bodybuilding common injuries with Jason

Bodybuilding Common injuries, fixes and how to break plateaus

Is Bodybuilding the final frontier to utilize sport science?

Bodybuilders know the grind, thousands of hours of pain and sacrifice all in the pursuit of physical perfection. Like most athletes, body builders typically started their journey with love, love for the sport and its physical and mental benefits.

This hobby became an obsession and the quest for physical perfection the goal. But when did this hobby become a purpose? Who should I seek for advice? Why am I plateauing? All great questions, but unfortunately all tend to be answered by gym “bro-science” or instagram research.

At the English Institute of Sport I was one of a six man Sport Science team who’s sole mission was to help our athletes be the best in the world.

So what is a Physiotherapist and how does it differ from a sports or massage therapist? 

A question I get asked all too often and the answer is simple… its knowledge. 

Physiotherapy is a degree in human mechanics i.e. a deep understanding of how the body works.

Using this knowledge allows us to identify “how” and “why” something is dysfunctional and not simply what is sore.

Bodybuilding requires you to push the envelope and squeeze out every ounce of potential. As a result injuries are part and parcel of constantly working at the limit of your ability.

The key to a good therapist is not simply using their knowledge and experience to “fix the injury” but identify why it happened and adapt your training to prevent it happening again (make a weakness a strength).

This is how we seek to achieve a performance impact. The mantra of a true “Sports Physio”; “Can we help you smash plateaus, reach new personal bests and provide clarity improving physical performance?”.

If you are experiencing pain or noticing a muscle isn’t firing properly, that’s dysfunction. It means that the muscle/ joint/ tendon isn’t working properly. So yes, it’s causing pain, but it will also be hampering your training. 

And this is why it’s critical we break the loop of train… get sore… release and repeat.

To get new outcomes your need to modify your input… i.e. you can’t train the same and expect different results.

Three common injuries and fixes;

  • Anterior (frontal) shoulder pain.

Often due to trapping the Supraspinatus or bicep tendon and inflaming the bursa.

This typically occurs because Pecs and Upper Traps are over active and Serratus Anterior and Lower Traps are weak.

This tilts your shoulder blade forwards and traps the tendons between the ball and socket joint.

FIX: strengthen Serratus and lower traps, increase Pec mobility, take topical anti-inflammatories (Check with GP), review your rotator cuff and try and include free weight pressing when symptoms allow strengthening shoulder stabilisers. 

  • Golfer’s and Tennis Elbow.
    Likely because you are curling a weight too heavy for your wrist to hold… 

These are most commonly a break down issue and an acute injury… i.e. only a tendon that can’t cope with the stress placed upon it breaks down and becomes tendonopathic.

SOLUTION: avoid preacher curl as this promotes excessive wrist flexion and although it can allow a heavier curl it can over stress your wrist. 

Add in some wrist rehab. Slow, negative wrist curls or Olympic bar twists (to load the common flexor and extensor tendons.Go to free weight bicep curls, set your shoulders back, imagine tucking your blades into your back pockets, and avoid full wrist flexion. Don’t worry if the weight goes down… your body responds to load so if it’s hard work it’s still working.

  • Back Pain… typically because of weak and tight hamstrings, poor mobility with squat/ deadlifts and weak core… i.e. you are bending in the middle.

Address but wink with sissy squat, avoid smith machine and go technical phase (lighter weight but addressing compensations) … achieve good depth pain free without adapting and then increase weight. 

Technique is key here. You don’t have to be “text book” perfect but you do need to be efficient in your lift. Imagine squatting on a trampoline, you can’t achieve as heavy a lift because your base is unstable… well butt wink, forward moving bar and collapsing knees are simply another form of instability… tighten these up and you’ll be able to lift heavier because you aren’t wasting energy dealing with a wobble.

  • Don’t be afraid of sport science! 
  • Athletes don’t rest… they adapt.
  • Build a team and seek advice to help steer your journey.
  • Ask questions; “why is this sore?”, “why have I plateaued?”
  • Remember, problems made in the gym are fixed in the gym.

Injury Prevention (the warm up and cool down)

Injury prevention (the warm up and cool down)

Whatever the level of intensity of your exercise; it is important to warm up and cool down. Both stages of these are imperative in injury prevention. 

A lot of people know the importance of this, however few go through this process, and even fewer know the difference between warming up and cooling down. 

The warm up!

Why?

  • Warming up increases the blood flow through a process called vasodilation (expansion of the blood vessels)
    • This helps to increase oxygen supply to the muscles and therefore helps to prevent the build up of lactic acid
  • It also allows the muscles to be more easily stretched
    • This improves dynamic flexibility (flexibility during movement)
    • Decreases the risk of tearing muscle at the end range of movement
    • Improves your muscular efficiency which helps to reduce fatigue
  • Prepares the cardiovascular system and respiratory system for more intense exercise

How?

  • It is important to warm up broad areas of the body rather than too specific initiall
    • This can be done through gentle walking or cycling
  • The warm up should also be dynamic  (Stretching with movement)
    • This prepares the body for activity
  • Sport specific drills – i.e gradually increasing the intensity or ferocity of tennis shots if playing tennis

Examples:

  1. Toe walk
  2. Heel walk
  3. Spiderman walk
  4. Straight knee walk
  5. Spinal rotation
  6. Shoulder circles

The cool down!

Why?

  • The cool down is important to aid in a gradual return to normal heart rate
    • This also allows the body temperature to return to normal more gradually
  • Cooling down also allows more effective disposal of waste products from exercise such as lactic acid
    • This helps decrease the risk of cramping and stiffness for the following 48 hours
  • Helps reduce the pooling of blood in the larger muscles that had been used during exercise
    • This helps to reduce the risk of dizziness or fainting after exercise
  • Helps return muscles to a less contracted state and avoid chronic over shortening
    • This helps reduce the risk of muscle tears during injury

How?

  • It is important to gradually decrease your exercise intensity with gentle cardiovascular exercise 
    • This can be achieved through gentle jogging, cycling etc after exercise
  • It is important to use a longer duration stretch of the muscles whilst cooling down
    • This should be done quite broadly and not just the major muscles used during the exercise
  • How long should you hold a stretch?
    • The research is varied, and there appears to be very little general consensus – however most research does summarise with the importance of stretching after exercise for the reasons mentioned above
    • Most recommend stretching for somewhere between 15-45 seconds per muscle group; 30 seconds is a good average

Examples: 

Calf and Hamstring stretch

  • Straighten the leg that you are trying to stretch in front of you whilst leaning forward.
  • You feel the stretch in the back of your leg. 
  • Hold this stretch for a minimum of 15 seconds but preferably 30. If you start to get pins and needles reduce the stretch.
  • If you pull/curl your toes upwards, the stretch will localise more in the calf.

 

Gluteal and stretch

 (if this hurts your back, reduce the stretch or stop). 

Laying on your back, bring one knee slightly up and then pull the knee towards your body. You should feel a stretch within your buttock region. Hold the stretch for 15-20 seconds before taking it to the next point of stretch. \

Seated Low Spine Stretch

  • Sitting on your chair, bend forward to a point where you feel stable, but also feel a stretch within the lower section of your spine. 
  • Ensure this stretch is not painful and hold it for 20-30 seconds. Take a deep breath in and push slightly further – again ensuring that it is not pain. 
  • Repeat this process three times.

Quadricep and hip flexor stretch

  •  Bend your tight or painful side so that your leg is up against the back of a sofa or chair, with the side that you are no trying to stretch in front of the chair. Lean your body forward to create the stretch. Hold the stretch for 20-45 seconds, focusing on your painful side. 
  • It would be worthwhile performing these exercises both sides, but focusing mostly on the painful side. 

Cat-cobra stretch

  • Go onto all fours assuming a position with a flat spine. 
  • From this position curl your upper back, sucking your belly towards your spine.
  • Return to neutral before arching your back keeping your belly sucked in.
  • Repeat this 10 times ensuring good control of your back during the exercise.

Shoulder/Pectoralis stretch

  • Find a door frame or wardrobe.
  • One arm at a time, place your flat palm on the surface.
  • Rotate your body to 45 degrees away from the wall, keeping your arm straight. This should create a stretch in the chest.
  • Hold the stretch for 30 seconds.
  • Take a deep breath in and rotate your body slightly further away as you breathe back out.
  • Repeat this process a further 2 times.

The Breaking the Push Plateau Shoulder Exercises

The Breaking the Push Plateau.

The bench-press: for some the most important piece of equipment in the gym and a staple exercise for all.

It’s the piece of equipment we gravitate towards during our first visit to the gym, an early strength comparison with our peers and a measure of success for our pain and sweat. 

Its also sculpts a great chest!

Because this is our early focus we start creating a shocking muscle imbalance from day one! 

Good shoulder health and function requires balance; its like a tug of war we don’t want to win, but when everyone pulls we stay centred.

When focusing on muscle groups that provide the best aesthetic (pecs, upper traps and lats) we leave behind the muscles that control the shoulder itself; serratus anterior, lower traps and the rotator cuff.

These muscles are often the key to smashing through any bench press plateau and will assist in resolving frontal shoulder impingement pain (trapping the tendons) by controlling the angle of the socket and so opening up the joint (sub-acromial space).

Your shoulder is a complex pulley system that has 17 muscles attached to the scapular (blade) alone. 

Imagine building a rally car; focusing mainly on power muscles is like upgrading the horsepower but leaving the steering and breaks at factory settings. At some point this imbalance will limit your ability to set a better lap time, or you’ll be let down and break as your speed exceeds your control.

In most cases a bench press is limited by three things:

  1. Poor technique:
    • This means not being efficient in how you transition the force of the press (you aren’t moving the bar from A to B in the best way).
  2. Muscle imbalance: 
    • Some of the muscles involved in the movement can’t keep up with the more developed ones (it’s no good if your pec and triceps are strong enough to press the weight if your cuff is struggling to hold the joint together under the weight).
  3. Pain:
    • Often due to trapping the supraspinatus or bicep tendon and inflaming the bursa typically because pecs and upper traps are over active and serratus anterior and lower traps are weak.

This tilts your shoulder blade forwards and traps the tendons between the ball and socket joint.

Like any muscle we need to apply sufficient load and stress to create training adaptation. 

The key muscles that support the shoulder:

Rotator cuff

Comprises of 4 muscles that rotate the arm and more importantly, act as the power steering for the shoulder joint (they control the movement).

They originate on the scapula (shoulder blade) and attach to the humorous (arm). They look to keep the ball, centred within the middle of the socket during arm motion. 

Imagine as you press the bar up, gravity and the weight of the bar are pushing back down into your shoulder, effectively trying to push the ball out of the back of the socket. 

It’s your rotator cuff that is acting to keep the joint together and control the direction of the bar.

Exercises:

 

  • Cable rotations:
  • Set the cable pully to elbow height, keep shoulders pinned back, elbow tucked into the side and pull the cable across your body horizontally.
  • Don’t let pecs engage!
  • Repeat a pull into the body until fatigue and then turn 180 degrees and repeat pulling out and away from your trunk.

 

 

  • I am not worthy:
  • Hold a pair of light dumbells, (start with 3kg), at head height with your shoulders at 90 degrees, elbows bent and your thumbs pointing at your ears.
  • Perform a straight leg deadlift keeping your thumbs in line with your ears and your elbows back throughout, i.e. resist gravity.
  • Hold for a few seconds and repeat: try and make the whole action take 8-10 seconds.

 

  • Flying “V”:
  • Buy a loop band that’s approximately 12 inches long.
  • Put your hands inside with elbows bent and thumbs pointing out.
  • Apply tension to the band taking your wrists out wider than your elbows, thus creating a “V”.
  • Lift the “V” into the air and don’t let your elbows come out.
  • Don’t lose the “V” shape!

Do’s:

  • Ensure your have a cuff strong enough to tolerate the weight you are able to push: these aren’t anecdotal exercises but how your arm is attached to your body.

Don’t

  • Stand holding a pair of dumbells and rotate your arms. The line of force is straight down and so not as effective: instead try the above.
  • Perform fast jerky movements. These muscles are stabilisers and so need to be exercised with control.
  • Let dominant muscles like pecs and upper traps take over.

Serratus anterior

This muscle looks like fingers that reach around your ribs and under your pec.

Its job is to keep the shoulder blade flat to the chest wall.

If your shoulder blade is winging at the back you are closing down the space at the front and so creating impingement and a sub-optimal socket position to press from. (NB true winging is a nerve injury and should be diagnosed via nerve conduction studies: see your GP or registered health professional).

Exercises:

  • Straight arm push up:
  • On your hands and knees, keep your elbows straight and lower your chest, squeezing your shoulder blades together. Now push away taking your chest up, shoulder blades go wide and keep your elbows straight.

 

  • Bear crawls:
  • On your hands and the balls of your feet, walk up and down on all fours pushing the ground away as you go.

 

 

  • Straight arm press:
  • Lie on your back with your arm vertical and a dumbbell in hand, keep your elbow straight and push up, lifting your shoulder off the floor.

Do!

  • Check your shoulder blades. If they are winging you need to add in this rehab or see a registered professional. 
  • Practice the action of shoulder protraction. Learn what it feels like to activate and squeeze this muscle. Chances are you will find it tricky at first if you have an underactive serratus.
  • Add the serratus squeeze into your bench press action.

Don’t!

  • Confuse this with simply pressing the arms.
  • Give up. You have spent years developing pecs that are strong enough and tight enough to create this issue: the fix will take time too.

Lower trapezius

This anchors your scapula, assisting with reducing “winging” and also helps to keep your shoulder blade retracted, thus opening up the front and preventing impingement.

Exercises:

 

  • Straight arm chin ups: 
  • Hang from a wide arm bar.
  • Keeping elbows straight, pull your shoulder blades together and down lifting your trunk a few inches into the air.

 

  • Seated row:
  • Perform a seated row thinking about keeping an open chest and pulling your shoulder blades back and down.
  • A coaching point would be to visualise your nipples going up and out as you squeeze the blades back and down.

 

  • Over head TRX Y’s:
  • Holding the TRX with both hands over head and facing the rig, lean back.
  • Then, focusing on the same shoulder blade “back and down” pull your arms back above your head returning you to the upright starting position.
  • Don’t Shrug!

 

DO’s

  • Focus on putting shoulder blades in your back pockets, pulling back and down.
  • Visualise nipples moving up and out.
  • Enjoy the delayed onset of muscle soreness that’s coming your way.

Don’t

  • Shrug!!! Avoid upper traps kicking in and taking over!
  • Going too heavy too soon, there is a skill to learning these movements: nail that and the weight will fly up!

Finally, this isn’t always a question of strength. Muscle patterning (i.e. when and how much a muscle fires during a sequence of movement) plays a key role here.

You might simply be in a bad habit, like having a limp, therefore addressing this poor movement pattern can provide startlingly quick results once you regain an optimal movement pattern and lose the “limp”.

It wont be painful if it’s working properly and the better it works, the heavier the push! 

Jason Beaumont BHSc Hons, PG Cert, MCSP, HCPC

Jason is a Director at Regen Physio ltd based out of Ultra Flex Gym York and Normanton, Clinical Director at Regeneration Physiotherapy ltd and former Head Physiotherapist at the English institute of sport. His Sport C.V. includes, 

  • 3 years Head Physiotherapist for Paralympic Table Tennis, (including Rio 2016 Paralympic Games)
  • 4 years English Institute of Sport contractor Physiotherapist with GB Boxing, Swimming and Multisport
  • 2 years Head of Medical Services for England Women Rugby Football League (including the 2013 World Cup)
  • International travel with the Professional Squash Association