Torn ligaments. Pulled muscles. Overuse injuries. With every new exercise routine comes a new risk of injury, whether it’s straining a muscle from lifting, developing knee pain from running or tearing a tendon during calisthenics. With an estimated 8.6 million sports and recreation-related injuries each year in America, these fears are not unfounded.
However, before you let this fear keep you from starting an exercise routine, the good news is that the majority of sports injuries are “overuse-related, rather than traumatic, meaning they typically don’t require surgery,” said Dr. Matthew Matava, an orthopedic surgeon and sports medicine physician at Washington University in St. Louis.
With the right precautions, you can develop a well-rounded exercise routine, one that maximizes the benefits while minimizing the risk of injury. To get a sense of the exercises that leave you especially vulnerable to injury, we turned to a mixture of sports doctors, physical therapists and athletic trainers to get their consensus on the most common mistakes people are making, and how to prevent them.
Don’t round the back for deadlifting
The deadlift — where a lifter starts in a squatting position, pulling a weighted bar up into an upright, locked position — is one of the most common lifts. However, its simplicity is deceiving. “Deadlift is one of the best tools, if done correctly, and one of the most dangerous things you can do if done wrong,” said Cameron Apt, an athletic trainer at the University of Rochester.
One of the major mistakes people make is rounding — or hunching — the back. The deadlift starts with the lifter in a squatting position, with a neutral spine, meaning the back is neither overarched nor rounded, from which they pull the weight up to their thigh. During this movement, even a slight rounding of the spine can put excess pressure on the muscles of the lower back, potentially throwing out the back or worse.
“It’s not even necessarily that people have bad form, it’s that people underestimate how much of a dynamic and hyper-focused exercise deadlifting is,” said Femi Betiku, a physical therapist at the New Jersey Center of Physical Therapy Riverdale. “They’re not paying attention for a split second, and then their back rounds a little bit, and then ‘Boom!’”
For those who are less experienced, there are a number of alternative exercises that can offer similar benefits and put less strain on the lower back. This includes hex bar deadlifts, in which the wide hexagonal-shaped bar, which surrounds the lifter, reduces the amount of pressure on the lower back.
For those who want to dead lift, it’s essential to pay close attention to form. When working with beginners, Apt will often have clients practice the movement with no weights. “We’ll see people for weeks before we give them a weight to move with,” he said.
It’s also essential to listen to your body, and to adjust as needed, especially if fatigue is starting to affect your form. “There’s nothing wrong with pushing into the fatigue,” Betiku said. “It’s all about being aware that ‘I’m fatigued, I have to focus on my form 100%.’”
Use proper bench-press form
When most people think of weight lifting, the first thing they might think of is the bench press, where a lifter lies on a bench, pressing the weight upward. The bench press is so familiar that comedians from Chris Farley to YouTube star Mike Tornabene have used it to poke fun at bodybuilders. But it can cause rotator cuff injuries if done incorrectly.
The rotator cuff is especially vulnerable because so many tendons, ligaments, blood vessels and nerves travel through a tight path, called the sub-acromial space, between the shoulder blade and humerus. “It’s this very small little space that is almost like a roadway,” said Lauren Shroyer, an athletic trainer with the American Council on Exercise, who specializes in chronic injuries.
A common mistake is hunching the shoulders upward, almost like slouching in a chair, which can put a huge amount of strain on this area. Shroyer said this could lead to impingement syndrome, a painful condition caused by the shoulder blade rubbing against the rotator cuff. The same can also happen if you raise the bar over your head, rather than your chest. To avoid this, she said, make sure that your arms are shoulder-width apart, the shoulder blades pinched together, with the bar being lowered to the middle of the chest.
Another common issue is lifting too much too quickly, which can lead to an acute injury, such as tearing the pectoral muscle. When this happens, the lifter will often feel a popping sensation, lose control of the weight, and now “one nipple is pointing one way and the other nipple is pointing the other way,” Matava said. “We’ll see that a lot,” he added, often in inexperienced lifters who try to lift more weight than they are ready for.
Pectoral muscle tears are excruciating and tend to happen as the weight is lowered to the chest. Although lowering a weight or your body may feel like the easier part of an exercise, it also creates a higher risk for injury because the muscles are both contracting and lengthening. This risk for injury is also heightened because lifters feel like the hardest part is done and are less focused, said Dr. Michael Maloney, a sports medicine doctor and orthopedic surgeon at the University of Rochester. Other examples of this kind of risky movement include lowering the bar to the ground during a dead lift, walking or running down a hill, lowering your body during a pullup or returning your torso back to the ground during a sit up. To avoid this, work on maintaining focus through the entire exercise.
Be mindful about running frequency
In his own clinical practice, Matava treats injuries from weight lifting and running most often. “Of the two, I probably see running the most,” he said. The bulk of these injuries are overuse related. “For running, it’s the rule of too’s,” Matava said. “Too many miles, too many hills, too little rest.”
One common issue in runners is knee pain, specifically patellofemoral pain syndrome, often called “runner’s knee.” Runner’s knee is thought to be nerve irritation caused by a muscle imbalance between the quadriceps, hamstrings and hip muscles that skews the kneecap. To prevent it, build up your mileage gradually and incorporate regular strength training. The good news is that although runner’s knee is an issue, research shows that running may serve to strengthen the cartilage of the knees, with runners less likely to develop arthritis than their non-running peers.
Another common overuse injury among runners is stress fractures. This often happens when a runner tries to add too many miles too quickly, without taking enough rest days. The impact of running causes microfractures in the bone, which, when given time to heal, lead to stronger bones. However, if a runner starts running more miles, without taking rest days, these microfractures build up to the point of injury.
Both of these injuries tend to happen because runners “did something out of the ordinary compared to what they were trained to do,” Matava said. Typically, he will see such stress fractures in people who just started running, or who decided to quickly ramp up training. A good rule of thumb is to limit mileage increases to less than 10% a week.
Use caution in dynamic movements
One of the most common acute, sports-related injuries is a meniscus tear, which at least 10% of people will experience during their lifetime. The menisci are discs of cartilage that act as shock absorbers, located on the ends of the thighbone and shinbone. Most tears are caused by degeneration of the cartilage, which makes it more susceptible to injury, and can happen during squatting or twisting motions, such as box jumps or weighted squats, or while playing tennis, soccer or basketball.
Meniscus tears often happen during dynamic movements. The risk of injury increases when these movements are performed too fast, with too many pounds or without having practiced the movement enough. For example, with squats, if a person has “too much weight, and they go down too deep, the meniscus can tear,” Matava said.
As with other injuries, the risk increases toward the end of a workout, when fatigue starts to set in. Shroyer learned this lesson the hard way when she pushed herself too hard powerlifting. “I was getting tired, but I told myself, ‘You can do another set,’” she said. Instead, she tore the cartilage at the end of her femur, an injury that required surgery and six weeks of immobilization.
When it comes to making progress in the gym, there is a tension between pushing yourself to get better and pushing yourself toward an injury. Shroyer’s advice is to focus on the idea that “next week, I can do more, because I have allowed myself time to recover,” she said. When it comes to a workout routine, she recommends blending consistency with a gradual progression.
“I always encourage people to do something that they are confident in doing,” Shroyer said. “Take it slow but do it anyway. Exercise can put someone at risk of injury, but not exercising puts someone at risk of poor health.”
This article originally appeared in The New York Times.