Preventing Injury in Female Bodybuilders

Preventing injury in female bodybuilders:

By Coby VandenBerg

Why do we lift? For bodybuilders it’s the gains. But for most of the population they want to “slim down,” “get in shape” and/or “be healthy.” As research shows there are many health benefits to lifting; increased bone density, increased lean muscle mass, increased/balanced metabolism, maintain/improve joint mobility, improve movement patterns and coordination, decreased body fat, reduces the risk of diabetes and cardiovascular disease, increased brain activity and reduced anxiety and depression (Fisher, Steele, Bruce-Low et al, 2011; Baechle and Earle, 2008; Cook, 2003).

So what happens when its 7pm, almost timeto head to the gym, but you’re still really sore from yesterday morning’s workout? Many may say, just push through it! That may not always be the smart thing to do. According to Alan Mikesky, PhD (Quill, 2010), if your muscle is sore to the touch, it is best to give it another day to recover. However, David Docherty, PhD (Quill 2010) goes on to say that if the soreness is less severe, then “active rest” is the way to go; such as light aerobic activity or lifting. Steer clear of a heavy workload.Docherty states the active rest will stimulate blood flow, and help remove some of the waste products causing the soreness, and stimulate the repair process.

It is clear, there are many benefits to lifting, so why is it that I hear of fellow bodybuilders nursing injuries caused by doing something that is supposed to prevent that? Too much working out and not enough listening to your body or providing it with proper nutrition and sleep canhave a negative effect on our health. You will notice your body wearing down, feeling more tired, maybe even sluggish.

When we lift, we create micro tears in our muscle(Jacob, 2014). Don’t freak out, this is a good thing. We want to create those micro tears, so that our muscle will recover and hypertrophy. But, in order to ensure sufficientmuscle repairwe need to fuel the body with proper nutrition and adequate sleep. This is an article about injury prevention so I will keep it short regarding this subject. According to the sleep foundation, during certainstages of our sleep cycle, the body is able to provide increased blood to our muscles, and aid in tissue growth and repair. However, if you don’t allow your body to get to that stage, or have enough time in it, then you will not be able to fully repair the damage done during the previous workout; instead you will add to the damage, putting yourself at risk for a more serious injury.

Another large part of preventing injury is body awareness. Forget “No Pain, No Gain.”; pain is your body’s way of telling you that something is not right (Cook, 2003). It may be injury (overuse, or acute) or a muscle imbalance. By trying to push through the pain it is likely that movement patterns will be distorted, promoting compensation and increasing abnormal stresses in other parts of the body, which puts your body further out of balance and at risk for more injury. Instead find a pain free alternative or switchyour lifting schedule to give that body part more rest until the next workout session. It is much better to take a couple days now, then to be out for weeks.

Shoulder:I get a lot of people coming to me asking about some shoulder pain they are experiencing. Usually it is associated with a rotator cuff (RC) or biceps tendon injury. The RC is made up of the Supraspinatus, Infraspinatus, Teres Major and Subscapularis muscles. As you can see in figures 1 and 2, these tendons have a very small space to live in, and when inflamed can cause pain with motion. Continuing to train hard without resting will only increase the irritation. As bodybuilders we strive for beautifully rounded and defined shoulder caps. The shoulder isn’t made up of large muscles like the legs. There are many “little” muscles involved in shoulder exercise movements, and to prevent injury while lifting big weights, you must not ignore these other muscles. These muscles are working with every arm raise and lower. Without the proper movement patterns about the shoulder joint you won’t be able to adequately train the shoulder muscles you’re trying to target, which will lead to compensation, muscle imbalance and possibly a torn RC.

Here are some exercises to help gain body awareness and strengthen those little muscles.

Shoulder Prehab/Rehab Exercises:

• Incline Y Raise: Lying face down on an incline bench. Grip two dumbbells, palms facing each other. Pull your shoulder blades down and together as you raise your arms up in a “Y” position until they are in line with your shoulders. Think of pulling the tips of your shoulder blade down your back. Don’t let your upper trap do all the work (when your shoulders migrate up to your ears). Here is a good video
• Prone/Incline T Raise: Again lie face down on an incline bench. Grip two dumbbells, palms facing forward. With thumbs up raise your arms out, as you squeeze your shoulder blades together. Focus on bringing the medial border of your shoulder blades toward each other, not putting too much emphasis on the upper trap muscles. video
• Dumbbell Side lying External Rotation: This exercise is most effective when lying on your side versus standing (unless you are using it as a warm up). As depicted in Figure 3, you want to keep your elbow at a 90deg angle. Start position is down, against the stomach. As you externally rotate the shoulder, keep the elbow in your side. If your shoulder mobility is compromised, you may not be able to get your wrist perpendicular to your side, don’t force it.

Training to prevent injury:Behind the neck exercises will put extra strain not only on your neck, but shoulder ligaments as well. If you have a shoulder injury and the bench press bothers you, as it does in most cases, then stay within a pain free range of motion (if you are able to do so with adequate range to allow for benefits of the lift), or do dumbbell bench, maybe on an incline, and/or with palms slightly turned in. But remember rest may be your best answer.

Knee:Many of the more serious injuries that occur with the knee (i.e. ACL & meniscus tears) are due to more dynamic movements, such as running and cutting, and may not be as prevalent in a gym setting. However that doesn’t mean bodybuilders are not susceptible to knee injuries. Aside from the ligament tears or patellar (knee cap) dislocations, many active individuals experience inflammation of certain tendons (tendonitis). The Iliotibial band (IT Band) and patellar tendon are common sites for this to occur (Fig.4). The insertion point of the IT band is generally where this irritation will begin to develop (Prentice, 2003). While some may experience it higher, at the muscle attachment (Tensor Fasciae Latae) the reason for the irritation at this point, by the knee, is due to the constant friction created between the IT band and the bones. The best way to alleviate this pain is to decrease the inflammation and stretch (Prentice, 2003) (Fig.5).

Jumpers knee (PFPS) is an inflammation of the tendon connecting your quad to your lower leg, creating a movement arm that allows us to bend and straighten our knee. This pain can be intensified when we run, jump, walk up stairs or even with seated quad extensions. If you find that your treadmill cardio session is causing pain, think about the fact that when you run, you create forces through your joints at about 2-3x your bodyweight! That is a lot of pounding.You may see people wearing straps around their knee, which is to disperse some of the forces so it is not all being absorbed by the tendon, this can be a useful tool.Other ways to help alleviate pain is to decrease inflammation (stop doing things that irritate it!) and stretch. Quad and IT Band stretches are both helpful in this situation.

Training to prevent injury: PFPS doesn’t mean you have to stop squatting. In fact, deep squats are preferred as it allows for greater range of motion- remember the quad is often tight because we aren’t stretching and strengthening the full range. Make sure the weight is appropriate to properly perform a deep squat, because when you compensate you encourage improper movement patterns, which can lead to injury. As for cardio, there are many alternatives to the treadmill. I especially like swimming and the elliptical as they are much easier on the joints.

Back:Low Back Pain (LBP) is one of the top 5 reasons for an individual to seek medical attention. Generally, the first course of action for people experiencing LBP is through exercise therapy. Well, for most of you reading this, the gym is your second home. So what is missing? Why would you be hurt while working out, something that is supposed to help reduce that risk? Well, form and core strength may be the culprits. Proper form is essential especially with Olympic lifts. Sometimes we just want to go heavy, see what we can do, challenge ourselves and hit a PR. But if increased weights causes you to have poor form you are just asking for injury. Back the weight down. Become efficient at the movement, and then add weight. Or maybe the weight isn’t the sole issue. Maybe you have a weak core. I am not saying you don’t work your abs, religiously, multiple times a week, because yourpersonal trainer makes you. I am talking about the deeper stabilizing muscles; transverse abdominis (TA) and Multifidus (MT). These muscles, with help from the erector spinae (ES), rectus abdominis (RA) and external oblique(EO) are your main spine stabilizers; they play a very important role in posture and back health (Fig. 6). Without the proper contraction/co-contraction of these muscles you will experience decreased spinal stability, and when you have the bar loaded on squat day, you don’t want to have decreased spinal stability (VandenBerg, 2011).

Core Exercises: In most LBP rehab programs patients are first asked to master the anterior pelvic tilt. With this move you increase body awareness of the activation of the TA (Fig.7). This move also helps you find your neutral spine. A spinal alignment that allows for correct muscle contraction/co-contraction without over or under exaggerated spinal curvature. You will notice this will be helpful not only in the gym while performing lifts (especially Olympic lifts and exercises while standing), but will translate into all areas of your life as you begin to stabilize with the TA instead of your back musculature. Other useful exercises are bridges, dead bug, bird dog, superman and back extensions.

• Pelvic tilts are performed by activating the TA to draw your belly button towards the table/floor and rotate your hips, so that your low back flattens against the floor/table. This is a subtle movement. You should not be pushing through the buttocks or back. Movement is created with the activation of the TA. You can feel if you are engaged by pressing your fingers into the stomach about 2 in away from belly button (Fig. 7)
• Bridges (Fig 8): Lying face up, activate the TA, press your hips up towards the ceiling until your hips, knees and shoulders are aligned. Slowly lower, to return to start position.
• Deadbug (Fig. 9): Lying face up, engage your TA. Then raise your legs up to table top position and your arms up towards ceiling. While maintaining a neutral spine, extend one leg and the opposite arm. As you alternate the movement, do not let your back arch. Maintain position through core activation. This exercise has multiple progressions which may be used.
• Bird Dog (Fig 10): Similar to the deadbug, except you’re starting positing is up on hands and knees. Still engage the TA (draw that belly button towards your spine/the ceiling). The important part in this exercise is to maintain level hips as you alternate movement of opposite arm and leg. Again this exercise has multiple progressions if necessary (i.e. arm or leg only movement).
• CatCow: great stretch for the back. Arch back, lift head up, tuck chin and round back (Fig 11).

In conclusion, most bodybuilders understand the importance of getting into the gym, and how to eat right. But that isn’t enough, and I do see injury among us. To prevent injury, we need to remember to train smart, listen to our body, and get adequate rest. I hope you found this article informative. If you have questions or comments you can reach me on twitter: @fitATC

References:

1. Baechle, T. R. & Eearle, R. W. (2008). Essentials of Strength Training and Conditioning (3rded.). National Strength and Conditioning Association. Champagne, IL: Human Kinetics
2. Cook, G., (2003) Athletic Body in Balance. Champagne, IL: Human Kinetics.
3. Fisher, J., Steele, J., Bruce-Low, S., & Smith, D. (2011). Evidence-based Resistance Training Recommendations. Med Sport 15 (3): 147-163. DOI: 10.2478/v10036-011-0025-x
4. Jacob. (2014). What Happens to Muscles After Lifting Weights? Retrieved from
5. National Sleep Foundation (n.d.). What Happens When You Sleep. Retrieved from
6. Prentice, W.E., (2003) Arnheim’s Principles of Athletic Training (11thed.). New York, NY: McGraw-Hill.
7. Quill, S. (2010). The Truth Behind 7 Muscle Myths, Men’s Health Magazine retrieved from
8. VandenBerg, J. (2011). Role of an Aquatic and non Aquatic Environment on Trunk Muscle Activation. Logan, UT: Utah State University
9. Wilcox, J. (2012). The Health Benefits Of Weightlifting And The New Science That Supports StrengthBuilding retrieved from