Exercise Selection and Common Injuries in Fitness Centers: A Systematic Integrative Review and Practical Recommendations

Abstract

Weight resistance training (RT) is an essential component of physical conditioning programs to improve the quality of life and physical fitness in different ages and populations. This integrative review aimed to analyze the scientific evidence on the relationship between exercise selection and the appearance of musculoskeletal injuries in physical fitness centers (PFC). The PubMed or Medline, EMBASE or Science Direct, Google Scholar and PEDro databases were selected to examine the available literature using a Boolean algorithm with search terms. The review process was performed using the five-stage approach for an integrative review and it was reported according to the PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSiST) guidelines. A total of 39 peer-reviewed articles (Price index = 71.7%) met the inclusion criteria and evaluated the link between exercise selection and the incidence of injuries in exercisers who regularly attend PFC. Most injuries occur to the shoulders, elbows, vertebrae of the spine, and knees. Although the injury etiologies are multifactorial, the findings of the reviewed articles include the impacts of overuse, short post-exercise recovery periods, poor conditioning in the exercised body areas, frequent use of heavy loads, improper technique in certain exercises, and the abuse of performance- and image-enhancing drugs. Practical recommendations addressed to clinical exercise physiologists, exercise professionals, and health professionals are given in this paper. The exercise selection in RT programs requires professional supervision and adhering to proper lifting techniques and training habits that consider the anatomical and biomechanical patterns of the musculoskeletal structures, as well as genetic, pedagogical, and methodological aspects directly related to the stimulus-response process to mitigate the occurrence of RT-related injuries in PFC.

Keywords: exercise movement techniques; muscle strength; musculoskeletal pain; resistance training; sports injury.

Figure 1

PRISMA flow diagram.

Figure 2

An integrative view of the multifactorial nature of injury risk. (A) General features of the interoception–allostasis process. While allostasis represents the adaptive process of stability through change, interoception refers to encoding representations of the internal (physiological) state of the body [86]. (B) Modulation of endogenous pain. Nociplastic pain conditions include the combination of central and peripheral pain sensitization, hyper-responsiveness to painful and non-painful sensory stimuli, and associated features (fatigue, sleep, and cognitive disturbances) [87]. (C) Detailed representation of the interoceptive–allostatic control (as a closed-loop system) of the human body in response to any stimuli. The injury or pain etiology might be discussed in terms of the role of the input signal (stimuli—distal physiology or external world), receptors (sensory surfaces, biological receptors), transmitters (spinal cord, anatomy trains), decoders (central nervous system), regulator elements (autonomic nervous system), and output signal (response, physiological effects). This block diagram was taken from Sennesh et al. (2022) [88]. (D) Representation of the changes in injury risk in response to stress exposition. Importantly, exercise selection is one of the many factors that might impact the allostatic load in fitness practitioners; therefore, it might influence the musculoskeletal or connective tissue overload. However, several other variables should be considered to avoid the risk of injury in PFC. AL: allostatic load. Source: designed by the authors (D.A.B.).

Figure 3

Seated bicep curls: (A) one-arm dumbbell concentration curl increases thoracic–lumbar kyphosis; (B) EZ bar Scott (preacher) curl provides proper positioning of the cervical and thoracic vertebrae. Source: Taken from Gym Visual available at https://gymvisual.com/ under copyright and owned by Aliaksandr Makatserchyk. Accessed on 14 January 2022.

Figure 4

Standing cable overhead triceps extensions: (A) this posture generates tension in the myofascial and muscular chains in different ways; (B) recommended posture. Source: Taken from Gym Visual available at https://gymvisual.com/ under copyright and owned by Aliaksandr Makatserchyk. Accessed on 14 January 2022.

Figure 5

Representation of the “high-five” position: (A) traditional technique requiring a “high-five” end-position range (upper arm in 90° abduction, elbow in 90° flexion, and terminal external rotation of the shoulder), where the risk of injury increases with the anterior instability; (B) modification to avoid the “high-five” end-position. Raising the arms slightly in front of the head without extending completely in military press is advisable to decrease injury or pain risk. Source: taken from Gym Visual available at https://gymvisual.com/ under copyright and owned by Aliaksandr Makatserchyk. Accessed on 14 January 2022.