ultimately, to bones. Cartilage does not normally repair itself well but is replaced after damage by fibrocartilage (which is not as strong or durable as normal cartilage). The knees are probably the joints of the body that are most prone to cartilage injuries, but such injuries are not uncommon in the hip and shoulder areas and can occur in any joint.

Nerve Injuries

The human body has a complex nervous system which consists of two subsystems: the central nervous system (the brain and spinal cord) and the peripheral nervous system (the nerves that innervate the muscles and the nerves that send information from the body to the brain). Blows to the head or spine and fractures and dislocations of the vertebrae can result in damage to the central nervous system. Such damage can be life-threatening and/or can lead to paralysis. Consequently, athletes who suffer head and/or neck injuries, especially those which result in a loss of consciousness or any sensations of tingling, numbness or paralysis in the limbs, should be treated as if cervical damage has occurred.

Damage to the peripheral nervous system generally occurs as a result of deep lacerations, severe sprains and dislocations and fractures of bones other than those of the skull and vertebrae. It should be noted that injury to nerves can also occur when there is severe or repeated compression. Damage to the peripheral nerves can be assessed by checking for motor function and sensation distal to the injury site (further away from the spine). If any evidence of nerve damage is discovered, the athlete should be immediately referred to a physician.

ContusionS

A contusion is a soft tissue (e.g., skin, muscle and/or tendon) injury caused by pressure (usually a blow or collision). Contusions often result in obvious “black and blue” marks in the skin where the injury occurs, but internal contusions (which typically result from a soft tissue being compressed against a bone beneath it by an external force) can lead to less visible (though normally painful) damage.

Fractures

Any break in the continuity of bony tissue is considered to be a fracture. Fractures that involve penetration of the skin by bony tissue are called open fractures. All other fractures are considered to be closed. Open fractures often result in greater blood loss than closed fractures, and they expose the bone to the external environment. Therefore, as a group, open fractures are considered to be more serious than closed fractures.

Within the category of closed fractures are displaced and non-displaced fractures. Displaced fractures are generally characterized by some sort of deformity in the involved limb. Non-displaced fractures show no external evidence of their existence, other than pain, and X-rays are needed to diagnose such fractures.

Special categories have been created for fractures with certain characteristics. Comminuted fractures involve the fracture of the bone into more than two pieces. Stress fractures result from repetitive stresses, such as running. Weak or diseased bones can suffer fractures when they are exposed to stress well below the level that would normally be required in order to sustain a fracture. Fractures that occur under such conditions are referred to as “pathologic fractures.”

Two kinds of fractures are associated only with children: greenstick and epiphyseal. In greenstick fractures the separation of the bone runs lengthwise through only a portion of the shaft of a bone. In epiphyseal fractures the “growth plate” is damaged. (See Appendix II for a further discussion of epiphyseal tissue.)

Tenderness at a certain point in the bone, deformity, inability to use the limb, swelling, discoloration (“black and blue”), exposed bone tissue, grating upon movement and unusual motion beyond the point where a limb would normally go are all signs of fracture and should be further investigated. Grating and unusual movement should never be tested for as they can cause further damage.

Dislocations

A dislocation is an injury to the joint in which the ends of the bones that are normally in contact at the joint are no longer in such a position. A fracture-dislocation occurs when, in addition to dislocation, one or more of the bones that normally meets at the joint is fractured near the joint. Most dislocations and fracture-dislocations are associated with a sprain of the ligaments that stabilize the joint. The signs and symptoms of a dislocation are: deformity of the joint, swelling, pain at the joint that is worsened by any attempted movement and loss of normal joint motion.

Tendinitis and Related Conditions

Tendinitis is an inflammation of the tendon due to overuse. Tenosynovitis is inflammation of the synovial sheath that surrounds a tendinous tissue.

Bursitis

Bursitis is the inflammation of the bursa sacs (sacs comprised of two layers of joint lining tissue with a thin layer of synovial fluid in between). Bursa sacs generally exist where a tendon would otherwise generate friction by contact with a bone, or where there would tend to be friction between skin and bone. During the inflammation, the amount of fluid in the bursa sac increases. Over time the walls of an irritated bursa can thicken and the nearby tendon can degenerate or become calcified.

Myofascial Pain

Myofascial pain is also known as fibromyalgia. It is a muscle response that can result from a trauma. The condition is characterized by the formation of myofascial “trigger points,” which are cord-like or nodular and are associated with muscle spasms. Trigger points are often quite painful, especially when pressure is applied to them. There is a school of thought which says that this kind of condition and its resulting pain comprise much of the pain that athletes suffer (particularly when it is a response to chronic injury). Deep-fiber massage techniques have been used to break up these spasming areas. Direct injection of analgesics and anti-inflammatory agents are also used by some practitioners to treat this disorder. In order for such treatments to work, they generally must be accompanied by rehabilitative exercise and a restructuring of the athlete’s training and/or technique to prevent a recurrence of the condition.

Syncope

Syncope is a transient loss of consciousness. I have never witnessed complete syncope in weightlifting competition or training. The reports of such occurrences in athletes lifting weights have generally been associated with serious medical conditions, such as heart disease, manifestations of which may have been brought to the surface by strenuous activity.

Weightlifters do occasionally suffer a near loss of consciousness during overhead lifting. The cause is not entirely understood, but it probably involves one or both of the following mechanisms: a) a reduction in the blood supply to the brain when pressure is placed on the carotid arteries, b) intrathoracic pressure increases as a result of performing the Valsalva maneuver (holding ones breath against a closed glottis), and, c) pressure on the carotid sinus, which can slow the heart rate (this latter theory was offered to me by a friend, avid weight trainer and eminent surgeon, Dr. Herbert Perry). Such pressure can develop when the bar is held incorrectly at the shoulders. It most commonly occurs when the bar has been lifted to the shoulders in the clean. In this position, it is possible for the bar to place considerable pressure on the anterior surface of the neck. In virtually all cases, this phenomenon occurs when the lifter is recovering from the clean, or shortly after he or she has done so. On one or two occasions I have also seen this kind of reaction occur as a lifter struggles to hold a weight overhead while holding his or her breath for an extended period (almost certainly a result of cause “b”.

Generally, the lifter senses a weakness and simply drops the bar forward. Often the lifter’s body will shake and generally exhibit a loss of muscular control ( which in many cases returns within seconds) and the lifter walks away. On other occasions the lifter will slump to the floor and display weakness and lack of muscular control for from several to perhaps ten or fifteen seconds. During this period the lifter is normally conscious but is often unable to speak for a very brief period and exhibits considerable muscular tremor. Recovery to near normal functioning is generally rapid. Indeed, I have seen lifters return to the platform within minutes of such an episode and succeed with the same weight that caused the episode.

I have experienced this phenomenon a number of times over the years. It is a strange sensation, because you maintain full awareness of what is going on but cannot control body tremors or sometimes speak to those around you, although you can clearly see and understand the concern on their faces. Within a few seconds, the episode is over. In every case that I have experienced the bar was mis-positioned on my neck and the onset of weakness was very rapid.

On rare occasions a lifter can very nearly lose consciousness and fall (generally backward) with the bar on his or her shoulders. As long as the bar remains in the area of the lifter’s neck, there is enough space between the bar when it is resting on the platform and the lifter’s neck to prevent any injury to the athlete. (Indeed, one of the reasons for the large diameter of the plates used in weightlifting competition is that the distance of the bar from the floor generally protects the lifter from injury.) The only potential for injury is be if the bar bounces toward the lifter’s head or chest, or if the lifter’s arms are somehow positioned between the bar and the floor when he or she falls. In the handful of situations in which I have seen such a thing, there has never been such an injury. In fact, the likelihood of a bump on the back of the lifter’s head appears greater than damage from the bar.

To protect against any injury when a “fainting” spell occurs, the lifter should drop the bar forward and then go down on one knee as soon as any sensation of weakness is felt. Ordinarily a lifter can feel this coming on and can move away quite easily. The way to prevent this kind of problem is to learn proper positioning of the bar on the shoulders and sound technique. When this is done, the likelihood of this affliction occurring is quite remote. Those who experience this problem will need to experiment with bar positioning in order to prevent its recurrence.

Dealing With Injuries

Should you incur an injury, you must first minimize the damage through first aid and then, where appropriate, seek professional treatment. When the professional treating you agrees, the rehabilitation process must begin. That is the athlete’s job, with the help of the coach and health professional where appropriate.

A basic pattern for rehabilitation is associated with any injury which causes a break in training. First, the athlete must restore the function of the injured area. Then that area must be reconditioned to withstand the specific demands of the sport. During this process the fundamental nature of the injury has a direct bearing on the way in which it is handled.

In the rehabilitation of acute injuries, the focus is on getting the athlete back into his or her previous regimen. The injury was an “accident” (i.e., it was not linked to an inherent weakness or training overload). Its causes are to be avoided in the future, but recurrence is unlikely.

Overuse injuries are a direct result of the athletes’ pre-injury training and physical state. Therefore, the athlete cannot merely return to the status quo. Otherwise, it is quite likely that the injury will recur. Some change in technique, training, restorative techniques or some combination of these is needed to prevent the same overuse cycle from being activated once again.

Sometimes the change is a simple matter. If the cause of the injury was a sudden or significant increase in the volume and/or intensity of the athlete’s training (the former being much more likely), the athlete can probably resume his or her earlier level of training, and the injury will not recur. If the increase in load was inadvertent, this may be an acceptable solution. If the increase in training load was considered critical to the athlete’s continued progress, the coach can devise a new plan that is different in any of several respects. One difference could be the rate of advancement to the new load. If that rate is made more gradual the second time around, the athlete is likely to tolerate it better. Another change that can be made is to give the athlete more opportunity to rest between periods of applying the desired load. A third approach is to use a somewhat smaller load, one that is effective in eliciting a training response, but is not as demanding as the level achieved before the injury.

Another means for reducing the “effective” load is to address the stress on the injured area from the standpoint of mechanics. For example, the athlete might have a tendency to “crash” into the bottom position in the clean (since the bar is permitted to build up considerable downward speed before the lifter catches it at the shoulders). When the lifter’s load of cleans was below a certain level, this error in technique did not result in injury. When the load of cleans was raised, the athlete’s knees simply could not take it. Correcting this technique flaw will enable the athlete to handle a greater load without injury. Alternatively, the lifter may be lifting with shoes that have a higher heel than the lifter requires to assume proper lifting positions. In this case a lower heel might reduce the strain on the lifter’s knee, permitting the athlete to train at the desired level.

The options open to the athlete and coach for dealing with overuse injuries are limited only by the coach’s imagination. The one approach that is destined for failure is a return to the combination of training regimen, lifting technique and restorative patterns that led to the injury in the first place.

This is an important consideration when the lifter has even minor overuse injuries. Pain that is moderate, comes on suddenly, and then goes away quickly is generally not a cause for concern. It merely signals the body’s response to a new stress. What should never be ignored is a pain in a soft tissue that lasts through several workouts. When it appears that in injury is becoming progressively worse (even if very gradually), it is time to act, before the problem becomes chronic. The solution is not simply to take an anti-inflammatory medication or apply some liniment and go on.

The First Key to Injury Management: First Aid

A detailed exposition of the general principles of first aid is beyond the scope of this book. There are many useful sources of information in this area, the most well known of which is the Red Cross. The Red Cross has local chapters across most of the United States. Most chapters offer training in first aid procedures, and the Red Cross has numerous publications that deal with first aid. There are many other excellent sources of information in this area as well. I encourage all athletes and coaches to become familiar with first aid procedures, including CPR. A knowledge of first aid can be useful in the gym, but its value extends far beyond that into everyone’s daily lives.

Most states have “Good Samaritan” laws which protect people who respond to an emergency, as long as they act in a way that a reasonable and prudent person would. This would include not moving a person unless his or her life is threatened, asking a conscious victim for permission before providing care, checking for life-threatening emergencies before rendering further aid, summoning professional emergency care and continuing to provide care until more highly trained personnel relieves you. When you are assisting an injured or ill person, you should always use common sense and do the best you can; you should not attempt to render care beyond your level of training. Coaches and others who supervise athletes may actually have a legal responsibility to intervene on behalf of an injured athlete under certain conditions. That is why coaches should be knowledgeable in first aid techniques.

In evaluating any injury, the Red Cross suggests three steps. The following is a brief summary of their recommendations, but the Red Cross should be consulted for training in the application of first aid techniques.

1. Check the scene. Check the scene for signs of danger. If either the person injured or the person seeking to render first aid are in danger of further harm, all reasonable efforts should be made to deal with that continued risk. If the person is in the street, this will probably involve stopping traffic. If the person is in the gym, it will probably mean halting all activity in the area and removing any threats to the injured person. If the potential first aid giver would be in danger if he or she began to render aid, he or she is not be expected to commence first aid until that danger had been removed. If this is impossible under the circumstances, the would be first aid giver should move on to the next step in the first aid process.

In checking the scene, the first aid giver should make an assessment of what happened, determine how many victims there are and whether any bystanders can help. An injured person should never be moved unless he or she is in imminent danger of life threatening injury by remaining where he or she is, unless a person who may be more seriously injured is blocked by this person or unless proper care cannot be administered where the person is (e.g., the person is in need of CPR but is on a surface which precludes the administration of CPR). When a person must be moved, avoid any twisting or bending of the victim, particularly of the head and spine and any other apparent areas of injury (e.g., a broken bone).

2. Call for help. You should call the local emergency number (generally 911) or arrange for that number to be called, by asking a specific bystander. He or she should be ready to give the emergency service dispatcher the exact location of the injured person(s), his or her name, the telephone number of the phone from which the emergency call is being made, what happened, the number and condition of the victim(s) and what care is being rendered at present. If the emergency number in your area is not 911, or if some other emergency procedure is in place at your facility, that emergency procedure should be posted prominently in the workout area.

If you are unable to elicit any assistance in calling for help and are capable of rendering urgent first aid (such as pressure to arrest severe bleeding), the Red Cross recommends that you render such aid for about a minute while you think about the location of the nearest phone. Then make the call as quickly as possible and return to the victim.

3. Care. Even a basic guide to first aid for life-threatening conditions is well beyond the scope of this book. The following conditions are considered to be immediate threats to life: choking, lack of breathing, lack of a pulse and severe bleeding. These conditions require immediate attention as they can lead to loss of life within minutes if left untreated. Whenever an injured or sick person is conscious, you should introduce yourself, tell the person how much training you have and how you plan to help (in the case of a child, get approval from a supervising adult). If the condition is serious, permission is generally implied if a supervising adult is not present. Once you agree to render first aid, you should continue to provide it until you are exhausted or help arrives.

First Aid for Fractures and Dislocations

First aid procedures for fractures and dislocations are similar. Assuming that an athlete’s vital signs have been evaluated and are stable and any open wounds have been treated, fractures and dislocations should be splinted. Only if there is an immediate threat to an athlete’s life should the athlete be moved before a splint is applied. Splinting reduces pain and movement, prevents the bones from doing any further damage to the soft tissues and reduces the likelihood that the bone will either restrict blood flow distal to the injury, or that excessive bleeding at the site of the injury will occur. If you do not know how to apply a splint. you should wait for someone who does before moving the victim.

First Aid for Sprains and Strains

When uncomplicated strains and sprains occur, the recommended treatment is represented by the acronym “RICE. ” (“Uncomplicated” means only a strain or sprain, i.e., there are no other injuries to the athlete.) RICE stands for: rest, ice, compression and elevation (which are not necessarily applied in that order). Rest means stopping activity to protect the athlete from the possibility of further damage and to treat the injury.

Compression can be administered in a number of ways, the most common of which is probably the application of an elastic or “Ace” bandage, which is wrapped firmly, not tightly, around the injured area.

Ice is applied to the injured area to minimize internal bleeding, swelling and pain. Ice is generally applied for periods of twenty to thirty minutes every one to two hours. This process should continue for from twenty-four to seventy-two hours (depending on the severity of the injury). A small number of athletes have significant negative reactions to treatment with ice. Nerve damage and frostbite are the most common of these effects. To prevent such reactions, the athlete should be monitored regularly. Particular care should be paid in situations where major nerves are relatively close to the surface of the skin. The peroneal nerve that is located in the posterior of the knee and the ulnar nerve that is near the surface of the posterior of the elbow joint are two examples of nerves that are susceptible to nerve damage when ice is applied because of their proximity to the skin’s surface.

Elevation (raising the injured area above the level of the heart, if possible) is another method, used in conjunction with compression and ice, to reduce inflammation and bleeding into the damaged tissues.

The Second Key to Injury Management: Proper Diagnosis

Many athletes have wasted considerable time unsuccessfully treating an injury that was misdiagnosed. Today’s doctors often rely on technology, such as MRI, to diagnose injuries accurately, but not every injury merits a diagnostic procedure that can cost $1,000, and even such spending may leave the problem improperly diagnosed. Diagnosis is as much a problem of logic as of technology. If the doctor is skilled at applying diagnostic logic and the correct information about the onset and symptoms of the condition is reported to the physician, the probability of a correct diagnosis is greatly enhanced. Analytical thinking in combination with up-to-date technology is critical to diagnostic success.

Soreness Versus Injury

One of the most common areas of misunderstanding among beginning athletes involves distinguishing soreness from injury. Exposing muscles to unaccustomed stresses often results in a response by those muscles that is referred to as “delayed onset muscle soreness” or DOMS. DOMS is an apt term for this phenomenon; the athlete seldom feels much during a workout, but a very significant level of discomfort can be felt twelve to forty-eight hours later .

The cause of DOMS is not completely understood, but it is generally accepted today that DOMS is symptomatic of minor (and perhaps beneficial) structural damage to muscle tissue (not a build up of lactic acid in the muscle as was once believed). In fact, the presence of a particular enzyme (creatine phosphokinase, CPK) during such soreness is evidence of some breakdown in the muscle tissue, albeit to a far lesser degree than when an actual injury occurs. (The level of CPK is far smaller during a period of DOMS than after an actual injury.)

What is not understood is why there is a delay in muscle soreness (strains, after all, are typically evident as soon as they occur), and why the condition is not worsened by activity (soreness generally diminishes after activity). Clearly there is some fundamental difference between muscle soreness and muscle strains. How do you tell the difference? The pain from strains tends to be localized and is more often in the tendon, or the juncture between the tendon and the muscle, than in the muscle itself. Moreover, strains feel worse with activity, while DOMS generally subsides gradually as activity is undertaken. DOMS can be worked through, while strains cannot.

Another differentiating factor is that strains often occur in the overtrained athlete, while DOMS ordinarily does not. On the contrary, DOMS occurs in the athlete who is returning to activity after a layoff or making a significant change in the training load or in technique. Strains can occur for these reasons as well, but they tend to arise even more often in an environment of fatigue.

The Third Key to Injury Management: Proper Treatment

Once the exact nature of an injury has been determined, a treatment plan must be formulated. Initially the treatment will probably focus on minimizing the swelling, bleeding into the wound and inflammation (e.g., the RICE treatment described earlier). Once the injury has been stabilized, there will generally be an effort to mobilize the injured area in a safe manner (ultimately restoring it to its full range of motion) and to reduce any residual inflammation. This is generally accomplished through some combination of rehabilitative exercise (including stretching), and the application of therapeutic modalities (such as ultrasound and muscle stimulation) and sometimes through the use of anti-inflammatory medications. Once range of motion and strength have been restored to the muscle, the gradual return to activity commences.

The details of these steps will vary significantly with the individual and the injury. For a sprain of moderate severity in a joint that can be easily stabilized, activity may begin soon after the injury. When a tendon is actually torn, it can take a year for its full strength to be restored. In such a case, vigorous activity will be curtailed for an extended period, and the return to activity will be very gradual indeed.

During the entire process, the advice of the health professionals who are rendering treatment should be followed. The athlete should provide input and ask questions about the rehabilitation process, but the right professional should be able to do much to make the rehabilitation process as short and effective as possible. The right professional is one who knows his or her business and understands and has dealt with your kind of condition.

Unfortunately, some professionals do not provide the kind of guidance people need. They may say something very general, such as “do what you feel you can.” This kind of advice is rarely specific enough. Yet even when pressed, some professionals are simply not able to articulate more detailed advice. They may know how to deal with a rehabilitation issue when they see it but be unable to provide advice prospectively or in terms of principles. This is particularly true when the athlete has reached a point of reasonably full function and now wishes to resume his or her training.

It is wise for weightlifters to develop a network of health professionals who can support them as needed. Orthopedists, physiatrists, chiropractors, physical therapists, nutritionists, sport psychologists, massage therapists and other health professionals can all be of help to the athlete, and the help they can provide goes well beyond treating injuries into the realm of preventing them. Health specialists who have worked with athletes have all seen the results of improper technique, unsound training methods and unsafe practices. It is good to benefit from their insights before a problem develops.

The difficulty in selecting appropriate professionals lies in determining whether they really have the knowledge that is needed. Professional credentials are important, but no credential guarantees competence or specific knowledge of your condition and sports activity.

Ideally, the health specialists you use should have experience with athletes, preferably athletes in your sport. They should at least have experience with your kind of problem. An orthopedic surgeon may be brilliant when working with knees but only mediocre with shoulders. Such a specialist may also be great with the scalpel, but tend to over-prescribe surgery and be weak in the areas of prevention and conservative treatment. Another orthopedic specialist may have the opposite strengths and weaknesses.

Do not be afraid to ask specialists about their experience in the area of your concern. Make your goals and concerns clear to them. (The approach may be very different if your goal is to return to competition for as many years as you can and not. merely to get around comfortably in retirement.) Discuss what they propose to do. Ask about the risks and benefits. Ask about alternative treatments and their risks and benefits. Ask for references from people who have had the procedure. Go to a medical library and do a little reading. The more you know, the better equipped you will be to make a judgment about the best treatment for you. It is important to bear in mind that when you have surgery, there is often only one chance to get it right, so the surgeon (and the procedure) must be selected carefully.

It is always a good idea to line up your network before you need it. When you are injured and in pain, you will be less likely to select the correct professional or to make the right decision about your course of treatment than when you can do so at leisure and with a cool head.

Avoid the Knife Whenever Possible

We have grown up in a generation that reveres the skill of the surgeon. Many of us to look to the surgeon the way we look to a mechanic. We expect the surgeon to rebuild, replace or reshape so that we can go on with what we want to do. There is no doubt that surgeons can work wonders, but the cases in which athletes are better than new for the experience of major surgery are rare indeed. Unfortunately, a significant number of surgeons believe that they can fix nearly anything, and this attitude is often communicated to naive patients. It must be remembered that surgeons do not earn what they consider to be a reasonable living unless they perform surgical procedures. A combination of true belief and economic incentives can make it nearly irresistible for some surgeons to recommend surgery.

Even the most medically necessary and the best planned and executed surgeries have their risks and failures. And the downside can be severe indeed. Therefore, it is wise for the athlete to avoid surgery whenever possible. Whenever a more conservative treatment is available, it is generally a wise idea to try it first.

There are important exceptions to this rule. One is the case of a complete avulsion of a muscle, tendon or ligament. When this kind of injury occurs, surgical repair is a must and the need for it is urgent. The probability of success in repairing a complete avulsion declines in a matter of days and plummets after a week. I have known many athletes who postponed surgery for such injuries and who have never been the same. In contrast, athletes who had the problem attended to quickly have made very successful recoveries more often than not.

Surgery must also not be avoided when a delay is likely to result in further damage. One example is the development of a bone spur (a bony outgrowth) in the shoulder. Such a spur can rub against the rotator-cuff tendons as the shoulder moves, actually cutting them. Over time the simple spur, which could have been removed arthroscopically at one point, causes a tear in the rotator-cuff tendons ,a far more severe problem than the spur alone.

The need to differentiate between injuries that require immediate surgery and those which do not underscores the importance of asking the kinds of questions that were discussed earlier. Only by understanding what will happen if nothing is done will the athlete be able to make the proper judgments. When in doubt (and even when you are not), get a second opinion and even a third. Doing so will increase your chances of a correct diagnosis, enable you to hear a prognosis from more than one person and give you more choice with regard to who will treat you. Also, it is important to talk to people who have had the treatment to determine how they feel about the result. Often the patient is a better judge of success than the doctor.

Training Through and Around an Injury

While an athlete is having an injury treated he or she may wish to inquire whether the injury can be “trained through” or whether training in the normal way will make the injury worse or delay the healing process. How do you determine whether further activity is likely to cause further damage or hinder the healing process? The first step is to ask the health professional who is diagnosing and/or treating you his or her opinion. In traumatic injuries of moderate nature, continued activity may be perfectly appropriate as long as the activity has no danger of further damaging the injured area (i.e., the traumatic event can be prevented from recurring). In the case of strains that are moderate or worse, continued activity will prevent the healing process from taking place. The stretching or contracting of an injured area may continually irritate the injured area. Athletes often have difficulty distinguishing tendinitis from a minor strain that can heal even with continued activity.

A rule of thumb that I have found useful is to have the athlete warm up thoroughly and progress to heavier weights. An injury that can be trained through will not get worse as weight is added. (Pain may increase somewhat from the lighter to the heavier sets, but then it will level off and may actually lessen with the heavier weights.) Such an injury will also not become more painful as the reps in a given set proceed. If the pain does worsen at heavier weights or with each passing rep, a rest must be taken in order for healing to occur.

Another important indicator of whether continued activity is safe is the post-workout experience of the athlete. If the injury has not worsened a day or two after a particular activity has been undertaken, or, preferably, it has gotten better, there is reason to continue. If, in contrast, the pain or other symptoms of the injury have worsened, the liniment is only a masking agent, and continued activity is contraindicated.

Aids to Training Through Injuries

There are essentially three approaches to training through injuries: to tough it out by training through the pain; to treat the pain with analgesics, anti-inflammatory agents and/or a variety of agents that reduce pain; or to provide mechanical support to the injured area. These approaches are not necessarily mutually exclusive.

The Errors In “Toughing It Out”

Toughing it out means continuing to train in spite of the pain as long as you have medical approval (which means the injury isn’t likely to worsen as a result of training). The main advantage of this approach are that you can maintain your physical condition in spite of the injury.

The main disadvantages of toughing it out are twofold. First, as my friend and former National Superheavyweight Champion Jerry Hannan, used to say, “the problem with pain is that pain hurts.” And Jerry had a point. No one likes pain.

But there is an even more important reason to avoid pain. An athlete in pain will generally not perform as well and may begin to make unconscious changes in his or her movement patterns in order to minimize the pain. This can have disastrous effects on technique, and many an athlete has suffered permanent damage to his or her technique by training through an injury.

Treating Pain with Analgesics and Anti-Inflammatories

Athletes who want to train through injuries generally do so with the assistance of analgesics or anti-inflammatory agents.. If the pain is non-functional, training under the influence of an analgesic is not the worst thing in the world, as long the analgesic does not affect the athlete’s alertness or coordination.

 Today more athletes who want to train through the pain use anti-inflammatory agents than analgesics. In the early days of sports medicine, physicians often relied on corticosteroids, such as cortisone, to treat inflammation. Over time, research began to suggest that long term use of cortisone preparations had a number of undesirable side effects. Moreover, the direct injection of cortisone into an injury site (such as an injured tendon) could cause a weakening of that tissue and thereby lead to a far more severe injury.

In recent years, non-steroidal anti-inflammatory agents (NSAIDs) have become increasingly popular for treating chronic and acute joint and related pain. Tens of millions, if not hundreds of millions, of people worldwide have been able to return to activity on a relatively pain free basis because of these drugs. Athletes  have also benefited from the development of these drugs.

While the side effects of NSAIDs are far more mild than those of corticosteroids, they can still be serious, particularly when these drugs are used on a long term basis. Ulcers and related gastrointestinal disorders, as well as damage to kidney function, are just two examples of the negative effects of NSAIDs. With respect to the use of NSAIDs by athletes, the jury is still out to a certain extent. It is as yet unclear whether the use of NSAIDs, on balance, prevents or causes injuries. They clearly reduce pain and permit continued training and competition. There is no doubt that unnecessary inflammation is reduced when they are used. But there is the possibility that prolonged use may have a negative effect on the integrity of injured areas, particularly if continued training leads to progressive micro-trauma and to severe injury at some point.

It is my belief that relying on NSAIDs over the long term is not a good idea. Apart from side effects (the incidence of which tends to grow with the term of use), the use of NSAIDs permits many athletes to employ lifting techniques and training methods that are inappropriate for them by putting off the consequences. Had the NSAIDs not been used, the athlete and coach would have been forced to address these issues earlier and to treat the cause rather than the symptoms of the condition.

If lifting is causing the wearing away of cartilage in an athlete, should the situation be masked until an athlete has no cartilage at all by age thirty? What if an athlete develops a reaction to NSAIDs at twenty-five? What will that athlete do when age causes joint pain without strenuous activity? What is left in the physician’s arsenal? To my way of thinking, having an athlete live on NSAIDs (i.e., use them long term) is akin to having a person daily re-infect an area and then rely on an antibiotic to treat the infection. The day will come when the antibiotic will be ineffective. At that point, the real trouble will begin.

All athletes will sometimes overdo things a little. In such cases, a substance that clears up temporary inflammations may be used to good effect if it is used in conjunction with modifications of training, technique and restorative measures designed to prevent a recurrence of the problem. Treating a symptom without treating the cause is a mistake of major proportions.

Topical Applications to Treat Pain

Many athletes like to apply liniments or other substances to the skin to ease the discomfort of aching muscles and other minor aches and pains. There is no doubt that liniments can reduce local pain sensations. How this is accomplished is not fully understood. The application of “hot” liniments results in skin irritation, which leads to an increase in the blood supply to the area. This generates a sensation of heat. The heat thus developed does not penetrate below the skin, so liniments are not actually “warming up” the muscles through any kind of increase in blood flow to the muscle. Nevertheless, the feeling of warmth in the area does result in a reduction or modification of any pain sensation in that area of the body and therefore may reduce muscle tension and any spasming that is occurring in the muscle.

As was noted earlier, a reduction in the sensation of pain can have both positive and negative aspects. If such a reduction results in an athlete’s engaging in an activity that causes further damage, it is of course a negative. If the pain was causing the athlete’s to favor the injured area (i.e., by contracting muscles that are not normally brought into play or inappropriately modifying technique to avoid pain), then reduction in pain has had a positive effect .

Certain kinds of pain are non-functional. Pain can be disproportional to the injury and can linger on after healing has occurred. When it is appropriate for an athlete to work through the pain (i.e., when it is unlikely that continued activity will cause any damage to the athlete) substances that minimize discomfort can be helpful.

Mechanical Aids to Training Through Injuries

In weightlifting parlance, “wraps” are strips of fabric with some kind of elastic material interwoven. They are generally quite strong and have a significant elastic pull when they are stretched. They are most often used to support the knees (a shorter and thinner version is often used to support the wrists), but they can be used to support and/or compress virtually every area of the body.

Lifters are divided in their opinions regarding knee wraps. Some athletes almost never use them (i.e., only on rare occasions to support acutely injured areas). Others athletes never attempt a heavy squat or C&J without them. There is no question that an athlete who is properly wrapped can squat more than one who is not. Powerlifters are quite aware of this difference, and no serious powerlifter would think of competing without knee wraps. There is also no question that the application of compression to an injured area can lessen the discomfort produced by that injury. In addition, wraps can provide extra warmth to the knees (which offers a number of benefits).

On the other side, wraps restrict a lifter’s range and speed of motion. They can also place added strain on a joint in its most completely flexed position (the same way an object placed on a hinge can break a it). They may also reduce the training effect of the squat exercise in a certain range of motion because of the extra support they supply in that range.

It is my opinion that the disadvantages of wraps generally outweigh the advantages when used on a daily basis. If an athlete has no injuries to speak of and is using wraps merely to improve performance in an exercise like the squat, the use of wraps is generally best avoided. A healthy lifter will gain strength through a greater range of motion by training without wraps and will avoid the possibility of damage as well. Any added ability to stand up from a low squat position that is gained through the use of wraps is probably offset by the speed lost in the descent under the bar as a result of wearing the wraps. (If the lifter is able to gain control of the bar at a slightly higher position because of speed in the descent, it will enable that lifter to recover more easily.)

Even when an athlete is in pain, there are some strong arguments against the use of wraps. First, masking the pain may disguise the symptom of an injury sufficiently for the athlete to do further damage. Second, we do not know how wrap masks pain. Does the painful area actually receive some added mechanical support, or does the diminution of pain occur merely because the wrap interferes with nerve impulses?

Some elite level athletes who feel that the added support, warmth and power that is derived through the use of wraps more than offset any of their disadvantages. Those who believe wraps actually do provide needed support for injuries will come down on the side of using them, even perhaps as an injury prevention measure.

There is at least one situation in which the knee-wrapper school is probably correct. It was suggested to me by Ben Green. Ben recommended the application of a knee wrap to my upper thigh in order to compress the area in which I was experiencing discomfort from an old groin injury. This particular injury was acting up in a way that told me (based on past experience) that I was going to have to lay off for a time in order to permit the injury to heal. By modifying my workouts somewhat and applying the wrap, I was able to continue my training for several weeks (at which time the pain went away). Although I had suffered this injury on a number of occasions, I had never been able to train through it before. Ben has reported similar success with himself and a number of other lifters with whom he has worked, so this approach is clearly worth investigating.

A similar treatment for the knee would involve wrapping only the quad tendon (if it were sore) or only the patellar tendon. The latter procedure is often employed for patellar tendinitis or “jumper’s knee.” This technique involves the use of a thin layer of wrap or a brace specifically designed for this purpose. The wrap is generally applied just above the tibial tubercle. This kind of wrap presumably supports the patellar tendon perhaps, by altering the mechanics of the pull on it. This combination of effects provides pain relief for some athletes and may reduce mechanical stresses on the tendon, thereby facilitating healing.

Training Around an Injury

In my judgment it is very important for athletes who cannot train through an injury to train around it as much as possible (i.e., to perform activities as close to those of the athlete’s sport as they can without aggravating the injury). Remaining in training at some level has several benefits. One is that the athlete maintains at least some level of conditioning (or even improves upon it) during the break from normal training. In the case of a weightlifter, this might mean breaking a squat record while treating a shoulder injury. The time away from normal training may actually permit the athlete to improve upon a lagging area while another area rests.

Another benefit of continued training is that it maintains at least some of an athlete’s overall ability to withstand training. A body that rests completely during an injury will lose not only function in the injured area but also some overall functional capacity as a result of inactivity.

Still another benefit of training around an injury is that activity which increases movement and blood flow into the area without irritating the injured area can actually promote healing and contribute to the rehabilitation process. Some trainers believe this is the single most important benefit of exercising while injured. Naturally the athlete must be careful not to aggravate the injury as he or she is training around it.

The final major benefit of continued training of some kind is psychological. The athlete who has a training regimen is likely to feel much more in control of his or her destiny than one who sits back and worries about when the injury will heal.

The only real limits that exist with regard to training around an injury lie in the creativity of the coach and athlete. Let me give you some personal examples. When I sliced a finger to the bone while doing an auto repair, the wound required a number of stitches to close. The doctor cautioned against bending the finger significantly for several days to avoid tearing the stitches. Since I had a heavy snatch workout scheduled for that evening, I created a splint for the damaged finger to prevent it from bending. With the splint I was able to maintain the finger in a straightened position. Using straps, I was able to snatch up to 95% of my best snatch at the time despite the mishap with my finger.

On a number of occasions, I have had injuries to an oblique muscle that made pulling, and especially squatting, quite painful. By wrapping a full size bed sheet, folded in thirds, tightly around my torso, I was able to squat with very heavy weights without irritating the injured area (although breathing during the squat was not easy).

In other cases, supporting the injured area is not enough. Exercises themselves must be modified. For example, squatting with a hip belt can work the legs without placing any strain on the upper body. Shrugging lying face down on an incline bench can provide exercise for the muscles of the upper back when the lower back is out of commission. J.C. Hise shrugs (shrugging with a bar on the shoulders) can exercise the trapezius muscles when the hands or arms cannot hold a bar for pulls or shrugs. In almost every case, where there is a will there is a way. The phenomenon of an injured athlete walking into the gym and merely watching others train should almost never happen.

It should be noted that all of these examples involve training around an injury rather than through it. When you train through, you continue to use the injured area. When you train around an injury, the injured area is not used during training; rather, it is taken out of the action by a mechanical aid or change in exercise.

There are exceptions to the general advice that injuries be trained around. Some injuries are to areas that are involved in so many movements that training, even on different exercises may aggravate the injured area. For instance, I had a groin pull that precluded my doing full squats or any lifting from the floor. I decided to train around the injury by doing partial squats and pulls from above the knees. It turned out that the combination of exercises that I performed did not worsen the condition. Unfortunately, performing this group of exercises absolutely prevented the injured area from healing. The result was an injury that lagged on for several months, when several weeks of more complete rest would have permitted complete healing in a matter of weeks and a much more rapid return to a full training load.

Similarly, there are times when an illness or injury places such systemic strain on an athlete that all of his or her resources are required merely for the healing process. In such cases medical advice must prevail. However, the athlete should work carefully with his or her physician to assure that a return to activity will be as rapid as possible.

Rehabilitative Exercise

No matter how skilled a surgeon, how complete a rest, how therapeutic a modality or how effective a drug, nothing takes the place of exercise in facilitating the recovery from an injury. After healing has taken place, the injured area must literally be remodeled so that it can withstand the rigors of training. In addition, the overall conditioning level of the athlete must be restored. Neither of these two important steps can take place without rehabilitative exercise.

Sometimes what is needed for rehabilitation is merely the same exercise which the athlete was prohibited by the injury from performing. (It should be added slowly to the training, as discussed earlier in this chapter.) In other cases special exercises are needed to strengthen, condition and restore the flexibility of the injured area. The advice of rehabilitation specialists should be sought when exercise of this nature is planned. However, the athlete must also consider the demands that will be placed on the area by weightlifting. Any program of rehabilitation must be designed with the ultimate need to perform the classical lifts in mind.

Returning to Training After an Injury

Once the health specialist has approved a return to training, you should move ahead without delay. In addition to following the advice of your health advisers, it is helpful to follow a number of principles when returning to training and competition. First, the comeback should be gradual. Very roughly speaking, comeback time should be equal to the time lost from training. If the injury interrupted training for three weeks, it should take three weeks get back into shape. This is far from a hard and fast rule. The time required for a complete comeback is affected by the what occurred during the break in training. If the athlete was in a cast for several weeks, it will generally take more than several weeks to come back. If moderate activity was possible during a training break of three weeks, it might take less than three weeks for the athlete to return to a full level of training.

A second rule is that the athlete should never do as much as he or she is able at the outset. My experience has been that an athlete who is left to do as much as he or she can may perform quite well on the first day because of being well rested. He or she may actually be surprised by the level of performance achieved. Unfortunately, while the injured area is fully rested, it is not fully rehabilitated and reconditioned. As a result, training at or near full capacity may overload the injured area, causing a reinjury shortly thereafter.

A much more sensible approach is to begin at something near the 50% level (even lower if the injury has lasted more than three weeks) and add approximately 10% per week to the program (i.e., 60% in the second week and 70% in the third week). It is important that both volume and intensity be increased gradually. A de-conditioned area of the body is out of condition with respect to both its functional ability and its ability to recover from a workout. Therefore, the reconditioning process needs to move ahead in carefully planned stages that are adjusted to the reactions of the athlete.

Larry Mintz, former National Champion in both weightlifting and powerlifting, had a very simple program that he used to come back from the numerous and serious injuries that he suffered during his career. He would always begin with the empty bar (e.g., 20 kg.). In an exercise like the squat (where his performance capabilities were typically in the 225 kg. to 260 kg. range), Larry would add approximately 20 kg. per workout until he neared his pre-injury level, then he would begin to go heavy only once a week (he typically squatted two to three times a week). Under this kind of program it would take Larry from several weeks to two to three months to approach a near normal level of performance. Using this kind of program he was never injured during a comeback, and he always returned to his previous levels of performance quite successfully.

Do Not Test The Injury

Injuries vary considerably in terms of their healing time. The nature of the injury and the age of the athlete are the two major variables in this area. Very minor injuries to young athletes can heal effectively within a few days. The same injury might take weeks to heal in a master lifter. Major injuries can take from several months to a year or more to heal fully. All injuries require a minimum of time for the injury itself to be repaired. Therapy and other forms of treatment can speed up the healing process, but nothing can eliminate the time required for the healing process.

In this context, distinctions must be made between injuries and dysfunction and between healing time and time away from training.

Certain phenomena can lead to muscle dysfunction but not cause injury (i.e., significant damage to tissue). For instance, an athlete can develop a simple cramp in a muscle. The cramp may be painful. It may absolutely preclude any effective use of that muscle for at least the duration of the cramp. Nevertheless, if the cramp goes away rapidly, it may be possible to resume general activity immediately. Activity that directly stresses the muscle that cramped should probably be halted for a day or two. (Severe cramping may be symptomatic of, or a cause of, muscle damage, and more rest will be required when such damage occurs.)

Similarly, an athlete who makes a misstep while lifting can damage the ligaments of the knee. If the damage is minor, and care is taken to protect the injured area, it may be possible to resume activity very rapidly because normal training activity will not aggravate the injured area.

When a tissue that actively participates in an activity is damaged, the case can be completely different. If an athlete actually strains a muscle unit that is actively used during training, the injury cannot be trained through (i.e., that muscle cannot be stressed during the healing process). Any stress placed on the muscle will simply preclude the healing process or will delay it dramatically.

The simplest illustration of the time required to complete the healing process is what happens when you sustain a minor cut. The cut occurs, then there is bleeding, then there is inflammation. A scab forms at the wound area, it hardens and eventually falls away from the wound. This leaves an exposed area that is still not fully healed. If the cut was shallow, any visible evidence of the injury eventually disappears. If the cut was deep, a scar remains. In either case, the entire process takes time. Any interference with the healing process will slow or even halt its progress. Try to move the injured area and/or separate the skin at the wound site, and bleeding will continue. Rub the scab as it forms or before it heals to a certain point, and another will have to be formed in order to replace it. Subject the area under the scab to friction as soon as the scab has fallen away, and it will not heal as quickly as if it were left undisturbed. In a similar way, muscle-tendon injuries take time to heal. If the athlete stretches the muscle-tendon unit or requires it to contract beyond a certain threshold, the area will not heal quickly or properly.

It has been my experience that injured athletes are anxious to determine when an injury has healed sufficiently for training to resume. However, the very process of testing itself can further damage a muscle-tendon unit that in undergoing the healing process.

If you do not test, how do you know when training can safely resume? There are no surefire methods for determining when an injury has healed, but there are several guidelines. First, a judgment of expected healing time needs to be made at the time of the injury, based on its nature. My experience has been that athletes in their late teens to mid-twenties require about three weeks to recover from a moderate strain sufficiently for training to resume. In such cases pain during light activity disappears within a few days. There is then a temptation to resume heavier activity. If the athlete does so, pain will recur when the activity level reaches the area of 50% to 75% of maximum. Unfortunately, when pain is experienced once again, it is the sign of a slight reinjury. If the athletes continues to add weight in hopes that he or she can work through the pain, further injury will occur, often enough to start the healing clock all over again.

Apart from projecting the healing time required, the second major tool for the coach and athlete who are feeling their ways after an injury is to make the comeback gradual in nature. There is evidence to suggest that during the healing process muscles and tendons are at or near their weakest point immediately after pain disappears. The major portion of the healing has taken place, but the area needs to go through a sort of toughening process in order to prepare itself for normal activity. Much like a cut over a joint that must be moved at a certain point to assure that the area heals with sufficient flexibility, an injured muscle or tendon appears to respond favorably to moderate stress as the healing takes place. Too little stress and the injured area will not adjust itself properly to the stresses to come, too much stress and the area will not have a chance to heal. If the comeback is gradual, it will stimulate the necessary adaptations on the part of the injured area, but it will not step over the line into creating detrimental stress.

The third major strategy for regulating the comeback is to be aware of the way in which the body is adapting to the comeback stress. The way to work out this issue is to apply some stress and then watch for the body’s reaction. For instance, let us assume that a lifter has injured a vastus lateralis muscle (one muscle of the quadriceps group). He or she has rested the muscle for ten days and feels no pain during light activity. The athlete decides to begin squatting again and works up to 40% of his or her pre-injury maximum for five repetitions on his or her first day back.

The athlete notices some discomfort on the third rep, and it worsens slightly on the fourth and then again on the fifth rep. The following day the athlete notices some soreness in the area. A day later, when the athlete squats again, he or she notices the same level of discomfort with the same weight, and the discomfort worsens with 55% of maximum. This scenario suggests that full healing has not occurred. Continued training at progressively higher intensities is likely to cause further damage, ultimately beyond the point of the initial injury. Unfortunately, further rest, perhaps three weeks this time, will be required.

In contrast, consider a slightly different case. The athlete rests for three weeks instead of ten days. During the first workout the athlete goes up to 25% of maximum. A very slight discomfort is felt on the lighter sets that were used as a warm-up, but the discomfort does not change with the heavier weight. Very little discomfort is felt the next day; in fact, the area feels a little looser and more functional than it did before the first workout. During the second workout less discomfort is experienced than during the first. By the time the athlete has reached 55% of maximum for five reps (in perhaps the fourth workout), the injured area feels ” as good as new.)

Observe the difference in the two approaches. In the second method, 55% of maximum was not reached until about four weeks after the injury (as compared with two weeks in the first example). In addition, several preparatory workouts were used to “coax” the injured area into condition. In my experience, the second method is far more successful than the first. Whichever method is used, the athlete must pay attention to what the body is telling him or her. Failure to do so can convert a minor injury that should take a lifter a few weeks out of his or her way to an injury that wastes months of the lifter’s time.

The Importance Of Mirrors, Video Cameras and Monitored Training When Returning to Activity

When an athlete is coming back from an injury or even trying to train through one, the input from mirrors, video cameras, training mates or coaches can be critical. There is a tendency for the injured athlete to favor the injured area. This can lead to technique errors that can cause injuries to other areas or to a decline in performance.

A mirror can be a valuable training asset as it permits the athlete to receive immediate visual feedback on his or her body positions. For example, let us assume that a lifter is coming back from a knee problem and is using the squat as a primary rehabilitation exercise for the knee and for the leg muscles. This lifter may have a tendency to shift his or her body away from the injured knee. Alternatively, the lifter might not permit that knee to travel forward over the toe in the squat position (while the healthy knee does assume such a position). A mirror can give the athlete immediate feedback about such behavior. More importantly, the lifter can use the feedback from the mirror to enable him or her to assume the correct position and then feel what the correct position is like. Videos and training mates can help in this regard, but they cannot give the same degree of immediate and precise feedback.

The drawback of the mirror is that the lifter will find it difficult use the mirror when he or she is moving fast. This is where the training mates, coaches and video camera can be used to good effect. Training mates and coaches offer the advantage of being able to view a lifter’s technique from many angles and to compare what they are seeing to what they have seen in the past. They can also provide feedback instantaneously, so that the lifter can make immediate adjustments.

Videos necessarily provide more retrospective analysis than the feedback of coaches and fellow athletes. However, they have the advantage of permitting slow motion analysis and more objective comparisons with past performances than the human eye (if the lifter has a video library of pre-injury lifts).

Using all of these tools in combination will enable a lifter to resume successful activity as quickly and in as trouble free a manner as is possible. Therefore, the lifter should avail himself or herself of each one.

Common Injury Sites

Wrist

Wrist injuries are among the most common experienced by lifters. Because the wrist supports the entire weight of the bar in the snatch and jerk and part of the weight in the clean, it is placed under considerable stress during lifting. Generally, the wrists adapt to that stress over time and are easily able to support the loads encountered. Occasionally, traumatic injury to the wrist occurs when a lifter fails to get his or her elbows up in racking the bar in the clean. Broken wrists are not unknown (although they are virtually unknown among lifters who keep the elbows up). When a break occurs, it most often happens in the scaphoid bone, which is below the base of the thumb.

When a break occurs, it must, of course, be treated by a physician, who will place it in a cast. Once the cast is removed, the lifter will gradually be able to return to training, and recovery is generally complete (as is the lifter’s dedication to keeping the elbows up when cleaning).

For more chronic kinds of injuries, lifters generally apply an elastic and cloth wrap (the “Ace” type bandage), a wrap made purely of heavy fabric (such as that used by boxers) or a leather wrist wrap that is somewhat akin to a belt. My preference is for the latter type of wrist support. It can be easily tightened when taking a lift and loosened thereafter. The support offered is substantial, particularly if the wrist support is placed high enough to be in contact with the base of the hand. Naturally, if the support is placed too high, it will inhibit wrist flexibility. This may be desirable when doing an overhead lift, so that the wrist is not placed in an extreme position and is well supported, but a wrist that is not flexible can affect performance in all of the lifts, most particularly when an athlete is “racking” a clean on the shoulders.

One other fairly common injury to the wrist is the ganglion cyst. When a ganglion occurs, the joint capsule has herniated, and a clear fluid fills one area of that joint capsule, causing a bulge. The bulge can be rather large and fairly hard to the touch. Sometimes the ganglion disappears spontaneously, at other times it requires surgical removal. If the ganglion is not painful and does not restrict the athlete’s range of motion, there is no particular reason (other than aesthetics) to treat it. Before considering surgery for this condition, an athlete should consider two remedies used by a number of physicians and others to treat this condition: deep massage and a blow to the ganglion with a blunt but relatively hard object. Massage therapists who use deep massage techniques have been able to disperse the ganglions of a number of people I know. The process can be somewhat painful, but it can help some people.

The best way that I can describe the second method is through the experience of female athlete of my acquaintance. She had a ganglion and mentioned it to her doctor during an office visit. The doctor said, “let me look into this.”  He picked up a large medical book and suddenly smashed the spine of the book against the ganglion. It disappeared as if by magic. (I had a similar experience when a large ganglion that I had for years suddenly deflated when I was doing a particularly strenuous set of snatch pulls and the material of the straps I was wearing pressed against the ganglion with significant and sudden force as I exploded into the finish of the pull.)

Hand Injuries

By far the most common hand injuries among lifters are skin avulsions of the calluses that develop at the base of the fingers. The irritation of gripping the bar causes the callus to form. When it becomes thick, it is likely that the shearing force of the bar when it is gripped will cause the callous and the upper layers of the underlying skin to avulse from the lower skin layers in that area.

There is typically moderate bleeding and pain when such a tear occurs. If not treated immediately, the tear can become more severe. Proper treatment involves cleansing the wound, trimming away the excess skin, applying an antibiotic and covering the injured area with a sterile dressing. Subsequently, the area should be treated with an antibiotic ointment that keeps the area moistened as well as clean. The hand should remain mobile during the healing process so that the new skin accommodates the full range of motion.

As with all injuries, prevention is a better approach than treatment for torn calluses. Proper prevention involves removing the excess skin of the callus on a regular basis. This is easiest to do when the skin has been wet for some time (such as after a shower or bath). Most athletes use an emery board, emery cloth or pumice stone for this purpose. Some use a single edged razor blade to cut off the excess tissue, but this method cannot be recommended. Using a razor blade always presents the risk of incurring an unintended laceration. A callus razor is specially designed to remove only a thin layer of skin at one time and is a much safer choice than a regular razor blade.

It is important for athletes to be able to continue their training during such injuries, but it is also important to protect the injured area. Most of the taping procedures used by trainers are not suited to this purpose. Nearly thirty years ago a training partner of mine, Dr. Theodore Ritzer (today an eminent cardiologist), developed a taping technique to address this problem. I have modified the technique substantially, and, in my experience, it is by far the most effective taping technique for this kind of injury. Karl Faeth, trainer to many United States World and Olympic weightlifting teams, who spent his own time and money to be there for US athletes before the USAW could afford to pay for trainers to accompany its teams abroad, subsequently adopted the technique and used it with great success for many years.

The technique utilizes a piece of 1″ surgical tape that is double the length of the athletes hand plus 4” to 6″. A hole is cut or torn in the center of the length of tape, and the finger at the base of which the injury exists is threaded through the hole until the tape is snugly against the base of the finger. (The sticky side of the tape runs along the lifter’s palm and the back of the lifter’s hand.) The last 2” to 3″ on either end of the tape are applied to the wrist, leaving enough slack on either end to permit the hand to move freely about the wrist without disengaging the tape. Finally, a length of tape is wrapped around the wrist to secure the two ends in their position on the wrist. This taping arrangement protects the injured area well and generally lasts for the duration of a workout. This method was not legal in competition for many years and so a more conventional taping method— tape wrapped around the hand— was used for competitive attempts. Recent revisions in the rules of competition now appear to permit using my taping technique. A number of lifters use a “liquid bandage” such as “Nu Skin” to treat this problem. “Nu Skin” is painful when applied, but it does form a protection layer over the injured area.

Another common problem is discomfort in the thumb when a lifter learns the “hook grip” (see Chapter 1 for a full description). During the process of becoming accustomed to this grip, it is not uncommon for the athlete to experience considerable pain (particularly immediately after the bar is released after a lift). The longer the lifter holds the hook and the heavier the weight, the more profound the discomfort. The athlete may also experience discoloration in the thumb (redness or “black and blue” marks). This is not unusual and does not present a problem unless there is significant swelling of the thumb as well, or the discoloration process continues at the same level from workout to workout. If either of these symptoms persist the lifter is overdoing it or (in extremely rare cases) may have actually done some significant damage to the thumb (something I have neither seen nor heard of, but which is at least theoretically possible). This discomfort can be mitigated by limiting the initial practice with the grip to just a few lighter sets and then gradually increasing the work load performed with the hook. In addition, most lifters find it helpful to wrap a single layer of tape around the thumb (with at least 1/2” of overlap in the ends of the tape, so that the tape can adhere to itself and thereby be more securely affixed to the thumb). This layer of tape (often two layers of 1″ tape placed side by side with a small overlap so that most of the thumb is covered) reduces the pain from the hook grip. It also protects the skin of the thumb from tearing or splitting when this grip is used extensively during a workout.

A common sense rule needs to be applied in adapting to the hook. If the hook is used too infrequently or for too short a period, the toughening process will not take place (or at least not fully). If it is used too much without letting the thumb toughen, the thumb will not have a chance to adapt. A good basic rule is that the athlete is proceeding too fast if any significant discomfort remains from one workout to the next. (Since a typical beginner is only training every other day or three days a week, the properly conditioned thumb should have adequate time to heal between workouts.)

The final hand problem that occurs with any level of frequency in weightlifting is direct damage from the bar. One example is when a lifter drops the bar from an open hand immediately before it hits the floor. In such a circumstance, the bar can rebound sharply and sprain a lifter’s finger(s). If the hand is kept on the bar but the wrist is placed over the bar when it hits the platform, the wrist can be sprained. There are three preventive measures that you can take to avoid this problem. The lifter can lower the bar slowly and softly, so that no significant rebound occurs. The lifter can release his or her hands from the bar when the bar is far enough from the floor so that a rebound will not cause contact with the hands. Finally, the lifter can make sure that the grip is loose and that the hand and wrist are well behind the bar when it contacts the floor. In this case, any rebound will tend to be straight up, and the lifter’s hands will be out of harm’s way. If the latter technique is used, the lifter should make an effort to slow the bar’s downward progress at the beginning of the lowering process, so that the full force of a drop from arm’s length will not be realized. (A very sharp rebound can slap on snap the hand or wrist that is positioned to the rear of the falling bar fairly smartly if the full force of a drop is permitted to be generated.)

Injuries to the Arm and Elbow

Injuries to the arm are not common in weightlifting, and elbow injuries are only a bit more frequent. Of the arm injuries that do occur, the most frequent are biceps or triceps strains. The biceps strains appear almost exclusively in lifters who bend their arms prematurely or excessively in the pull. (The arms are properly used to help the body move rapidly under the bar once the squat under has begun, not to pull the bar upward during the earlier stages in the pull.) This injury occurs in lifters who use their arms inappropriately because they are attempting to lift with the arms at a time when the force that is being applied to the bar can only be withstood by the larger muscles of the legs, hips and back. (Biceps pulls are not uncommon among power lifters who bend their arms while deadlifting.) The only triceps injuries that I have ever seen resulted from a lifter’s trying to press out a snatch that would never have passed the referee’s scrutiny (because of the extent of the pressout). Therefore, a lifter should never press out or try to “save” a lift if the bar is significantly out of position and lower than is necessary to execute a clean lift.

Elbow injuries occur almost exclusively in the squat snatch position and then only to lifters who have elbows which hyperextend (continue to bend backward after the arm is fully straight). Lifters with this kind of “armlock” find it relatively easy to hold weights overhead once they have reached arm’s length, but the hyperextended elbow does make them more prone to injury in that area. Such lifters should be careful not to overextend the elbows in the snatch and jerk as they lock out (particularly with light weights). They should never fight a snatch that is out of position, especially if they feel any stretching or discomfort in the elbow or the bar is too far to the rear. Finally, such lifters will find it useful to strengthen the muscles around the elbows, so that the joint is stabilized as much as possible. These lifter must also be very careful about finding a stable position in the snatch. Too wide a grip may place too much of a strain on the elbows as the angle between the lifter’s arms and the bar grows smaller. On the other hand, a grip that is too narrow causes the lifter to twist the shoulder and elbow somewhat, making it more subject to injury. Often a minor change in grip width will significantly reduce the strain on the elbow joint.

It is particularly important to avoid elbow injuries in young athletes, because such injuries can damage the growth plates of the maturing athlete’s arm, causing permanent problems with the joint and its maturation.

When an elbow does dislocate, rapid reduction of the dislocation is necessary to prevent permanent instability and reduce the likelihood of nerve and vascular injury. However, the reduction must be done by someone skilled in this area, and fractures at or near the elbow joint must be ruled out. Restoring mobility to an elbow that has been dislocated is a difficult process. Such an elbow injury rarely recurs, as a joint once injured does not normally return to the hyperextended position which first predisposed the lifter to the injury (except when the ligaments have not fully healed after the injury and no longer stabilize the joint properly, a very rare occurrence).

Lifters occasionally suffer nerve entrapments in the infraspinatus and supraspinatus muscles that surround the largest nerves in the arm. Surgical decompression and intensive therapy are sometimes needed to treat this condition, but more conservative forms of treatment are often successful.

Back Injuries

Spinal cord injuries are quite rare in weightlifting. I know of only one, and it reportedly occurred because an unevenness in the surface of the lifting platform caused the lifter’s foot to become caught while he was moving under a jerk. The bar fell on the lifter, causing the lower spinal cord area to be traumatized by the bar and its force.

A much more common problem is low-back pain, which is caused by overstress on the muscles and/or ligaments that surround the spine. Such an injury generally causes a sharp pain when it occurs. The condition normally worsens over the ensuing hours, typically reaching a maximum level of discomfort twelve to twenty-four hours after the injury.

Low-back injuries can be quite painful and debilitating. However, if they are not accompanied by serious damage to a disk (which is usually the case), the problem tends to be more painful than serious. The symptoms of this problem are treated with ice, analgesics, spinal manipulation and, later, with any of a full complement of therapeutic modalities like ultrasound and electric muscle stimulation in order to break the considerable spasming of the lower-back muscles that typically accompany this injury. Subsequently, stretching and strengthening exercises are often performed. When the acute stage of muscle spasming is taking place, the athlete may find that his or her body is stooped over and pulled to one side (the most common kind of spasming occurs on one side or the other of the spine). If the lifter remains stationary for an extended period of time, particularly if he or she is sitting in a chair, the spasming will tend to increase markedly when the lifter tries to stand up.

I have had the misfortune of apparently inheriting a back that is very subject to this kind of injury (my father had a similar problem). My first lower-back injuries occurred as a child, long before I ever began lifting weights. I have tried virtually every treatment known for the problem. Spinal manipulation has been the most effective means of alleviating the acute pain of such an injury; therapeutic modalities have been somewhat less effective, and muscle relaxants have been almost worthless. Conventional static stretching of the lower back has helped on certain occasions, but at other times (especially when the pain was most severe), seemed to make the pain, and even the condition, worse.

There was a point in my competitive career when my back problem become so severe that I thought I was almost certainly finished (this was at age twenty-one). Over a period of a few weeks, I injured my back five times. Initially, reinjury only occurred when I tried to resume training, but later, minor things, like lifting a light sack of groceries, caused a recurrence. Spinal manipulation and other techniques offered temporary relief, but then another flare-up would occur. Static stretching seemed to have no effect.

Fortunately, I discovered a treatment technique which lengthened my competitive career dramatically. It has served me well in the more than twenty years since I discovered it. (interestingly, Tommy Kono independently found a similar approach to treating lower-back problems—which he described in the June/July 1974 issue of Strength & Health Magazine).

I present the technique not because I recommend it (it would make most orthopedic surgeons and rehabilitation specialists cringe in horror), but because it emphasizes the need for injured athletes to “find their own way” when conventional and even unconventional wisdom has nothing to offer.

I was near the peak of my career at this time, having cleaned a weight within 7.5 kg. of the world record in training several months before. All of my dreams of weightlifting success seemed to fade away as I could barely accomplish the activities of daily living. I was working in a health spa at the time and was extremely depressed over my latest episode of back pain. I literally could not touch my kneecaps with my hands without serious pain and spasming. Desperate would be too moderate a word to describe my condition. Then I did something “stupid” that turned out to be a career saver for me. In frustration, I decided that I was going to stretch my back forcefully to make it loosen up. In an effort to accomplish this, I lifted a 50 lb. bar from a rack with a clean grip and attempted to lower the bar without hesitation to as low a position as I could in a stiff-legged deadlift. By the time I got near my knee caps, I was in agony, but I continued to lower the bar to kneecap level and then returned to a standing position. Then I lowered the bar again, determined to go further than the previous rep. I did get about 1″ further, but only with the same amount of pain as I had experienced on the first rep. I went on to do ten reps, and on the last one I managed to reach the mid-shin level. I then stood up and replaced the bar on the rack.

At this point a strange thing happened. I felt a release of the tension in the lower back and a sense of mobility and relaxation that I had literally not felt there for months. What a relief! Within about thirty seconds, the stiffness and pain returned, but I seemed to be on the right track. A few minutes later I did another set, this time reaching near my shoe tops with the bar (its small plates permitted this). The pain was virtually the same as on the first set, but I was going further.

This time it took perhaps two minutes for my back to seize up again after the set. I repeated this process for several more sets, and by the end of my session my back remained relaxed for about twenty minutes and did not resume its full stiffness for several hours. The next day I could hardly walk from the soreness that had developed in my hamstrings from stretching the lower back so strenuously, but my back condition was dramatically improved. I continued to treat the back with several sets of stiff-legged deadlifts for the next couple of days, by which time my pain had practically disappeared. By the third day I resumed training and within a week was back at it nearly full force. My back problem was essentially cured.

In the years since, my injury has recurred, but the same treatment has always had the same effect. I now include stiff-legged deadlifts with an empty bar at the beginning and end of almost every workout. As long as I do them without fail, my back rarely troubles me. If I slack off my deadlifts for some reason, my back soon provides me with a “friendly” reminder that I had better not neglect it. Over the years a number of other lifters of my acquaintance have tried this “treatment,” and most have had success.

Ordinarily, stiff-legged deadlifts would be considered perhaps the worst exercise for an athlete with an injured back. My explanation of its effectiveness for me and others who have tried it relates to the way in which the movement is executed. I perform the exercise with the head down, the bar so close to the body that it virtually touches the legs, the abdominals flexing lightly to support the weight and the weight very light (e.g., 20 kg.). In addition, I perform the descent into the low position at progressively lower levels with each rep. The pace is smooth but not explosive or jerky; neither is it very slow. I come up almost immediately after reaching the low point on each rep (though not explosively and there is no “bouncing”). This methodology seems to stretch the muscles of the lower back and help them to relax their spasm, while it (at least in my case and for others who have used this exercise) does not seem to damage the ligaments, disks or vertebrae of the spine. (Static stretching seems to transfer the stretch from the muscles to the ligaments as the position is held, and, at least in my case, makes the condition worse.)

I am not recommending this exercise to anyone. Anyone with an injury should follow conventional medical wisdom first. If conventional treatment does not work, some athletes may want to explore other approaches (the ones with the lowest degree of risk should always be tried first). In the event that such treatments fail, some athletes may want to explore other areas if they have a plausible treatment method and are willing to accept the risk of injury that may arise out of unconventional treatments. I was willing to take the risk and it worked out for me. In your case it might not, and you could be far worse off for the attempt.

It has been my observation that the stiff-legged deadlift and other exercises which stretch the lower back are not useful during the first twenty-four hours or so after the onset of an acute episode of lower-back pain (i.e., before the pain and spasming appear to have peaked and stabilized somewhat). At such a time, the entire area seems to be too unstable for the athlete to attempt to “retrain” the muscle so that is does not remain in a condition of spasm. I have had the experience of trying to do my stiff-legged deadlifts shortly after the onset of an acute episode and have done more harm than good.

The exercise described above should never be attempted when the athlete is experiencing numbness, tingling, pain radiating away from the injured area or any loss of sensation. These phenomena are symptoms of “disc” problems, and any extreme form of motion during a period when a disc may be injured can worsen the condition substantially.

Discs are structures that separate the vertebrae. They follow the shape of the vertebrae. They have cartilaginous outer and inner walls, with softer tissue between the walls. The disk can be damaged by stress in a way the causes the cartilage wall (particularly the inner one) to break, permitting the softer substance within the disk to “leak” into (press against) the spinal cord itself. Alternatively, the broken cartilage itself impinges against the spine, causing the pressure there as well. In either case, such pressure can lead to terrific pain and can compromise the functioning of the nerves of the spine. In my experience, non-weightlifters experience this problem more often than weightlifters (who, through proper conditioning and the use of good technique are well protected—though not immune—from traumatic disc injuries).

If the damage to the disk is not severe, conservative treatment can cause the disk to assume its natural shape, and normal functioning can continue. Surgical intervention may be required in more severe cases. Such intervention can range from the injection of an enzyme which dissolves the tissue which is impinging on the spine to the surgical removal of the damaged material, the complete removal of the disk or the “pinning” together of the vertebrae between which the disk was positioned before its removal. The results of such surgery range from virtually complete recovery to lifelong disability, so this kind of surgery should not be undertaken without careful thought.

Injuries to the neck and upper back also occur occasionally among weightlifters. The only kind of neck injury that I have encountered in weightlifters is similar to, but generally less severe, than the musculoskeletal low-back pain. Rather suddenly, the lifter experiences a sharp pain in the neck. The onset typically takes places when lifting with the head or neck twisted or flexed to one side or the other. (This is one reason why lifter should always look straight ahead and never turn or tilt the head sideways while lifting.) On other occasions, the lifter awakens with stiffness and pain in the neck. The pain generally increases when the lifter turns his or her head to one side or the other. Heat and anti-inflammatories can help to relieve this problem, but in my experience, the most effective treatment is manipulation followed by range of motion exercises.

A second condition that occurs occasionally is a strain in the thoracic region of the back. The muscles involved can vary, but generally the rhomboids and/or trapezius muscles near the spine are affected. The onset is typically sudden, with the lifter feeling a sharp pain, most often while the arms are over the lifter’s head. The pain is often worsened with deep breathing, turning or lifting the head and raising the arms over the head. Fortunately, the pain is usually far worse than the condition. If the lifter does not perform exercises that worsen the pain, the injury typically heals itself within a few days.

A third condition that is only rarely reported in weightlifters is “spondylolysis,” a stress fracture of one or more vertebrae. It is not a very common occurrence among weightlifters, but it does happen on occasion. Such an injury can be difficult to detect by X-ray, so often a bone scan is required. When the diagnosis is confirmed, rest is indicated. Stretching and abdominal work are often recommended once the injury has healed enough to withstand the stress of these exercises (the former to relieve any tension that may have contributed to the injury and the latter to create better support for the spine and prevent a recurrence). Any athlete who develops this condition would be well advised to evaluate his or her techniques, as some modifications that will reduce the stress placed on the spine during lifting may well be possible and appropriate.

Spondylolisthesis is a forward displacement or slippage of one or more vertebrae. While it is reported only rarely in weightlifters, the most frequent site of its occurrence is at the juncture of the fifth lumbar vertebrae and the sacrum, but can occur elsewhere. Prepubescent athletes and athletes early in puberty are most often afflicted by the problem. It generally results from chronic lower-back strain (which should rarely occur as a result of training because athletes at this age should not be subjected to training of an intensity or volume that can cause it). Treatment is normally conservative, but care must be taken to avoid re-instituting the stresses that caused the problem, at least not before the athlete has had an opportunity to better prepare for such stresses the second time around.

Finally, fractures of the spinous processes can occur while weightlifting (and doing many other things). They result primarily when a lifter accidentally drops a weight on his or her back or when a lifter carelessly replaces the bar at shoulder level behind the neck after doing a behind the neck jerk or similar exercise. Such an injury, while painful, rarely leads to any instability in the spine, and an athlete is often able to continue to train as the pain permits. However, the decision to continue training should never be made until after a thorough diagnosis that assures the lifter there is no danger to the spinal cord as a result of continued activity.

Prevention of lower-back pain should take several forms. First, the back should not be subjected to sudden and severe changes in the loads it is subjected to. Such changes can occur as a result of technique modifications, the addition of exercises that load the lower back and increases in the training load from existing exercises that stress the lower back. A second measure is to strengthen the lower-back muscles specifically, with such exercises as hyperextensions and deadlifts. These measures can be useful, but the athlete who employs them must be careful to assure that these exercises are not merely adding to a load that is already causing excess stress. In such a case, the “cure” will worsen the condition.

A third measure is to assure that the lower back is not being unduly stressed by faulty technique. The most common example is the athlete who fails to retain the natural arch in the lower back (or loses this arch at some point during the lift). Once the arch is lost (particularly if this occurs when the back is in a position of significant stress) the ligaments of the back are vulnerable to injury on the micro or macro levels. The most dangerous positions for this to occur are at points when the lifter is applying great stress to the lower back. (For instance, as the bar is taken from the floor in the pull, as the bar passes the knees, or when the lifter is fighting through the “sticking point” in the squat.)

A fourth measure is to stretch the lower back, hamstring and illiopsoas muscles. The purpose of stretching the lower-back muscles is to remove any unnecessary tension in that area. Such tension can itself place pressure on the spine. In addition, this tension can predispose the back to injury, either by fatiguing the back muscles (which makes them more vulnerable to strain) or by predisposing them to the kind of spasming that leads to an actual injury. The hamstrings are stretched because tension and shortness there can pull the back out of its natural position, particularly when the athlete is moving, predisposing the lower back to injury.

The purpose of stretching the psoas muscles relates to their function. These muscles normally act as hip flexors. However, they can cause hyperextension or flexion of the lumbar spine under certain conditions. Consequently, if these muscles lose their flexibility or generate abnormal tension, they can worsen or even cause a back condition. Because the psoas is a primarily a hip flexor, any exercise that extends the hip will stretch it. One example is the split position, in which the psoas is stretched on the side of the leg, which is placed posteriorly. An even simpler way of stretching the psoas is to straighten the leg and let the pelvis tilt slightly rearward while standing. This exercise has the advantage of being so simple that it can be done at any time of day.

A fifth measure is to strengthen the abdominal muscles and all of the muscles which surround the spinal column. Conditioning of these muscles strengthens the entire muscular “girdle” which supports the spine and protects it from injury.

Finally, the lifter should not overlook the importance of an appropriate bed and sleeping positions in the prevention and treatment of back problems. A lifter who sleeps on his or her stomach may find that this brings on or worsens back pain. A lifter’s mattress should be firm and supportive (you do not want a bed that sags in the middle like a hammock, particularly if you sleep on your stomach), but a hard bed is generally not desirable either. Mattresses that were “as hard as a rock” were the fashion for a number of years. But now health professionals realize that a bed that is too hard can impair circulation and cause the spine and other joints and limbs to fall out of alignment while the person is sleeping. In order to avoid this, the upper layer of the bed should give enough to conform to the body’s contours and offer contact and support to the entire body. (A layer of foam rubber on top of a more conventional and reasonably firm bed is often used today to deliver a combination of give and firmness.)

Shoulder Injuries

Serious shoulder injuries are not very common in weightlifting, but the incidence has been on the rise in recent years. It is the contention of some coaches that this increase in the injury rate can be attributed, at least partially, to the failure of many of today’s lifters to practice shoulder strengthening exercises, such as overhead pressing movements. Up until 1972, when the press was eliminated from weightlifting competition, weightlifters practiced pressing extensively. At that time serious shoulder injuries were extremely rare. Perhaps the correlation is simply a coincidence, but I doubt it. I believe that most lifters would benefit in terms of performance and injury protection if they practiced more pressing.

Of the injuries that do occur, dislocations are occasional, and damage to the rotator cuff muscles and tendons also occurs. More often than not, these kinds of injuries result when a lifter attempts to save a lift that has drifted out of position. The awkward position of the weight places an unusual strain on the shoulder, and damage results. Such injuries can also occur when an athlete’s shoulder joint is unstable (e.g., the glenoid capsule into which the humerus normally fits is shallower than normal). This predisposes such a lifter to a shoulder injury. Finally, lifters may be predisposed to such injuries because activities in which they have previously engaged (e.g., sports in which repetitive shoulder strain occurs, such as baseball pitching or handball playing) have damaged the shoulder joint.

A more common occurrence for the lifter is a sore shoulder, which tends to be an overuse injury. The athlete may have added exercises or repetitions in exercises that affect the shoulder, and resulting in overuse, or a change in technique may have increased the stress on the shoulder. Such a problem can be addressed by reducing the training load and/or modifying technique.

Shoulder injuries can be very slow to heal. One reason is that everyday activities can place stress on the shoulder joint. Even carrying something at your side can place a strain on the shoulder joint. Amazingly, even sleeping can trigger, exacerbate or irritate shoulder injuries. This is because many people have the habit of sleeping with one or both arms over their heads. An arm placed in this position for long periods can place serious strain on the shoulder joint.

I learned this the hard way when a slight shoulder injury turned into a long term problem that always seemed to be worse in the morning. Eventually, it struck me that when I woke up with my arm over my head, the problem was far worse that day. The healing process was facilitated when I began wearing a long-sleeved nightshirt to bed. Before retiring, I would pin the sleeve of the arm with the sore shoulder to the bottom of the shirt so that I could not pick up my arm while I slept. (Immobilization of any limb during sleep can aid in the healing process if you discover that sleep patterns are adversely affecting an injury.)

Many athletes who have shoulder problems find that certain exercises aggravate the shoulder joint. In my case it is dips. Performing dips on a parallel bar, or even supporting myself from such bars, places a strain on my shoulders that they cannot long endure. While many lifters used to swear by dips as an assistance exercise for the press, I know several who had career ending injuries from doing that exercise with heavy resistance. A number of lifters I have known have also injured their shoulders and/or pectoralis muscles doing bench presses.

Knee Injuries

Knee injuries (particularly of the overuse type) are fairly common in weightlifting. Many sports medicine experts would not be surprised by this statement because they have been taught that full squatting (which weightlifters practice with great regularity) is very dangerous for the knee joint.

I have yet to find someone who has sustained a knee injury from performing full squats correctly. (I have known some athletes who have hurt their knees doing partial squats and many who have inflamed their knee joints while performing heavy leg extensions.) There is no evidence that the ligaments of lifters who perform full squats are “lax” (i.e., have been loosened by that activity). In fact, there is some evidence that squatting may improve the congruity and stability of the knee relative to one that has not been trained by full squatting. (Squatting is beginning to gain some popularity in sports injury rehabilitation programs.) In addition, there is considerable evidence that ligaments become stronger with training, both because of adaptive changes in the composition of the ligament and because of changes in the architecture of the ligament (e.g., alignment of the fibers of the ligament with the stresses that it must withstand). Moreover, evidence is accumulating that “open kinetic chain” exercises (where the body is fixed and a limb moves, as in leg extensions) are far more stressful to the joints than “closed kinetic chain” exercises (where the distal end of the limb is fixed and the body moves, as in squatting).

Most weightlifters who do sustain knee injuries attribute them to an accident while lifting (e.g., catching a foot or twisting a knee) or to overstress. It is important to evaluate all knee injuries as soon as they occur. Serious acute knee injuries tend to be accompanied by considerable swelling in a relatively short period. When examinations are delayed beyond fifteen to twenty minutes, diagnosis can be hampered by such swelling.

It must be realized that the fundamental means which a lifter uses to impart force to the bar in the snatch, clean and jerk is the jumping motion with a heavy load. In addition, fixing a weight in the snatch or clean involves receiving considerable force in the low squat position. Even fixing a weight in the power snatch, power clean or jerk involves a sudden stop. All of this strain placed on the knee and the muscles that support it makes the knee joint susceptible to sprains and strains (with the latter being far more common than the former).

Tendinitis in the quadriceps and/or patellar tendons is perhaps the most common knee problem experienced by lifters. Overuse leads to irritation of the tendon. This can be a particularly difficult problem because of the constant use of this area during nearly any form of training on the competitive or related lifts. Perhaps the most conservative treatment for this problem is icing the tendon after the workout. A number of lifters have found that this treatment alone provides relief in a relatively short time, particularly if the workouts are modified to reduce any additional irritation to the tendon. This does not mean that training must necessarily stop altogether. Rather, the lifter must identify the positions and exercises that are the most irritating and reduce or eliminate them. For instance, the lifter may find that squats present no problem but that cleans do worsen the condition. In such a case, cleans can be eliminated for a time, and clean pulls and squats can be continued. This will maintain and even increase the lifter’s strength, while permitting the inflamed tendon to heal.

Other treatments for the condition include stretching the quadriceps muscle group. There are two theories behind the stretching treatment. Each theory argues for a different approach to stretching. The first premise is that a low level tension in the quadriceps muscles is created by hard training. That tension is relieved by relatively gentle stretching. The relaxed state induced by the stretching enables the tendon to rest more fully and this causes or reduction in the inflammation of the tendon. The second theory is that lack of flexibility in the muscle-tendon unit leads to micro-trauma when extreme positions are assumed in the squat (i.e., low positions in which great pressure is placed on the tendon as the bar is fixed in the snatch and clean). If the muscle-tendon unit is stretched to assume a greater resting length, trauma to the tendon will be relieved.

I find the first theory more convincing than the second. Many lifters I know have noted that their tendons are irritated at least as much by movements that do not involve extreme positions (such as power cleans) as by movements that do. They have reported relief using gentle stretching that merely relaxes the quadriceps group.

Some lifters who have had the most flexible quadriceps muscles imaginable (i.e., athletes who could touch their buttocks to the floor quite easily in a full squat position), have had serious injuries to the quadriceps unit. Why would these highly flexible athletes suffer such injuries if flexibility were a protective element? This is not to say that flexibility is not important or that some athletes may indeed have an increased injury risk because of lack of flexibility. However, flexibility is clearly not a panacea.

For the athlete who wants to try stretching as a treatment for tendinitis of the quad or patellar tendons or other tendons, several cautions should be followed. First, a stretching program which relaxes the tendon should be attempted before one that seeks to increase the lifter’s range of motion. Second, the lifter should warm up thoroughly; stretching a “cold” tendon can be a bad idea (particularly if the lifter is trying to increase its range of motion). Third, every effort should be made to stretch the muscle rather than the tendon itself (a tendon which is already inflamed can be further irritated by efforts to stretch it). This is not easy (and some would argue that it is not possible), because the muscle and tendon are connected, and stretching one necessarily involves stretching the other. However, the emphasis does seem to vary with the position in which the leg is placed when the athlete stretches. Generally, if an athlete kneels on the floor and then sits back towards his or her heels, the stretch will tend to be felt most in the tendon. If, in contrast, the athlete curls the heel of the opposite leg part of the way toward the buttocks while standing on one leg and then reaches behind to grasp the ankle of that leg in order to stretch it, more pull will be felt in the quadriceps area. This is particularly true if the athlete pulls the ankle rearward while doing the stretch (as compared with pulling the heel towards the buttock). By experimenting with the different angles of pull, the lifter can find the one in which the stretch is felt most in the belly (middle) of the muscle.

Athletes seeking a relaxing stretch will often find that stretching to a point where there is some stretch and no discomfort and then holding that position for thirty to sixty seconds will provide a greater degree of relaxation than assuming a more extreme position. Others find that repeated stretches of much shorter duration (e.g., AI stretching) are far more effective. (Chapter 3 describes such stretching methods.)

The athlete must also pay careful attention to the effects of the stretching session. If the tendon feels more irritated after the session, then perhaps that method of stretching is not beneficial for that particular condition. As with all forms of training, the exercise used and its intensity and frequency need to be monitored in order to achieve the desired purpose most effectively.

Knee wraps are employed by some lifters to “treat” tendon pain. Some of the pros and cons of using knee wraps were presented earlier in this chapter.

Doctors often prescribe NSAIDs to treat this problem. If the inflammation is a one-time occurrence with a specific cause, the athlete can generally benefit from this kind of treatment. However, for truly chronic pain it is important to look at the fundamental causes rather than merely treating the symptoms with NSAIDs or any other palliative measure.

Injuries to the meniscus also occur occasionally as a result of a technique error that is made while the lifter is resisting the downward force of the bar (e.g., from the mis-positioning of the foot while catching a heavy clean). If the injury is minor, conservative treatment is sometimes effective. When the injury is more severe, arthroscopic surgery can be an effective treatment, and an athlete is often able to resume very limited training within a few weeks. Weightlifters should recognize that coming back from a meniscus injury in weightlifting is not as simple as coming back from such an injury in a sport like running, in which the knee is not put through its full range of motion. Comebacks are generally quite successful, but doctors who tell you that you will be back at your full level of activity in three weeks have probably never tried any squat cleans after having such surgery.

Young athletes sometimes develop a condition called Osgood-Schlatter’s disease. This a growth disorder at the site of the tibial tuberosity. The problem presents itself as swelling, tenderness and pain in the patellar tendon at that site. The condition tends to improve with maturity, but it can be quite a problem for some lifters, and it warrants careful medical monitoring and attention so that it does not become a long term problem.

Chondromalacia patella is another condition that can affect the knees of lifters. This injury involves a deterioration of the cartilage of the under-surface of the patella where it is in contact with the femur. The onset of chondromalacia is generally somewhat gradual (the lifter feels it progressing over at least a series of workouts). Typically, the athlete feels pain and/or stiffness and pressure in the area under the patella. The pain is normally worsened when the lifter is in a full squat position or taking a weight from the floor in the clean or snatch. My experience has been that conservative treatment is more effective in treating this condition than surgery. Few lifters, if any, have come back from surgery on this area.

Some years ago, I developed a fairly serious case of chondromalacia patella. Two surgeons recommended surgery but a third told me that if he (or anyone else) operated, it was unlikely that I would every lift heavy weights again. Instead, he recommended that I try an arch support in my shoe to alter the position of my feet t. More important, he recommended that I change my way of squatting to keep my shin nearly vertical when I squatted. (This involves sitting back with the squat rather than permitting the knee to travel well forward of the foot in the squat position.) I also avoided or temporarily eliminated the classic lifts and anything else that seemed to irritate the knee (deadlifts with a close or frog-leg foot position bothered my knee). This conservative method of treatment took nearly a year to lead to a complete recovery. That is an awfully long time. But some people I know who had the surgery at the same time that I began my more conservative treatment never came back from the surgery. While my performance never reached pre-injury levels, there were other reasons for that. (My knee healed almost completely over time.)

It has been my experience that a lifter’s shoes can have a significant influence on knee problems. Some years ago a major shoe manufacturer came out with a new model of weightlifting shoes that looked great. Many lifters bought them, but within a year’s time I saw several of those lifters suffer a complete quad-tendon rupture (something I had never seen in all of my years of lifting). Two of my friends suffered the same injury wearing these shoes. I bought a pair, and within few days I experienced a sharp pain in my quad tendon while doing relatively light snatches. When I changed back to my old shoes, the pain went away, and it has never returned in that way. Were the shoes responsible? If so, why were these shoes a problem? No one knows for sure. The manufacturer has long since discontinued them. Perhaps it is just a coincidence that just after distribution of these shoes stopped, the incidence of quad-tendon rupture fell precipitously, to the point where it is once again rare in the United States.

The real point of the story is that when a lifter changes his or her shoes, it takes time to get accustomed to them. Unless you are sure they are identical to the ones you have been wearing, do not begin using them full time all at once. Wear the new shoes for a few warm-up sets and then do the rest of the workout with the old shoes. Over a period of a week or so, work up to doing one exercise with the new shoes. Over a period of several weeks, phase them in to the entire workout. This process is particularly important when the height of the heel on the new shoe is different from the old shoe.

Generally, lower heels place less stress on the knees but more stress on the hips, back and shoulders (the latter when one is snatching). But this is not universally true. Some knee conditions improve when a lifter wears a higher heel.

As long as the lifter acclimates to a new shoe gradually, he or she will rarely encounter any serious problems. However, if knee pain has its onset shortly after new footwear has been introduced, the effect of the new shoes is worth investigating.

Pubic Bone Bruise

In the modern style of pulling, the bar often comes into vigorous contact with a lifter’s thighs or hips. In the latter case, contact with the body at the level of the pubic bone can actually cause a bone bruise in that area. This rarely occurs with heavy weights, as the speed of the lifter and the bar are simply not enough to generate very hard contact. But when lifters are warming up, the contact can be very hard indeed. For most athletes, the solution to this problem is to widen or narrow the grip slightly, so that severe contact exactly on the point of the bone is avoided. Caution must be exercised to assure that the use of a slightly different grip does not cause the lifter to damage his or her technique in any way.

Some lifters who make violent contact with the pubic bone protect the area with some form of padding. The rules of lifting are somewhat vague in this area. Wearing any supportive device under the lifting costume is clearly prohibited by the rules. However, it is not clear whether a pad which protects the pubic area (e.g., a sponge or folded handkerchief) is supportive. Therefore, an athlete who wears a pubic pad should be aware that he or she might be challenged by an official in competition.

Should an injury occur, a combination of padding and a slight grip change can permit the lifter to continue to train. For most lifters, a rapid restoration of old technique patterns will occur as soon as the injury is healed and the old grip is resumed. The greater risk is generally in the athlete’s continuing to train in pain. Such a process may cause further damage and will almost certainly be injurious to the lifter’s technique. In an effort to avoid pain, the lifter is likely to slow the explosion down, bend the arms or do something even worse from a technical standpoint. The net result may be some permanent damage to technique. This is why training in pain is a major mistake for most athletes and why training around the pain makes so much more sense.

Groin Pull

The groin pull is a fairly common injury among weightlifters. It can arise either as a result of overuse or a sudden slip. The latter most often occurs when the lifter is in or is moving into the split position. If the lifter’s back foot does not land on all of its toes, it can twist toward the inside edge of the foot. In this position, much of the strain on the back leg is taken up by the ligaments of the knee and the adductors of the leg (as compared with the quadriceps and hip flexors, which absorb most of the strain when the foot is correctly positioned on the toes). Such a position places the groin and knee at risk. Many groin pulls have occurred as a result of this position.

The other major cause of a groin injury is overuse. The athlete must realize that the adductor muscles are strongly activated during the back squat and the pull from the floor. When the athlete is increasing the load on these exercises significantly, there is always the risk of overstressing the adductors. This is especially true when the athlete has added or increased the load of deadlifts, pulls, deadlifts or lifts while standing on a raised platform (especially when they are done with a snatch grip). When these kinds or changes are made and the back foot turns in the jerk the risk of a groin injury increases substantially. Because the adductors are involved in so many movements, a complete rest is sometimes needed in order to clear up a difficult groin injury (along with taking steps to reduce the causes of overuse once the athlete does recover from the injury).

Abraded Shins

It is not uncommon for an athlete to abrade his or her shins with the bar while pulling. In a sense this can be viewed as a result of a technique error because when an athlete pulls correctly the bar only grazes the shins. Nevertheless, it is not uncommon for athletes, even those with good technique, to abrade the shins occasionally, particularly if they are training with a bar that has a sharp knurling.  Wearing full sweat pants generally protects and athlete from abrasions. When they do occur it is important to treat the abrasion as one would any such injury.

In terms of recovering from the injury, it is important to give the shins extra protection while they are healing. A band aid applied to the injured area that is covered with tape is generally more than enough protection. Coupling the bandage with wearing full sweatpants should definitely be sufficient. If it is not you definitely need to take a look at your pulling technique. Constant abrasions are evidence of attempting straighten the back too early in the pull and of having the balance too far to the rear during the start of the pull.

Injuries to the Ankle and Foot

Injuries to the ankle are quite rare in weightlifting. Since most ankle injuries in sport result from twisting the foot or ankle while running or jumping, this should not be surprising. Despite the relatively low incidence of ankle injuries, some weightlifters are comforted by the perception of ankle support afforded them by a high- top athletic shoe, but many (if not most) prefer the freedom of movement that is available from a low-top shoe.

Naturally, supportive taping for the ankle should be considered if an ankle injury occurs, but care must be taken not to restrict the movement of the ankle that permits the knee to move forward over the foot while squatting. Restrictions in this area can cause uneven positioning of the legs and consequent changes in positioning in other areas of the body. This can result in injuries to those other areas.

The only injuries to the foot that occur often enough in weightlifting to be worth mentioning are the result of a lifter’s dropping the bar or a plate on his or her foot. In one very unusual case, an athlete dropped a jerk behind himself, failed to step forward out of the way and kept the rear foot on its toes. In this case the heel of the foot was high enough for the bar to make contact with it. The result was a broken bone in the lifter’s foot, which was painful and cost that lifter valuable training time. It could have been entirely avoided by the lifter’s getting out of the way as the bar fell.

The more common injuries occur as a result of a plate falling off a bar that is supported by a rack or the a lifter dropping the plate while his or her foot is directly under the plate. In all instances these injuries are the result of carelessness or faulty equipment. Weight training is a relatively safe activity when it is practiced with care, but no activity is completely safe if a participant becomes careless. The athlete should avoid dropping any weight, especially when there is anything underneath it (e.g., a plate, a foot, another lifter), and should always pay attention to what he or she is doing when handling any weight.

Non-Surgical and Post Surgical Treatments for Injuries

There are a wide array of techniques for treating injuries without surgery or following surgery. The most important form of non-surgical treatment—exercise—has already been discussed. In this section we will examine a variety of non-surgical or post surgical treatments for injuries. Medicine has developed many therapies (also known as modalities) to assist in the healing of injuries. A complete description and analysis of these modalities is beyond the scope of this book. There are many texts which ably describe the full range of therapeutic tools, their mechanisms of action (at least as far as they are understood today) and the ways in which they are used. In this section we will merely touch upon the major categories of modalities.

Massage

Massage has been used by athletes for thousands of years. There is no doubt that sore and aching muscles are comforted by massage. Other soft tissues, like tendons, can also respond favorably to massage. Massage can be divided into at least two categories: massage that is designed to improve circulation, remove metabolic wastes, etc., and massage that is designed to break the pain cycle.

The former type is more common. Most of this kind of massage is performed by the masseur’s full hand and generally consists of stroking and light “percussive” techniques. Such massage generally produces relatively pleasant sensations. It causes no harm (unless it is applied to an injured or infected area), and it does appear to promote the healing process. Athletes who have access to massage are therefore wise to take advantage of the opportunity. Athletes who are not as fortunate may be able to utilize mechanical substitutes, such as vibrators and whirlpool baths. While probably not as effective as skilled human hands, these modalities can achieve positive results.

Massage that is designed to break a pain cycle is an entirely different animal. It is generally relies on the application of considerable pressure to specific areas in which pain is mostly deeply experienced. The pain which results from such treatment can be excruciating. Practitioners of this kind of massage use thumbs, knuckles, elbows and even foreign objects to apply pressure to areas of the muscle and/or tendon that are regarded as responsible for an athlete’s pain and disability. The theory behind this form of massage is that pain is often non-functional. It can persist after any injury, and the pain itself can cause non-functional muscle contractions (.e.g., contractures) which themselves cause pain, leading to still further pain causing contractions. By applying pressure to the “trigger points” of pain, the contractures in these muscle-tendon areas are broken along with the cycle. (Otherwise, contractures can lead to changes in circulation and metabolism, which lead to further contractures, which impact circulation and metabolism in a vicious circle.)

Many athletes swear by these painful treatments. My experience has been that they can be useful under certain circumstances. Therefore, athletes who are experiencing chronic muscle pain may find such massage worth a try, particularly if alterations in training loads and technique and careful stretching have already been explored in an effort to address the problem.

Massage directed at breaking the pain cycle is best administered by trained professionals who specialize in this kind of treatment. However, some athletes will find that they are able to self-treat if the location of the injured area lends itself to self-treatment and the athlete receives the proper training.

Spinal and Joint Manipulation

Chiropractors, osteopaths, physical therapists and other medical professionals use spinal manipulation, and, to a lesser extent, manipulations of other joints to alleviate a variety of musculoskeletal ills. On the basis of my experiences, and those of other athletes who I have known, I have no doubt that manipulation can be very useful for treating certain kinds of conditions, particularly back and neck pain. No one, including its practitioners, fully understands the mechanisms through which manipulation works. The most common explanation is the theory of “subluxations,” which essentially says that minor misalignments of the joints, especially the spine, can cause pain and loss of function. Manipulation presumably realigns the area in which the subluxation exists and thus corrects the condition.

Some practitioners carry the theory of subluxations much further. They attribute virtually every human ill to pinched nerves which result from subluxations. To many true believers, germ theory and other explanations for disease which have been scientifically demonstrated to be true can merely be ignored. These extremists even ignore evidence that is provided by their own theory. For example, subluxations of the spine have been blamed for disorders of the eyes, even though the nerves of the eyes travel directly to the brain, with no involvement with the spine. The errors made by the manipulation extremists do not alter the effectiveness of this treatment in certain circumstances, however.

Manipulation is clearly contraindicated for people with certain vascular problems, fractures of the bones that are being manipulated and some with “disc” problems. Reputable practitioners of manipulation are aware of these limitations and do not proceed when they exist. Patients should also be wary of manipulators who claim cures for such ills as cancer, infections and the like.

Because of their aversion for the use of drugs and surgery, many chiropractors and osteopaths have become very knowledgeable in areas of injury treatment that practitioners of surgery and/or drug therapy never bother to explore, but this is not universally true. Therefore, health practitioners need to be judged as individuals and not solely on the basis of the degree or license that they hold.

Cryotherapy (Cold Therapy)

Most therapeutic modalities use thermal energy to change the temperature of injured tissue and thereby facilitate the healing process. In the case of the application of cold, the purpose is to minimize damage to injured tissue.

When tissue is injured, much of the damage that occurs (particularly in the surrounding areas) results from oxygen deprivation (circulation that has been compromised by the injury leads to a lack of oxygen in the area). The application of cold reduces the temperature near the injury site and slows the metabolism in that area, reducing the area’s need for oxygen and hence the damage that is done to it. The application of cold also causes vasoconstriction, which reduces the severity of the body’s inflammatory response. Finally, cold tends to reduce pain (by reducing the excitability of nerves) and spasming at the injury site. Ice massage, the application of ice packs, immersion in cold or ice water and spraying with vapocoolants (such as flouro-methane) are all means to generate cooling of the tissues.

Because of its analgesic properties, cryotherapy is often combined with exercise during the rehabilitation process, because therapeutic exercise can be undertaken with less pain after or during the application of cold. However, such exercise should only be performed under supervision, because the presence of cold can mask protective pain and permit the athlete to exceed his or her capabilities. But when used properly, cryotherapy can be helpful in permitting an athlete to work through non-functional pain (such as when breaking adhesions, scar tissue that inhibits motion) to restore function.

Thermotherapy (Therapeutic Heat)

There are a wide variety of therapeutic modalities designed to generate heat within the injured area. In order for therapeutic heat to be useful, it must cause an increase in molecular activity. When the level and penetration of heat is too small, it will not lead to any improvement in the healing process. If the heat is excessive, actual damage to tissues can occur. The action of heat and the relative benefits of heat from different sources are not fully understood. The benefits of heat include improvements in tissue and joint flexibility, reductions in pain and spasming, reductions in swelling and cellular debris in the injury area and an increase in the blood flow in the area.

Thermotherapies include: moist heat packs, whirlpool baths, infrared radiation, fluidotherapy, contrast baths, shortwave diathermy, microwave diathermy, continuous electromagnetic energy ultrasound and phonophoresis. All of these therapies have their strengths and weaknesses, but some are clearly more effective than others. However, effectiveness can be offset by lack of availability and the athlete needs to balance these considerations. If the athlete can apply moist heat packs several times per day but can only travel to a therapist for ultrasound treatment once a week, the former treatment (though less effective than ultrasound) will prove to be more effective for that athlete. In most cases a combination of therapies will work more effectively than any single one.

Electrotherapy

While not used as widely as thermotherapies, electrotherapies are gaining in popularity. Electrotherapies involve the conduction of an electrical current through a particular tissue or group of tissues. Electrical impulses vary in shape, direction, amplitude and duration. Their primary effects are to modulate pain and to stimulate contraction of muscles. The mechanisms of pain relief are complex, but it is sufficient to say that electrical current can be very effective in controlling pain, which has an associated benefit of assisting the muscle to relax and freeing it from the pain/contraction cycle that was discussed earlier in this chapter. The stimulation of muscle contractions can avoid atrophy in muscles that have not been exercised, pump blood and other fluids through the muscle, strengthen muscles and reeducate them to contract after injury or surgery. Perhaps the most common form of electrical device for pain control is the transcutaneous electrical nerve stimulator (TENS).

A more experimental use of electrical current is in the stimulation of the healing process in bone and soft tissues. Here the electrical current is of a very low level that cannot be detected by the senses, but it alters the electrical activity in individual cells. This kind of device used for this purpose is referred to as a microcurrent electrical current neuromuscular stimulator (MENS).

Low Power Lasers

Lasers have long been used in certain types of surgery and other medical treatments that typically involve the destruction of unwanted tissue. Today the use of lower power lasers is being experimented with in hopes that they will be able to stimulate collagen synthesis, destroy microorganisms, increase vascularization and decrease inflammation and pain.

Acupuncture and Acupressure

Acupuncture is founded on the premise that there are a series of “meridians” that run through the body. Points on these meridians are associated with pain in various areas of the body. By inserting needles into these points, pain can be relieved in the related areas. The Chinese, who developed the practice, believe they have identified thousands of these points.

There is evidence that these points do have some different characteristics than other areas in the body (e.g., electrical resistance is lower at acupuncture sites than other areas of the body), but there is no evidence that the explanation the acupuncturists have posited are accurate. However, there is significant clinical support for the idea that the pain reducing effects of acupuncture are real (whatever their cause).

Acupressure is the application of massage techniques to the points that have been identified by acupuncture (and generally pinpointed by the therapist as a source of pain). Pressure is applied to the appropriate area with a finger, elbow or other probing device. The degree of effectiveness of the treatment is generally positively related to amount of discomfort that it causes. Relief generally lasts for at least several minutes to several hours, and many athletes have reported a relatively permanent form of relief after one or a series of treatments.

Therapeutic Uses of Flexibility Training

Thus far we have focused on the use of flexibility training to permit the lifter’s body to assume functional positions in executing the snatch and C&J. There is at least one additional purpose for doing stretching exercises. That reason is therapeutic.

Sports medicine specialists have found at least four major reasons for an athlete to practice stretching. First, stretching can be used to restore the flexibility to a muscle that has been restricted in terms of its motion and/or been damaged in some way. If a joint has been immobilized (e.g., placed in a cast), it loses strength, size and flexibility rather quickly. After the cast is removed, the athlete often needs to work just as hard to restore the range of motion to the joint and muscles involved as to restore the strength and size of the muscles. This requires flexibility training.

A second reason for stretching is to break up the spasming that is caused by certain types of injuries or muscle malfunctions. If a muscle is damaged, it will tend to spasm, and that spasm is part of a protective mechanism. It is not appropriate to stretch a muscle that has been damaged until sufficient healing to the damaged tissue has taken place. Premature stretching ruptured muscle or tendon fibers can undermine or preclude proper healing and thereby prolong the recovery process. However, a muscle that has gone into a state of spasming after an injury will tend to remain in the spasmed state (or at least a state of abnormal tension)longer than necessary. In fact, muscle tension can generate pain, and that pain tends to foster the continuation of the tension, creating a vicious cycle of pain, tension, more pain and more tension.

When sufficient healing has taken place, stretching will help break up any spasming, interrupt the pain/spasm cycle and restore the muscle to its normal level of functioning.

It has been demonstrated that stretching exercises can relieve muscle soreness and cramps. When a stretching stimulus is applied to a sore or spasmed muscle, the symptoms tend to be relieved faster than through pure rest. The mechanism of this relief is not well understood, but the effectiveness of the procedure has been well established on a practical level. Similarly, stretching the muscles of the lower-back often helps to relieve the lower back pain that arises from spasming muscles and serves to prevent the recurrence of this pain. Proper stretching for this condition can be more effective than medication (i.e., muscle relaxants) in controlling unwanted muscular tension.

A third therapeutic reason for stretching is to relieve tendinitis. A number of athletes and sports medicine specialists have reported that the careful and sustained stretching of a muscle that is attached to a tendon exhibiting the symptoms of tendinitis tends to relieve the symptoms of the tendinitis for many sufferers. When stretching to relieve tendinitis, care must be taken to assure that the force of the stretch is felt in the muscle and not the tendon; stretching that is felt at the site of a tendon can make the tendinitis worse. The athlete will need to experiment with the position of the joint and the effort applied to the stretch in order to attain a stretch that is felt in the muscle and not the tendon. Most often this occurs when the muscle is stretched only to the point of a slight tension followed shortly by a sense of relaxation and then the relaxed state is maintained without attempting to increase the range of motion. Here again, no one seems to fully understand the mechanism involved in stretching the muscle attached to the ailing tendon, but this technique does help many people. (It is believed that such stretching lowers the degree of resting tension in the muscle and that in turn relieves unnecessary stress on the tendon.)

It should be noted that when stretching for therapeutic purposes, the type, frequency and intensity of the flexibility training that is applied should be guided by two considerations. The first and most important consideration is the advice of the physician, physical therapist or other health professional who is treating the injury. A second consideration is the response of each individual to any flexibility training. While health professionals have access to research and practical experience that helps them to prescribe effective exercise programs, the unique needs of each individual need to be considered as well. People heal at different rates and have different pain tolerances, and different interpretations of instructions.. Consequently, responses to exercise therapy need to be observed and considered in making prescriptions. The patient’s input and analysis are therefore critical.

A fourth therapeutic reason for stretching is to restore the original length of muscle tissue that has shortened in response to overuse. Overuse of any muscle group can cause the muscles of that group to assume a shortened position in their resting and active states. This shortening can lead to weakness, discomfort and a greater potential for injury. Regular stretching can help relieve these symptoms (though the athlete would be well advised to treat the cause of the overuse condition as well as the shortened condition of the muscle itself). An example of this is the shortening of the psoas muscles that can take place during the process of training. This shortening can lead to an accentuation of the curvature of the lower back (i.e., lordosis). Stretching the psoas muscles (by lying on your back and flattening the arch of your back, then lifting one knee up while other is flat in floor) can relax the psoas muscles and take the pressure off the lower back..

It is interesting to note that clinicians have discovered that stretching several times a day can prevent capsular contraction but that overdoing it can worsen the condition. This finding offers both a further therapeutic application of stretching and further evidence of the importance of exercise dosage in relation to the results obtained. It explains why one arthritic patient might complain that stretching made them worse, another might notice no significant improvement and still another might obtain significant relief through the use of stretching exercises.

One final therapeutic benefit of stretching is psychological rather than physiological. Stretching can contribute to a relaxed mental as well as muscular state.

Food Supplements and Derivatives

Nutritional aids to recuperation and adaptation have already been discussed in Chapter 10. In this section we will briefly touch on some nutritional approaches which some athletes believe have been of benefit to them in dealing with injuries

 Promoters of “health foods” are always claiming that they have discovered “the cure” for a wide range of illnesses and injuries. Laboratory and clinical support for such claims is often scarce, and many of these treatments have little or no value, but some may be of help to some athletes under certain conditions. Since most of these treatments are relatively safe, there is little harm in trying them (as long as their use does not result in the avoidance of more proven approaches). It is worth mentioning a few substances in this context simply to give the reader a sense of what is out there.

It must be remembered that there is an entire medical and drug industry that benefits solely from the use of prescription drugs and especially brand name drugs that are under patent protection. There is no financial incentive for these companies to promote the used of natural alternatives which cannot be patented. This does not mean that there is a “conspiracy” to destroy the health food industry, but it does mean that some very worthwhile therapies may not be heavily promoted because it is difficult to make a profit selling them.

As an illustration, in just one area, the treatment of joint injuries, several athletes I know have reported success with a specific substance after experimenting with many others that they found to be of no value. I know several athletes who feel that a dietary supplementation of manganese has helped them with joint problems that they had been experiencing for some time (tendinitis in particular). Karl Faeth, trainer for many United States world and Olympic weightlifting teams, reports that his arthritic joint pains virtually disappeared when he added cod liver oil to his dietary regimen. Giselle Shepatin, many time National Champion and American record breaker swears by the use of a pine bark derivative called “pycnogenol.” The use of the enzymes bromelain and papain (pineapple and papaya derivatives, respectively) to treat injuries has been accepted by many in the medical community for years. There is some evidence that grape seed extract can be helpful is this regard as well. Finally, the “popular” health literature in recent years has been promoting the use of glucosamine and chondroitin sulfate as two agents that can relieve joint pain and possibly help to regenerate soft tissues.

There are even some externally applied non-traditional restorative and/or therapeutic methods which some athletes believe have been of value to them. For instance, a number of athletes have reported relief from soft tissue injuries through the use of natural “poultices” (e.g., tincture of arnica or linseed oil poultices). Practitioners in a wide variety of natural-medicine disciplines have their own formulas for treating athletic injuries, and most of these treatments can do little harm as long as they are not substitutes for clearly needed treatments like casts or surgery.

Herbs, vitamin and mineral supplementation and a variety of food derivatives may work for some and not others. You will find some books which discuss natural remedies for a wide variety of afflictions in the Bibliography.

Mental Factors in Treating Injuries

Chapter 7 discusses a number of techniques that can be used by the injured athlete to maintain performance. Mental rehearsal is just one example of a method that can be used by an injured athlete.

A more controversial approach to applying the mind’s power in sport is the use of positive affirmations and visualization to promote healing. Some people believe that visualizing recovery will actually improve the athlete’s self-healing powers. They argue that direct physiological reactions to thought aid in healing. Others believe that the proper mental attitude improves the functioning of certain bodily systems so that healing may be promoted in an indirect way.

A more certain effect of visualization and similar techniques is that the athlete’s anxiety declines because he or she believes that something positive is being done for the injury. An athlete who is becoming confident that he or she will make a successful comeback is more likely to do the right things in terms of treatment and rehabilitation.

“Chronic” Conditions That Go Away

When I was in my very early twenties, I developed rather severe bursitis and general inflammation in my knees. It came on as a result of overuse but then persisted over an extended period (even after a layoff and careful comeback). I became quite concerned and began to wonder how much longer I could continue my training with such a painful condition. Visions of my knee joints turning to “powder” at the age of twenty-five danced in my head. When I mentioned the problem to my friend, many time national champion, American record holder and silver medalist at the World Championship, Phil Grippaldi, his response surprised me. He told me that he had had such a condition for some time several years earlier. It came upon him rather suddenly, remained for several months and then just disappeared, never to return in anything like its initial severity. My problem lasted longer than Phil’s, but one day it did indeed go away, and it never returned in anything like its previous severity.

Over the years, I have noticed a similar phenomenon with respect to other injuries. No matter how intractable an injury may seem, it can suddenly go away as quickly as it arrived. However, in my experience, this is most likely to happen when the athlete is willing to experiment with changes in training methods and lifting techniques. An injured lifter is often changing a number of variables at the same time when suddenly an effective combination comes along.

Spontaneous remission is far rarer. Such remission never occurs with respect to a strain of a major muscle group. Strains simply require rest in order to heal. This rest must be followed by or coordinated with a period of careful reconditioning.

My advice to any lifter afflicted with a chronic problem is to keep training around the injury and experimenting with treatment. Eventually, the right combination of treatment and training modification is likely to be developed. Virtually no injury should ever be accepted as permanent.

On the other hand, no injury should ever be ignored or masked with anti-inflammatory agents while the lifter continues with his or her training unabated. Such an approach to injury has the potential to turn a chronic injury of manageable proportions into a career ending tragedy.

It should be remembered that many lifters have gone on training at some level for years while nursing a particular problem and then discovered a solution to it. A lifter should neither give up prematurely nor delay addressing an injury in any way.

Restorative Measures

While some athletes are as attentive to recuperating from their workouts as they are to the workouts themselves, they are clearly in the minority. Many athletes train hard but fail to get adequate sleep and rest. Others have an improper diet or a highly stressful life outside of sport. Some athletes abuse drugs or alcohol.

Part of what it takes to be a great athlete is a feeling that you are virtually unstoppable, that achievement of your goals is inevitable. Because of this attitude, some athletes say, “I can drink all night, or dance all day or drive my car at 100 miles an hour because when the chips are down, I will always come through and avoid disaster.” Unfortunately, while confidence is generally a great virtue, it is absolutely destructive when it is taken to an irrational level.

One area in which smart athletes gain an edge over their competitors is in the careful use of restorative methods. Restoration takes place on several levels. During the workout it takes place between reps and sets as the pause between lifts permits the body at least partially to rebuild its energy stores. Athlete recuperate from their training at different intervals, depending on the capability that is being restored (e.g., the majority of ATP stores are replenished within minutes of the end of a heavy set of exercises). In the hours immediately after the workout (and, if the workout was very long and strenuous, in the days that follow it), the body further replenishes its energy stores. (Glycogen stores require several hours or even days in order to be fully restored following a very long and exhaustive exercise session.) Proper nutrition and adequate rest between lifts and workouts, facilitate this process, and these issues have already been covered in earlier chapters. However, there are still other levels of restoration that need to be addressed.

A third level of restoration involves the adaptation that the body makes to training stress. Tissues are broken down in training . Those tissues and a variety of waste products need to be removed from the muscles and other tissues, and the body must deploy healing agents to the cells that will enable them to remodel in a way to enable them to better tolerate similar stresses in the future. (In this sense it is impossible to separate training from restoration because a training session can be both depleting and restorative.)

A fourth area of restoration takes place within the athlete’s nervous system. Both the athlete’s volitional and automatic nerve functions can be temporarily diminished following intense training, so the nervous system also requires time to recuperate.

Perhaps the most powerful restorative method available is a regular and well balanced schedule. Training at one hour on one day, and at a very different hour on another, sleeping at odd hours, eating irregularly and other such changes in the daily schedule place significant stress on the athlete and are therefore to be avoided.

Dietary agents (which have already been discussed in Chapter 10), a variety of mental and physical activities and a number of externally applied agents are believed by some to be restorative. The effects of some have been better documented than others, but we will mention a significant number here in order to convey the range of things that are used in the hope of improving restoration processes.

In terms of externally applied treatments, there are steam rooms and saunas, hot and cold alternating showers, bathing in mud or mineral water and being swatted by birch branches. All of these techniques are believed to stimulate the removal of wastes from the body and/or to facilitate the relaxation that is itself a means for improving recuperation.

 On a psychological level, there are a number of methods which are believed by some to restore function. Simply sleeping and relaxing are perhaps the most popular measures. Socializing, enjoying various forms of entertainment, pedagogical sessions, eating in pleasant surroundings, hypnosis, autogenic training, going outdoors, hiking in naturally beautiful areas, lying in flotation tanks and listening to certain kinds of music or the sounds of nature: all can be psychologically restorative. Research regarding the use of these modalities is rather limited, but on an intuitive level we recognize the need for relaxation and change when it comes the brain and the rest of the nervous system. Most athletes will need to experiment to see which methods seem to benefit them most. Many athletes will find that any one method loses at least some of its beneficial effect after a while. Consequently, for these athletes, alternating techniques will often be beneficial.

The athletes and scientists of the former Soviet Union and its allies devoted significant attention to the use of restoration methods. They employed electrostimulation with a variety of amplitudes, frequencies, intensities and duration to facilitate recuperation (rather than restricting the use of these therapies to injured athletes, which is the typical practice in the West). They used barometric pressure chambers to reduce the pressure to a specific area of the body (e.g., an injured limb), which is believed to increase circulation and tissue temperature and thereby stimulate recuperation in that area. Larger chambers were used to permit athletes to breathe oxygen under pressure, another measure that is believed by some to facilitate recuperation. Most high level teams had masseurs who worked on athletes daily to help restore function to tired and aching muscles.

Because these methods were used so widely, specific protocols were often developed for their use. For instance, one author spoke of taking a sauna for ten minutes, moving to progressively higher benches in the sauna over a period of minutes (the higher you go, the hotter it normally is). The athlete was advised to remain in a horizontal position during most of the stay in the sauna but then to place the legs in a vertical position for the last two to three minutes, presumably to prepare the athlete to walk out comfortably (i.e., without feeling lightheaded). Sauna temperatures of just under 200^o Fahrenheit were generally recommended.

In addition to formulating specific guidelines for the employment of restorative methods, Soviet coaches also factored them into the developmental process and the training schedule. For instance, local healing measures (such as massage) might be used more during the competitive phase and more general recuperative methods (such as the sauna) might be used more heavily during the preparatory phase of training. Similarly, showers and massage might be used after the morning workout (indeed massage might be used during the workout), but more fatiguing methods, like the sauna, might be reserved until after the last workout of the day. Some authors have even suggested that restoration methods not be applied immediately after very heavy training for fear that these measures might in some way interfere with the training effect the strenuous workout was designed to create.

The stage in an athlete’s career might influence the kinds of methods to be used in the restoration process of specific athletes. Beginners would clearly need more instruction on the principles of weightlifting, while more experienced lifters might focus on the more physical and psychological aspects of restoration. Author and coach Medvedyev has even suggested that recuperative methods be assigned a volume across the training year (e.g., 8.5 to 166 hours for a particularly modality and .5 to 2.5 hours of restorative activities a day, 10 to 12 hours a week).

Some would argue that athletes who employ optimal training methods and technique should not need massage or any other restorative technique in order to train and compete effectively because their training schedule will include adequate time for recuperation. However, such arguments are not completely convincing. If an athlete could recuperate from training more rapidly, he or she could presumably adapt more often within the same time period than another athlete who is not employing special recuperative techniques. In addition, training is seldom so perfectly structured that in athlete can be injury and pain free at all time. There will be occasions when even the best-laid plans result in an athlete’s overdoing it somewhat. When slight excesses do occur, restorative techniques can be a vital mechanism to help the athlete return more quickly to normal levels of training.

Finally, it should be noted that some athletes who have reduced their training loads to the minimum level at which progress can be sustained or conditioning can be maintained and who have developed the least stressful techniques available, may still develop rather persistent aches and pains as they age (physiologically and in terms of their years in the sport). For such athletes, various restorative measures may be able to lengthen their careers significantly.

Summary

Weightlifting is a relatively safe sport. Proper training methods, sound technique and adherence to safety rules greatly reduce any risk of injury. The athlete who avoids injury takes an important step toward top performance. When injuries do occur, they must be treated promptly and effectively in order to minimize any loss of training time and function. The causes must also be analyzed in order to minimize the chances of a recurrence. A proper approach to the issues of injuries will help an athlete to have a long and healthy career.