Modifications to Contraindicated Exercises: Playing It Safe in the Gym

Many of the traditional exercises which we either learned en route to getting certified, or along the way from various industry leaders and professionals, have the potential to cause injury.  While controversy does exist among professionals, biomechanical research clearly delineates some specific moves to avoid, particularly if a client presents with a certain pre-existing mechanical/physiological condition. Read on to learn about these exercises as well as some easy swaps to render them safer and more applicable for any client.

Understanding the Meaning of “Contraindications”

When a trainer, coach or physician uses the term contraindicated to describe a particular exercise or workout format, the implication rests in the potential for injury. We can further categorize this term for even more clarification.

An absolute contraindication takes into account conditions under which a client should definitely not engage in any workout until such time as he can receive treatment to manage the underlying conditions appropriately. Examples include the following ~

• Unstable angina/arrhythmias
• Systolic blood pressure higher than 180
• Very low blood pressure
• Resting heart rate above 100bpm
• Uncontrolled diabetes
• Deep vein thrombosis

Relative contraindications, typically viewed on an individual basis, may include the following ~ –

• Severe electrolyte imbalance
• Aortic stenosis/coronary artery stenosis
• Poorly controlled arrhythmias
• Stroke within the past month
• Severe hypertension

The Importance of a Health Assessment

While the standard of care in our industry strongly suggests that trainers conduct an assessment/health history before training any new client, those with easily recognizable health problems warrant particular attention. For these clients, certain modes of exercises will not prove safe or effective and may result in dangerous health outcomes. In severe heart-related conditions or bypass surgery, contraindications may exist for any cardiovascular/endurance workouts.

How To Identify Risky Movement

The most commonly contraindicated exercises typically make the list due to their capacity for carrying higher risks to joint structure and/or soft tissue. The following scenarios highlight the reason trainers must always weigh the benefits of an exercise against the potential for injury ~

• Improper body alignment
• Locking of joints
• Rapid or uncontrolled movements
• Hyperextension
• Overstretching
• Excessive compression of structures

Once a trainer identifies any of the above characteristics in an exercise, he may opt for seeking out a safer alternative exercise. Many exercises lend themselves to slight modifications while still enabling the client to train a specific body part, thereby significantly reducing the possibility of an injury.

Easy Mistakes with Grave Consequences

As we might predict, some of the most common errors made by novice lifters and experienced bodybuilders alike include actions at the shoulders and low back during movements that focus upon the pulling and/or pushing motions; pelvic instability during hip/ knee flexion exercises; and over- recruitment of hip flexors while working the abdominal muscles. One reason for such inaccuracy in lifting technique lies in the overabundance of “instructional guides available on the Internet. Without proper training, many individuals simply mimic what they see online; yet more often than not, movement compensation occurs due to weakness along the kinetic chain. In many cases, trainers identify these problems can correct them by slightly tweaking body positioning or, in some cases, swapping out the exercise for something else that perhaps confers more stability to the joints and forces utilized.

Exercises with Potential Pitfalls and Their Safer Modalities

The remainder of this article aims to provide examples of some of the more commonly encountered exercises, the reason they may prove dangerous, and then to suggest safer alternatives.

1. Back Arches
   These moves involve hyperextending the lower back. Such exercises often place excessive strain on the lower back, proving especially hazardous if performed in a bouncing fashion.

Alternative: While ensuring some extension in the low back, try stretching and strengthening in a slower, controlled fashion.

2. Straight Leg Sit-Ups
   When executing this move for the purposes of training abdominals, keeping the legs straight ends up involving the hip flexors as well as the abdominals. The contraction of hip flexors tends to elicit hyperextension of the lower back and a forward tilt of the pelvis. In this fashion, the abdominal muscles get neglected and will remain weakened and unstable.

Alternative: A curl-up, or a partial sit-up, executed with bent knees safely and efficiently will target the abdominal muscles more directly, helping to relieve lower back pain.

3. Standing Straight-Leg Toe Touch
   A holdover from the early “Jane Fonda” era of exercises, many individuals thought of the straight-leg standing toe touch as an ideal way to stretch the hamstrings. However, research has deemed this movement not only ineffective at targeting hamstrings but also places unnecessary strain on the lower back muscles and the spinal column. Many professionals now try to have their clients avoid any unsupported forward flexion.

Alternative:  Have the client lie on his back and raise one leg straight in the air. By putting his hands around the lower portion of the raised leg, he may gently pull the leg toward his chest. Keeping the elevated leg as straight as possible ensures a maximal hamstring stretch.

4. Head Circles
   Gone are the days of group fitness instructors rolling their heads around in circles. The cervical vertebrae, delicate at best, cannot handle stress this movement induces, especially when performed quickly and/or forcefully. Neck hyperextensions may lead to a compression of nerve roots located within the neck, a particular contraindication for those individuals who may suffer from degenerative disk disease.

Alternative: When moving the head to loosen up the neck, proceed in a slow side-to-side motion.

5. Hurdler’s Stretch
   We often encounter individuals sitting on the floor with both legs apart, one leg tucked behind and outward, while the individual reaches forward to touch the toe of the extended leg. While such a stretch does indeed feel good, it places a tremendous amount of stress on the ligaments within the knee joint of the bent leg.

Alternative: Perform this exercise on a raised bench or the side of a firm bed. This places the leg not currently stretching to remain in a neutral position. Instruct clients that when bending forward, they should focus on bending from the lower portion of the back as opposed to the mid-back, thereby maximizing the stretch on the hamstring.

6. Full Squat
   The full squat, often done until the quads surpass the level of “parallel to the floor” or 90 degrees, also places a tremendous amount of pressure on the knees. In particular, the knee ligaments and cartilage end up in an extremely vulnerable position.

Alternative: Partial squats provide and safe yet still highly effective stretch in the muscle.

7. Lat Pull-down behind the Head

This position elevates the risk of cervical injury while also reducing activation of the latissimus dorsi.

                          Alternative: While sitting in a neutral spine position, instruct clients to depress

                          and adduct scapula while pulling the bar to the top of the sternum.

8. Anchored Sit-Ups

Sit-ups, a popular move for decades, have now been rendered inappropriate for most of the general population. This traditional move leads to trunk imbalances and a further risk for low back pain. Sit-ups, often executed in the name of strengthening abdominal muscles, heavily recruit the hip flexors. Anchoring one’s feet further increases the hip flexor pull on the hip and spine, placing undue stress on the connective structures. 

                         Alternative: Abdominal curl-ups place the desired resistance on the rectus

                         abdominis while not engaging hip flexion.

 The Other Side of the Coin

While the restrictive guidelines given to injured individuals or those with biomechanical deficiencies – often suggested by a physical therapist or orthopedic surgeon – serve a specific and protective purpose, orthopedically healthy individuals need not abide by these regulations. Ironically, an injury-free individual may run a greater risk of injuring himself by purposefully avoiding a movement that a friend was told not to do. If one can follow sound training principles (and adaptation criteria only when necessary), he should continue to strength-train in the regularly accepted mode. Avoiding a movement or a particular range of motion during an exercise may actually increase the risk of injury, particularly if the joint ever experiences a load greater than that to which is had grown accustomed, either in real world situations or in training. Only by strengthening joints/muscles/tendons can we hope to continue pushing/pulling/carrying heavier loads in an effort to build lean muscle mass.

Final Words

Exercising safely means avoiding potentially dangerous exercises and instead choosing exercises appropriate for one’s level of fitness. In order to ensure proper technique, any new move or exercise routine should proceed at an appropriately slow pace, taking care not to increase the level of difficulty and intensity too rapidly.

References:

https://www.livestrong.com/article/505755-definition-of-contraindicated-exercises/#google_vignette

https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults/

https://www.medxonline.de/wp-content/uploads/2017/03/rationalapproachtotreatment.pdf

https://breeze.academy/blog/what-are-the-contraindications-to-exercise/

https://personaltrainertoday.com/top-10-contraindicated-exercises

https://www.cooperinstitute.org/blog/contraindicated-exercises#:~:text=Contraindicated%20exercises%20are%20those%20that,are%20inappropriate%20for%20most%20individuals.

https://brainly.com/question/41904704

https://www.lausd.org/cms/lib/CA01000043/Centricity/Domain/245/Contraindicated%20Exercises.pdf

https://www.unm.edu/~lkravitz/Teaching%20Aerobics/YoungExercise3.pdf

https://www.ncsf.org/pdf/ceu/contraindicated_exercises.pdf

https://exrx.net/Kinesiology/Deficiencies

https://sportmedbc.com/article/potentially-harmful-exercises/