Common Exercise Injuries and Prevention

Exercise injuries are rarely random — they follow predictable patterns with identifiable causes. Understanding the root causes of injury enables prevention, not just treatment.

The four primary injury mechanisms in recreational and competitive exercise:

• Load spikes: Increasing training volume or intensity too rapidly. Tendons and connective tissue adapt at roughly one-quarter the rate of muscle — the 10% per week rule for running volume exists for this reason.
• Technical breakdown: Poor lifting mechanics place stress on structures not designed to bear it. A rounded lower back during deadlift concentrates load on the lumbar discs rather than distributing it across the posterior chain.
• Cumulative fatigue: Tired muscles lose the ability to stabilise joints, shifting load to passive structures (ligaments, cartilage, bones) that are not built for primary load-bearing.
• Training through pain: Pain is a signal, not a challenge to overcome. Continuing to train through sharp or escalating pain reliably converts a minor issue into a significant injury.

Injury Type	% of Training Injuries	Most Common in	Primary Cause
Lower back strain	25–30%	Strength training, deadlift, running	Flexion under load, overuse
Shoulder impingement	15–20%	Pressing, overhead work, swimming	Internal rotation + elevation, weak rotator cuff
Knee pain (patellofemoral, IT band)	20–25%	Running, squatting, cycling	Overuse, tracking issues, weak hips
Wrist/elbow tendinopathy	10–15%	Grip-intensive lifting, racket sports	Repetitive load, grip positioning
Hamstring strain	8–12%	Sprinting, heavy RDL, hurdling	Speed + fatigue, insufficient warm-up

Lower back pain (LBP) affects approximately 80% of adults at some point, and training-related LBP is overwhelmingly caused by flexion under load — rounding the lower spine during deadlifts, rows, or repeated bending movements.

The lumbar spine's intervertebral discs can tolerate significant compressive force when the spine is neutral, but disc pressure rises sharply as the spine flexes. A flexed lumbar spine under load (e.g., a rounded deadlift) can generate intradiscal pressures 2–3 times higher than the same load with a neutral spine.

LBP Cause	Identifying Feature	Fix
Lumbar flexion during deadlift	Lower back rounds at hip crease	Hip hinge drill, "proud chest" cue, reduce weight until form is clean
Butt wink (squat)	Pelvis tucks under at depth	Widen stance, reduce depth, improve hip mobility
Hyperextension (overhead press)	Excessive lower back arch during press	Brace abs, squeeze glutes, reduce weight
Overuse / volume spike	Diffuse aching after high-volume sessions	Reduce volume by 40%; add bird-dogs and McGill Big 3
Disc herniation	Pain referring down the leg (sciatica pattern)	Stop aggravating movement immediately; see physiotherapist

The McGill Big 3 — curl-up (not crunch), side plank, and bird-dog — are the evidence-based rehabilitation and prevention exercises for LBP, developed from spinal biomechanics research. These should be in every strength trainee's routine.

Warning: If lower back pain radiates down one or both legs, or is accompanied by numbness or tingling in the leg or foot, stop training the affected movement immediately and see a physiotherapist or sports medicine physician. These are red-flag signs of nerve compression.

Shoulder impingement syndrome occurs when soft tissue structures — primarily the supraspinatus tendon and subacromial bursa — are compressed between the humeral head and the acromion during overhead arm movement. It is one of the most common overuse injuries in overhead athletes and lifters.

Classic symptoms: pain at the front or side of the shoulder during overhead pressing or lateral raises, often described as a painful arc between 60–120° of arm elevation. Pain may radiate into the upper arm but should not go below the elbow (if it does, consider rotator cuff tear or cervical issue).

Contributing Factor	Why It Causes Impingement	Correction
Internal shoulder rotation	Narrows subacromial space	Face pulls, band external rotation (3×15 daily)
Forward head / rounded shoulders	Tilts scapula, further reduces space	Thoracic extension mobility, chest stretching
Weak lower trapezius / serratus	Impairs scapular upward rotation	Prone Y-raises, wall slides, serratus push-ups
Elbow flare on bench press	Increases shoulder internal rotation load	Tuck elbows to 30–45°; use a slightly narrower grip
Volume spike (overhead work)	Tendon overuse without adaptation time	Reduce pressing volume 30–40%; add external rotation work

Daily shoulder prehab routine (5–10 min): Band external rotation 3×15 each side → Face pull 3×15 → Wall slide 2×12 → Prone Y-raise 2×12. This targets the rotator cuff and lower trapezius — the two most commonly neglected shoulder stabilisers.

Knee pain in exercisers most commonly falls into three categories: patellofemoral pain syndrome (runner's knee), iliotibial band syndrome (IT band syndrome), and patellar tendinopathy (jumper's knee). Each has distinct causes and fixes.

Condition	Pain Location	Common Causes	Evidence-Based Fix
Patellofemoral pain syndrome	Behind or around the kneecap	Weak hips, patellar tracking issues, overuse, squat depth	Hip strengthening (clamshells, lateral band walks), VMO exercises, reduce volume
IT band syndrome	Outer knee, 2–3cm above joint line	Running overuse, weak hip abductors, sudden mileage increase	Hip abductor strengthening, reduce running volume, address hip drop
Patellar tendinopathy	Below kneecap, on the patellar tendon	High-volume jumping/squatting, load spikes	Isometric leg press holds (45 sec × 4–5), progressive tendon loading, reduce plyometrics
Knee valgus during squat	Not painful initially but predictive	Weak glutes, poor ankle mobility, cue awareness	Band-assisted squats, "push knees out" cue, glute activation work

For patellar tendinopathy, isometric loading (holding a wall sit or leg press at 60° for 45 seconds, 4–5 repetitions) provides immediate pain relief — the analgesic effect of isometrics on tendons is well-documented. This makes isometrics uniquely useful for in-season training when complete rest isn't possible.

Tip: Most knee pain in runners responds well to a 20–30% reduction in weekly mileage combined with hip strengthening. The knee is usually the victim, not the cause — the problem originates at the hip or foot.

Wrist and elbow pain in lifters typically manifests as two types of tendinopathy: lateral epicondylitis (tennis elbow, outer elbow pain) and medial epicondylitis (golfer's elbow, inner elbow pain). Wrist pain in lifters is often associated with grip positioning, wrist extension during pressing, or overloading before wrist flexors have adapted.

Condition	Location	Common Trigger in Gym	Management
Lateral epicondylitis (tennis elbow)	Outer elbow	Rows, pull-ups, heavy grip work	Eccentric wrist extensor exercise (Tyler Twist), reduce grip volume, modify technique
Medial epicondylitis (golfer's elbow)	Inner elbow	Pull-ups, curls, heavy deadlifts without straps	Eccentric wrist flexor exercise, reduce load, forearm stretching
Wrist pain during front squat / clean	Wrist joint, dorsal surface	Lack of wrist flexibility in rack position	Wrist mobility work, use straps temporarily, front rack stretching
Wrist pain during push-up / bench	Under the wrist joint	Excessive wrist extension under load	Use push-up handles or hex dumbbells; improve wrist flexor/extensor balance

When to see a physiotherapist:

• Pain that is sharp, not dull (sharp pain suggests acute tissue damage)
• Pain that persists beyond 2 weeks despite rest and load modification
• Numbness, tingling, or weakness in the hand or fingers (nerve involvement)
• Swelling, heat, or redness around a joint (may indicate inflammation needing medical evaluation)
• Pain that limits normal daily activities such as typing, driving, or holding objects