How to Avoid Workout Injuries

This article examines ways that trainers and coaches can take steps in order to effectively reduce the risk of clients suffering a training-related injury.

The following is a peer-reviewed article Nick Tumminello coauthored with Dr. Jason Silvernail, who holds one of highest Physical Therapist positions in the US Army. It was originally published in the NSCA Personal Training Quarterly Journal, Vol 4, Issue 2.

Strength and conditioning helps to improve a plethora of health and fitness parameters, including managing weight; lowering the risk of disease, death, and functional limitations; and reducing the risk of sports injury (4,10,13,21,23,41). The best ability in training is the availability to do it in the first place. The personal trainer should not only train clients towards their goals, but do so in a way that allows individuals to continue training. This article will examine ways that personal trainers can take steps in order to effectively reduce the risk of clients suffering a training-related injury. 

Injury risk factors and concerns often vary by sport (e.g., factors for swimmers are not the same as for soccer players) and body part (e.g., factors for anterior cruciate ligament [ACL] rupture are different than for low back pain). Strength and conditioning is a low-risk activity, but it is not a no-risk activity (17). The following strategies can help the personal trainer successfully use exercise to reduce the risk of injury in their clients.


First, it is important to review a couple of strategies that are commonly believed to be “well-established” methods of reducing injury risk. 


A 2014 systematic review and meta-analysis of randomized controlled trials published in the British Journal of Sports Medicine looked at the effectiveness of exercise interventions to prevent sports injuries. The authors of this paper stated that, “our data do not support the use of stretching for injury prevention purposes, neither before nor after exercise,” (21). It is important to note that the effect estimate of stretching in this study corresponds to earlier reviews (12,42). These research findings do not say that nobody should use stretching in their strength and conditioning sessions. Stretching can be beneficial in several ways, such as increasing joint range of motion and improving one’s tolerance to stretching (33). However, stretching solely for injury prevention is likely misguided. 


Several movement-based evaluation systems have been promoted to discover poor movement patterns that indicate increased risk of injury. While these approaches are well-intentioned, evidence continues to build that these scoring systems have limited ability to predict injury and that better scores do not necessarily mean better athletic performance (9,19,26,32,34). Proponents of movement screens argue that some evidence shows that using a cut-off score can identify those at higher risk of future injury (2,6). However, validity problems remain, for instance it is impossible to know if the score itself is helpful or if there are other explanations for the injury risk findings in some of those studies (2,6). One such explanation is that individuals with a current or recent injury—a known risk factor for future problems—will tend to score lower on such tests (48). This means that the lower score may just identify a known existing risk factor. These systems can certainly be useful in exercise prescription, but current evidence does not support using these systems as general injury prediction or prevention tools.


When it comes to minimizing training-related injury, most people are already familiar with the saying “don’t overdo it.” Generally, it is commonly recommended to avoid exercises that tend to put the body into an awkward position (e.g., behind the neck pressing and behind the neck pull-downs) or loaded end-range spine movements. Although that advice is fine, there is far more practical advice that can be added. The following are a variety of general, practical strategies that a personal trainer can use immediately, along with the rationale for why they can help in reducing the risk of training-related injury. 


If an exercise hurts the client—for any reason—the personal trainer should find a modification or an alternative that does not hurt the client. This recommendation does not apply to the sensation of muscle fatigue. Instead, it applies to any aches and pains that exist outside the training session or flare up when the client performs certain movements. Such problem areas may simply need time to rest and heal, or they may be injuries to body parts that can no longer tolerate the same level of load and do not improve without appropriate care. 

Either way, a personal trainer who has their client train through the pain is not helping the situation. Although this fact should be obvious, many athletes and personal trainers are stubborn and use exercises that cause pain—a practice that is more often rooted in habit and ego rather than evidence. Continuing to perform exercises that cause pain could very well make things worse and lead to further damage, changing a painful area from something a personal trainer can easily train around temporarily to an injury that is more debilitating. 


As a general rule, avoiding forced end-range joint and spine actions are typically advised when lifting heavy loads or using medium loads for high repetitions. Research has shown that as the spine reaches full flexion, such as when performing deadlifts with an excessively-rounded back, support of the spine shifts from the muscles to the disks and ligaments (27). Weight shifts in the fully flexed posture can be quite dramatic and can easily cause excessive shear load (29). In full spinal flexion, not only is anterior shear loading higher, but the spinal ligaments are also at a heightened risk of injury (28). Additionally, repetitive compressive loading of the spine can exceed tissue tolerance and cause injury (11). Therefore, maintaining a relatively neutral spine posture when lifting heavy loads is sound training advice. 

When joints are moved to their end range of movement, the load shifts from the contracting muscle to the noncontractile connective tissue (e.g., ligaments, joint capsules). This is not ideal for two reasons: the exercise no longer provides as effective of a training load for the working muscles, and the client may injure the other connective tissues. Weight training helps build those connective tissues as well. Tissues respond positively to load by getting stronger over time. Personal trainers should not be afraid to load their clients; however, loading excessively at the end range of motion does not have a good risk-benefit ratio. 

Joints function very well in their mid-ranges of motion, but also need some full range-of-motion activity in order to stay healthy and maintain their current range of movement. Yoga or mobility drills can serve as a nice complement to comprehensive resistance training workouts. Due to their low-load and slow-paced nature, many yoga moves and mobility exercises require the joints and spine to move into their end-range of motion. Additionally, yoga and mobility drills get the client to move in a manner that they usually do not in weight training. This can provide more variety of activity and help the client to not just get stronger and leaner, but also to get more mobile. 


Injury risk is usually increased in those with a previous injury (25,38,44,48). Clients should tell personal trainers about any previous injuries that they have sustained. Additionally, some other advice that may be useful for personal trainers include:

Progress load and volume carefully around injured areas.

Be especially careful with movements and positions that were part of the previous injury. For example, an athlete who injured his or her knee coming down from a jump in basketball should be careful on single-leg plyometric exercises.

Do not neglect injured areas; building strength around an injured joint is important. Specific training of injured areas helps prevent future injuries (22). 


A study that compared unilateral versus bilateral squat training for strength, sprints, and agility in rugby players found that rear elevated split squats were just as effective as back squats in improving measures of lower-body strength, 40-m speed, and change of direction (40). Another study also found that single-leg and double-leg training increased strength and decreased fatigue, with no differences between single-leg and double-leg results (37). Interestingly, this study also found that single-leg training did not decrease fatigue during double-leg repeated maximal voluntary contractions, and double-leg training did not decrease fatigue during single-leg repeated maximal voluntary contractions (35). In other words, although these results demonstrate that improvements in strength are similar between bilateral and unilateral training, the results also suggest that unilateral training does not decrease bilateral fatigue and vice versa. 

Single-leg performance during sidestep cutting may be a better indicator of how an athlete will move in sport activities, and therefore, may be a better predictor of injury risk than bilateral drop jump testing (20). Although this example applies better to the sporting realm, the following studies can also be applied directly to the personal training realm. For example, a study suggested using single-leg performance to detect deficits in unilateral force development, while another study showed that a 15% or greater variance in closed-kinetic chain strength or movement control ability in single-limb performance between the right and left leg is a good indicator of increased injury risk (31,36). Additionally, because weakness and fatigue in single-leg landings have been shown to increase the risk of injury, it may be beneficial to regularly incorporate single-leg training exercise variations in a client’s program to improve single-leg control, strength, and strength endurance (3). 


As clients move through their workout, muscular fatigue builds. Many studies have demonstrated that fatigued trainees lose efficiency of movement. For example, fatigue-related changes have been found in the muscles around the shoulder and knee (3,7,8,18). Muscular fatigue is associated with biomechanical changes in loading response and mechanics that may lead to injury. It is important to note that these biomechanical changes do not necessarily lead to injury in every case; however, avoiding complex skills and movements while fatigued is a reasonable precaution. The practical implication is that it is safer to avoid fatiguing clients until the end of the workout and after they have done complex or explosive exercises that involve more motor skill, such as agility and speed activities, plyometrics, and weightlifting movements. 


Since fatigue is a risk factor in injuries, improving conditioning levels can help an individual become more resistant to fatigue, potentially lessening the risk of injury from fatigue. In several studies, those with low levels of conditioning have been found to be at a higher risk of sustaining an injury (5,14,24,46,48). Besides conditioning levels, total training load is emerging as a risk factor for injury (15). All training is an applied stress to the body. This stress causes the body to adapt by becoming stronger, bigger, or faster to account for the stress. Smart, individualized training is about applying enough stress to the body to make it adapt without applying too much stress and overloading the tissues to the point where they can become damaged. With this in mind, planned rest days throughout a training week, along with incorporating rest or active rest weeks (consisting of lower demand activities) between several weeks of hard training can help in avoiding too much overload or stress. 


One commonly found injury in sports or training sessions is hamstring strains. This can occur when individuals explode off the starting line doing a quick start when beginning a sprint. To reduce the potential injury risk from quick starts, one can jog to the starting point and begin sprinting upon reaching the starting line. Doing this will prevent the person from going from a static position straight into a sprint. If training for a specific test or event that demands a sprint starting from a static position, the client should train specifically using quick starts. In such cases, personal trainers should simply use what they believe to be the minimum effective dose of quick starts in their training program. Then the personal trainer could mix in several repetitions that include the jogging start. 


It is commonly thought that smoking is generally bad for overall health; additionally, some studies have demonstrated that it can also be a risk factor for injury (5,16,45,48). Smoking is a consistent risk factor for poor recovery after injury and poor healing. Therefore, it is advised to avoid smoking, both to reduce injury risk and to improve recovery after an injury or surgery. 


Sleep and its effect on health, illness, and athletic performance have become more prevalent in research lately. Are adolescent clients and athletes getting 9 – 10 hr of sleep per night? Are adult clients and athlete getting 7 – 8 hr of sleep per night? If not, they may be at an increased risk of sustaining an injury (30,39,43,47). Reviewing appropriate sleep guidelines with clients for enhancing performance and reducing injury is a solid evidence-based practice for personal trainers (1,39,47). 


To sum up, the following are some basic suggestions that a personal trainer can adhere to in the effort of reducing the risk of injury in their clients: 

  1. Train around, not through, pain problems
  2. Avoid extremes of motion under load in the spine and joints
  3. Use caution with previous injuries, but still train the injured area to improve resilience
  4. Program more single-leg strength exercises
  5. Perform complex motor skill exercises and movements in a relatively rested state
  6. Prioritize aerobic conditioning and manage training load with care
  7. Lessen or eliminate quick starts for sprinting and agility work
  8. Encourage smoking cessation in clients who smoke
  9. Make sleep management and sleep hygiene part of the training program 

There are several potential risk factors for injury. It is important to remember that risk factors are not guarantees. Having one of these factors present does not doom a client to injury, while having none of them does not guarantee an injury-free future. These factors vary in predictive ability and relevance across different groups of people, and the recommendations here are considered a practical interpretation.


1. American Sleep Association. What is sleep? Retrieved August 24, 2016 from
2. Bonazza, NA, Smuin, D, Onks, CA, Silvis, ML, and Dhawan, A. Reliability, validity, and injury predictive value of the Functional Movement Screen: A systematic review and meta-analysis. American Journal of Sports Medicine 45(3): 725-732, 2006.
3. Brazen, DM, Todd, MK, Ambegaonkar, JP, Wunderlich, R, and Peterson, C. The effect of fatigue on landing biomechanics in single-leg drop landings. Clinical Journal of Sports Medicine 20(4): 286-292, 2010.
4. Brill, PA, Macera, CA, Davis, DR, Blair, SN, and Gordon, N. Muscular strength and physical function. Medicine and Science in Sports and Exercise 32(2): 412-416, 2000.
5. Bulchazelli, MT, Sulsky, SI, Rodriguez-Monquio, R, and Karlsson, LH, and Hill, MO. Injury during U.S. Army basic combat training: A systematic review of risk factor studies. American Journal of Preventative Medicine 47(6): 813-822, 2014.
6. Bushman, TT, Grier, TL, Canham-Chervak, M, Anderson, MK, North, MK, and Jones, BH. The Functional Movement Screen and injury risk: Association and predictive value in active men. American Journal of Sports Medicine 44(2): 297-304, 2016.
7. Chappell, JD, Herman, DC, Knight, BS, Kirkendall, DT, Garrett, WE, and Yu, B. Effect of fatigue on knee kinetics and kinematics in stop-jump tasks. American Journal of Sports Medicine 33(7): 1022-1029, 2005.
8. Chen, SK, Simonian, PT, Wickiewicz, TL, Otis, JC, and Warren, RF. Radiographic evaluation of glenohumeral kinematics: A muscle fatigue model. Journal of Shoulder and Elbow Surgery 8(1): 49-52, 1999.
9. Dorrel, BS, Long, T, Shaffer, S, and Myer, SD. Evaluation of the Functional Movement Screen as an injury prediction tool among active adult populations: A systematic review and meta-analysis. Sports Health7(6): 532-537, 2015.
10. FitzGerald, SJBC, Kampert, JB, Morrow, JR Jr., Jackson, AW, and Blair, SN. Muscular fitness and all-cause mortality: A prospective study. Journal of Physical Activity Health 1: 7-18, 2004.
11. Gooyers, CE, McMillian, EM, Noquchi, M, Quadrilatero, J, and Callaghan, JP. Characterizing the combined effects of force, repetition and posture on injury pathways and micro-structural damage in isolated functional spinal units from sub-acute-failure magnitudes of cyclic compressive loading. Clinical Biomechanics (Bristol, Avon) 30(9): 953-959, 2015.
12. Herbert, RD, and Gabriel, M. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. BMJ 325: 468, 2002.
13. Hunter, GR, Brock, DW, Byrne, NM, Chandler-Laney, PC, Del Corral, P, and Gower, BA. Exercise training prevents regain of visceral fat for 1 year following weight loss. Obesity (Silver Spring) 18(4): 690-695, 2010.
14. Jones, BH, and Hauschild, VD. Physical training, fitness, and injuries: Lessons learned from military studies. The Journal of Strength and Conditioning Research 29(suppl 11): S57-S64, 2015.
15. Jones, CM, Griffiths, PC, and Mellalieu, SD. Training load and fatigue marker associations with injury and illness: A systematic review of longitudinal studies. Sports Medicine 47(5): 943-974, 2016.
16. Kaufman, KR, Brodine, S, and Shaffer, R. Military trainingrelated injuries: Surveillance, research, and prevention. American Journal of Preventative Medicine 18(suppl 3): 54-63, 2000.
17. Keogh, JW, and Winwood, PW. The epidemiology of injuries across the weight-training sports. Sports Medicine 47(3): 479-501, 2016.
18. Kernozek, TW, Torry, MR, and Iwasaki, M. Gender differences in lower extremity landing mechanics caused by neuromuscular fatigue. American Journal of Sports Medicine 36(3): 554-565, 2008.
19. Kraus, K, Schutz, E, Taylor, WR, and Doyscher, R. Efficacy of the functional movement screen: A review. The Journal of Strength and Conditioning Research 28(12): 3571-3584, 2014.
20. Kristianslund, E, and Krosshaug, T. Comparison of drop jumps and sport-specific sidestep cutting: Implications for anterior cruciate ligament injury risk screening. American Journal of Sports Medicine41(3): 684-688, 2013.
21. Lauersen, JB, Bertelsen, DM, and Anderson, LB. The effectiveness of exercise interventions to prevent sports injuries: A systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine 48(11): 871-877, 2014.
22. Leppänen, M, Aaltonen, S, Parkkari, J, Heinonen, A, and Kujala, UM. Interventions to prevent sports related injuries: A systematic review and meta-analysis of randomised controlled trials. Sports Medicine44(4): 473-486, 2014.
23. Malik, S, Wong, ND, Franklin, SS, Kamath, TV, L’Italien, GJ, Pio, JR, and Williams, GR. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 110(10): 1245-1250, 2004.
24. Malone, S, Roe, M, Doran, DA, Gabbett, TJ, and Collins, KD. Aerobic fitness and playing experience protect against spikes in workload: The role of the acute:chronic workload ratio on injury risk in elite Gaelic football. International Journal of Sports Physiology and Performance 24: 1-25, 2016.
25. McCall, A, Carling, C, Davison, M, Nedelec, M, Le Gall, F, Berthoin, S, and Dupont, G. Injury risk factors, screening tests and preventative strategies: A systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues. British Journal of Sports Medicine 49(9): 583-589, 2015.
26. McCunn, R Aus der Fünten, K, Fullagar, HH, McKeown, I, and Meyer, T. Reliability and association with injury of movement screens: A critical review. Sports Medicine 46(6): 763-781, 2016.
27. McGill, SM, and Kippers, V. Transfer of loads between lumbar tissues during the flexion-relaxation phenomenon. Spine 19: 2190, 1994.
28. McGill, SM. Low back exercises: Evidence for improving exercise regimens. Physical Therapy 78(7): 754-765, 1998.
29. McGill, SM. The biomechanics of low back injury: Implications on current practice in industry and the clinic. Journal of Biomechanics 30: 465-475, 1997.
30. Milewski, MD, Skaggs, DL, Bishop, GA, Pace, JL, Ibrahim, DA, Wren, TA, and Barzdukas, A. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. Journal of Pediatric Orthopedics 34(2): 129-133, 2014.
31. Myer, GD, Martin, L Jr., Ford, KR, Paterno, MV, Schmitt, LC, Heidt, RS Jr, Colosimo, A, and Hewett, TE. No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction: Evidence for objective returnto-sport criteria. American Journal of Sports Medicine 40(10): 2256-2263, 2012.
32. Okada, T, Huxel, KC, and Nesser, TW. Relationship between core stability, functional movement, and performance. The Journal of Strength and Conditioning Research 25(1): 252-261, 2011.
33. Page, P. Current concepts in muscle stretching for exercise and rehabilitation. International Journal of Sports Physical Therapy 7(1): 109-119, 2012.
34. Parchmann, CJ, and McBride, JM. Relationship between functional movement screen and athletic performance. The Journal of Strength and Conditioning Research 25(12): 3378-3384, 2011.
35. Ramsey, N. Single-leg and double-leg training implications for basketball. NSCA Coach 3(1): 10-12, 2016.
36. Rohman E, Steubs, JT, and Tompkins, M. Changes in involved and uninvolved limb function during rehabilitation after anterior cruciate ligament reconstruction: Implications for Limb Symmetry Index measures. American Journal of Sports Medicine 43(6): 1391-1398, 2015.
37. Rube, N, and Secher, NH. Effect of training on central factors in fatigue follows two- and one-leg static exercise in man. Acta Physiologica Scandinavica 141(1): 87-95, 1991.
38. Saragiotto, BT, Yamato, TP, Hespanhol, LC, rainbow, MJ, Davis, IS, and Lopes, AD. What are the main risk factors for runningrelated injuries? Sports Medicine 44(8): 1153-1163, 2014.
39. Simpson, NS, Gibbs, EL, and Matheson, GO. Optimizing sleep to maximize performance: Implications and recommendations for elite athletes. Scandinavian Journal of Medicine and Science in Sports 27(3): 266-274, 2017.
40. Speirs, D, Bennett, MA, Finn, CV, and Turner, AP. Unilateral vs. bilateral squat training for strength, sprints, and agility in academy rugby players. The Journal of Strength and Conditioning Research 30(2): 386-392, 2016.
41. Tanasescu, M, Leitzmann, MF, Rimm, EB, Willett, WC, Stampfer, MJ, and Hu, FB. Exercise type and intensity in relation to coronary heart disease in men. Journal of the American Medical Association 288(16): 1994-2000, 2002.
42. Thacker, SB, Gilchrist, J, Stroup, DF, and Kimsey, CD Jr. The impact of stretching on sports injury risk: a systematic review of the literature. Medicine and Science in Sports and Exercise 36(3): 371-378, 2004.
43. Uehli, K, Mehta, AJ, Miedinger, D, Hug, K, Schindler, C, Holsboer-Trachsler, E, et al. Sleep problems and work injuries: A systematic review and meta-analysis. Sleep Medicine Reviews 18(1): 61-73, 2014.
44. van der Worp, MP, ten Haaf, D, van Cingel, R, Mijer, A, Nijhuisvan der Sanden, M, and Stall, B. Injuries in runners; A systematic review on risk factors and sex differences. PLoS One 10(2): e0114937, 2015.
45. Van Middelkoop, M. Risk factors for lower extremity injuries among male marathon runners. Scandinavian Journal of Medicine and Science in Sports 8(6): 691-697, 2008.
46. Watson, A, Brindle, J, Brickson, S, Allee, T, and Sanfilippo, J. Preseason aerobic capacity is an independent predictor of inseason injury in collegiate soccer players. Published ahead of print. Clinical Journal of Sports Medicine, 2016.
47. Yarnell, AM, and Deuster, P. Sleep as a strategy for optimizing performance. Journal of Special Operations Medicine 16(1): 81-85, 2016.
48. Zambraski, EJ, and Yancosek, KE. Prevention and rehabilitation of musculoskeletal injuries during military operations and training. The Journal of Strength and Conditioning Research 26(suppl 2): S101-S106, 2012.