Dr. James Manos (MD)
August 19, 2018
Is safety a priority when working out?
Image (public domain): Photo of Arnold Schwarzenegger before defending the title for his fifth Mr. Olympia contest in 1974. Uploaded by the user: Kaldari and Light show. Source: Wikipedia. Link: https://commons.wikimedia.org/wiki/File:Arnold_Schwarzenegger_1974.jpg
I wrote this article as a doctor and physio, as my first degree is in physical therapy.
a) Working out at the gym
From my perspective, the most important things in training are safety and avoiding overstressing the joints, as doing an exercise in the wrong way may predispose to arthritis. Protection is essential when working out and is related to how someone performs an activity and the individual's outfit and gadgets!
For example, many people talk or use their social media on their smartphones while working out, while others wear earphones to listen to music. Both are unsafe as people who train at the gym should not be distracted but concentrate on the exercise, be alert to noises, and be careful not to bump into another athlete, a training machine, or objects such as ropes and belts.
Additionally, headphones harm the ears, as loud sounds may cause deafness. It should be mentioned that when the gym has music, the individuals wearing earphones must increase the volume (many also do it in the subway)! The loud music that many gyms have is also disruptive. Wearing earphones to listen to music is especially dangerous at the gym for people who do weightlifting or use an exercise machine. I still wonder why the trainers do not notify them that their practice is unsafe! Also important is for people not to chew gum while training, as they may choke. They must also have their shoes tied; otherwise, they may stumble.
A naive thing some do when working out is to wear heavy clothing. Some may wear a jacket when the weather is hot and humid instead of a T-shirt (preferably sleeveless in the summer) and shorts (some wear isothermal compression tights even in the summer). Perhaps, they do it as they wrongly think they will lose weight this way. But instead, they lose water and electrolytes, which may make them collapse from dehydration, electrolyte imbalance, and hypoglycemia. Many athletes wear isothermal stockings, such as in a warm environment, even when they do not need them. People should generally need them only when exercising out in the winter.
For example, many people talk or use their social media on their smartphones while working out, while others wear earphones to listen to music. Both are unsafe as people who train at the gym should not be distracted but concentrate on the exercise, be alert to noises, and be careful not to bump into another athlete, a training machine, or objects such as ropes and belts.
Additionally, headphones harm the ears, as loud sounds may cause deafness. It should be mentioned that when the gym has music, the individuals wearing earphones must increase the volume (many also do it in the subway)! The loud music that many gyms have is also disruptive. Wearing earphones to listen to music is especially dangerous at the gym for people who do weightlifting or use an exercise machine. I still wonder why the trainers do not notify them that their practice is unsafe! Also important is for people not to chew gum while training, as they may choke. They must also have their shoes tied; otherwise, they may stumble.
A naive thing some do when working out is to wear heavy clothing. Some may wear a jacket when the weather is hot and humid instead of a T-shirt (preferably sleeveless in the summer) and shorts (some wear isothermal compression tights even in the summer). Perhaps, they do it as they wrongly think they will lose weight this way. But instead, they lose water and electrolytes, which may make them collapse from dehydration, electrolyte imbalance, and hypoglycemia. Many athletes wear isothermal stockings, such as in a warm environment, even when they do not need them. People should generally need them only when exercising out in the winter.
b) Dietary Supplements & anabolic steroids for muscle gain and improving athletic performance
Supplements are also an issue of consideration. Many, if not most, bodybuilders wish to have a beefy body fast. The same is true for many athletes. However, a stocky body and better performance are impossible without supplements, many of which have serious adverse effects. Many athletes usually consult ''Dr. Google'' and buy supplements online or ask their trainers about them.
But they omit to ask a healthcare professional if they are safe! Anabolic steroids have numerous side effects. Many consume excessive amounts of animal products, including meat, eggs, and dairy, which are harmful as they elevate blood cholesterol and triglycerides, increasing the chance of heart disease. Processed meat is also carcinogenic, namely causing cancer! Protein supplements may also have high amounts of lipids (fats), including harmful saturated fats.
Regarding the kidneys, creatine's safety is questioned. Protein, usually taken in powder forms, may also harm the kidneys at high doses (e.g., fifty grams). Other supplements such as ephedra, caffeine & guarana, thyroxine & iodine, and diuretics (taken to lose weight) may even cause death. People who exercise think supplements will boost their energy and build their muscles instantly, like Popeye eating spinach! But safety should count first!
From my point of view as a medic, the only supplements that I recommend are spirulina & chlorella (both are algae), royal jelly (unless someone is allergic to honey products), arginine (people with heart problems should avoid it) & carnitine (the previous 2 are amino acids), tart cherry (helps muscle recovery), beetroot (helps oxygen utilization by the muscles), coenzyme Q10, and pycnogenol. The last is contraindicated on people taking blood thinners. Herbs such as Eleuthero and Rhodiola may help as adaptogens.
Athletes should consult a doctor other than their personal sports medicine doctor before taking a supplement, as some dietary supplements may be deadly! In any case, they should NEVER take anabolic steroids, ephedra, thyroxine (and iodine), guarana (which has high levels of caffeine that may cause arrhythmia), and diuretics. The most hazardous supplements are ephedra and anabolic steroids, which can even cause death.
c) The adverse effects and risks of over-exercising
Another widespread phenomenon is training resembling the training of special forces units. Many men, even middle-aged, train as if they were members of the army special forces! The most vital thing in training is safety. However, this is not a priority for many, and personal trainers and coaches often do not focus on safety. But that is not a priority, even for the individuals who train.
Undoubtedly, most young men, especially the young, exaggerate their gym workout, especially with the CrossFit workout. I guess they are confused with the video games they play all day, watching battles with special forces or SWAT teams trained for combat. For some, the incentive may be to upload a picture or video on their social media to gain some ''likes'' from their robust appearance and six-pack. But I guarantee you that someone doing a few or not at all crunches may have perfect six-packs if they are slim, as, without superficial fat, they delineate!
An example of an exercise many young people do is lifting a weight plate above the shoulders' level, even reaching a vertical, above-the-head position. You may watch the ‘front weight plate raise exercise’ on https://www.youtube.com/watch?v=Xa1FgEZ5qAc and https://www.youtube.com/watch?v=ujxSomtxxdE and https://www.youtube.com/watch?v=hFo-LIkCozU
Many people do crunches holding with their hands a weight plate. This exercise, along with tension to the shoulder muscles predisposing them to injury, has the additional risk of overusing the sternocleidomastoid muscles of the neck pressing major arteries and veins, and causing blood pressure elevation. You may watch the ‘weight plate crunches’ exercise on https://www.youtube.com/watch?v=QkCt6s3TGMA and https://www.youtube.com/watch?v=z_zQsJbPM-A and https://www.youtube.com/watch?v=pfrePDBRFiQ But of the above two mentioned exercises predispose the shoulders to severe injury and especially the rotator cuff or the impingement syndrome. Instead, for this purpose, horizontal bar exercises or training machines are safer if done correctly.
A risky exercise for the lower back (especially the disc) is a ‘leg raise’ from a flat position for an abdominal workout. You may watch this exercise on https://www.youtube.com/watch?v=l4kQd9eWclE https://www.youtube.com/watch?v=JB2oyawG9KI Similarly, the abdominal crunches exercise machine at the gym is not safe for the lower back. You may watch this exercise on https://www.youtube.com/watch?v=_O1xunCfYEM and https://www.youtube.com/watch?v=YtJZcoaMHsY, and https://www.youtube.com/watch?v=NpjB_rp756Y Biomechanical research has demonstrated that bending in the sitting position exhibits greater tension to the discs of the spine predisposing to low back pain.
A dangerous exercise for the knees (and the lower back) is the ‘Barbell single leg/ split squats.’ You may watch this exercise on https://www.youtube.com/watch?v=JlTojfaAXBo https://www.youtube.com/watch?v=JOvvAbR4sBs and https://www.youtube.com/watch?v=r1jukGZPnZI Another risky exercise for the knee is the ‘single-leg lateral (side) press’ that exhibits significant tension to the knee joint, muscles, tendons, and ligaments, predisposing to severe injury and arthritis. You may watch this exercise on https://www.youtube.com/watch?v=JvvrBu3lKpk https://www.youtube.com/watch?v=AIKPcOtxFQc and https://www.youtube.com/watch?v=YvNrVkTkSc0 I have to remind that this exercise is done for both frontal leg press, so some invented this risky variation without thinking about the forces that the knee is exposed to.
A dangerous exercise for the knees (and the lower back) is the ‘Barbell single leg/ split squats.’ You may watch this exercise on https://www.youtube.com/watch?v=JlTojfaAXBo https://www.youtube.com/watch?v=JOvvAbR4sBs and https://www.youtube.com/watch?v=r1jukGZPnZI Another risky exercise for the knee is the ‘single-leg lateral (side) press’ that exhibits significant tension to the knee joint, muscles, tendons, and ligaments, predisposing to severe injury and arthritis. You may watch this exercise on https://www.youtube.com/watch?v=JvvrBu3lKpk https://www.youtube.com/watch?v=AIKPcOtxFQc and https://www.youtube.com/watch?v=YvNrVkTkSc0 I have to remind that this exercise is done for both frontal leg press, so some invented this risky variation without thinking about the forces that the knee is exposed to.
Squatting is a dangerous popular exercise that both men and women do as they are obsessed with their buttocks and want to make them ''bubble butts''! So, they do the squat with a bar workout that harms the lower back and the knee joints as it may cause lower back injury (especially at the disc and the facet joints) and knee arthritis, respectively. You may watch the squat exercise using a bar’ on https://www.youtube.com/watch?v=MVMNk0HiTMg and https://www.youtube.com/watch?v=X0qC1k0Zi6k and https://www.youtube.com/watch?v=C73Y3EsJWIk The squat workout without a bar is also harmful to the knees and also expose the lower back to significant tensions. You may watch it at https://www.youtube.com/watch?v=zaC133_Frj0 and https://www.youtube.com/watch?v=94gqJHxjd0o and https://www.youtube.com/watch?v=UI6lNNkkhho
Another risky knee exercise is the dumbbell lunges, front, reverse, or lateral, walking or drag walking or still, which expose the knee joint to significant tension. You may watch the ‘dumbbell lunges’ exercise on https://www.youtube.com/watch?v=MYNWjf0qjxE and https://www.youtube.com/watch?v=8OYsCRAb5c4 and https://www.youtube.com/watch?v=xvC10-eCuXs and https://www.youtube.com/watch?v=D7KaRcUTQeE A safer approach is to use this exercise for stretching or performing it without holding dumbbells. The single-leg lunge using the Smith machine is harmful to the knee. You may watch the ‘single-leg lunge using the Smith machine’ exercise on https://www.youtube.com/watch?v=MXrSCU4P9L4 and https://www.youtube.com/watch?v=glsjsPWwGb0 and https://www.youtube.com/watch?v=73CD40T-III
Running on the treadmill may also cause problems when intense. When jogging or running is done at extreme levels, aerobic ''cardio'' exercise turns anaerobic, as galactic acid is released and free radicals harm our body. Running should adapt to the runner's age as the maximum heart rate is related to age with the equation 220 - someone's age in years. Many people are unaware of this. Extreme incline and speed on the treadmill are inappropriate, especially for the middle-aged and the elderly.
From my perspective, as a medic, the maximum incline should be 3 percent, while the maximum speed is ten miles per hour. To lose weight or because they feel too lazy to run, many walk on the treadmill at an extreme incline, even 10 - 12 percent, damaging their knees. Another choice with deleterious effects is jogging on the sidewalk, where the tension of the hard surface injures the knees while the athlete jogging in the city breathes smog! A safer solution is jogging at a park or a sports center with special running track surfaces/ resilient jogging track flooring.
Notably, many people do exercises they watch on YouTube, and the latest craze is the exercise in which the person stays still in the push-up position! You may view the ‘push up plunk’ exercise on https://www.youtube.com/watch?v=uco2g3YexwA and https://www.youtube.com/watch?v=2kEnT-CdXyE and https://www.youtube.com/watch?v=En8xcgrqyq8
I would never trust a YouTube video, especially uploaded by an anonymous, as a coach or do a workout just because it is popular without asking a trainer first.
If you ask a gymnast or trainer if the above exercises are safe, he/she may answer that they are. However, my perspective is based on my medical and physical therapy studies. That means I can debate the safety of many ‘extreme’ exercises that people do, thinking themselves Bootcamp commandos, do! Trainers should advise against dangerous exercises. But this may be a different aspect as my priority is safety while a trainer’s or an athlete’s aim may be to become, in a brief time, well-built and then a champion, regardless of the cost of health. The Bootcamp motto is ''faster, stronger, better.'' But the question is if ''safer'' is a priority. I think it is not!
However, being a top athlete champion means the body is exposed to significant ligament, tendon, and cartilage tension, predisposing to infirmities such as arthritis. The knees and the waist are especially prone to injury.
Excessive exercise is unhealthy, as it may cause problems such as amenorrhea (lack of menstruation|) in women. Sterility problems in males may be caused by cycling for many hours, as the genitals are pressed when sitting on a bicycle. Running marathons is not as healthy as many believe. Long-term runners develop cardiomegaly (increased heart size) and dangerous heart irregularities (dysrhythmias). Moreover, running, especially under heat, may cause electrolyte (especially potassium and sodium) and other metabolic (especially glucose) abnormalities, such as hyponatremia, which may manifest with spasms. It may also cause heatstroke.
Weightlifting is not so innocent; apart from causing blood pressure upsurge, it may also cause a hernia and low-back pain. Importantly, many spend 1 - 2 hours on weightlifting, which has zero benefits apart from looking well-built or osteoporosis prevention in post-menopausal women. At the same time, they omit aerobic exercise that benefits the heart. But even when they choose an aerobic workout, many exaggerate. For instance, you can see middle-aged people doing long-distance running with no substantial health benefits, but, as mentioned, it causes heart enlargement and heart arrhythmias.
A common mistake that many people make to lose weight fast is to run on the treadmill with a very high incline that predisposes their knees to arthritis or jog on the street instead of a park, breathing the polluted air of the city and walking on the sidewalk, they predispose their knees to arthritis.
Moreover, many people enjoy isometric exercises, including the ''human flag on a vertical pole''! See https://www.youtube.com/watch?v=66ZlZ44s944 and https://www.youtube.com/watch?v=ckZPkWGuvyk and https://www.youtube.com/watch?v=Cl_jIUGYh2w and https://www.youtube.com/watch?v=JmHtLycyIvQ In my opinion, isometric exercises offer nothing to health. On the contrary, they offer extreme muscle, ligament, and joint strain and a steep elevation of blood pressure that may contribute to the hardening of the arteries (arteriosclerosis). The same effects may occur in bodybuilding when the repetitions of weightlifting or using a training machine exercise are less than 8-10 and when the weights are heavy. Contrary, aerobic exercise, which many people who train omit or perform for an abbreviated time or infrequently, is beneficial for circulation, offers longevity and well-being, and gives a sense of 'being high' because of the released endorphins!
A risky choice is when trainees lift heavy weights on weightlifting (barbell and dumbbell weight set) or a gym machine. You may watch the videos on https://www.youtube.com/watch?v=pn77iK8KzXQ and https://www.youtube.com/watch?v=wAKa5MCIKAY and (did it turn into a cardiac arrest?) and https://www.youtube.com/watch?v=brpwQHewUw0 and (I guess he died from tension pneumothorax or cardiac arrhythmia/ tamponade) https://www.youtube.com/watch?v=rgYDfporX00
d) Deaths in sports
Weightlifting is not so innocent; apart from causing blood pressure upsurge, it may also cause a hernia and low-back pain. Importantly, many spend 1 - 2 hours on weightlifting, which has zero benefits apart from looking well-built or osteoporosis prevention in post-menopausal women. At the same time, they omit aerobic exercise that benefits the heart. But even when they choose an aerobic workout, many exaggerate. For instance, you can see middle-aged people doing long-distance running with no substantial health benefits, but, as mentioned, it causes heart enlargement and heart arrhythmias.
A common mistake that many people make to lose weight fast is to run on the treadmill with a very high incline that predisposes their knees to arthritis or jog on the street instead of a park, breathing the polluted air of the city and walking on the sidewalk, they predispose their knees to arthritis.
Moreover, many people enjoy isometric exercises, including the ''human flag on a vertical pole''! See https://www.youtube.com/watch?v=66ZlZ44s944 and https://www.youtube.com/watch?v=ckZPkWGuvyk and https://www.youtube.com/watch?v=Cl_jIUGYh2w and https://www.youtube.com/watch?v=JmHtLycyIvQ In my opinion, isometric exercises offer nothing to health. On the contrary, they offer extreme muscle, ligament, and joint strain and a steep elevation of blood pressure that may contribute to the hardening of the arteries (arteriosclerosis). The same effects may occur in bodybuilding when the repetitions of weightlifting or using a training machine exercise are less than 8-10 and when the weights are heavy. Contrary, aerobic exercise, which many people who train omit or perform for an abbreviated time or infrequently, is beneficial for circulation, offers longevity and well-being, and gives a sense of 'being high' because of the released endorphins!
A risky choice is when trainees lift heavy weights on weightlifting (barbell and dumbbell weight set) or a gym machine. You may watch the videos on https://www.youtube.com/watch?v=pn77iK8KzXQ and https://www.youtube.com/watch?v=wAKa5MCIKAY and (did it turn into a cardiac arrest?) and https://www.youtube.com/watch?v=brpwQHewUw0 and (I guess he died from tension pneumothorax or cardiac arrhythmia/ tamponade) https://www.youtube.com/watch?v=rgYDfporX00
The Smith Machine bench press is just as effective as the Barbell bench press, and, most importantly, it is safer with the weight bar slides! You may watch the videos on https://www.youtube.com/watch?v=bqmo9MrWeiI and https://www.youtube.com/watch?v=z_r6hDOYtO0 and https://www.youtube.com/watch?v=jn-WjbWQ8lo and https://www.youtube.com/watch?v=b8DqTO6ak0k
But you should not perform Smith machine exercises that do not use the bench, as they are unsafe! For instance, death lifts are also dangerous when using the Smith Machine. See https://www.youtube.com/watch?v=rtYH-SKh0to and https://www.youtube.com/watch?v=p6KK6yHxd4k and https://www.youtube.com/watch?v=sAJnhZed51E and https://www.youtube.com/watch?v=NBR6tozmx2I
Although many people do it to have muscular thighs and buttocks, I do not recommend it. The deadlifts without the Smith machine are also risky for the lower back and the knees. Simultaneously, they may raise the blood pressure steeply and cause a fatal hemorrhage in people with a brain or an abdominal aneurysm who are often unaware of its existence. For the original deadlift exercise, See https://www.youtube.com/watch?v=ytGaGIn3SjE and https://www.youtube.com/watch?v=hCDzSR6bW10 and https://www.youtube.com/watch?v=RyJbvWAh6ec
It is safer to lift bearable weights, less than 70-80 percent of your maximum potential (the lower, the safer). When using a barbell weight set, you should place the weight plates equidistantly on each side, considering the bar may overturn from the heavier side weight. For instance, on a bar of 10 kilograms, you can put bilaterally (on each side) a lower weight plate, such as 5 kilos on each side. Otherwise, you should place them simultaneously (alone, if applicable) or ask another trainee's help to do this.
Another common mistake most individuals make when exercising is training anaerobically or turning their aerobic exercise into anaerobic! Anaerobic activities, including weightlifting and exercise machines at the gym, increase lactate levels (that cause tiredness and lactic acidosis) and generate free radicals implicated in a myriad of diseases, as they damage the DNA! This oxidative stress may occur when an aerobic exercise is performed anaerobically. For instance, endurance long-distance running, fast short-distance running (such as 50 or 100 meters), and treadmill pacing at an exceedingly high incline and/or speed or running for a long time on the treadmill (i.e., long-distance running) without declining the speed and/or the slope may be anaerobic rather than aerobic, meaning that free radicals are generated. Thus, the trainee is exposed to the harmful effects of oxidative stress!
d) Deaths in sports
Deaths in sports are not unusual. The primary cause, apart from congenital cardiomyopathy, is dysrhythmias (heart rate irregularities) caused by training and electrolytic and metabolic disturbances (such as in long-distance runners). An autopsy cannot attribute arrhythmias as a cause of death unless the person is wearing a Holter during an exercise, a smartwatch measuring the pulse, or if there is a pre-existing or discovered post-mortem structural heart disease. Children have died from chest blows, causing severe arrhythmia (called ''commotio cordis''). These usually happen in martial arts, when neck strikes may cause severe bradycardia (slow heart rate), leading to asystole (the heart stops).
Long-distance runners have a large heart (cardiomegaly) and slow pulse, and it is lately debated if these are without health effects. Risk, when training, is not negligible, as in my article ‘strenuous exercise is risky’ in which I say that weightlifting may even cause death in people with a brain (or abdominal) aneurysm that they are unaware of! You may visit and read my article at https://mymedicaltexts.blogspot.com/2016/02/strenuous-exercise-including.html It may also cause aortic dissection.
Straining may also cause Boerhaave syndrome. That is a spontaneous perforation of the esophagus that results from a sudden increase in intra-esophageal pressure combined with negative intrathoracic pressure.
A cervical injury, such as in martial arts and other combat sports, may also be lethal as it may cause paralysis of the lower or upper and lower extremities or even death if it involves the first 2 cervical bones. Additionally, death may also occur from the ‘special’ points that martial arts teachers teach (even in children), such as above the jugular notch of the sternum’s (breastbone) manubrium (the upper part of the sternum, which is a bone that looks like a sword).
e) ''Stunts'' and Extreme sports
Young people do foolish things because of attention-seeking behavior, trying to post a ''catchy'' video (of a jackass type) or selfie or do stupid ‘stunts.’ On the internet, you may find numerous stupid videos uploaded by young people to show off and win the 5 min of fame they deserve! However, often these ''stunts'' may turn lethal! A typical example is parkour (which consists of stupid acrobatics), a stupid (in my opinion) sport that attracts young people, even children! Wikipedia has a biased article about parkour, something like advertising of this naive ''sport,'' where people who died during parkour are not mentioned.
It should be noted that many parents allow their children to play dangerous ''stunts'' such as parkour, neglecting that a head injury may be proven lethal. A cervical (neck) injury may cause, if not death, permanent paralysis! Backflips, front flips, and skating on a skateboard or roller skates without protective gear (helmet, knee, and elbow pads) may also cause severe injuries. A bicycle helmet does not protect you from a cervical injury! It is unbelievable that people, including minors, die from these 'stunts' in their attention-seeking attempt to upload videos with their naive stunts.
Many young people enjoy risky extreme hobbies such as bungee jumping from mountains or bridges or skydiving, canoe-kayaking, or scuba diving. Unfortunately, many people do extreme sports without proper training from an expert. Moreover, many neither follow all the safety rules nor wear the appropriate safety outfit. For instance, many kids enjoy skateboarding and doing amazing ‘stunts’ but neglect wearing helmets and protective gear. Their parents neglect as well to impose safety rules and equipment. However, ironically, the supposedly more experienced people have accidents more often, perhaps because they overestimate themselves and their capabilities.
Conclusion
To sum up, ''safety comes first,'' and I was taught this motto in first aid courses as a medic. As an athlete and a physician, my top priority is safety, not predisposing my joints to arthritis or my lower back to severe damage. Regarding safe and effective training, you may visit the text at https://mymedicaltexts.blogspot.com/2015/10/the-benefits-of-aerobic-exercise.html
Thanks for reading!
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