In the last couple articles, we discussed the most prevalent side effects of anabolic steroids that I see in my every day practice.  In this installment, we'll veer into the more common upper body injuries I see from lifting weights.

First, let's cover some basic terminology:

1-Sprain: Overstretching (partial or micro-tearing) of a ligament (connective tissue connecting bone to bone)

2-Strain: Overstretching (partial or micro-tearing) of a muscle or tendon (connective tissue connecting muscle to bone)

3-Contusion: Deep bruise, usually to a bone or muscle

4-Tendonitis: Inflammation of a tendon

5-Bursa: Fluid filled sack that serves as a cushion between rough bone surfaces or protuberances and the overlying muscle

6-Bursitis: Inflammation of a Bursa

7-Tear: Complete rupture or avulsion of a structure, usually a tendon or ligament

The most commonly injured joint in the body, is the shoulder.  The shoulder is the only joint in the body which allows complete circumduction, which makes it the most mobile of our joints, but this mobility is gained at the price of stabilization.  The shoulder is predominantly held in place by the tendons of the rotator cuff muscles (infraspinatus, supraspinatus, subscapularis, and teres minor) and the labrum.  The bench press can cause shoulder injuries by restricting the normal motion of the shoulder blades. The shoulder joint (glenohumeral joint) will have to move excessively to compensate for the restricted movement of the shoulder blades. The bench can prevent the shoulder blades from going back flat against the rib cage and towards the spine. If this happens, the shoulder blades are now rounded forward. In order to lower the weight all the way down to the chest, the "ball" must move while it is not centered in the socket. This can be very dangerous for the shoulder joint itself and the external rotators that attach to it as they will become tight and the internal rotator cuff muscle (subscapularis) will become weak. This causes the "ball" to move forward and up causing injury and pain.  This is also what gives lifters that rounded shoulder appearance, like an ape carrying luggage.  This position of the shoulder leads to rotator cuff tendonits, and possible tears; but also places the biceps tendon in a very stressed position.

The most common injuries I see in the shoulder are 1)Rotator Cuff Tendonits, and 2)Biceps Tendonitis.

The rotator cuff is actually four muscles.  We call them the "SITS" muscles:  Supraspinatus, Infraspinatus, Teres minor, and Subscapularis.  These muscles are stressed during any heavy shoulder movement, but especially so during the bench press.  The stress leads to inflammation of these muscles and especially their tendons resulting in shoulder pain in the side or front.  It usually worsens on chest day, and with any heavy movements.  When the tendons are inflamed, they naturally swell and take up more space, causing them to sometimes compress against the acromion (a projection at the top of the shoulder blade), where it meets the collar bone, or against the sub-acromial bursa..  This is called impingement syndrome.  The treatment is usually the most dreaded word a bodybuilder can hear: "Rest".  Ice and anti-inflammatory meds either orally or locally injected can also be employed.  Prevention involves warming up and stretching, and especially warming up the rotator cuff muscles on chest day, with a few light sets of internal and external rotation.  Additionally, if your chest overpowers your back, and you have the "ape carrying luggage posture" then you need to do two sets of rows, for every set of chest pressing movement until the imbalance is overcome.

Biceps tendonitis is an inflammation of the biceps tendon where it inserts on the coracoids process of the shoulder.  Stressed by the bench press, flies, and some curling movements; the pain is all anterior.  Treatment is the same as rotator cuff tendonitis, only if injection is warranted; it's aimed directly at the coracoid process.

Lateral epicondylitis is the medical term for "tennis elbow".  Bad name since I'm at my wits end with patients insisting that they,  "...don't play tennis!"  This is an inflammation of the extensor wrist tendons (the ones that pull the wrist backward like revving a Harley) where they meet the elbow, on a bony process called....(wait for it)...the lateral epicondyle.  This area is stressed during reverse curls, reverse wrist curls, push-downs, and cleans.  Treatment is still, rest, ice, and anti-inflamatories, but can also be aided by a tennis elbow strap/band or brace.  This goes across the meat of the forearm.  The purpose is to change the fulcrum, or point of stress from the lateral epicondyle to the band, so it must be fairly tight. I believe this works best following an injection, because these can be nuisance injuries that linger.  ART (active release techniques) is also extremely effective for "tennis elbow" annoyances.

Wrist pain can be tricky, because there are so many bones in a very small area.  I have seen an increase in wrist pain in my weight-lifting patients over the past year.  Usually the pain is dead center in the wrist, right at the crease.  This injury occurs from heavy pressing, period.  The bones get compressed from gravity plus heavy weight.  The bones, and ligaments then get stressed and it "hurts".  I have injected my own wrist, twice, in the past year.  The pain can also be more on the thumb-side, in an area called the "anatomic snuffbox".  If you pull your thumb back, in hitchhiker position, you will see two tendons pop.  It is between these two tendons and up the forearm where pain is experienced.  This is DeQuervain's tenosynovitis.  An inflammation of these two tendons and their synovial lining.  This can be treated with the usual rest, ice, and anti-inflammatory medications.  Any questions, hit me up on the Q&A boards, or TPT, who handles these things on the physical therapy side.  As, always, any nagging injuries or concerns, feel free to call my office!

Anthony F. Human, D.O.

General Practice/Sports Medicine

Active Healthcare & Rehabilitation

Human Wellness Group, LLC

678-689-6888