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Risk vs Reward - is it worth it?

Exercise. The statement that "exercise serves great benefit for the body and mind" is universally accepted. But exercise does come with some pitfalls, and potential issues sometimes will make people question whether their endeavours was worth their effort.

Primarily this revolves around the occurrence 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 over 27 years with over 25 years in private practice, I've come across numerous injuries that simply should not have happened. Some common examples include '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 person 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 not cope with, or 'overload', and suffers from either a strain or in more severe cases - tears and ruptures. Put 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, without an easy solution.

But why did it happen? When asking for a mechanism of injury, this patient group will frequently report that they were lifting weights.

The conversation goes something like this.

"How did it happen?"

"I was lifting dumbbells above my head"

"How heavy were they?"

"...about 8-10kg each"

"How much ????"

"I think they were 6kg" (starting to look sheepishly)


"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!"

"did you have a specific target or aim for your strength?"

"no, not get strong??"

"...are you planning on competing at the Olympics? ...or 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 significant 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 (injury).

"You must determine what you are trying to achieve and whether there are ways in doing so without putting your self at risk"

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 exercise (go at 95%)

Low Risk Exercises Have Long-Term Rewards

The issue is that some of these higher risk exercises produce faster and more effective results. 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 in your legs, compared to a higher risk of long term injury? Your muscles will still be strong and sufficient for the needs of 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.

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