Web12-05 - Safe and Contraindicated Exercises

Strength and Muscular Endurance

 

Each of the following exercises is considered to be a “contraindicated” exercise which means they aren’t recommended for most people due to a greater risk for harm or injury. While it may be possible to perform these movements without pain for a number of repetitions, the accumulated damage or microtrauma can lead to injuries or significant pain over time. In nearly all cases, the goals of these exercise movements can be more safely be performed with alternative exercises. The risks associated with each of the exercises below are described followed by an explanation of a safer alternative exercise.

 

The Swan

Repetitive hyperextension of the lower back has several objections. First, it stretches the abdominals. These muscles are too long and weak in most people and should not be further lengthened. Second, it can be harmful to the back, causing an impingement on the nerve, compression and even herniation of the disk, myofascial “trigger points” and spondylolysis. Examples of exercises in which this occurs include cobras, back bends, straight leglifts, straight leg sit-ups, prone back lifts, donkey kicks, fire hydrants, prone swans, backward trunk circling, weight lifting with the back arched, and landing from a jump with the back arched. One of the back hyperextension exercises commonly seen is the swan.

 

 

ALTERNATIVE: Back extension

Lie prone over a roll of blankets or pillows and extend the back to a neutral position.

 

 

 

 

 

The Donkey Kick

The donkey kick exercise is performed for the purpose of developing strength and/or endurance of the buttocks muscles (hip extensors). It may involve touching the nose with the knee, followed by a ballistic backward kick, a lifting of the head (neck hyperextension), and hyperextension of the lower back. Hyperextension of the back is generally undesirable in exercises for the ``masses.'' The same is true for the neck. This exercise should be modified as shown in the knee-to-nose touch, so the leg does not lift higher than the hips, and the neck and lower back are not allowed to hyperextend.

exercise.

 

ALTERNATIVE: Knee-to-nose touch

Kneel on “all fours.” Pull knee to nose, then extend leg and head to horizontal (do not go higher). Repeat. Then change legs.

 

 

 

 

 

The Double Leg Lift

The double leg lift is usually used with the intent of strengthening the lower abdominals, when in fact it is primarily a hip-flexor (iliopsoas) strengthening exercise. The iliopsoas attaches to the lower back and tilts the pelvis forward, arching the back. Most people have overdeveloped the hip flexors and do not need to further strengthen those muscles. Even if the abdominals are strong enough to contract isometrically to prevent hyperextension of the lower back, the exercise produces excess compression on the disks. The same criticism is true of straight-leg sit-ups. These can displace the fifth lumbar vertebra (spondylolisthesis).  A bent-knee sit-up, which is usually used to strengthen the upper abdominals, creates less shearing force on the spine, but some recent studies have shown it produces greater compression on the lumbar disks than the straight-leg sit-up. An example of a safer and better exercise to strengthen the lower abdominals is the reverse curl.

 

ALTERNATIVE: Reverse curl

Lie supine, knees bent, feet flat on floor (hook-lying), arms at side. Lift knees to chest, raising hips off floor. Do not let knees go past the shoulders. Return to starting position and repeat.

 

 

 

 

 

Sit-Up

Placing the hands behind the neck or head during the sit-up and crunch allows the arms to pull the head and neck into hyperflexion, stretching the posterior ligaments. If the hands are not placed at the sides or across the chest, then the hands should be placed so the palms or fists cover the ears to prevent pulling on the neck. Another alternative is to cross the hands behind the upper back by reaching  down the spine as far as possible (about the third or fourth thoracic vertebra) and holding this position while resting the weight of the head on the arms.

 

ALTERNATIVE: Crunch (hands on ears)

Assume a hook-lying position, with palms of hands lightly covering ears. Curl up until scapulae leave the floor, then roll down to starting position and repeat.

 

 

 

 

 

Deep Knee Bends

Deep squatting exercises, with or without weights, placing the knee joint in hyperflexion tends to ``wedge it open,'' stretching the ligaments, irritating the synovial membrane, and possibly damaging the cartilage. There is even greater stress on the joint when the lower leg and foot are not in straight alignment with the knee. If you are performing squats to strengthen the knee and hip extensors, then try substituting the forward lunge or half squat (also called parallel squat) (knees at right angle) with free weight or knee extensions and leg presses on a resistance machine.

 

ALTERNATIVE: Alternate Leg Kneel (lunge)

From a standing position, with or without a free weight, take a step forward with right foot, touching left knee to floor. The front knee should be bent only to a 90-degree angle. Return to start and lunge forward with other foot. Repeat, alternating right and left.

 

 

 

 

 

The Bench Press

The bench press or similar exercises lying on a bench can be hazardous when the back is arched during lifting on a weight machine. The exercise can be safe if you are able to keep the back flat against the bench when lifting.

 

ALTERNATIVE: Bench press (knees bent)

To prevent lumbar hyperextension and possible strain on the lower back, bend the knees and place the feet on the bench in a ``hook-lying'' position. If the bench is too short, substitute a longer one or place a chair at the end of the bench. Note: If the bench is unstable or if your position on the bench is unstable do not perform this exercise with the feet on the bench.