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014 Common lifting issues

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014 Common lifting issues

By Jurmaine Health

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We love our lifting athletes, so here’s an episode specially for you. The common injuries in weightlifting and crossfit. If someone says you have carpal tunnel syndrome, sometimes it is not necessarily true – so do not rush to get a surgery. Here, we talk about the shoulder, wrist, median nerve, the knee, the back, movement patterns etc Enjoy the episode, and make sure to drop us a message on facebook or instagram to let us know what else you’d like to hear!​

JACKIE [03:38] And you have to be careful with it because it can for any bones that have a poor blood supply, they can become weak or necrotic, which means they start dying. And if you want to continue lifting, that is definitely not something you want to be ending up with.

JACKIE [06:39] Forearms as well as their hands like the muscles through the hands, and all goes upwards. So the tensions are very high through their forearms themselves and they are the ones where you see a lot of the median nerve being pinched as well.

JACKIE [09:13] Yeah. And you see the other one going over hyper, yeah extension on to compensate for it which often happens to then become the unstable shoulder believe it or not, but as we discussed previously, between stability instability, it’s a very fine line. ​

Dr Jacqueline Swiatlowski is a qualified chiropractor with over 6 years of experience. She has worked in a range of different environments including roles within the allied health industry, professional sporting clubs as well as in her own private practice. With a Master of Clinical Chiropractic from RMIT University as well as a number of additional qualifications, including Active Release Technique (ART), Animal Flow and a Certificate III & IV in Fitness from the Australian Institute of Personal Trainers, Jacqueline is an expert in movement restoration and chiropractic care. In the past she has worked alongside local athletes, including players from the Western Eagles Soccer Club, Melbourne City Soccer Club and the Coburg Lions Football Club. In her role at Jurmaine Health, Jacqueline’s main focus is treating patients and looking after their health. “Jacqueline is also a TRE provider now and can offer TRE treatments to patients.”

Episode 014: Common lifting issues

Podcast brought to you by Jurmaine Health

JACKIE [00:00]

This is Jurmaine Health, the center to help you achieve wellness in both your brain and body. We endeavor to encourage cross communication between health professionals for your health and well being. We bring you topics on neuro psychology, neuro behavior, neuro musculoskeletal, neuro gastro, movement is well being, metabolism and microbiome, which are also some of the services that we provide. Today, we're going to try and interact a little with our weightlifting participants/ fans, as we've seen that you guys have taken an interest in our podcasts. So yay.

And I have Cera Lai with me today. And for those of you who may not remember, she's a lifting coach, as well as our in house physio, and we'll be talking about the common injuries that we've seen in our lifters. And with that say, Hello, Cera.

CERA [00:46]

Hello.

JACKIE [00:47]

So today, I think the topics that we've decided that we most commonly see and that we'll go over with a little, probably a little bit of discussion/case studies that we may have seen for hip impingement tears, unstable shoulders, median nerve issues. So through, running down your arm into your wrist, forearm and wrist and then as well as compacted wrists along with it. So knee pain issues and then some back pain issues which we most commonly see of other causes. With that, um, Cera, where would you like to start?

CERA [01:22]

Why don't we do a top down approach? What do you reckon?

JACKIE [01:26]

Okay, starting from the top, so yeah, so what do we what are we calling the top? Unstable shoulders or median nerve wrist issues, which ones are top in your case?

CERA [01:35]

Let's go from the wrist.

JACKIE [01:36]

Alright. You had one?

CERA [01:38]

Yeah, well, yes, I've had

JACKIE [01:39]

perfect example

CERA [01:40]

I had a few. So if you've been lifting a while, there might not be an occasion where you are in the middle of, mostly in the jerks because that's when you pop the bar off your shoulders and you're trying to punch under the bar and having to bear the weight of the bar in your wrist as you're receiving it. So that's a timing issue, sometimes it can be a very jarring effect. And if you don't have great wrist mobility that usually results in a sore, painful wrist, or in the second instance that usually raise its ugly head when catching a clean, not getting the bar high enough rushing under and then not being able to actually catch the bar on your shoulders, resulting in the bar crushing down into your wrist and sometimes make worse because you're in the bottom of a squat. The bar's on your wrist, your wrist pushes your elbow into your arm you're your thigh, which is kind of like a sandwich crushing effect. And that's usually the worst ones that we've encountered, or I've heard off.

JACKIE [02:52]

Yeah, more so with the compacted wrists that we're looking at in this case is where you may have had a stress fracture or actual fracture put through in often it's the scaffold itself. So one of the little bones just under the thumb, and then occasionally in your siloed processes in either of the in bones of your two forearm bones. I think you may have had one of them.

CERA [03:19]

I have one in the middle.

JACKIE [03:21]

Yes.

CERA [03:23]

Yeah, but the most common one is the one at the base of the thumb. And that's quite worrisome because that particular bone has very poor blood supply. So the healing is really poor.

JACKIE [03:38]

And you have to be careful with it because it can for any bones that have a poor blood supply, they can become weak or necrotic, which means they start dying. And if you want to continue lifting, that is definitely not something you want to be ending up with. Especially if it's time to get to that point because if it's healable still it can put your recovery time, a nice decent time backwards. Otherwise, once it's become a bit more pronounced, it can do a lot more damage to the rest of the bones as well. So that's lifting gone. So if you are starting to feel any issues with your wrists

CERA [04:14]

don't just put straps on and just deal with it.

JACKIE [04:17]

Go see someone get it addressed. If you're worried about any of what we've talked about yup, x rays and MRIs, at least the best way to go. MRI is clearly always the golden standard, but if it's already fairly pronounced, an X ray will show it as well.

Moving on from the wrists, because it also contributes into it is what we've got the median nerve, we'll also be discussing this further on, in it's going to have its own podcast, believe it or not, for its for the amount of involvement that it has in a lot of issues and for the misdiagnosis where this occurs with the median nerve. It's the nerve that's involved in carpal tunnel syndrome. And it's the one that most people pretty much as soon as there's an impingement on anyway, they automatically assume it's carpal tunnel. It's in especially in lifters. Because it's in around the carpal tunnel, when they talk about is right at that wrist area, they do associate it with it heavily and just go, okay, it's carpal tunnel syndrome.

Most of the time, especially if I've seen around here, or Shermain has seen around here, we've seen that it's not been the carpal tunnel itself, not the extensor not the retinaculum itself, not the retinaculum itself, that's been the cause of it, it's usually been an impingement higher up so the median nerve does travel between and under certain musculature as well as the nerve roots higher up. So in and around like your armpit area as well as up in and around your neck there's a few exit points for the nerve roots through there for you brachial plexus and stuff and they have a tendency to also get caught up there.

So they mimic the wrist pain and the finger pain and stuff. Because again, it's the median nerve supply. So we do see it a lot more commonly as well with tight forearms. And it's predominantly seen post, a lot of gripping exercises. So as much as we see it in lifters where that like we talked about earlier, poor biomechanics, where they're not using the right musculature, same sort of thing goes here where they're relying on a lot more grip strength to try and lift bars instead of like pulls sort of thing or instead of pushing them through their legs, they are using their arms to pull up. This happens to be where a lot of it comes from, they start gripping.

CERA [06:34]

over gripping

JACKIE [06:35]

Yeah, and they end up using a lot of their

CERA [06:38]

Forearms

JACKIE [06:39]

Forearms as well as their hands like the muscles through the hands, and all goes upwards. So the tensions are very high through their forearms themselves and they are the ones where you see a lot of the median nerve being pinched as well. And so they tend to mimic the pain into the wrist and into the carpal tunnel sort of thing.

So a lot of them be aware of that one so that you don't necessarily just fall under the trap of alright I've got carpal tunnel syndrome. I have seen it a couple of times and a few not just lifters but a few other people that have put it down to carpal tunnel, and we've treated other areas and it's released. So and they've pretty much become either symptom, symptom free, or very minimal as compared to what they were. So be careful so that you don't end up having surgery more so than anything else. Just because somebody said it's carpal tunnel doesn't necessarily mean it has to be there's a few issues that mimic it more so just be aware of it, and listen out for our podcasts on median nerve itself. So you'll get a bit more of an understanding as to where it might feel entrapped for you so that you can actually have a feel for it yourself. But yeah, that's the median nerve and the wrist covered for you guys. So moving up onto the shoulders.

CERA [07:48]

Unstable shoulders I believe.

JACKIE [07:54]

No, did I? I don't think so. No, I didn't have any shoulders yesterday. When Cera was referring to yesterday as I was covering for Shermain at Training Geek guys, so that's our Moorabbin clinic. That's why she was asking to see who I had. So no I don't believe I have any shoulders. So I'm going to leave that on to Cera.

CERA [08:18]

Yeah, unstable shoulders. So if you imagine the sport of weightlifting, the ultimate goal is to get the bar overhead, either in one swift movement, in the snatch or in two movements the clean and jerk. That's a lot of load to put through the shoulders if you don't act, if you don't, if you can't support the weight. It's quite dangerous. The shoulder is the most mobile joint in the body.

JACKIE [08:44]

It's a ball and socket joint again

CERA [08:46]

Yep

JACKIE [08:47]

Supported by

CERA [08:47]

The scap and your collarbone and all that jazz. So it's

JACKIE [08:50]

Rotator cuff as everyone knows

CERA [08:52]

yes. So it's pure, muscular ligamentous. Yeah. And the timing of activation it's very important as well. So shoulders cop a lot. You can get anterior shoulder pain, limited range.

JACKIE [09:10]

Limited range is usually the one that you see.

JACKIE [09:13]

Yeah. And you see the other one going over hyper, yeah extension on to compensate for it which often happens to then become the unstable shoulder believe it or not, but as we discussed previously, between stability instability, it's a very fine line. So it's not always the unstable shoulder that's the problem one, the problematic one. Or trying to stabilize the unstable shoulder is not always the fix for it.

It's the biomechanics as we're talking about and how it's moving itself in specific movements that happen to be an issue. In this case, like Cera just said, for the overhead work. If you're seeing your shoulders suddenly going, being caught, very far backwards or very far out to the side. You know, there's a problem if you're seeing yourself leaning into one side with the bar versus straight on one side, and then you've got your other side's coming out a good 20-30 centimeters out on the bar on the other side, again, you've got there's problem going on there somewhere.

It may not be again, it may not be the side that's coming out. It may be the side that's locked in. But it's something that's unstable or it's something that's not mobile. So it needs to be looked at, because you should be pretty much going through equally on both sides, both sides most of the time, even as an I'm not a lifting coach. So I'm going more biomechanically wise and as a movement rehab therapist, I'm rolling with that one, so I'm observing that way. So you want pretty much both areas, both shoulders, both arms moving in the same direction versus not in the same direction

CERA [10:54]

because the asymmetry might show up in other areas. For example, if you're like, Jackie said receiving the bar, let's say if you look at a person with their arms overhead in the v position

JACKIE [11:07]

Yes

CERA [11:08]

One side of the V is lower, or vice versa, that shift causes, usually goes elsewhere. And that could end up being in the hip or your knee. And that's usually the case where the asymmetry and it's often on the opposite side

JACKIE [11:23]

On the opposite side, so whichever side so in this case with Cera describing the V, so the one that's looking more vertical, that's usually not too bad, but believe it or not, that's usually the side that when we're talking about the asymmetry, that's the side that will cop the hip pain or the knee pain, because it's having to compensate for that shoulder that's unable to support the weight on the opposite side.

So it's pretty much taking everything to okay, just imagine you're looking at a person front on and their right side's vertical and their left side's, their left sides out pretty much more horizontal that right side is going to be the one that's going to be taking every all that weight because it's trying to, take the weight of the bar, because that left side has got it very far extended, so it's not able to hold it

CERA [12:15]

muscularly yet. We spoke up about instability, but in weightlifting, as well, you get people with like the rotator cuff pain, and that's usually from muscling the bar into position as opposed to driving with the legs and then getting into position to stabilize the bar over head. So that is very common as well, especially in CrossFit because of the high repetition and doing it quickly for time doesn't actually allow you to get into a good position to actually use your larger muscle groups, your glutes and your quads in the lift.

JACKIE [12:53]

and it does and then it moves on to like we just talked about with the median nerve as well. So that's the reason you're actually using those with overusing it, try and use it to try and finalize those movements versus like you just said the big muscles to push pull etc.

CERA [13:07]

So a shout out to our coach Lester, hashtag use your legs.

JACKIE [13:13]

squeeze your glutes control, control. Yeah.

CERA [13:17]

Slow down everybody.

JACKIE [13:18]

Yeah, very true control.

CERA [13:21]

So we very nicely segue down to our hips and knees from the shoulder just then. So it's when you have an issue in a particular area that might not always be the primary cause the root cause. It's always good to look elsewhere. But in this case, we're going to talk about touch on the hip. In our hip series, we just came up with the hip series

JACKIE [13:44]

We did discuss we've got hip impingement and tears here listed but believe it or not, again, we and we discussed this within the hip series in our last podcast yeah if we don't see it as commonly in the weightlifters, it's not, if it's a finding, it's usually more of an incidental finding with when it comes to the impingement. So that FAI

CERA [14:08]

structural

JACKIE [14:09]

the actual structure. So as in the actual structure itself, it doesn't have to be actually ,being it, doesn't a lot of the time that we've seen in a lifter, it's been asymptomatic. It's just been an X ray find. But we do see it more commonly in our crossfitters, like we talked about, for that very reason for the high reps, and the loss of control. So where you start with the control, but then the more reps that you put through it, you start just relying on them. You're just pretty much going through the movements, you stop focusing on trying to land so say if you're doing box jumps or if you're trying box jumps is a good example, actually,

CERA [14:48]

yeah.

JACKIE [14:49]

So you start off carefully, but then as soon as you start putting more and more of them into it, you start going for more reps. You just start pretty much just going alright, just jump land, just jump land, just jump land. You're not focusing on how you are landing, you're not trying to absorb the forces through your feet through your knees through your hips, you're just pretty much landing and going back up.

CERA [15:08]

You can get back pain from from box jumps, high rep box jumps, you just end up like Jackie said, end up clearing the box and then just landing passively, a lot of the time, you'd be rounding your back as well because you're tired, I can imagine it's tiring. So don't be surprised if you get back pain.

JACKIE [15:18]

Back pain as well and with that it can actually be more dangerous. In this case, it can be back pain of the actual back pain cause because you can actually end up putting stress fractures through yourself for that sole reason of as I said, you're not actually absorbing the forces. So you're more or less just jarring your back and youre just

CERA [15:46]

all your joints

JACKIE [15:47]

Yeah you are jarring or your joints. But just because you're landing smack bang down, you can be pretty much putting a lot of direct forces onto that back and stress fractures can be common in that case also with the box jumps, shins can also be a big culprit with that. So shin splints can be a big flare up with that as well. But that was a big segue.

JACKIE [16:11]

We clearly don't like box jumps, and crossfit apparently.

Well no, none of us actually noticed this. I am sure that we'll talk about the lower limit some point like rebounding box jumps, but let's just stop there. Yeah, that's a better one. Yeah. No, it's not.

CERA [16:32]

That's great. All right, back to the weightlifting injuries. So in the hip, we discussed in the shoulders when you're catching the bar asymmetrically it's the same in the hip. If you find that when you actually jump your feet out that one foot moves more than the other, or one toe points out more than the other.

JACKIE [16:53]

Or you're rotating your hips.

CERA [16:54]

Or you're rotating.

JACKIE [16:55]

So, you've got a rotation component coming through

CERA [16:57]

and you know that because your bar helicopters. That's not good because that's when the impingement is more pronounced.

JACKIE [17:08]

More pronounced. And this is where you can actually end up putting in tears through this. So whether it's labral tears ligamentous tears, that is where there is tendinopathy, that's when it can start occurring. Because then you are again, loading one particular joint versus, and then putting in not just loading but you're also what we call translating. So you're shifting it to whether it's a rotation or anything, whether it's an upwards downwards thing, depending on how you're sitting your hips, pelvis, it will also depend on that but you're also moving, you're moving that socket, so you're moving the femoral head in that socket as opposed to it sitting nice and settled. It's either being moved upwards, it's being moved forwards, it's being moved backwards, just depending on which way you're loading it, and then which way the bar's being loaded on top of it. So yeah, you are right, they do often go hand in hand. And then occasionally you do have the lack of control where you fold into it.

CERA [18:10]

Yeah, like you just drop underneath it and just using your structures passively to just receive the weight. Just because you've got the mobility for it doesn't mean you should do it. If someone I know is listening to it, you know who you are. I'm talking about you.

JACKIE [18:28]

Yeah, moving on.

CERA [18:36]

Knee is usually a product of either the ankles or the hips. Yeah, it's very uncommon for you to get actual knee pain from squatting or weightlifting itself. It's usually cause your hips or your glutes are not firing properly or in the right order. And or you're shifting a lot because you don't actually have the range, in the ankles, or the hips to allow you to sit nicely into a squat, which

JACKIE [19:05]

that one I had yesterday yeah, that's very common.

CERA [19:08]

So yeah so knee pain usually is just a product of what going, not wrong, not ideal so it's all about train retraining your movement patterns really yeah, so that's a good thing if you get knee pain it's not the end of the world. And very rarely you'll get structural issues like meniscus, it's usually meniscus I find in weightlifting, not so much ACLs or MCLs because it is a non-contact sport. What's your take on this?

JACKIE [19:40]

and then I agree it's not a traumatic one. I'm surprised by the meniscus I wouldn't have been expecting a meniscus either. They usually pop and rotate as well.

CERA [19:48]

I only know one.

JACKIE [19:50]

So they're not that common either. So if Cera's saying the same thing, and also I haven't seen it very commonly we are inclined to say direct structural damage to the knee itself is not probably the most common one that we see. It's usually a referral of somewhere else I talked about hip or knee, or it can be so tendinopathies I have seen so whether it's

CERA [20:13]

Patella tendon

JACKIE [20:14]

Patella tendon or quad tendon that I have seen but again

CERA [20:18]

that is from loading your knee and not your hip.

JACKIE [20:20]

Yeah, that's majority of the time that's what I've seen. So like you just said, loading the hip or loading the ankle moving left, the knee over the ankle to try and get the actual squat happening versus the ankle itself doing the action. So yeah, those are probably the two more common ones that I've seen versus actual structural damage to itself in lifting. Neither the hip nor the knee, have we seen too much structural directly damage, it's usually been a product of something else, or a biomechanical problem that's brought it to light, which is a good thing. Moving on. From there, we have back pain, which is also very rarely the root of the problem. It's usually from

JACKIE [21:01]

Over use of other muscles

CERA [21:02]

or just again, not using your legs enough. If you think of, yeah, if you think about

CERA [21:13]

if you think about the first pull from the floor, if you don't have good ankle mobility, there's a lot of time your back you are quite over, your back angle is quite exaggerated. Yeah. So that puts a lot of stress on your lumbar spine to keep it neutral. If you don't actually push through your legs or feel the loading through your lower half of the body, you're actually just pulling the bar up with your back and then going to that extension by whipping your back from hopefully a neutral to a hyperextension and then catching it in. That's hoping that it is not flexion. That's a lot of curves to go through.

JACKIE [21:52]

So we're trying to say to keep it from a straight to a slight extension, as opposed to starting at with the lift at a curl position, that's when damages, that's when it occurs where you've actually taken a lot of the forces on your back. It's very difficult to try and lift it with a straight back using your actual back muscles. That's at least you know, you've got a little bit more power coming from the legs. But once you start seeing the curl kicking in, you know, your back started to take the job. And you see it very commonly.

CERA [22:24]

Yeah, a lot of time. It's also not so much the flexion injuries like the disc issues that we see it's more the hyperextension like the facet joints, or again, like the jarring back pain, where has anyone ever landed in a jump with like, stiff legged and feel the forces running through your spine, that that's how it usually is. So again, because you're fighting very hard to keep your chest up, you're already creating like an exaggerated curve in your lower back and then you're going to an extension moment, you bring it further into range. So if you look at your spine, there is bony protrusions at the back and when you actually�

JACKIE [23:03]

Called the spinous processes

CERA [23:04]

spinous processes when you hyper arch your back, that's when it impacts on each other. Yes, it's got nowhere to go, where else?

JACKIE [23:12]

Yeah, they can collide with each other and again, they don't like. So bones don't like being bruised. In this case they become bruised, when they collide with each other, there's a little bit of bone bruising that happens. So you can be pretty much sure that you're going to end up having some form of back pain can be felt more of a bruise sensation than anything else, but it can actually last for all the way up to about 12 weeks depending on just how much forces you've actually driven through there, and just how much you've landed in that unsupported arched position and had your spinouses collide.

As I said bones do not like being bruised, but then you're not like being hit and colliding one on top of the other and not only do you run the risk of as I mentioned before about stress fractures, you run the risk of stress fractures again here, just in the backwards part versus in the vertebral bodies is what I mentioned before, but here you run the risk of them fracturing having in putting a stress fracture through the back ones or running the risk of �

CERA [24:13]

facet joints.

JACKIE [24:14]

Yeah, facet joints can, well not dislodge, but can have a little rotation put through them more. So, our form of subluxation that we refer to in the chiropractic society, in the chiropractic world would be we are more referring to here, or you can have as a result of having facet joint sprains as well Cera just pointing to herself as a prime example of that.

CERA [24:38]

and why does that happen? Probably tight hips. If you get back pain and you go see someone guess what kind of exercises they're going to give you. Glute activation, lower abs activation, loosening up your hip flexors. Yeah, so those are usually the reasons why you move the way you do.

JACKIE [24:55]

You also have the other one, the other culprit tends to often show up as well is hamstrings. So tight hamstrings are also the other one where it's just the pulling down of that pelvis. So as a result of tightness just because of its insertion yeah or its origin I should say they start yanking down the pelvis. So as I call it, yeah always call a yanking down on the pelvis. So it feels like it's pulling down on the back. So it's straining and it's making it feel tight. A lot of the time that presents more with a tightness versus anything else, like a tightness through the lower back yeah, not so much as a sharp pain. In most cases. It's just a lack of mobility through there. Yeah, but it's also fairly evident. It's as soon as you see a toe touch or something the person's automatic thing is hamstrings and that one's a lot more evident and easier to pick up if anything.

Any other things that you've seen or any other things you'd like to address.

CERA [25:53]

I think those are the major ones. So I guess the take home message guys is record yourself. While stand in front of the mirror while you squat, see how you're moving. If you notice something that is, doesn't look picture perfect, the World Championships is going on right now maybe have a look at how the elites move.

JACKIE [26:12]

Don't necessarily compare yourself to others. We've discussed this time and time again.

Different body types respond differently move differently. Yeah, do not always compare yourself. But at the very least, maybe have a look at the movements themselves. If you can, or you can always try and see if you think the person is moving correctly. We can always do if you want, we can do it as a yes, record. And we can have a discussion session on one of our Facebook pages, what we see what you guys see, so that we can have a comparison there. So it can also be a discussion, an interactive thing and it can also give you an idea of how people are moving, how different people are moving whether you're moving correctly. Same thing goes for your own videos, send them through on our Facebook pages and stuff. We're going to try and organize a Facebook page for our group videos and everything, so that you guys can send it through and we can have discussions and give you feedback on them. So get that one happening so we can start sending us through on our Facebook page, please. And our Facebook page is Jurmaine Health j u r m a i n e h e a l t h,

CERA [27:20]

Body, b o d y

JACKIE [27:23]

No, that's not our Facebook one, our Facebook one's just Jurmaine Health, Instagram Jurmaine Health Body,

CERA [27:29]

Look at the Jurmaine Health at jurmaine health. Our social media manager just cut it and just tried to correct us

JACKIE [27:43]

so the facebook page itself is called Jurmaine Health. But if you're looking at trying to type it in with a little at in front of it, it's just Jurmaine Health. But if you're looking at sending it through via Instagram that yes that is if you want to find us on our Instagram, that is Jurmaine Health Body also spelt the same way.

So guys, If you like what we're presenting, please give us a thumbs up a like or share it with one other person who you think we may be a help. For those of you who are coaches, dancers or athletes, and may find difficulty with expressing or executing movement patterns. Please do connect with us on our website, www.jurmainehealth.com.au and Jurmaine Health is spelled j u r m a i n e h e a l t h. Or please socialize with us on Facebook, which is Jurmaine Health and Instagram which is Jurmaine Health Body. And last but not least, since this podcast is made for you, our clients, patients and fans, please do let us know what else you might like to hear about. And that's US for today. Have a good week, guys. See you!

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2020-10-16T19:47:49+10:00