How to Prevent Knee, Back, and Shoulder Injuries

You know how some exercises seem almost too intimidating to perform? Chances are, you’re right.

Many exercise programs place you — and your body — in positions that leave you vulnerable.

That’s not to say you should never squat with a barbell on your back, perform deadlifts, or do a variety of other exercises.

But, it does mean that recognizing when you are at risk — and how to avoid putting yourself in a position to get hurt — are the first steps of assessing whether a program is right for you. After all, if you can stay healthy and exercise consistently, you will see results.

Before you start another workout, let these tips be your guide to staying healthy, picking the right moves for you, and progressing to the more intimidating when they no longer feel like a challenge.

The Revolving Door of Pain

There are really only two ways you could hurt yourself in the gym. Call them “Whoops!” and “Wearing Down.”

“Whoops!” refers to times when you do something like drop a dumbbell on your foot and break your toes (not that it would ever happen to you). If you dive into the data, you’ll see these events are breathtakingly rare.

Research published in The American Journal of Sports Medicine found that just of 0.2 percent of lifters were admitted to emergency departments—over the span of 18 years. Four times more people wind up in emergency rooms due to bathroom-related injuries every year. Seriously.

You’re far more likely to wind up in AN EMERGENCY ROOM due to a “bathroom-related injury” than you are from lifting. Weightlifting is a tremendously safe activity.

Bottom line: Weightlifting is surprisingly safe, so you don’t need to spend much time worrying about “whoops!” events.

The real danger — the revolving door of injury — is by “wearing down” — and it can oftentimes be prevented.

Wearing Down refers to those times when a move just feels…not quite right. Like when you perform an overhead press and your shoulder says, “stop!” Or when your elbows hurt when you bench. Or when you finish a set of squats or deadlifts and it feels like your lower back got more of a workout than your legs.

These pains can start out subtle and may seem like no big deal, but they can grow into something serious (think: strains, sprains or tendinitis) over time. So it’s important to tune in to these cues. Then you can address them before they become full-blown issues.

“The vast majority of strength-training related injuries are due to overuse or poor technique, and can build up over time into more serious problems,” explains California-based exercise physiologist Pete McCall, M.S., C.S.C.S., C.P.T.

The good news? “Wearing Down” injuries are entirely preventable. Rather than muscling through those times when your body sends you a warning shot, you can identify what they are trying to tell you. Then you can correct the problem.

Or, in some cases, knowing that there are different variations of an exercise can help you avoid pain in the first place. You wouldn’t do algebra before you could add, so why are you doing complex lifts before you master the basics?

Here, McCall and other top strength coaches share the most common causes of weight-room pain for each of the four major movement patterns—squats (or “knee-dominant” moves), hinges (“hip dominant” moves like deadlifts), push exercises, and pull exercises—and explain what’s happening. Follow their advice and you’ll ensure that the lifts you perform do what they’re meant to do: Build you up and make you stronger.

Knee-Dominant Exercises: Squats, Step-ups and Lunges

What you feel: Knee pain (especially around the kneecap), low back pain

What’s causing the problem: “Most knee injuries for knee-dominant moves stem from improper tracking of the knee joint,” explains Mathew Kite, C.S.C.S., an exercise scientist and general manager of D1 Sports Training in Dallas, Texas. Basically, your knee should go in one direction, but winds up going in another instead.

In the case of the squat, your knees collapse inward, a position called valgus. Valgus knees place damaging side-to-side stress on your joint, particularly on your patellar tendon.

Worst of all? “Going valgus” isn’t your knees’ fault. The real culprit is a set of weak glutes.

When your glutes aren’t as strong as they need to be to handle the load on your back, your knees automatically fall inward in order to help you lift the weight. This is okay if it were to happen only occasionally, like on the last rep of your last set while setting a new max. (You’ll see some powerlifters’ knees go inward onsets when they’re really going for broke.) But other than that, you don’t want this to happen.

Making matters worse, having weak glutes can cause you to lean too far forward when you squat. While a little bit of a forward lean is OK, having too much of one can put excess pressure on your lower back.

There’s one more thing that can cause you to lean forward excessively when you squat: poor ankle mobility. You’ll know this is your problem if you feel that it’s difficult to keep your heels on the floor as you lower your butt to the floor, McCall says.

WANT TO AVOID KNEE PAIN? DEVELOP A STRONGER BUTT.

What you can do: Your first goal is simple: “Develop a stronger butt to save your knees,” says Kite. Building up your glutes will help your knees track correctly (think of them angling toward the pinky toes when you squat or lunge). To strengthen them, try adding frog pumps, glute bridges and hip thrusts to your workouts.

If you have a bar on your back, focus on pulling it down into your traps. That will help stabilize the upper part of your torso and prevent it from tipping forward, Callaway says.

If you’re having a hard time keeping your heels on the floor, McCall recommends foam rolling, stretching, and doing mobility drills for your calves prior to squats. Try taking them through their full range of motion with toes-elevated bodyweight calf raises.

Lastly, you don’t need to squat with a barbell on your back. Goblet squats — which are typically done with a dumbbell or kettlebell — are variation that is knee and back friendly, and it makes it easier to squat without your knees collapsing or body leaning forward.

Hip-Dominant Exercises: Deadlifts, Hip Thrusts, and Glute Bridges

What you feel: Pain in your lower back (a.k.a. the lumbar spine) or neck (cervical spine).

What’s causing the problem: “An incorrect set-up,” says Meghan Callaway, CPT. “Many deadlifters set their hips too low and end up ‘squatting the deadlift’—or they set their hips too high [and wind up rounding their back in order to reach the bar]. Both can place the body at a greater risk of injury.” Having a rounded back or overly arched back stresses your spine in its weakest positions.

What you can do about it: Your goal here is to maintain what’s called a neutral spine, which has a natural (but not excessive) curve inward at the lower back, then slightly outward at the shoulder blades, and back inward at the neck.

“Maintaining a neutral spine is what’s going to keep that back healthy and ready for the next workout,” Kite says.

To achieve this when you perform a hinge-style movement like the deadlift, you want to think about getting as much movement as possible from your hips with as little movement as possible from your knees. Drive each rep with your hips, pushing your butt as far backwards as you can.

A good way to learn this pattern is to set a foam roller (or anything that’s straight, like a PVC pipe) against your back so that it has three points of contact with you, touching the back of your head, your shoulders, and your tailbone.

https://www.youtube.com/watch?v=_TfzOviOVes

Another way to make sure that you are running the show with your hips rather than lower back is to make sure the weight remains as close to your body as possible during deadlifts, Callaway says. When you lower the weight, image the bar almost scratching against your shins, which will help keep the bar closer to your body throughout the movement.

If deadlifts are difficult, there’s no need to pull the weight from the floor. You can place a barbell or dumbbell on boxes or platforms. What this does is limit the range of motion to help you be in a position of power.

That way, you can perfect the movement without getting into a position where you are overly rounded. As you can stronger and better, you can lower the boxes — or, you might find that you never need to pull the weight from the floor. Unless you’re an Olympic lifter, there’s no reason to hold to this belief unnecessarily.

Or, you can do a staggered stance deadlift. The joy of this variation is that it provides the benefits of a single-leg deadlift (where less weight is needed), without the advanced difficulty of balance. The back leg works like a kickstand to make it easier to move in a way that doesn’t make your body vulnerable to injury.

“Push” Exercises: Bench Press Variations, Push-ups, Shoulder Presses, Triceps Extensions

What you feel: Shoulder pain, elbow strain, wrist discomfort.

What’s causing the problem: Not keeping the wrist, elbow, and shoulder stacked during bench and shoulder presses can also introduce instability in the shoulder joint, Kite says. Bending your wrists can also introduce pain.

 

 

What you can do about it:  Think tight, tight, tight—all of the way from your wrists to your core.

To get your wrists in order, you need to start by gripping the bar correctly. Here’s an instance where what “feels” natural—and what most people do—is actually wrong.

Watch Starting Strength author Mark Rippetoe explain how to properly grip the bar for a press starting at 1:57 in this video. Note that the process depends you placing your palms on the bar first, rather than wrapping with your knuckles first. Properly placing the bar across your palms will stack the weight on the bones of your forearm, making for a more powerful (and far less injury-prone) press.

From there, you’ll want to keep your core muscles engaged, obliques braced, and rib cage down (no flaring!). “This will help prevent the spine from hyperextending,” says Callaway. She adds that if you can’t press a weight while keeping a natural curve in your spine, you need to decrease weight. It also wouldn’t hurt to build your core strength with the help of exercises like the dead bug and Pallof press.

Still concerned about pressing? For one, barbells are not necessary. You can challenge your muscle just fine with dumbbell variations or even bands or cables. If your shoulders are vulnerable with the bench press, try a floor press, instead, which will limit the range of motion. Worried about overhead pressing? If you have a landmine (or you can just place a barbell in the corner of a room), try this press variation, which is easier on your shoulders and elbows.

“Pull” Exercises: Rows, Pull-ups, Face-pulls, Biceps curls

What you feel: Shoulder pain, wrist discomfort, tennis elbow

What’s causing the problem: “Not controlling the lowering (eccentric) part of the lift,” Callaway says.

Many people put their body at risk by not controlling the lowering phase of the pull-up. If you are allowing your body to free-fall from the top position, that could be part of your problem. Doing so exerts additional force on the joints from your shoulder blades, shoulder, elbows, and wrists. The effect can hold true when you’re doing biceps curls, rows, and any other “pulling” exercise.

What you can do about it: Start by using lighter weights. If you can’t control a weight both up and down, you’re just asking for injury. In general, if you can’t control the weight for 2-3 seconds on the descent, the weight is probably too heavy.

Next, if you know that lowering the weight can lead to injury, it only makes sense to emphasize that type of training. Turn a weakness into a strength and you won’t get hurt. Here’s how it works: “Take three to five seconds to lower your body [from the pull-up bar] or the weight,” Callaway says. You can do this with almost any exercise. And the benefit isn’t just injury prevent; research shows that focusing on the eccentric can cause more of the good “microtears” that helps your muscles become bigger.

With each rep, pretend that you are pinching and slowly releasing an orange from between your shoulder blades. Then, keep your entire body tight and braced to keep your body in a more stable position and prevent swinging (ak.ka. don’t kip). Engaging your core properly will be especially helpful on “hanging” moves like pull-ups. Tony Gentilcore, C.S.C.S., explains the proper way to set up for these moves in this short video:

While pullups are an effective exercise, they’re not necessary. For bodyweight pulling, you can do inverted or bodyweight rows. The closer your body is to parallel to the floor, the harder the movement becomes.

Also, if you’ve experienced elbow pain (or something like tennis elbow) in the past, McCall recommends try performing some or all of your pulling exercises with a palms-up (supinated) grip or with your palms facing each other (neutral grip). The rotation of your palm changes the stress you put on your shoulders, and, therefore, makes the movement more kind to your elbows.

READ MORE:

The End of Shoulder Pain

Why Do Squats Hurt? (And How to Fix the Problems)

The Complete Deadlift Guide

K. Aleisha Fetters, M.S., C.S.C.S., is a Chicago-based personal and online trainer. She has a graduate degree in health and science reporting from the Medill School of Journalism at Northwestern University and regularly contributes to Men’s Health, Women’s Health, SELF, U.S. News & World Report, TIME, and SHAPE. When she’s not lifting something heavy, she’s usually guzzling coffee and writing about the health benefits of doing so.