There is little doubt weight ­training offers many potential health benefits. For both men and women, it can tone, shape, strengthen and generally foster healthy muscles, increased energy and improved self-esteem. The problem occurs when ambition outstrips reality, and impatience leads to injury. Sensible, progressive weight training will generally produce the desired results, but only over time. People who want bulging biceps, rippling pecs or six-pack abs tomorrow, piling on weight plates for quick results, are only asking for trouble. Just as unwise are those who don't bother to learn proper lifting technique. In both cases, physical therapy clinics fill up every year with patients seeking rehab for weight-training injuries.

Male vs. Female

Chad Clark, MSPT, CSCS, is owner of Physical Therapy Connections, a clinic located within a fitness club in Pueblo, CO. He estimated 20 to 25 percent of his patient population presents with some type of weight-training injury. Interestingly, approximately two-thirds of that subgroup is female.

"I think part of the reason is females generally seek treatment earlier when they feel a twinge of pain," he told ADVANCE. "Whereas males tend to hold off until it gets really bad or there's a tear."

Females are also more likely to injure their lower bodies, Clark added, specifically hips and knees. For males, lumbar, spine and shoulder injuries are more common. He attributed the predominance of female lower-body injuries to hormonal issues, anatomical differences and an emphasis on exercises that target the area.

"Males tend to work more on what we call the 'mirror muscles'-abs, pecs and biceps. So they get forwardly rounded shoulders, as well as shoulder and lower-back strains."

Age Effect

There are two distinct age groups among Clark's weight-training population-teens and early 20s on one hand and people in their 50s or 60s on the other.

"For the younger population, trying to do too much too soon is a common cause of injury," he explained. "It's a combination of increased volume and not getting great instruction from their coaches or physical education teachers."

Among the older population, one problem is lack of recognition their bodies simply can't handle the physical stresses they could earlier in life.

"Another issue for that group is the 'January Syndrome' you'll see in many health clubs," said Clark. "People haven't done anything fitness-related for years, then they will come into the club because of a New Year's resolution and hit the weights too hard. Sometimes they read about a training program in a magazine and decide that's what they're going to follow right from the start. Faulty instruction can be a problem as well."

Meryl Goldstein, PT, MPT, ART, is clinic manager at Excel Physical Therapy and Fitness, Cherry Hill, NJ, also located inside a health club. Like Clark, she estimated approximately 25 percent of her population is comprised of patients with some type of weight-training injury. Although at Excel, that subgroup is about 70 percent male and primarily includes people in their 40s and 50s.

Common Injuries

"The most common weight-training injuries I see are rotator cuff, tendonitis of the knee and sometimes neck strains," she told ADVANCE. "The injuries can be a little more traumatic in males because they try to lift a lot more weight than they really can."

Asked to name specific exercises more likely to cause injury, Goldstein mentioned the shoulder overhead press as well as knee extensions with heavy weight.

"Your rotator cuff tendons sit in a very small area between two bones in the shoulder," she related. "And when you do a lot of heavy-weight overhead pressing, it compresses the rotator cuff between those two bones, decreasing blood supply to that area. Then it can start to break down and cause either tendonitis or tendonosis."

Clark, meanwhile, cited the bench press as a prime cause of injury for the male population. Ailments can range from shoulder strain to rotator cuff tendonitis and tear, sometimes requiring surgery. Among females, he singled out the seated leg-extension machine.

"It's meant to isolate the quad, but also puts a lot of stress on the ACL, patellar tendon and front structures of the knee," he explained. "Faulty mechanics when females are squatting and lunging with free weights is another cause of injury."

Jonathan Fass, PT, DPT, ART, CSCS, earned his doctorate from The City University of New York in 2009. He was accepted as an orthopedic resident at the University of Delaware before taking his current position as personal physical therapist and trainer of a private, high-profile international client. Dr. Fass has been a weightlifter for more than 15 years and served as a strength and conditioning coach for Rutgers University club sports.

"Lower back pain is a fairly common issue among weight trainers," he told ADVANCE. "Which probably won't surprise anyone involved in orthopedics or sports rehabilitation due to its prevalence in the population at large. Various forms of patellofemoral pain, such as patellar tendonitis, are also fairly common as well as shoulder injuries such as subacromial ­impingements."

Often these injuries have underlying mechanical causes, Dr. Fass continued, including scapular dyskinesis or lumbopelvic dysfunction. The conditions can worsen because of improper lifting form and/or poor exercise selection leading to injury.

Lifting Form

"In my experience, lifting form is probably the single most important factor to address in this population when treating exercise-related injuries," he noted. "By correcting their form and in turn strengthening the weaknesses in their movement through neuromuscular reeducation and specific corrective exercises, therapists can quickly and effectively return weight trainers to the gym. In addition, these measures will help ensure the weight trainer is able to continue lifting safely and injury-free, often with better results than prior to injury."

There tends to be some difference among injuries sustained by novice weight trainers compared to those who are more experienced.

"Acute injuries such as biceps tendonitis or persistent muscle strains are more typical of a novice weightlifter whose body is not yet accustomed to the physical stresses," related Dr. Fass. "Experienced weightlifters tend to have more chronic and possibly severe injuries, such as subacromial impingement, labral pathology in the shoulders or hips or meniscal damage in the knees."

These injuries usually occur over time, as initial mistakes in the lifter's form or technique during formative lifting years accumulate, taking their toll on passive joint structures until significant damage has occurred.

Rehab

So what type of rehabilitation is involved for a typical weight-training injury?

"Just like with any injury, the rehabilitation program is tailored to each unique patient," related Dr. Fass. "However, there are a number of similarities in this population where a general approach can be used to identify specifics."

His approach includes five steps:

1. A thorough evaluation is vital, including biomechanical analysis of the lifter's form, especially if there is a specific exercise complaint. Simple corrections to a lifter's squat form, emphasizing a widened base of support or improved hip flexion/extension and concurrently decreased lumbar flexion/extension, will often have immediate and lasting effects on the patient's symptoms.

"Weightlifting injuries are rarely as simple as a dropped weight on a foot or slipped bar landing on the patient's chest," Dr. Fass explained. "They are typically caused by faulty mechanics/form and strength imbalances. These need to be evaluated from the beginning through direct observation of movement."

2. Identify not only the compensatory strategies in the patient's movement and exercise form, but strengthen these patients with proper form as well. Without the neuromuscular ability to integrate movements in strength during simpler therapy-exercise activities, isolated strength training will have little or no lasting impact on the patient's ability to safely return to the complexities of weightlifting. The patient needs to learn how to properly integrate all muscles involved in a particular exercise, which almost always requires a full-body approach to corrections. Even a bench press, when performed properly with leg-drive and scapular stabilizing, is a full-body exercise.

3. Soft-tissue assessment can provide a great deal of information about persistent injuries, either by the soft-tissue structure directly causing the patient's pain and mechanical symptoms, or by influencing these symptoms through compensatory and altered mechanics and muscle activity.

4. Decreased mobility in the hips, ankles, thoracic spine and shoulders is very common and often contributes to injuries through mechanical compensation underlying the patient's chief complaints. Restoring proper joint and muscular mobility through mobilization, static and dynamic flexibility training is an important part of ensuring treatment offers a lasting effect.

5. "Although the scientific literature has had limited success in identifying the link between muscle strains/tears and weaknesses in synergists or strength imbalances between agonists, clinically this is a very important area to identify and address," added Dr. Fass. "For instance, I have yet to treat a hamstring strain that wasn't accompanied by weakness of the glutes and stiffness of the external rotators of the hip, particularly the piriformis muscle."

By improving muscle balance along the kinetic chain, compensatory strategies leading to overuse injuries can be reduced or entirely eliminated. The good news, according to all three sources, is weight trainers are inherently motivated to adhere to treatment and exercise regimens.

Motivation

"Compliance in general seems very high," noted Clark. "Part of the reason for that is they're already motivated and doing something to help their body, which lends to home program adherence. Part of what we do is hopefully encourage them and provide the right tools to feed into that highly motivated attitude."

For his part, Dr. Fass believes PT professionals can do more both to understand weight training and practice it themselves.

"As the preferred health care providers treating movement disorders and musculoskeletal injuries, I think sports/ortho physical therapists have a unique opportunity to positively impact the weight-training community," he said. "Not only in addressing injuries when they occur, but also in preventive training and education. However, I think many of us fall short of truly understanding weightlifting and exercise, even though it plays such an important role in our profession."

To legitimately make a difference with weightlifting patients, physical therapists should extend their education beyond the basic therapy-exercise classes taught in graduate school, continued Dr. Fass.

"By attending educational seminars, becoming involved in the literature produced in exercise physiology, strength and conditioning, as well as actively participating in regular training exercise, physical therapists can improve their quality of care and the experience patients have in their clinics."

Brian W. Ferrie is managing editor of ADVANCE and can be reached at bferrie@advanceweb.com