Lower back, shoulder, knee, and wrist injuries — causes, technique corrections, and when to see a physio.
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:
| 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.
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.
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:
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