Influence of exercise technique on risk of injury

[jab]

Hi,

Jordan says "all the time" that there is no correlation between "bad form" and risk of injury. I guess his usual example are the tons of DL's we see on youtube where ppl pull a lot of weight with a rounded back.

I am very curious how to back that up in a discussion/talk with friends. Is it basically just the argument that we see a lot of ppl with bad form that dont get injured (right now) and that there are ppl with good form who do get injured? Or are there actually studies about that? I was using google scholar since i am not having access to any other source of studies to find out whether there are studies to back up that claim.

I would really appreciate if one could point to a study or explain how to defend the notion that bad exercise form is not correlated to risk of injury.

Thanks in advance

[Nick C]

Hi Jab, I am certainly not as well versed as the Drs are on this subject matter but I will reply with some knowledge that I have gained via the bbm crew. The first thing is the issue of defining what exactly an injury is as we know that “injuries” such as a herniated disc can occur in the absence of pain and pain can occur in an otherwise “healthy” spine.
The next issue is with the dicotemy of good versus bad form as if there was one set in stone model that all humans have to conform to to be able to perform a lift. When coaching “correct” form the goal is to have the person perform the lift with the most efficient motor pattern. So with your deadlift example a person should do their best to set their back as a rounded back typically makes the lock out harder as opposed to a flat back.
I think the main point you can bring to a discussion is that pain is far more complex then the typical bio structural model of pain where x is “injured” so that’s why there is pain. This approach seriously underestimates and often dismisses the power that variables such as prior experience, social learning and learned expectations have on pain. As for suggestions on learning material I don’t have any studies to point to but in terms of pain science Professor Lorimer Moseley as some excellent material and wonderful YouTube videos that I have learned from.

[jab]

Thank you very much for your response, expecially the recommendation to watch Professor Lorimer Moseley's stuff. I will def have a look.

I am pretty much aware of any point you mentioned. My problem here is, that "bad form doesnt correlate with risk of injury" is a claim. A claim has to be "proofen" or at least you should have some sort of (good) evidence to back up your claim.

Saying: We dont know what good form is and "our old model of pain is wrong", does not help with the burdon of proof. What can be claimed without evidence can be dismissed without evidence.

Thats the problem i want to have solved. And by evidence, i dont mean a mathematical proof. I am not going so far. A good study or better a few good studies or even better a meta analisys would be fine with me.

I actually have to think about whether dismissing the claim "bad form causes injury (in the long run)" because of things you mentioned (which are valid points i guess) means that the claim "the technique has no correlation with the risk of injury" is true.

So if anyone could help, more input would be appreciated.

edit: I just checked out Professor Lorimer Moseley and realised that i enjoyed his ted talk 5 days ago . So i will look further into his stuff.

[matt]

Jab,

I'm also not one of the docs but I'll throw in my two cents:

I think you are correct that there is a burden or proof and that claims need to be proven, but I think the better question is which claims need to be proven? The default position assumed in scientific research is the null hypothesis. The starting point should always be to assume that two phenomena are not related. The goal of research is to attempt to disprove the null hypothesis. If you have enough evidence then you can reject the null hypothesis, but it's your starting point until proven otherwise.

In this particular case you would start with the default position that there is no relationship between form and injury. The claim that needs to be proven, then, is that there is in fact a relationship between the two. I suspect that what Jordan is arguing is that, given the null hypothesis as a starting point, there's not enough evidence (yet) that proves a relationship between form and injury. So until there's enough to reject the null hypothesis, he (and any good scientist) will assume there is no connection.

[Matthew Rupiper, PT]

jab, This is a fun discussion to have.

Full disclosure, I don't think you're going to get an answer or proof, but here are a two things to think about.

First:
For a moment, throw out the idea of good form vs. bad form. Put in its place the term "load." With resistance training, running, cycling, you name it, the technique used simply applies "loads" differently.

A back squat with low bar, flexed trunk and restricted anterior knee migration will "load" the lumbopelvic-hip region. A front squat with upright trunk will load the knee more. A conventional deadlift will "load" the lumbar erectors more than a hex bar deadlift. So what people sometimes call "bad technique" is merely placing more loads on a body region or structure.

A forefoot strike in running "loads" the achilles, etc.

Second:

We are a biological organism with the ability to adapt and become resilient to "loads." If a person has been progressively loading over the long period of time. Those tissues are more resilient to that technique. Tim Gabbett's research has shown high chronic loading actually reduces injury.

I hope this helps. It is a plausible premise that takes into account progressive loading and adaptation of the organism.

[Michael Ray]

Hi,

Jordan says "all the time" that there is no correlation between "bad form" and risk of injury. I guess his usual example are the tons of DL's we see on youtube where ppl pull a lot of weight with a rounded back.

I am very curious how to back that up in a discussion/talk with friends. Is it basically just the argument that we see a lot of ppl with bad form that dont get injured (right now) and that there are ppl with good form who do get injured? Or are there actually studies about that? I was using google scholar since i am not having access to any other source of studies to find out whether there are studies to back up that claim.

I would really appreciate if one could point to a study or explain how to defend the notion that bad exercise form is not correlated to risk of injury.

Thanks in advance

We actually just recorded a podcast on this topic last night.

jab, I'd begin this discussion with defining our terms - what is bad form and what is good form? We do not have evidence to determine good vs bad or as many attempt to state, injurious vs non-injurious. This is the crux of the problem, a false premise. Regarding evidence for injury risk reduction (we will not prevent - too many variables to control for and this is a game of probability) - the evidence we have on the topic demonstrates efficacy for load management, fatigue management, and psychosocial coping skills:

Jones et al - Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies. https://www.ncbi.nlm.nih.gov/pubmed/27677917
Eckard et al -The Relationship Between Training Load and Injury in Athletes: A Systematic Review. https://www.ncbi.nlm.nih.gov/pubmed/29943231
Ivarrson et al - Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention. https://www.ncbi.nlm.nih.gov/pubmed/27406221

Happy to discuss.

[jab]

jab, This is a fun discussion to have.

Full disclosure, I don't think you're going to get an answer or proof, but here are a two things to think about.

First:
For a moment, throw out the idea of good form vs. bad form. Put in its place the term "load." With resistance training, running, cycling, you name it, the technique used simply applies "loads" differently.

A back squat with low bar, flexed trunk and restricted anterior knee migration will "load" the lumbopelvic-hip region. A front squat with upright trunk will load the knee more. A conventional deadlift will "load" the lumbar erectors more than a hex bar deadlift. So what people sometimes call "bad technique" is merely placing more loads on a body region or structure.

A forefoot strike in running "loads" the achilles, etc.

Second:

We are a biological organism with the ability to adapt and become resilient to "loads." If a person has been progressively loading over the long period of time. Those tissues are more resilient to that technique. Tim Gabbett's research has shown high chronic loading actually reduces injury.

I hope this helps. It is a plausible premise that takes into account progressive loading and adaptation of the organism.

I really like this approach. Nice way to look at it and i think putting things your way, at least gives some (nice) different perspective. Really appreciate your effort to explain it your way .

To add to that: Thanks for saying "this is a fun disussion to have". I thought i am gonna get stoned by being a fundamentalist (regarding:a claim has to be proven,..) by ppl saying: "well, look at this and that, why do you need more evidence,.." and because of playing "word games" here. Which i would answer: Both accusations are not true. I just want to know more about that stuff and obv there are things i want to dig deeper into. The best source i found so far for "scientific use of barbells" is BBM. So i asked. So thanks for thinking that open the pandoras box on that topic is nice

We actually just recorded a podcast on this topic last night.

jab, I'd begin this discussion with defining our terms - what is bad form and what is good form? We do not have evidence to determine good vs bad or as many attempt to state, injurious vs non-injurious. This is the crux of the problem, a false premise. Regarding evidence for injury risk reduction (we will not prevent - too many variables to control for and this is a game of probability) - the evidence we have on the topic demonstrates efficacy for load management, fatigue management, and psychosocial coping skills:

Jones et al - Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies. https://www.ncbi.nlm.nih.gov/pubmed/27677917
Eckard et al -The Relationship Between Training Load and Injury in Athletes: A Systematic Review. https://www.ncbi.nlm.nih.gov/pubmed/29943231
Ivarrson et al - Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention. https://www.ncbi.nlm.nih.gov/pubmed/27406221

Happy to discuss.

Brilliant answer as well, thank you.

This is the crux of the problem, a false premise.

I love fallacies, thanks for pointing it out. (https://en.wikipedia.org/wiki/False_premise)

Regarding evidence for injury risk reduction (we will not prevent - too many variables to control for and this is a game of probability)

I think Jordan said in (at least) one of the videos that you two, Derek Miles and Michael Ray, hate the term injury prevention, since there is no prevention. Yep, i watch the videos i am supposed to . I will use your term "injury risk reduction" in the future, so thanks for telling someone again what it should be called .

Jones et al - Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies. https://www.ncbi.nlm.nih.gov/pubmed/27677917
Eckard et al -The Relationship Between Training Load and Injury in Athletes: A Systematic Review. https://www.ncbi.nlm.nih.gov/pubmed/29943231
Ivarrson et al - Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention. https://www.ncbi.nlm.nih.gov/pubmed/27406221

Thank you very much for the links. I will def read/go through them and broaden my knowledge with these.

Ok, having said that, i still have a problem. Is Jordan right in claiming: There's no correlation in "bad technique" and risk of injury?
If i understood correctly - he's not. I dont want to proof him wrong, thats not my point here. My point here is a sound chain of argument IF (which i did and i couldnt back it up, thats why we are here) I claim that there isnt a correlation in a discussion with a friend.
Again, im not trying to be the smart ass here. If I claim something, I want to be able to back it up. I dont feel like (although i get where you all are coming from - and i totally get/agree with your points) the absence of evidence FOR the notion that "bad form" increases the risk of injury is a scientific sound reason to be able to claim "it doesnt".

Stating it again: Not trying to be a smart ass, just trying to find out whats correct and trying to apply things i learned debating in the scientific community in a non medical/health related field

We actually just recorded a podcast on this topic last night.

Who, where, when, what? What channel? For youtube? Give me more info pls. Where can i get a hold of this?

[Matthew Rupiper, PT]

jab,

It is a fun discussion to have for those that enjoy deep intellectual conversations on topics without simple answers (me). It only becomes heated if someone has intellectual/financial incentives to defend their beliefs/views (most people making claims in PT/chiro/personal training/doctoring/etc). Just think of how many hits you'll get by typing in "the worst exercise for backs" in google....

You'll hear many in the science/research community say "causation is not correlation." Folks outside of the science/research community fail to understand causation and correlation. Causation takes a controlled and specific research design to establish. Some would say establishing a root cause for anything would require you to go back to the Big Bang. Correlations is easier to draw, but there are many factors in an outcome that make it challenging to define how strong the correlation is.

This is a fun discussion for intellectuals. It is less fun when talking to folks looking for a quick answer/marketing claims/providing anectdotes/click-baiters/etc...

Fun questions to ask if you have the conversation:

What does injury even mean? Tissue trauma (i.e. fracture/ACL rupture/Achilles rupture)? Time away from training? We can't call it pain, because pain and tissue pathology don't have a positive correlation (think headache). How can we define good and bad technique in something like barbell exercise. Our anthropometrics will dictate the technique if we have concrete rules (barbell, weight plates, etc). Watch the 2018 world weightlifting championships to see the differences in techniques. You may see upright lifters, flexed lumbar spines, valgus knees, asymmetrical catches, etc while moving loads in excess of 2-3x/bodyweight without injuries.

[Michael Ray]

Ok, having said that, i still have a problem. Is Jordan right in claiming: There's no correlation in "bad technique" and risk of injury?
If i understood correctly - he's not. I dont want to proof him wrong, thats not my point here. My point here is a sound chain of argument IF (which i did and i couldnt back it up, thats why we are here) I claim that there isnt a correlation in a discussion with a friend.
Again, im not trying to be the smart ass here. If I claim something, I want to be able to back it up. I dont feel like (although i get where you all are coming from - and i totally get/agree with your points) the absence of evidence FOR the notion that "bad form" increases the risk of injury is a scientific sound reason to be able to claim "it doesnt".

Stating it again: Not trying to be a smart ass, just trying to find out whats correct and trying to apply things i learned debating in the scientific community in a non medical/health related field

Who, where, when, what? What channel? For youtube? Give me more info pls. Where can i get a hold of this?

Jab,

If I'm understanding your question correctly (please clarify if I'm not), you are asking - Is there a correlation between technique and risk for injury?

To define our terms - technique = how a movement is completed
injury = much more difficult to define but here is what we have as definition(s) in the research evidence: a) missed practice or competition due to reporting of pain and/or dysfunction (amount of time missed before warranting the label of injury is variable in the research) or b) reporting of loss of bodily function or structure and/or c) reporting of pain.

As Matthew Rupiper, PT mentioned - defining injury is complex because we are realizing more and more that tissue alteration is not a sufficient observation for the label of injury given how often we find tissue alterations from textbook "normal" in the absence of symptoms (pain and/or dysfunction).

Austin and I recently were discussing this on the podcast and in essence if an athlete thinks they are injured due to experiencing pain then they may self-select activity (dysfunction) and therefore are "injured". This can further complicate the discussion given the misunderstanding of what pain means.

With all that said, this is a discussion of burden of proof (at least in my mind). We (BBM) doubt the "truthfulness" of the statement - "bad" technique = "injury", for the reasons discussed above. Therefore, the person(s) making such a claim need to demonstrate evidence in support of this claim - not those doubting the claim.

Also, this isn't an absence of evidence argument (no research has been done on this topic) or an argument of ignorance (something is true because it hasn't been proven false or something is false because it hasn't been proven true) - we have evidence of what is strongly correlated to injury occurrence (as cited above). Perhaps as more investigation occurs we would find such evidence regarding technique but ethically this may be unlikely given it would most likely require imposing harm on study participants.This is likely related to the topic of falsifiability as well.

However, I argue, if load is managed appropriately then it is likely technique is irrelevant. We have examples of movements not as prevalent for those outside of the weight lifting world such as the Jefferson Curl (https://www.youtube.com/watch?v=kV73sWu_QEQ).

We do have evidence from a kinematics standpoint how a movement like the deadlift is completed is different based on the structure of the individual - see Pavlova.

I discuss this in the mobility blog on BBM. Excerpt:

"Pavlova recently completed a study examining the curviness of participant’s lumbar spine and its effect on lifting an object from the ground during three different trials. The first trial the participant lifted “freestyle”, no cueing. The second trial the participants were cued to squat (“keep the back straight and bend at the knees”), and finally the third trial to stoop (“keep the legs straight and bend at the back”). The authors’ findings:

“In this study we have shown that the curviness of the lumbar spine is associated with the way in which individuals lift a weight from the floor. When no instruction was given, individuals with more lordotic lumbar spines preferred to stoop down to pick up the box, while those with straighter spines preferred to squat. Our results also suggest that these natural movement preferences are maintained when instructions are given, especially in individuals with curvier spines who prefer to lift by stooping. In changing between lifting styles, individuals adjusted their knee flexion while maintaining their preferred lumbar flexion range.”

These findings certainly question the forced constraint or “one size fits all mentality” rather than allowing for variability and a degree of subjective preference when completing a task.

The authors go on to conclude:

“These results could be important for a reassessment of lifting guidelines, one size does not fit all, and for training of athletes where a given task may place different demands on different athletes depending on their natural lifting technique, which may depend on the shape of their lumbar spine.”"

Clinicians, coaches, athletes, etc are the ones applying movement constraints and making claims how movements should be completed to not "cause" injury but the research evidence we have is against this stance. If you continue reading the blog, I discuss the research on movement variability and how it is an important component for learning (most especially when learning novel tasks).

Blog: https://www.barbellmedicine.com/mobility-explained/

Finally, it is important to delineate conversations - the discussion of injury and the discussion of performance as it relates to technique are different.

Happy to discuss. As Matthew stated, you are not going to offend us with a discussion of the topic - we are not dogmatic but rather attempting to be less wrong.

[jab]

Thanks Matthew and thanks Michael for your answers. Both gave me more insight into the whole "technique & injury correlation" topic. Of course the other answers helped as well. My main reason (i guess) to open this thread was to get a deeper understanding of the topic and i feel like this is not a usual internet forum (that one usually goes visits) since the answers given where so much on point and without any "trolling" or heated discussion. I really appreciate that .

Thanks all for clearing things up for me

[jab]

Great podcast guys, well done @Michael Ray as well.

Does it work like that usually: Someone starts his first thread and then you talk for 20min about that topic in your next podcast - i gotta say: nice service BBM crew .

[Michael Ray]

Great podcast guys, well done @Michael Ray as well.

Does it work like that usually: Someone starts his first thread and then you talk for 20min about that topic in your next podcast - i gotta say: nice service BBM crew .

Hahaha, not usually. We had this podcast in the works for a few weeks. Glad you enjoyed it!

[delacoal]

Hey all,

I came across this thread when I was faced with a similar discussion in a facebook group chat. It's associated with the Powerlifting Society at my University which I am a committee member of.

I realise it's not really in your interest to fight internet battles for other people, but in this case, there is an opportunity to potential help or harm a load of new joiners to our society.

Yesterday, someone said that "it should probably be said that the risk of injury from powerlifitng/weightlifting WITH CORRECT TECHNIQUE is very low compared to other sports".

I said that yes, the rate of injury in powerlifting is low compared to other sports - but that if this person had evidence there was a 'correct' technique and that not adhering to it would increase the risk of injury I'd be interested to read it.

They didn't have any, but continued by saying "An example of unsafe (or I guess 'incorrect' if we're going by what I said earlier) technique would be benching with suicide grip or deadlifting without efficiently loading the posterior chain (ie. effectively doing an overloaded 'good morning')" and "'Round back' deadlifting is actually fine if the spine remains in a neutral position. Admittedly 'round back' deadlifting does have a tendency to be associated with 'incorrect/unsafe technique' when in reality that's not always the case."

Finally, they pointed me to this website https://blogs.umass.edu/bodyshop/fil...atexercise.pdf to which I said it was published in 2009 and wasn't substantial evidence.

I tried to point them in the direction of the evidence mentioned earlier in this thread (Pavlova), and the Wu and Dhawale studies mentioned in the mobility article. To which, I was told I was cherry picking and that one study (Pavlova) doesn't mean you should apply it to training.

If I understand this thread, there is no evidence to suggest that there is a 'bad form/incorrect technique' and no evidence that form is related to injury risk, there is some evidence - even one study - that shows that technique is variable dependant on the individual and there is also evidence that not being dogmatic about technique actually improves training outcomes in novice lifters.


My question:

How would you go about reducing the potential harm to new lifters by the spread of disinformation? (ie. there is a correct form and if you don't do it you'll get hurt, or more specifically if you don't load the posterior chain effectively you could hurt yourself deadlifting)


Sorry for the wall, and thanks for taking the time to read my post

[delacoal]

Just to add on to my question.

How do you respond to things like :
1. 'Just because there's no research on something doesn't mean it's wrong'

2. 'The large majority of fitness professionals will agree that lifting with shit form eg rounded back is wrong and will result in injury, just because there’s no research for it doesn’t mean that the large majority of fitness pros are all wrong'

3. I don't have any specific sources but a slight rounding of the upper can be ok so long as that is maintained throughout the lift. As it changes in the position during the lift that causes problems as you change the load of the vertebrae. I'd agree there is no optimal form but that's more because everyone biomechanics are different so what works for one person won't necessarily work for another. That what's I believe the last paper (Pavlova) you referenced is getting at but I feel there is a big difference between picking up 15kg (that paper) and picking up 100kg+.'

[Austin Baraki]

How would you go about reducing the potential harm to new lifters by the spread of disinformation? (ie. there is a correct form and if you don't do it you'll get hurt, or more specifically if you don't load the posterior chain effectively you could hurt yourself deadlifting)

We simply focus on putting out good information ourselves, and educating others to spot bullshit. We don't go out of our way to attempt to change others' minds.

1. 'Just because there's no research on something doesn't mean it's wrong'

Correct; however, we should all "assume the null hypothesis" until we have sufficient controlled evidence to suggest we should reject it.

2. 'The large majority of fitness professionals will agree that lifting with shit form eg rounded back is wrong and will result in injury, just because there’s no research for it doesn’t mean that the large majority of fitness pros are all wrong'

The large majority of people once thought the earth was flat, or that the sun revolved around the earth.

3. I don't have any specific sources but a slight rounding of the upper can be ok so long as that is maintained throughout the lift. As it changes in the position during the lift that causes problems as you change the load of the vertebrae. I'd agree there is no optimal form but that's more because everyone biomechanics are different so what works for one person won't necessarily work for another. That what's I believe the last paper (Pavlova) you referenced is getting at but I feel there is a big difference between picking up 15kg (that paper) and picking up 100kg+.'

Injury risk likely increases when loaded in a way that you are unprepared for. There is a difference between picking up 15 kg and 100 kg for someone whose best deadlift is 60 kg. I could likely pick up 100 kg just as casually as 15 kg with a fully rounded back, no valsalva, and do a Jefferson curl with it and no ill effects, because I'm well-prepared for such loading.

The point here is that movement, in general, is safe. Load matters to the extent you have / have not been prepared for it.