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Exercise: Risk vs Reward

Exercise: Risk vs Reward

by Mr Amir A Perzuck 14/09/2018

Exercise. Endless research citation is unnecessary to justify the statement that exercise serves great benefit for the body and mind. But exercise doesn't come pitfall free, and potential issues sometimes make people question the whole exercise is worth it.

Primarily this revolves around the incidence of injury, in particular injury that can potentially lead to sustained adverse implications on peoples lives. But surely it doesn't have to be that way, does it?

Having been a physio for nearly 24 years with over 20 years in private practice, I've come across endless injuries that simply should not have happened. There are too many to recall. A common classic example is 'middle age rotator cuff tendon tears.' Another example is back injuries involving spinal discs and nerves. These injuries, unlike basic muscular and soft tissue strains and sprains, can potentially lead to medium to long-term lifestyle changes.

Risk vs. Reward Scale I have now become accustomed to preaching to my patients about a concept I call "the risk vs. reward scale" for exercise. In educating my patients I try to outline that they need to seriously consider what they are trying to achieve in their choice of exercise and it’s intensity and in doing so to be sure that they understand what risk they put themselves into with their choices.

To explain more clearly I use the common more specific example of the middle aged women who presents with a shoulder injury after a gym work out, lifting weights amongst other forms of exercise. More often than not an injury will occur when a structure is put under pressure it can't cope with, or 'overload', and suffers from either a strain with microscopic damage within fibres or macroscopic changes in tears and ruptures. Pure and simply, if you load a structure enough and it exceeds its capacity to withstand that load, then there's a fair chance you'll injury it.

So the 50 year old who presents now with an acute tear of their supraspinatous tendon in their shoulder. It's a difficult problem. Tendons are notoriously poor healers, hampered by poor blood flow. It's painful, impacts on function, sleep and one's ability to continue exercising. It's difficult to treat with remedies varying dependant on the severity of injury. From rest, physiotherapy, cortisone, PRP (blood injections) to surgery. Many jump on a merry-go-round trying to find an answer. Not a straightforward injury.

But why did it happen? When asking for a mechanism of injury, this patient group will frequently report I was lifting weights. The conversation goes something like this.

"How did it happen? "I was lifting dumbbells above my head" "How heavy were they?" "about 7 or 8kg each" "How much ????" "I think they were 6kg" (starting to look sheepishly) "Why?" "Why what? "Why were you lifting that much weight over your head?" "....because I've been told it's good to lift weights, it's good for my bones, and I need to push myself to get stronger!" "right OK then, do you have a specific target or aim for your strength?" "no, not get strong??" "...are you planning on competing in Rio De Janeiro? ...have you entered a body building competition?"

......and the drift is generally gathered by now. It's at this point that I bring in the risk vs reward concept.

Safer Strength Training You can easily derive benefits of strength training from safer practice like doing higher reps with a lower weight, restricting lifting weights below the horizontal and still work your shoulder muscles and you can do all of this without tipping the scales in the favour of risk.

High Risk Exercises Some other examples of high risk exercises include:

deadlifts (there are plenty of safer ways to strengthen gluts/hamstring/back muscles) deep squats and lunges (do half squats and lunges) kettle bell swings (take your pick) extreme intensity (go at 95%) The issue is that some of these higher risk exercises produce faster and more effective results.

Low Risk Exercises Have Long-Term Rewards However my argument centres on the philosophy that I'd rather err on the side of slightly less sized shoulder muscles and slightly less power and strength that can be generated compared to a higher risk of long term injury? Your muscles will still be strong for the average person. Your body will still derive all the benefits you get from exercise, but you'll keep yourself safe and sound.

So here's a bit of advice. Always ask yourself:

Is what I'm doing potentially too much for me?
What am I really after here? Do I feel under control, am I not over straining? If you can't answer these questions confidently and safely then ask someone who can offer advice.

Seek professional guidance Ensure your personal trainer or exercise prescriber is experienced not just in years but in their ability to differentiate between requirements of age groups, personal needs and limitations. If that's not practical then remember, err on the side of caution. Erring the other way can cost you big time. Good luck.