Injury Prevention Principles for Weight Training
I’ve been spending some time on Quora recently talking about Injury Prevention.
A lingering concern for many people is that if they start resistance training or weight training or strength training — whatever you want to call it, I prefer neuromuscular training — they will get injured.
When it comes to what is safe to do in the gym, what is not and what is questionably used. You will not find a completely unanimous resource on the topic.
However, this article I hope will provide a great deal of clarity. If you follow these ten or so principles you will delay or reduce injury risk as best you possibly can.
I can’t promise you’ll never get injured because frankly even if you don’t resistance train, you will get injured at some point in your life. We all do.
Resistance training done well, following these principles should be one the least injurious activites a human being can participate in though. It’s even a major element of the rehabilitation process for that reason alone.
I’ve heard some good and bad arguments for various styles of lifting, almost all of these are dependent upon the context of the exercise and the desired outcome of utilizing a particular exercise. I want to dive into some of that context.
However, my first guideline addresses what I believe to be THE SINGLE MOST IMPORTANT THING to consider when training.
#1 – If it hurts, DON’T DO IT.
The rule to rule all other rules. No pain, no gain is a myth.
You will likely be uncomfortable when you train, but there is a big difference between discomfort and pain. Don’t train through pain.
Now, in no particular order, here are some other general suggestions or guidelines for weight training with optimal effectiveness and injury prevention that go a long way:
#2 – Aim to Train with a Neutral Spine
Competition may be a different thing. This is usually unique to the powerlifting or olympic lifting world where the goal is maximum weight.
Almost all the contentious issues around injury prevention in the world of resistance training start here.
You have one camp that thinks because powerlifters or weightlifters look a certain way, that this in fact is Okay for everyone else who isn’t competing.
Most people aren’t competing and most competitors can make the change between competition and training anyway. When they are warming up, or using submaximal weights, you see dramatic change in the technique.
When it comes to injury prevention, the back is the #1 injured area. 80% of people will have some kind of back pain in their life, so let’s treat it with some respect.
For the average person, neutral spine position should always be emphasized whenever possible — except perhaps in no-load circumstances like flexibility* exercises.
*To maintain range of motion (ROM) of the spine, you may still want to move it through flexion, extension and rotation cycles, without load.
My best advice? Find good base posture for you.
Easiest or fastest way to do this? Press a ~10 lbs (~4-5kg) weight straight out from your chest. Like this:
It doesn’t work every single time, but 95% of the time it will give you a preview of your natural “ideal” static spinal posture.
The chin is back/tucked. There is a slight curve in at the lower back, a slight curve out in the upper back. Then when you train, you’re simply trying to maintain a similar spinal position for most lifts.
You may find standing against a wall or using a dowel alone your spine is easier for you. In this instance, you should have a gap (that you can’t stick your hand through but you can stick your hand into) in your low back. And a larger one at the neck. Your glutes/butt, upper back and back the head should all be in contact with the dowel or wall.
With the understanding that posture is not in fact static — like the photo above would suggest. Not all assessments like this are perfect. I’ll eventually do a write-up on posture but for now, this will have to do.
Your neutral position will change a bit through any given range of motion depending on compression forces or shear forces that you have to counterbalance.
You may see the spine flatten out a bit from this posture when at the bottom of a deadlift or squat. While at the top, it looks more like your natural neutral position.
Your position will also change to a small degree relative to the lift involved.
For instance a barbell on your shoulders. The head might come back a little further if you’re in a front squat position, or a little forward in a back squat position.
You will deviate from your neutral position, but what truly matters is the intent to stay neutral. Perhaps more importantly, it’s to maintain the tension that trying to stay neutral generates.
When you stick that weight out from your body, the long-lever forces your body to exert tension to hold it there. That tension is protective to your spine.
You want that tension when you lift, so you can protect your spine and execute the lift with easy.
If you can’t control your spine, you likely don’t have that tension, and that’s the injury potential problem down the road. A lack of appropriate tension.
Bottomline: If you’re cranking on your spine into a heavy arch, or a heavy rounding, it’s only a matter of time before your spine loses this battle.
Your head and spine are perhaps the two most important things to protect when weight training, period.
#3 – Aim to Train with Stacked Joint Positions
The number 2 and 3 common injuries are the knee and shoulder. To prioritize injury prevention here, it’s best if force transfers over the entire surface of a joint or joints.
With the maximum amount of muscle actively contributing to stabilize that joint.
Your run into problems when large forces are transmitted over small areas. You also limit how much force could ever be applied before breakdown.
That’s why you don’t see people squatting just on their toes (heels up) or just on their heels (toes up). This makes the base of support small and limits how much weight can be lifted.
You want those forces spread evenly over the heel and the ball of the big toe and balls of the 2 outside toes (pinky toe area). The tripod of the foot, as I’ll discuss more in detail below.
However, you also want the joints above to be stacked above. Like so:
If the knee is caving in or out during a squat or lunge, then you’re getting a lot of force distributed onto just the inside part of the knee.
If the knee is drifting so far forward that you can’t evenly distribute the load to the feet below, that could also be a problem.
If the hands are too far forward, or too far away from your body in a push up, then the load can’t be distributed evenly into the wrist and hand, it’s the same thing.
You want to evenly distribute forces whenever possible, that means paying attention to where your joints are in space*. At least, to the best of your ability.
*Some joint structures will make even distribution impossible without shortening the range of motion. And in some cases this is the ideal strategy under load, especially heavy load.
i.e. a tall person with a long femur should consider not doing full depth squats, and only go through the range they can maintain even force distribution with.
Unloaded is a different story. Training for ROM is different (unloaded) than training for strength improvements. Due to the forces involved.
Pay extra special attention to areas where you’ve had issues in the past, or have developed an issue over time. i.e. if you develop a wrist issue, revisit hand positioning on your lifts.
Stacked joints are the neutral spine of lifting. They help distribute forces in productive ways.
The reason a person can lay on a bed of nails or walk over a bed of nails is that the force is easily distributed over nails packed close enough together.
Put that same amount of weight onto one nail, and the nail penetrates your skin. Owwie.
Same thing here.
#4 – Tripod of the Foot and Locked Wrists
These two things are effectively the same. One is for the feet to absorb force in an optimal fashion, the other for the wrist/hands to absorb force more optimally.
For injury prevention, wrists and ankles are less common than some of the other injuries mentioned above, but they still occur.
Let’s start with the tripod of the foot. It’s basically three points of contact:
- Heel of the foot
- Ball of the big toe (maybe some overlap with long toe)
- Balls of the Pinky and Ring toes (two outermost toes)
Ideally there is relatively equal distribution of weight into all three of these points when you’re doing any closed chain leg work (squats/ deadlifts/ lunges/ etc…) on the working leg.
When there is too much pressure on the heel and big toe the foot rolls in and the knee follows, you end up with unequal force distribution.
That’s the most common issue, but too much pressure on the outside balls of the feet with the hell can be problematic in it’s own way too. This plays into injury prevention at the knee as a result.
Likewise the wrist can become a problem area when the wrist is loaded with large amounts of weight and isn’t locked out.
On the left is an undesirable position. On the right, is the locked out ideal position.
This is mostly a problem issue when pressing (as opposed to pulling) and like the foot, is more problematic when moderate to heavy loads are used.
I like to think of it like a punch and this is how I explain to to clients. I ask them to pretend to punch a bag (or me) and stop shy of doing so. Then we take a look at their wrist position.
It’s instinctual for most people to punch with a locked wrist? Why? Better force distribution and a small chance you’ll break your wrist.
If you threw a punch with the position on the left (floppy wrist) you’d likely hurt yourself more than whatever you were trying to punch.
Injury prevention here, may be key for all us keyboard warriors!
A Grey Area
Admittedly, there is a bit of grey to this recommendation. You don’t always experience problems by not following this guideline. However, generally speaking I think it’s a good idea when using moderate to heavy loads.
Some exercises like push ups off the floor won’t permit a neutral wrist position, you’ll have to flop the wrist back or prop it up onto something for a neutral position.
There is a reason however that push up bars and the perfect pushup exist.
Anecdotally plenty of people who maintain the range of motion on a pushup and don’t load it too much or too frequently don’t experience too much in the way of wrist issues.
If your wrist bothers you, try getting into a more neutral locked out wrist position.
Likewise, there may be some value to changing the distribution of load on the tripod of your foot.
If you always roll in, trying to put more weight proportionately onto the heel and outside of the foot may help prevent your natural inclination to roll in.
If you want to train more of your quads (anterior chain) then more weight onto the balls of your feet and less on the heel may be an ideal method.
And vice versa, putting more weight on your heel rather than the balls of your feet results in more glute/hamstring (posterior chain) activation.
All of these are fairly high level concepts though, so you can’t go wrong with locking your wrist out when you press. And equally distributing your weight onto the tripod of your feet when they are the contact point for your leg training, is an excellent initial idea.
The four recommendations above are really my only ‘no exceptions’ sort of rules.
Even there, you do see some special recommendations based on your size, structure or tendencies. If you make a strong effort to follow those four guidelines, you’re going to mitigate most problems.
For instance most ‘training’ shouldn’t be done with the sole intent of creating fatigue and fatigue increases injury risk.
For this reason, I like to challenge fatigue sparingly while training and only emphasize it if you compete in something.
Training is training and competing is competing. Keep them separate and you’ll find more success.
I’m not saying you’ll never deal with pain or an injury, I can’t guarantee that. I’m saying these practices will lower the odds.
However, here are few more special circumstances worth discussing for certain people.
#4 – Let the Shoulders Rotate
I almost always prefer handles on machines that allow you to rotate your shoulders as you’re pressing or pulling.
As opposed to fixed handles.
At the very least, fixed handles should favour that neutral locked wrist position.
This just favours the shoulders natural inclination to rotate through any given range of motion and allows you to keep that neutral wrist position and stacked joint position with the elbows.
This is a more important consideration for people with a history of shoulder issues or a current shoulder issue. Again, in the domain of injury prevention, shoulder injuries are fairly common.
If you don’t have that issue and love overhead pressing with a barbell. I’m not saying stop, but if you develop shoulder issues, one of the easiest things you can do is move to a dumbbell or kettlebell overhead press instead.
I estimate about 25-33% of the population of the shoulder structure for training a lot without this natural rotation. With another 25-33% have the potential for problems if they don’t plan their training appropriately.
The last 25-33% of the population have a type 3 or 4 acromion and will likely battle shoulder issues at some point. This is really the group that this comment is aimed at.
If you have to compete in powerlifting, bench will be ‘fixed position’ barbell work. There is no way around that because you have to compete with that tool.
The best strategy there is to make sure that you’re programming cyclically, and making sure you train the support structures of the shoulder independently.
This is a conditional recommendation, but rotating handles and single arm work just permits a more fluid movement of the shoulders too.
# 5 – Consider a “Packed Neck” Position
Neck injuries are common and problematic, so this can be a good injury prevention idea even if you don’t currently have a neck issue and don’t plan on competing in powerlifting or olympic lifting.
However, it’s another conditional recommendation that is most relevant to those with a history of neck issues (like me).
It may also apply to overhead athletes like volleyball players, or baseball players where there is a lot of repetitive looking up.
This may not apply to training for olympic lifting or powerlifting. Whereby looking up (and destabilizing the neck) may help give you that extra 2-5% kick you need for competition.
The packed neck position is a slight exaggeration on a neutral neck position. It looks something like this and is easy to find with either a wall, the floor or a dowel finding neutral spine positioning.
Think about extending the top portion of the head upward, tucking the chin slightly — just a little, like a double chin, it should be against your neck — and getting a little bit tight through the neck when doing deadlifts, squats, etc…
It also means keep your head back on the bench when you’re pressing. Keep your chin tucked when you squat or deadlift. Don’t try to lift your chin over the bar when you do pullups or chinups.
Bringing the neck forward or up isn’t going to be a big deal for anyone other than those with neck issues. It may over time (if done to excess) encourage ones to develop over time.
If you compete and you want to look up, go for it, you likely need it. But I’d still attempt to pack my neck for all the rest of my submaximal training.
If you’re worried about getting enough power into the lift with a packed position. Then practice looking up with your eyes only and drive your tongue up into the roof of your mouth. The tongue can increase force production, believe it or not.
#6 – Consider a “Packed Shoulder” Position
More in injury prevention and the shoulder, it’s a sensitive unstable joint.
This is more of a conditional consideration for open chain work. It’s also a recommendation for those with shoulder issues or a history of shoulder issues.
The packed shoulder position is actively pulling the shoulder blade down and into your ribs or armpits. Photo on the right.
I find it to be most relevant or useful when doing open-chain pressing work from a restricted position like bench pressing.
However, it is also ideal for stability drills like a Turkish Get-Up or Windmill — these are more advanced exercises I do not recommend if you don’t have a lot of experience with strength training.
This doesn’t mean that the the “active” shoulder on the left is “wrong.” The shoulder will always move a little. You’ll just get better stability for these specific types of lifts.
The shoulder needs to move, but the best way to train that is to include closed chain pressing actions like push-ups, yoga push ups, wall walks and feet elevated push ups (or trap raises). It may also want to move in overhead pressing or landmine pressing.
All of which is a little more complicated than I really want to get into.
However, many people end up with poor upward rotation if they pack the shoulder too much. It’s about balance, and it’s a bit of a catch 22. The shoulder does need to move in certain ways, but you shouldn’t just let it move all the time in destabilized positions either.
Benches don’t permit free movement of the shoulder, but a landmine press or some free-form variations of overhead pressing might help rather than hinder, depending on the person.
Again, about 25-33% of the population will likely never have an issue here based on shoulder structure. While another 25-33% of people have some risk if the programming is too biased in one direction or the other. While the last 25-33% will thank me for packing the shoulder when on a bench or doing stability drills.
Just don’t forget to program things that move the shoulder too, at least under some amount of load.
#7 – Rotation Should Happen Through the Thoracic (T) Spine
Back to injury prevention for the spine.
For the most part I like helping people train anti-rotation. Or how to control movement without letting the body rotate. My thought process is if you can control it first, you can then execute it where you should.
In the upper back, where your ribs are. AKA the Thoracic Region of the spine and not the less flexible lumbar spine. However, the hips will be involved too, which is why this can’t be a hard guideline.
The T-spine has the great rotation ability, and it drives a lot of shoulder movement (and shoulder pain sometimes by extension). It’s about 4x more flexible than your lower spine.
Most people herniate their low back or neck, not the T-spine, that isn’t to say it can’t happen. It does, it just seems to happen less so, based largely on it’s anatomical design. It’s built for rotation.
We know that spinal flexion — and even excessive hyper-extension of the cervical and lumbar spine — with rotation, particularly in the lumbar region, is one of the most damaging overuse movements that can be done to the spine.
Sadly I see a lot of flexion and rotation going on at the gym. No, I’m not a fan of Russian twists for this reason, because you can’t know how well the lumbar spine is rotating during such a movement.
I also see it a lot in Yoga. It’s one thing I believe to be a big shortcoming in the practice — there are otherwise a lot of great exercises in Yoga.
If you’re going to train rotation, stick to exercises that emphasize rotation with flexion or extension only in the thoracic region (like sledgehammer work, pallof presses, medicine ball throws, or some chopping movements).
Remember ‘Neutral’ spine is position specific. There is a unique neutral spine position when you’re dealing with rotational torque forces — instead of or sometimes in combination with the shear/compression forces I mention above.
Making your hips and shoulders move as one through as much of the rotational movement as possible is a key factor in good rotation training.
But any follow through on either side of that equation should happen mostly at the thoracic spine and to some degree the head following the t-spine.
That all comes down to developing good motor control too for rotational sports like golf, tennis, and soccer. Again this is conditional to rotation training and people with a history of low back, neck or shoulder issues.
#8 – Emphasize Movement Quality over Load
Progressive resistance training literally means adding weight to the bar. That’s the goal most of the time, but I prefer another way to gauge progress.
Make it look easy.
This is more of a subjective offering in many cases. I think the biggest compliment you can give someone at the gym is that they made something look easy.
Sure it’s more impressive when there is substantial load on the bar but when you emphasize making things look easy, load usually comes along for the ride.
It’s hard to make things look easy, without improving your technique. Technique is what drives your ability to lift more load, so it all goes hand in hand.
Competition is different. In order to win, many athletes have to make sacrifices whereby fatigue can wear down technique. That’s a risk the athlete takes to perform.
It also means that training should be incredibly safe, absent of too much fatigue and well-executed technically speaking. This all prepares an athlete for any potential breakdowns in competition.
Load in any lift eventually reaches a peak and well you may lose interest at that point as a result. But making a lift look better is always something you can strive for.
Make it your training goal to receive the ‘wow, you made that look easy,’ complement.
#9 – Emphasize Variety but Not “Too Much”
In order to get good at something you have to practice it regularly. Weekly in our context at the very minimum, likely twice a week is better.
Resistance training needs about 36-72 hours of recovery depending on your approach. This means we’re limited to doing the same movements 2-3 (maybe 4) times per week.
Yes, there is some grey area here too, but if you’re new to the lifting weights game, keep it simple. Do full body training then take a day off, or use a 2-day split twice a week, with a day off between the split.
For instance upper/lower, what I’m now calling the ‘t’ split, or something like the ‘x’ split.
If you’re not taking it to failure (like movement prep/warm up stuff) and it’s really important, do a little every day.
However, there is always a point of diminishing returns.
You can improve your joint health and training longevity by mixing up your training every 3-8 weeks. Maybe twelve weeks depending on experience or what you’re trying to accomplish with the training.
Change the rep ranges you use. Mix up the exercises, even if only slight variation. Change the volume. Change the tempo/cadence. Just change your approach.
In order to learn good technique in a wide variety of lifts you need time. There is also an indication that movement variability, improves motor learning. Movement variability being slight variations on the same theme. Front Squat vs Back Squat vs Goblet Squat vs Low Cable Squat vs Box Squat.
Or push up vs dumbbell press, vs barbell press. Hopefully you get the idea. The former are all squats, so similar, but slightly different, while the latter are all pushing exercises but also slightly different.
I’m not 100% opposed to machine training. It’s certainly better than no resistance training. Mix it in.
But I think it’s ideal if you can also learn the motor control element of free weight or free resistance training.
The movements involved under load are useful for everyday living. You get improved coordination in a more practical environment.
At least learn them in tandem with any machine training you want to do for whatever reason. Muscle mass gains are one such excellent reason.
#10 – Injury Prevention 101: Prepare to Move
AKA Warm Up. In lieu of a much overdue article on how to properly warm up for resistance training. Here’s a Cole’s notes version:
When I say warm up, I don’t mean stretching. At least not statically holding any stretches, like we used to when I was in high school.
In fact, static stretching is likely the confounding warm up factor that has yielded poor results in a lot of warm up literature/research. Static stretching has been shown to decrease performance and not prevent injuries.
For a long time, it was also a go-to-method for warming up. I don’t really recommend it per-training, unless you can do it about 20 minutes before training.
No, I recommend raising your core tissue temperature, priming the mobility you have, rehearsing any training intended movements and preparing your nervous system for what’s about to come.
Wonderfully simplified by Mark Verstegen almost two decades ago.
A) Increase Tissue Temperature
Is the one that gets exaggerated to death, because the majority of people will hop on a cardio machine for 3-5 minutes and get on with the training session.
Yes, it’s better than no warm up, but it doesn’t do anything for the next 3 elements. Unless your training session for that day is sticking to the machine you’re at.
Simply doing cardio before a workout leads to no additional injury prevention on it’s own. Whereas a specific warm up like the FIFA 11+ has been shown to reduce injury occurrence.
Yes, FIFA 11 is specific to soccer, not resistance training, but there are a lot of similarities worth considering.
We can create something similar to the FIFA 11 in concept, but specific to the resistance training you’re going to do. Mainly that the warm up tools for raising body temperature, mimic the sport itself.
Likewise, when resistance training warming up your tissues, your movement selection should mimic to some degree what you are planning on doing later in the training session.
If there are squats in your training session, put some lighter squats or bodyweight squats in your warm up. If there is pressing, put some pressing in your warm up.
I like bodyweight or light weights for this purpose. Gradually increase the speed as you warm up and you’ll raise tissue temperatures.
B) Prime The Mobility You Have
Or ‘Tap’ into the mobility you already have. What I might also call ‘amplitude.’ Yet another thing I’ve been meaning to write about more in-depth.
More of a dynamic stretching element here but working within your existing ranges of motion. The purpose is to improve proprioception/body awareness within your existing ranges of motion.
As opposed to increasing your existing ranges of motion. i.e. actual mobility training.
This can be confusing to a degree, because it often looks like the moves I’d recommend here are for improving mobility.
It’s real purpose is to maintain existing mobility and sharpen or improve awareness in your existing ranges of motion, for the training at hand.
Again this should be somewhat specific to what you plan to train this day.
You may plan on doing some half squats or, lunges without the knee to the floor, or some board presses or other short(er)-range movements with load.
However, it may still be wise to do some full range, likely unloaded, movements in a manner that increases stability or control within those ranges of motion. Active stretching might be another term for this.
Stability = control in the presence of change.~Charlie Weingroff
Save improving your mobility for another day, another time or later in the workout.
C) Movement Rehearsal
See B. When you’re fresh, it’s easier to work on highly technical elements or components of your lifts.
My warm ups now, look a lot like the resistance training workouts I might give to a beginner. Less weight, maybe bodyweight exercises, exaggerated pauses to reinforce end range, things of that nature.
Or at least there is a gradual transition towards movement rehearsal. So maybe I do something slow, deliberate, with some pauses here or there to start.
Then I add a little speed or a little load, then I add a little more, and a little more until I get to a “working load” or a “working speed.” Depending on what you’re training.
This element feeds into yet another concept I’ve been meaning to do a post on. The difference between warm up sets and work sets.
Don’t just throw the weight you want to work with on a bar, or grab that heavy dumbbell off the rack, and go to work.
Here’s a better idea:
- Practice a similar unloaded full range bodyweight only movement first (maybe put a pause in the stretched active/stable position)
- Take 50% of weight you plan to use for your ‘work sets’ and do less than or about half of the number of reps you’ll be doing in your workout itself.
- Then do 75% for half the prescribed reps
- Now you can go for your working weight
This is by no means fool-proof and when you become more advanced or are lifting more weight, it will take you more and more warm up sets to get to your work sets.
This is more important for complex/technical or heavily loaded movements that tend to happen earlier in the training session.
As opposed to isolated, lower resistance movements like arm curls or leg curls.
Working down from technical movements long after your “warm-up” negates the need to do this for ‘every’ movement you’ll do in your training session.
Yet, you should highlight or dedicate some warm up time to these more technical movements.
Although isolation movements can help create some stability when they come first (usually only applicable to hypertrophy goals). For beginners, they will usually come towards the end.
D) Prepare the Nervous System
There is a tremendous amount of overlap in relation to these components but ultimately your nervous system needs to be ready to respond to the movement, the load, and/or the speed of movement.
For simplicity sake I like to start all warm ups by setting the foundation.
This means all of my warm ups feature some kind of spinal stability exercise sequence for the sides, the front, maybe anti-rotation and the back. Or a combination thereof.
For instance, the very basic warm up featured in the free eight minute workout:
- McGill Curl Up (front)
- Bird Dog (Anti-Rotation/Front/Glutes)
- Side Plank (Sides)
With the torso/core nervous system stable, you now have the necessary stability to load the spine and challenge it a bit.
Then you can gradually layer the low load main movements you’re going to train during the training session. And then utilize something similar to the sequence I mentioned above.
In 2×2 training for example this might represent those 3 warm up drills above.
Followed by a squat variation, a pulling variation, a single leg hinge/hamstring/glute variation, and a pushing variation on day 1.
On day 2, you’d see a hinge variation, a single leg squat/lunge variation, and a different pulling/pushing variation.
7 movements. Four of which are more specific to the compound movement work at hand. These specific warm up exercises may also be done more than once with gradually increasing load or speed.
Anyway, that in my mind is a decent starting point for a warm up. I’ll finish that post some day but that about wraps up this one.