Birmingham Medical News
Benton A. Emblom, M.D.
With the increased popularity of extreme conditioning programs (ECPs), a group of Birmingham physicians noticed an increase in the rate of injury among participants of these programs. A cross-sectional study determined that the injury rate related to ECPs was no greater than the same injuries in other sports. However, information from the study is enabling fitness trainers and physicians to prevent and manage injuries related to the programs.
Andrews Sports Medicine & Orthopaedic Center in Birmingham and Iron Tribe Fitness representatives worked together on the study, along with Kyle Aune, MPH, an epidemiologist at the American Sports Medicine Institute. "The medical community's original reaction to these conditioning programs was, I think, unfairly dismissive in the beginning. Physicians saw an uptick in injuries from those programs, probably because the programs were becoming more popular, not because they were more dangerous," he says. "On the flip side, supporters of extreme conditioning were dismissing any criticism of the program. That was the impetus for our study."
To gather information, investigators sent an online survey to participants at all Iron Tribe gyms in the Birmingham area. "The Iron Tribe staff was incredibly helpful with the study because they saw the value of being proactive in identifying possible weaknesses or dangerous activities that might be slipping under their radar," Aune says. 
The positive finding from the study was that the injuries are not occurring at the extreme rate that has been reported in various media. "We did find that the shoulder is a susceptible area for ECP participants," Aune says. "If you have had a previous shoulder injury, you are eight times more likely to sustain a new shoulder injury during this program. With that in mind, we recommend that these gyms screen all new athletes to assess their functional abilities and to pinpoint any weaknesses they may have."
The study also revealed four specific exercises that were more likely to result in injury - squat cleans, ring dips, overhead squats, and push presses. "The common denominator in these exercises is that they all focus on the shoulder. We suggest that trainers be careful when they program those exercises and anything else that may result in shoulder-heavy workouts, especially among people who have functional limitations from a previous injury," Aune says.
The final recommendation from the study is to emphasize form and technique, because most people attribute the cause of their injury to overexertion, fatigue, or improper technique. "If you are tiring because you overexert yourself with improper form, that can lead to injury," Aune says.
Orthopedic surgeon Benton A. Emblom, MD, of Andrews Sports Medicine & Orthopaedic Center said they wanted to participate in the study to identify injury rates and patterns related to these exercises to have a better understanding of the types of injuries that are occurring in the ECPs. "We didn't do the study to discourage participation in these programs," he says. "There is a lot of benefits from these exercises, but we saw injury patterns in people of certain ages and activity levels that were concerning. We want to be aware of that."
Rotator cuff and bicep tendon injuries are the most common in ECP participants. "A lot of these athletes use heavy weights and do high repetition, explosive overhead lifting. That can cause injury to soft tissue in the shoulder," Emblom says. "The overall rate of injury was not much different than normal activities and exercises. It's just specific injury patterns that tend to show up in these types of programs."
Kyle Sottung, Director of Product Development for Iron Tribe Fitness, is encouraged by the study findings, and his team plans to use the information to minimize injuries in Iron Tribe gyms. "We are using a consistent approach in our 43 gyms around the country. We deliver the same programming and coach development for all our gyms, and our coaches go through extensive training and deliver the same workouts so we can control quality from a central point," he says. "We evaluate our athletes when they start the program so we can keep them safe and sustainable. We are using the information from this study to help reduce our low injury rates even further. We have started implementing screening tools like the Functional Movement Screen, reorganized our programs to offer an option that does not include the barbell and some of the potentially injurious exercises, and added equipment such as dumbbells, assault bikes, and battle ropes which give great intensity with a lower risk of injury."
Although Iron Tribe offers a group program, they will make changes to adapt the program to fit every participant. "When you put one workout on the board for 300 members in the gym, that workout is not going to be exactly right for every person," Sottung says. "We educate our coaches to know the abilities and goals of our clients so they can adjust the workout and exercises to fit the capacities of the people in the class. A program is only good if it can be scaled to fit every person at the gym. That's how we deliver an individual experience for each client who comes in."
Emblom, too, is encouraged by the study. "Trainers have learned that certain injuries can occur with specific exercises and they've done a good job modifying workouts to prevent injury," he says. "I think the crux of what we've seen is there are certain injury patterns that tend to spike with these programs. Fortunately, they are repairable and give the athletes the ability to return to those programs if they desire. But more importantly, the injuries can be prevented if you are aware of what potential injuries are out there. That's the main thing."
