Sunny Skies and Exercise: How to Avoid Common Injuries to Your Upper Extremities in the Gym

While it’s always a good time to get or stay active, spring is the season of growth and new beginnings for all things, especially for all of us trying to get in shape for the summer. And as the weather warms up, our sleeves get shorter and shorter. As the saying goes, “sun’s out, guns out”, but those toned arms and broad shoulders can come with a price. The season may have you wanting to get started with a workout routine, but you have to put your health first.

Starting a New Workout Routine: Talk to Your Doctor
Before starting any exercise program, or changing your current one, you should be sure to understand your strengths, weaknesses, and your realistic abilities. Upper extremity workout programs can be especially stressful on the body since most of us are not used to heavy lifting with our arms. Walking, climbing stairs, and even standing at least provide some regular activation of the muscles in our legs. Most motions that you might try at the gym that work your shoulders and arms are not commonly performed multiple times per day.  Therefore, you need to start slowly and work up to harder and harder workouts. Remember, that includes not only the total weight but also the amount of reps. Injuries can happen from single lifts that are too heavy or from repetitive overuse, especially if you ramp up too fast.  

Common Gym Injuries: Shoulder and Elbow Pain
Common injuries that happen in the gym can involve either the shoulder or elbow. Tennis elbow or golfer’s elbow, also known as epicondylitis, are common overuse injuries that don’t have to have anything to do with golf or tennis.  Pain on the inside of the elbow (golfer’s elbow) can be caused by workouts that include pull-ups/chin-ups, biceps curls, chest flies and wrist curls - anytime the wrists are flexed when lifting or you are pulling your arms towards your body with your palms up. The opposite is true for lateral epicondylitis or tennis elbow. 
Wrists extended or pushing away from you (think tennis backhand) can cause this problem. These conditions typically result in tightness and stiffness as well as pain with use. They can be very limiting with daily activities as well and sometimes disrupt sleep. Treatment requires avoiding the exercises that caused the problem, but you can also use anti-inflammatory medicines (like Motrin, Advil, ibuprofen, or Aleve), wrist and forearm stretching, ice and massage. Epicondylitis almost always goes away on its own but can take several months.  In the worst cases, or in those that don’t respond to these treatments, we can help with different injections or surgical procedures.

Shoulder injuries are especially common in the gym and are usually the result of overuse type repetitive injuries. Tears and rips of muscles and tendons can happen but are caused by heavy lifting and quick motions.  You should avoid these until your strength and endurance have improved and you are used to hard workouts.  Even then, avoid weights you can’t handle comfortably and always use a spotter. The lifts most likely to cause these types of injuries are pushing exercises like bench press, incline bench and overhead or military press. If you lose control of a weight during these lifts, it’s easy to tear your labrum or even a tendon like the pec major. Remember, our shoulders are not designed to push weight overhead or even in front of us very well and the difficulty and risk of injury increases as the angle of push increases from the perpendicular.  Unfortunately, these tears are likely to require surgical repair, so the best treatment is to avoid them in the first place.

Dealing with Tendonitis and Bursitis
Tendonitis and bursitis are the overuse injuries we most commonly treat in the shoulder. Biceps tendonitis is pain in the front and top of the shoulder that radiates into the biceps muscle. This tendon is likely to become inflamed with many lifts and exercises including pushups, pull-ups, lateral raises and even kettle bell swings.  Overhead lifts and poor technique on other activities like swinging a racquet or swimming can result in rotator cuff tendonitis or bursitis. This is usually characterized by pain deep in the shoulder and down the side under the deltoid. It can disrupt sleep as well. These inflammatory conditions typically respond to the tried and true R.I.C.E. treatments:

• Rest from the activity that caused the problem
• Ice the injured part 2 to 3 times per day for about 20 minutes
• Compression to help reduce swelling
• Elevation 

While the compression and elevation may be difficult for a shoulder, you can add in anti-inflammatory medications to help reduce swelling. Physical therapy is critical to getting better as well.  If needed, these conditions typically respond well to cortisone injections when combined with the other treatments mentioned.  Rarely do these conditions require surgery.
You can safely complete your upper extremity workouts and get beach-ready arms without getting injured by following these guidelines.  Workouts need to be challenging for you to improve but understanding where your limits are and pushing them safely will keep you from getting hurt.  If you do feel more than soreness the day after or pain during your lifts, stop and take a break.  If it doesn’t resolve on its own, make an appointment and we will get you back on track.