Injuries in Training: How to Manage Risk

Nobody plans on getting injured, but it is common and sometimes seems inevitable if you are in strength sports for the long haul. Lifting can certainly beat a body up, especially the ultra competitive who may be willing to roll the dice on intensity from time to time. So is there anything one can do to reduce the chance of injury?

If we want to prevent injury, we first have to broaden our understanding of what an injury is, and what may or may not contribute to its occurrence. Staying injury free is likely a result of reducing risk of overuse,and managing training volume through intelligent stress and loading strategies, rather than obsession with how movement looks (within reason). So, what is an injury?

What Is An Injury?

“This is quite a complex term to define…Overall, the consensus is around reporting of pain and/or dysfunction (defined as objectively measurable decrements in performance) by the athlete,” says Dr. Mike Ray (Doctorate of Chiropractic, M.S. Exercise Science), rehab clinician and coach (Barbell Medicine). “A major issue with such a definition, which is hinged just on pain – if the athlete has a misunderstanding regarding the premise of pain (threat detection system) as pain equals tissue damage equals ‘bad,’ then it is a real possibility he/she self selects activity for fear of pain and ‘injury’; which would mean they are injured because they think they are injured.”

Injury epidemiology studies such as this study on strongman injuries, used definitions such as “Injury was defined as any ‘physical damage to the body that caused the strongman athlete to miss or modify one or more training sessions or miss a competition.’” This is a solid working definition, but given that in that particular study, only about half the athletes ever saw a doctor, we don’t simply don’t know if what they think caused the injury actually caused the injury.(1)

If we want to stay really broad in our definition, injury is associated with a moment in time where we felt something out of the expected during a movement, and then pain occurred. Pain, of course, is not always very straight-forward.

kettlebell armbar
The author performing a kettlebell armbar

Pain Is Complicated

Injury may seem simple at first, like if an athlete feels intense pain mid-bench press and their pec rolls up; a complete tear having occurred, it seems pretty obvious what happened. But that is an extreme example and there are many injuries that are not this clear cut. How many athletes have a “cranky shoulder,” or non-specific low back pain that they believe coincided with a specific incidence, or that gradually came out of seemingly nowhere? Likely many, but there is not necessarily a clear cut relationship between an ongoing pain sensation and a perceived moment of injury, due to pain itself being a very complicated sensation that can be misleading.

Take for example, referred pain, which is when pain-signals become “confused,” in a mechanism that is not widely understood, like the when the left arm hurts during a heart-attack. One theory is that this has to do with a density of nerves converging and becoming over crowded at the spinal cord, and thus misdirecting or confusing the pain signal.(2)

If pain is complicated and our working definitions of injuries are hinged on them, that means…injuries are complicated and there is not an easily pin-pointed strategy of identifying them.

“This discussion can be further complicated by our inability to classify when someone is ‘injured’ based on image findings (x-ray/MRI/etc). We have a lot of data on the prevalence rate of musculoskeletal ‘issues’ in the asymptomatic population (no pain or dysfunction reported); which further muddies the water of a tissue issue necessitating the classification of injury and warranting treatment/intervention,” said Dr. Ray.

This means many large swaths of the population have herniated discs, rotator cuff damage, or other common issues associated with major injuries, but NO symptoms of pain or inability to perform – which means one particular issue, like a herniated disc, is not a clear-cut map to understanding what is injurious.(3)

Mike Ray deadlift
Dr. Mike Ray deadlifting

Why Do Injuries Happen?

What causes injuries? Well, what doesn’t?

The recent explosion in popularity of lifting in the last decade means that there is a demand more than ever for strategies for mitigating risk and intelligently progressing training. Unfortunately, there are many prevailing myths when it comes to what injures, such as specific exercises (I’ve anecdotally heard quite a bit of fear-mongering about movements like deadlifts, upright rows, various overhead movements, and leg extensions, for example),or specific forms, but there does not seem to be a lot of data to support these claims – that could in part be because strength athletes themselves have not been studied that much.

In the 2014 study of strongman injuries, the first ever for strongman athletes using more than one subject athlete, the authors noted that only 12 injury epidemiology studies have been done at all on lifters in powerlifting, weightlifting and bodybuilding, and in 2018 this study noted that NO studies have equally cross-examined male and female lifter populations.(4)

So while it remains unclear what the direct causes of injury are, the data we do have points slightly more toward injury being related to poor intensity management – lifting a weight that your tissues were unprepared for, due to potential factors like high training fatigue, overall stress, and high training load.(5)(6)(7)

Bodies are highly adaptive as well as highly diverse from person to person, and will adjust to the demands placed on it, provided the demands are scaled intelligently.

There certainly is an argument to be made for poor form being a contributing factor, as that is something that by nature would be hard to design a study for: Inefficient movement can lead to poor load management, due to the body shifting and straining to try to find a more optimal position, thus causing irregular loading or a sudden dramatic spike in loading an unprepared tissue, and thus causing an injury, but there is not one thing inherent in one particular position that determines injury. It may be more likely that injuries are caused by poorly or un-planned intensity increases.

It’s Not ‘Prevention’, It’s Risk ‘Management’

It is unlikely one can prevent injuries in the strictest sense; there are too many factors and of course, accidents happen beyond the individual’s control.

“A better and more scientifically based approach is risk reduction, which is now a discussion of probability. The way I typically discuss this is based on chaos theory,” says Dr. Ray.  What does mathematical theory have to do with injuries?

“For many, life appears as a state of randomness with little interconnectedness, but chaos theory postulates a different perspective and elucidates the interconnectedness of occurrences, and if we play close enough attention over time, then we will find patterns of connectedness ([also known as the butterfly effect, or Lorenz attractor). If we examine the data we have on athletic injuries, we find patterns of interconnectedness with correlation to risk.”

If injury is often correlated with overuse, fatigue and stress as much of the data suggest, then managing that stress/load/fatigue would the logical risk reduction strategy, especially given that these stresses can be psycho-social in nature – our minds interact with bodies to a deep degree.(7)

strongman front squat
The author performing a front squat

There is a training theory developed  by TJ Gabbetts called the Acute:Chronic Workload Ratio (ACWR). Dr. Pat Davidson (Ph.D, Exercise Physiology), former lightweight strongman, and current fitness educator, strength and conditioning coach, and personal trainer, believes it’s important to pay attention to consistent load management using such a system.

“A chronic training load is established once you have four weeks of data,and then the acute training load is the fifth week compared to the training load of the previous four weeks; the average of that training load,” says Dr. Davidson, “There is a numerical ratio he recommends you follow that should prevent you from moving into the realm of red-flags when it comes to injury likelihood,”

Dr. Ray made a similar point about RPE based training: “Overall, we should be cognizant of loading of the athlete, which is primarily being advocated for by tracking Rate of Perceived Exertion (RPE) and Acute:Chronic workload ratios (ACWR)….Fatigue will be accounted for by monitoring external intensity (objective measurement of load being lifted or training demands) and internal intensity (subjective how hard the athlete views a particular training session – measured by RPE and session RPE).”

In order to progress, an athlete must build up training intensity with progressive overload, but too much too soon and we potentially tread into injury territory. High intensity training is not necessarily a problem in and of itself if one can get there gradually safely.

So what sorts of methods can we utilize to manage the intensity and increase it intelligently?

Workload Consistency

Keep workload consistent. Even if you are coming off of a deload post-meet deload and feel fresh, your body is likely not used to high training volume. You’ve deloaded your volume, which, according to Dr. Davidson, is a risk factor.

“I keep people on a fairly normalized training load, and if I’m trying to introduce things to them, I don’t introduce too much too soon, or I don’t totally back them off too far…I have to respect what seems to be emerging as important data on this ratio…it’s almost like, you’ve been prepared for what you’ve been doing, and if you haven’t been doing it consistently, you aren’t really prepared for it, so you have to be really aware of these drastic drops or spikes in what you’re doing on a weekly training basis.”

Reload After Deload

Following this line of reasoning, a risky time for a strength athlete could be immediately following a deload after a big meet – after meets, emotions are often high, and personally, completing a big contest usually really stokes my desire to get back to the gym and train hard.  But this is a risk factor, as my gradual volume has likely DECREASED leading into the competition, and my body might not be ready to jump back into a 5 day high volume training week, even if I feel fresh.

Davidson said, “They might not hurt themselves week one, but it’s very likely that they’re gonna start having problems week two or week three…when someone is peaking for something, their training volume is going to decrease as their intensity stays the same or increases as they’re getting close to their competition, so even if they go right back to normal training right after a competition, it might be a spike in terms of overall volume.”

Take your time increasing your volume after time off, and you can gradually re-sensitize yourself.

Novelty Can Be A Risk

Beware novelty. You could keep your training load consistent, but novelty can act the same way as an intensity spike if not approached strategically.

“Novelty is….something that could be associated with injury, and I think that this is an important concept for a lot of strongman athletes to get their heads around,” said Davidson.

“Maybe you’ve been doing pressing, but you haven’t been doing pressing with a block, so…it is novelty. Or you’ve been deadlifting, but you haven’t been deadlifting with whatever implement is coming up in the next show…make yourself accustomed to the new thing you’re going to have to work with, and do it in a fairly respectable manner. Again, that involves being to just establish where you’re at today. You don’t have to be good every day in a sport like strongman, you only have to be good on ONE day.”

That said, novelty can also be introduced as risk mitigator if done slowly and intelligently.

Start Slow and Use Novelty As a Deload

When starting up again after a long break, like coming back from an injury, the desire to “get back to where I was” can be pretty overwhelming. Tempering that desire is important from an injury-risk standpoint. A new movement can help act as a forced deload, provided you focus on learning the new movement, and not overloading it.

On deload strategies, Dr. Davidson said, “Novelty’s a great deload, but respect the fact that the loads will probably be backed off…if it’s a new movement, if you respect the fact that you’re probably not good at it, you learn how to do it; it is a deload from the standpoint of intensity.”

A powerlifter coming off of an intense meet prep might benefit from less frequently utilized squat, press and deadlift variations, unilateral work, or training in different planes and stances to address smaller muscle groups and areas that may get neglected in the last few months and weeks of peaking.

Chill Out

It should come as no surprise that our mental and emotional well-being is a stress factor that can and does affect our physiology and thus our training performance. Just based on my experience training clients, I have seen people come in and crush it on no sleep and poor nutrition because they were having a great week and feeling good, and I’ve seen people be adequately rested and fed but suck at everything and have no extra “Go” in them because they’re depressed and anxious about work and their relationships and so on and so on. The Ivarsson study reviewed 48 studies on injuries “to examine (i) the effect sizes of relationships between the psychosocial variables (suggested as injury predictors in the model of stress and athletic injury) and injury rates, and (ii) the effects of psychological interventions aimed at reducing injury occurrence (prevention),” and concluded that “that psychosocial variables, as well as psychologically, based interventions, can influence injury risk among athletes.” (7)

Overall, taking care of your mind and soul and treating your mental stress the same way as your body is a good tactic if you want to mitigate injury risk.

Basics and Tracking

Good form and efficient movement are also risk mitigators. “And of course, I do think that just having appropriate technique with your movements is critical. Gain a foundation of the basics in the beginning…a really solid foundation of the movements that are associated with whatever barbell or iron sport that you participate in,” said Davidson.

The more competent you are with a movement, the more consistently you will load the involved tissues, the better they will adapt. And any lifter, from novice to elite, can execute the relatively simple tasks Davidson associates with injury prevention:

“Have a managed measured training load that you keep track of, and respect that novelty can be both a deload and, if you do too much too fast, something that could be problem for you.”

Track your volume, increase it an appropriate rate, take care of your mind and emotions, and watch out for shiny fun new lifts.

Editor’s note: This article is an op-ed. The views expressed herein and in the video are the author’s and don’t necessarily reflect the views of BarBend. Claims, assertions, opinions, and quotes have been sourced exclusively by the author.

References

1. Winwood PW, et al. Retrospective injury epidemiology of strongman athletes. J Strength Cond Res 28(1): 28–42, 2014
2. Greg M. Murray. Referred pain. J Appl Oral Sci. 2009 Dec; 17(6): i
3. Lederman. The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain. CPDO Ltd., 15 Harberton Road, London N19 3JS
4. Strömbäck, MSc, et. all. Prevalence and Consequences of Injuries in Powerlifting: A Cross-sectional Study. Orthop J Sports Med. 2018 May; 6(5): 2325967118771016.
5. Jones CM, et al. Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies. Sports Med. 2017 May;47(5):943-974. doi: 10.1007/s40279-016-0619-5.
6. Eckard TG, et al. The Relationship Between Training Load and Injury in Athletes: A Systematic Review. Sports Med. 2018 Aug;48(8):1929-1961. doi: 10.1007/s40279-018-0951-z.
7. Ivarsson A, et al.  Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention. Sports Med. 2017 Feb;47(2):353-365. doi: 10.1007/s40279-016-0578-x.

By Cara Brennan from BarBend

bengarves

Editor-in-Chief and founder of WeRCrossFit.com. Web developer for the stars of CrossFit, and all-around fitness enthusiast and fan.

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