Workout advice for gain without pain

From back twinges to shin splints, the injuries from working out are many but basic techniques can help to avoid them.

The trend for extreme fitness means a lot of people are overdoing it and paying the price. Pictures: iStock.

For every person content to lounge on the sofa, it seems there’s another who is not satisfied with joining a gym and wants to push through the pain barrier of a hellish obstacle course or triathlon. We are a nation with disparate ­fitness goals, but while couch ­potatoes face impending doom in the form of a raised risk of heart disease and diabetes, the aspirationally athletic are encountering their own set of health issues: ­injuries that threaten to cause long-term harm if left untreated.

Hardcore workouts and high-intensity interval training sessions have contributed to a shift in our perception of what is required to get fit. A survey of more than 4000 people from across Britain, commissioned by Bupa health clinics, reveals that more than a quarter of gym-goers assume that they have had a good session only if they feel pain during or after it.

Matt Todman, the director of Six Physio in London, says the trend for extreme fitness, in terms of gym classes and endurance challenges, means a lot of people are overdoing it and paying the price. “A lot of these things are fine but people are diving in to do too much too quickly,” he says.

Todman says neglecting to treat injuries is more of a risk as you get older. “In your 40s and 50s your muscles and body are less ­resilient and less compliant than in your 20s,” he says. “Not only are you more likely to suffer an injury in the first place but the implications of it are ­greater if you don’t take action. It could mean long-term pain and problems.”

It’s boring but a proper warm-up can help you to avoid injuries. The results of a 2011 study by the Feinberg School of Medicine at Northwestern University, Chicago, showed that a 20-minute routine, including some balance and agility exercises, lessened by as much as 50 per cent the chance of getting a lower-extremity ­injury, including ankle sprains and anterior cruciate ligament tears. Todman says you can do less for the same benefits.

“You need to get really hot and sweaty for a warm-up to be beneficial but that can be as little as five to seven minutes of activity,” he says. “One of the best injury-prevention exercises you can do is to stand on one leg for 90 seconds, three or four times a day. It ­improves balance, leg strength and ankle strength.”

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Spinning

Group of people in a spinning class a the gym

Common injury: Lower-back pain

Cause: A lack of hip flexibility is an underlying cause of back pain in indoor cyclists. “We tend to have a limited range of hip motion ­because of our sedentary life­styles,” Todman says. “We don’t very often raise our knees towards our chest in the way we do when ‘spinning’ and the pressure of doing it repeatedly can lead to back pain.” Pushing through the pain barrier in a class can also be problematic. Studies at the University of Limerick have shown that when a cyclist’s hamstrings and calf muscles become tired, it can trigger changes in muscle movement patterns and spinal posture. The more fatigued a cyclist becomes, the more they hunch forward and splay their knees, putting pressure on the lower back.

Prevention: It’s crucial to maintain hip flexibility, Todman says. “A simple exercise to do every day is to lie on the floor and hug one knee to the chest, allowing the other to flop in a relaxed way straight ahead,” he says. If you have back pain after spinning it may be that your bike is set wrong. Try lowering the seat to promote a more upright posture and lean from the hips, not the waist. In the gym, work on all leg muscles. ­Cycling engages the quadriceps (at  the front of the legs) more than the hamstrings (at the back) and the quads pull at the front of the pelvis when you pedal. If your hamstrings aren’t strong enough to counterbalance this they can ­become overstretched and affect the joint angle of your spine.

Treatment: “First, you should put either a hot or cold pack, ­whichever feels best, on the sore area,” says Hannah Zreik, a Bupa physiotherapy leader. “Avoid sitting or lying down for long periods and do a series of stretches, such as the yoga child’s pose and some pelvic tilt stretches, throughout the day.”

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Squats

Common injury: Cartilage damage and knee pain

Prevention: Squats are the exercise of the moment for those wanting shapely buttocks and, Todman says, they are an essential movement that we should be doing daily. “Generally, people in the West don’t squat enough in their daily lives and it ultimately causes knee problems in old age, which you don’t see in Asian populations where squatting to sit is normal,” he says. “The irony is that suddenly adding a lot of squats to your gym training can be problematic for the knees, leading to torn ligaments or the wearing down of cartilage behind the kneecap.” Deep squats are better for the knees than squatting to 90 ­degrees. “A shallow squat places huge pressure on the kneecap, whereas a lower, deeper squat with your weight forward and your hips, toes and knees aligned is much less likely to cause harm,” Todman says.

Treatment: “It’s really ­important to rest and allow the soft tissue to heal,” Zreik says. “Apply an ice pack for pain ­relief and manage the swelling. Minor soft-tissue injuries can take up to six weeks to heal, although your physio may suggest using a knee brace to protect from further injury.”

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Walking/step-counting

Common injury: Shin splints

Prevention: Most of us think of shin splints as a side-effect of too much running. Yet if an obsession with your activity tracker has led to you diligently clocking up more daily steps, you might also be at risk. What physios call “aggressive walking” can give rise to shin pain as the muscles in the lower leg ­become tender or inflamed through excessive loading stress. “Any constant, repetitive action of the lower leg can cause shin pain,” Todman says. “We see a lot of walkers with it.” Wearing the wrong shoes can exacerbate the problem. “Walking in shoes that allow limited movement of the ankle, such as office shoes, will put pressure on the muscles in the lower leg,” he says.

Treatment: “An inconsistency in walking frequency or intensity can lead to the structures around your shin being overloaded,” Zreik says. “If you do develop shin pain, ­reduce or stop the aggravating ­activity and see a physio or doctor.” Applying ice immediately can help, as will a period of rest. After that, stretching and strengthening are key. “Stretch your calf muscles daily and practise walking on your heels for three minutes a day to strengthen the muscles in the shin area,” Todman says.

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Crossfit and plyometrics

Group of young people lifting weights on a cross training in the gym. They are doing deadlift. All men and women are in their early thirties. They were placed in a line one behind the other. (The girl in the foreground has a necklace with her name)

Common injury: Groin strain

Cause: Physiotherapists have noticed a rise in the number of people turning up at clinics after intense workouts such as HIIT circuits and CrossFit. “It’s largely to do with the high repetitions of exercises and the constant change of direction that’s ­required by our muscles in sessions like these,” Todman says. A group of muscles in the inner thigh, called the ­adductors, make up the groin area, and when stretched too far through explosive movement, tears can occur to the muscle ­fibres. It’s these tears that constitute a groin strain or pull. It’s ­painful and can take months to heal.

Prevention: “We mostly move in a straight line and our tendons are not used to a forceful change in speed and direction,” Todman says. “The main rule is not to do too much too soon of this kind of activity. Start with a low number of repetitions and build up slowly.”

Treatment: “As soon as you ­realise you have pulled your groin muscle, apply an ice pack to the area,” Zreik says. “This helps to ­reduce the swelling or bruising and will lessen the pain. It is important you get some early intervention, and don’t stretch until you have sought advice as it can lead to a longer recovery time.”

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Handstands

Pilates at home, istock.

Common injury: Shoulder-­impingement syndrome

Prevention: Celebrities from Gisele Bundchen to Beyonce love a good handstand and by sharing their inversions on Instagram have inspired the rest of us to do the same. Physios are reporting an increase in shoulder injuries caused by the trend. “Handstands are a fantastic way of building upper-body strength and developing core muscles, but can sometimes lead to injury,” Zreik says. “I’m seeing more patients with this kind of thing.” Stacking your body weight on top of your spinal column stresses the muscles and ligaments of the neck and shoulders, leaving them vulnerable to straining. A risk is shoulder-impingement syndrome, in which the rotator cuff tendons in the shoulder are trapped and compressed, causing damage and resulting in painful shoulder movements.

Todman says you should train to do a handstand by lying on the floor and holding a 5kg kettlebell in both hands behind your head with your arms outstretched, lifting it a few inches and keeping it there for 20 to 30 seconds. You can raise it higher but not it’s above your face. “It simulates the handstand action. It’s much harder than you think and you need to be strong enough to manage it.”

Treatment: If you have shoulder pain and it gets worse when you lift your arms, Zreik recommends resting, but not stopping moving the arms completely. “Use an ice pack or pain relief, such as paracetamol, if you need to. It can take a few weeks or several months to get better and a physio may recommend shoulder exercises to help improve mobility and strength.”

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Lifting weights

Common problem: Haemorrhoids

Prevention: Lifting heavy weights has resulted in an unexpected rise in haemorrhoids among gym users. “Weight training is a common cause as people often hold their breath while lifting weights, which forces the air in your lungs downward, putting pressure on your internal organs and the veins in your rectum,” says Amyn Haji, a consultant colorectal surgeon at the Whiteley Clinic in London. “As a result, the veins near your anus become swollen and are forced outside the body, which can cause uncomfortable and sometimes painful haemorrhoids.”

Treatment: In some cases haemorrhoids disappear within a few days. “However, I’d recommend seeing a qualified personal trainer to help you perfect your breathing technique while weight training,” Haji says. “To prevent it from worsening, avoid weightlifting if you have already developed the condition, drink plenty of fluids and buy some over-the-counter medicines — there’s a variety of creams, lotions and gels available to treat the problem.”

The Times