Nothing worth doing is completely risk free. This includes exercise. You can train with good form and avoid obvious stunts and ego lifts, but sometimes accidents just happen. Not every injury is the result of overuse or strain, and not every injury can be predicted.
Sure, prevention starts with common sense. But even experienced lifters and trainers are unaware of how their common practices often put them or their clients at risk.
That's why it's critical we learn about how these injuries occur and bump up our prevention efforts. How? Easy. Just look at the stats. We can actually see the most common causes of workout-related emergency room visits.
Here's what causes the most injuries and how to prevent them.
1 – Free Weights
You're going to be picking up weights and putting them back multiple times a session. And each time you do, you run the risk of dropping one on yourself or someone else.
A paper on epidemiology of weight training-related injuries from 1990 to 2007 found the most common injury mechanism requiring an emergency room visit was (wait for it) dropped weights (1).
Problem is, most of us don't think about racking and un-racking weights. We just do it. But it's the only "lift" everyone repeatedly does at the gym while not paying much attention, despite the fact it could (and often does) cause serious injury.
Of course, simply being aware every time you're moving weights will decrease the chance of dropping one on yourself. But there are a couple simple protocols you can follow when handling traditional Olympic weight plates.
How to Actually Load Plates (Yes, There Are Rules)
- When loading plates on the barbell for bench presses or squats – basically any time the rack or barbell is around mid-shin height or above – load the plates with the lip facing inward. This way you get a secure, two-handed grip when sliding them on and off, and also while carrying them from rack to barbell and vice versa.
- That said, when the rack or barbell is low (below mid-shin level), load the plates with the lip facing outward. This is especially useful when it's just above the floor like when doing deadlifts. This way you can grab it and get your fingers underneath the lip without first having to slide the plate out.
Recap: Plates that are racked low (below knee level) go lip facing out; plates racked higher go lip facing in.
How Plates Should Be Racked
If you're not a gym owner, you might not have a say in this part. But the way most gyms have their plates set up doesn't make sense. The heaviest weight plates are often lowest on the rack, making them more difficult and awkward to grab than the lighter plates, which are usually closer to torso level.
Here's how it should look instead:
It makes more sense to rack heavier plates at torso-level while putting lighter plates on the lowest and highest points of the rack. This can help reduce the chances of a lifter dropping a larger plate on him or herself. You're better able to get a more secure grip on the larger, heavier plates at this height.
That said, some racks are specifically designed to have the biggest plates at the bottom. So, no matter how high or low the plates are racked, or what type of Olympic-sized plates, keep at least a two fingers' width between the end of the rack and the last plate on the rack. This way you have wiggle room to maneuver it and get a secure grip without running the risk of the plate falling before your able to grab it properly.
Another smart precaution to take when racking and un-racking plates is to position your feet wide and out of the drop-zone before you begin maneuvering the plates on and off the barbell or rack.
In situations where you're pulling a larger plate off the rack from a low position with one hand, don't fling it up to grab with your other hand because this also increases the risk of dropping it. Instead, use both hands to slide it off. Or try this – after you've slid it off the rack with one hand, bring it down to the floor, and rest it upright, then grip it more securely with both hands before you pick it up.
2 – Treadmills
It's actually the MOST injurious piece of equipment, but I didn't rank it first here because you're most likely a lifter who occasionally uses cardio equipment... or walks right past it in order to lift.
But each year, there are over 24,000 treadmill injuries. How do I know? Well, the Consumer Product Safety Commission collects current injury data from hospital emergency departments from across the U.S.
According to the data, between 2012 and 2014 there were approximately 72,900 injuries (24,300 injuries per year) associated with treadmills, which was the highest number in the exercise equipment category (2). The most common cause was associated with what we'll refer to here as "the trip and fall" maneuver (3).
Also reported, more than 30% of workout-related ER visits involved jogging, sprinting, or walking on a treadmill (4). Slips and strains are the most common causes. And apparently, your youth won't protect you. These incidents were reported among all age groups, not just older folks.
Note: The data only captures injuries among patients treated in hospital ERs. So there are probably even more injuries occurring – some may not require an ER visit while others may be treated in other health care settings, like the chiropractor's office.
Now, this isn't saying to stop using treadmills. However, if they account for one in three workout-caused ER visits, it makes sense to be as smart as possible when using them.
Strains are more of an overuse issue that can be lessened by being conservative with your approach and avoiding pushing yourself too much too soon. However, slips are accidents that could be lessened by minimizing the distractions that occur while you're on the treadmill: simply pay attention and remain present.
It's no different than not texting while driving. And obviously, avoid stunts like dancing or jumping on the moving belt.
Big-box gyms have to keep plenty of treadmills to gain and keep members. However, if I'm an owner of a smaller, private training facility, I'd think twice about having them because they're a liability you don't really need in a private fitness studio.
Additionally, home treadmills and younger kids don't mix. From 2007 to 2011, most ER-treated injuries from home exercise equipment were associated with treadmills. The majority of injuries were of children under 10-years old (5).
Not to mention, a 2016 study published found that pediatric treadmill burns are the second most common hand injury after stovetop burns. But they're more severe and require greater and longer care in comparison to other contact hand burns (6).
3 – Medicine Balls
Seven percent of workout-related ER visits for women and five percent for men involved a medicine ball. Most of the injuries recorded involved some kind of head collision. Damage to the head most likely comes from slamming or throwing the bouncy medicine balls against hard surfaces.
So, when slamming a medicine ball, use one that doesn't have much bounce. If a bouncy medball is all you have access to, and you insist on doing slams, make sure to have the ball contact the floor just outside your body and be mindful of where your head is on each rep.
If you're doing medicine ball throws against a wall, stand far enough back to catch the rebound in a controlled manner. And, if you're throwing a medicine ball with a partner, you can always catch it off the bounce, or throw the ball in the area of their torso. Avoid throwing it near their head where it can hit their face if they fail to catch it.
You can also use the block method, demonstrated here.
You'll need a non-bouncy med ball for this.
4 – Stability Balls
Some exercise tools get misused and abused, but that doesn't mean we should dismiss them as valid tools. Heck, if that were the case we wouldn't use any equipment at all judging by some of questionable things you've seen people do with barbells, dumbbells, machines, and kettlebells.
The stability ball is like any other training tool. How well it's used is determined by the exerciser or the trainer. But let's break this one down into bad uses and good uses.
Bad ways to use these giant inflatable balls is lifting free weights while standing, kneeling, or lying on your back on them. All of those are just asking for an accident.
Aside from the risk of falling off, the ball can pop. This is especially true when using stability balls in big box gym where the staff doesn't replace them very often and members abuse them by jamming them against (and between) objects that can damage the integrity of the ball.
In 2009, the NBA's Sacramento Kings lost starting forward Francisco Garcia for a huge chunk of the season after an exercise ball accident broke his right wrist. Garcia, who weighed 195 pounds, was lying on his back on an exercise ball, lifting 90-pound weights in each hand (doing a chest press), when the ball burst. Fun fact: His contract was worth $29.6 million over 5 years. Expensive lesson there.
With this in mind, it's great to do stability ball exercises like rollouts, pikes, leg curls, etc. However, the risks far outweigh any the benefits of any so-called "functional" trainer's claim of holding heavy free weights while laying on your back, much less while kneeling or standing on top of one.
- Kerr ZY, Collins CL, Comstock RD. Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med. 2010 Apr;38(4):765-71.
- U.S. Consumer Product Safety Commission Web site [Internet]. Bethesda (MD): U.S. Consumer Product Safety Commission; [cited 2015 December 24]. Available from: www.cpsc.gov/en.
- Betul Sekendiz, M.Sc., Ph.D. Risks Of Treadmills In Health/Fitness Facilities. July/August 2016 . ACSM's Health & Fitness Journal. pilarmartinescudero.es/OctNov16/Risk%20treadmill.pdf
- Graves JM, Iyer KR, Willis MM, Ebel BE, Rivara FP, Vavilala MS. Emergency department-reported injuries associated with mechanical home exercise equipment in the USA. Inj Prev. 2014;20(4):281–285.
- Dana L. Noffsinger, Susan R. Johnson, Krista Wheeler, Junxin Shi, Huiyun Xiang, Jonathan I. Groner. Exercise Treadmills. Journal of Burn Care & Research, 2016; 1