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You may have noticed that your Physiotherapist or Athletic Therapist will help you get back to your sport or activity by targeting that area with strength exercises. Usually, the first steps in physio are to first address the site of injury with treatment, correction of proper muscle firing patterns, encouraging gentle loading, and lastly, strengthening!

It is particularly important for those wanting to return to the gym or a sport to strengthen with more than rehabilitation exercises, so we know that you are sure you can handle it, especially under fatigue (how many times have you heard you are more at risk of injury under fatigue?). When we are strengthening with compound exercise, we are not just targeting the injured area, we also target the joint above and below, as well as your core, to make sure you can coordinate those strength movements. The reason for this is because when we get injured or endure pain and dysfunction for a period of time, our body will adapt--it is very good at this, almost too good sometimes! This can lead to compensations at other joints. For example, if you roll your ankle and are limping, you may start to twist or lurch more through the low back and hip. Or maybe whiplash from a car accident means that the upper back has to twist more when you turn to look at someone, due to a loss of mobility in the neck.

Essentially, physiotherapists know that it is important to prevent further injury in the affected area, as well as dial down compensation in other areas that will be at risk of becoming injured as well. Usually, if we have been offloading the area due to pain or dysfunction, we also lose muscle mass and strength from not using the muscles. It really is true, if you don’t use it, you’ll lose it!!

Today, our Physiotherapist, Certified Athletic Therapist, and Certified Strength and Conditioning Specialist Jacalyn Moore is here to talk about “compound movements.” Compound Movements are advanced exercises that may be used as part of re-integrating you to tolerating activity again.

Compound exercises are exercises that challenge multiple joints and muscles in the body at the same time, compared to isolation which uses one specific muscle and one joint. An example of compound exercises include deadlifts, squats, chest press, and push-ups. The great thing about these exercises is that they can be completed by any age group, even younger athletes (we just don’t load them with weight), to improve strength and coordination of movement. In this blog, I will be reviewing these exercises with you, to show you:

1. The benefits of strength
2. Common ways to become injured from strength training
3. How to prevent injury during your gym sessions

The deadlifts and squats challenge your lower extremity and lumbar spine muscles, and the chest press and push-up challenge your upper extremity, your core, and mid back strength. These exercises are great for improving overall strength in the upper or lower extremity but can lead to some injuries since all the joints and muscles have to be optimally working in order to complete the exercises properly. As physiotherapists, we do not use them a lot in the early stages of rehabilitation, since injured individuals often have a weakness that needs to be addressed first before we can introduce them to compound exercises.

BECAUSE OF THE COMPLEXITY OF COMPOUND EXERCISES, THEY CAN LEAVE YOU AT A HIGH RISK OF INJURY. THIS CAN COMMONLY HAPPEN IN 2 WAYS:

1. If you are not performing them with proper technique
2. You add too much weight, too soon, with poor technique to control this weight, which can overcome the strength of your soft tissues

From our perspective, proper form is a must. What I have found in my many years as a Strength & Conditioning Coach, is that people in the bodybuilding and powerlifting realms complete a slightly different form of these compound exercises compared to people in the athletic and Olympic lifting realms of fitness. The bodybuilding and powerlifting realms often stress the muscles, bones, and tendons at a very high weight and volume. This explosive type of training forces our soft tissues to adapt quicker than they are naturally capable of. A perfect example of this is "tennis elbow," or "jumper's knee."

Many common injuries we see in our clinic related to the lower body compound exercises are patellofemoral pain syndrome (pain around the knee cap), meniscus tears in the knee, hip impingement, and low back muscle strains. Common injuries we see for upper body compound exercises: biceps tendinopathy, rotator cuff strains, labral tears in the shoulder, and medial elbow pain.

We have provided some videos below of how we teach certain compound exercises. Our aim is to help you identify flaws in your own form, decrease your risk of injury, and if you have not done any compound lifts before, hopefully, these videos help get you started!

*Please make sure that you have also been cleared by your physiotherapist or physician to begin compound exercise training.*

Exercise Demonstrations:

1. Bench Press

Movement goals: pectoralis major, anterior deltoid, triceps brachii

Video link: https://www.youtube.com/watch?v=XwmJH18dKAU&list=PLuiB-dgIokDVTt_wljYdvX7SMPl6klSnp&index=2&t=0s

2. Push-Up

Movement goals: pectoralis major, anterior deltoid, triceps brachii

Synergist muscles: rhomboids, lower and upper fibre trapezius, serratus anterior

Video link: https://www.youtube.com/watch?v=sCSe6s22mWQ&list=PLuiB-dgIokDVTt_wljYdvX7SMPl6klSnp&index=4

3. Front Squat

Movement goals: quadriceps (vastus lateralis, vastus medialis, rectus femoris, vastus intermedius), hamstrings (biceps femoris, semimembranosus, semitendinosus), gluteus maximus

Video link: https://www.youtube.com/watch?v=l3qez767H4M&list=PLuiB-dgIokDVTt_wljYdvX7SMPl6klSnp&index=2

4. Back Squat

Movement goals: hamstrings (biceps femoris, semimembranosus, semitendinosus), gluteus maximus, lumbar spine (erector spinae)*, quadriceps (vastus lateralis, vastus medialis, rectus femoris, vastus intermedius),

Video link: https://www.youtube.com/watch?v=dWKz0HdCqe8&list=PLuiB-dgIokDVTt_wljYdvX7SMPl6klSnp&index=3

5. What is the Hip Hinge?

Movement goals: The hip hinge is a movement pattern that we teach to better your lifting technique. Is just uses hip movement, and keeps a stable lumbar spine and knees. The hip hinge helps protect the back and transfers more force to your hip and leg muscles with lifting. It is an extremely important movement pattern to grasp before you start deadlifting.

Video link: https://www.youtube.com/watch?v=RujbsefkPtI&list=PLuiB-dgIokDVTt_wljYdvX7SMPl6klSnp&index=9

6. Traditional Deadlift

Movement goals: quadriceps (vastus lateralis, vastus medialis, rectus femoris, vastus intermedius), hamstrings (biceps femoris, semimembranosus, semitendinosus), gluteus maximus

Video link: https://www.youtube.com/watch?v=N-r5mL9OBfY&list=PLuiB-dgIokDVTt_wljYdvX7SMPl6klSnp&index=6

7. Romanian Deadlift

Movement goals: quadriceps (vastus lateralis, vastus medialis, rectus femoris, vastus intermedius), hamstrings (biceps femoris, semimembranosus, semitendinosus), gluteus maximus, lumbar spine (erector spinae)*

Video link: https://www.youtube.com/watch?v=ETysypb7-hM&list=PLuiB-dgIokDVTt_wljYdvX7SMPl6klSnp&index=7

8. Stiff-Legged Deadlift

Movement goals: hamstrings (biceps femoris, semimembranosus, semitendinosus), gluteus maximus, lumbar spine (erector spinae)*

Video link: https://www.youtube.com/watch?v=hCYoW50GT0o&list=PLuiB-dgIokDVTt_wljYdvX7SMPl6klSnp&index=8

* all these compound exercises use your lumbar spine muscles to some degree, but these exercises with the asterisks use a higher percentage of your low back muscles and have higher risks of low back injury if completed incorrectly. *

Best Strategies to Prevent Back Injuries During Weight Lifting

1. Strengthen at lighter loads through the full range of motion, rather than heavier through a partial range of motion (think: what is the point of doing a 3 inch bicep curl when you could curl all the way? You’ll be much stronger at lifting heavy grocery bags all the way up, if you train the full muscle movement!)
2. Keep core and glute muscles engaged throughout the whole movement, to maintain balance stability, and coordinate corrections effectively. Here is an example of how to utilize this to prevent back injuries, as good glute and core activation will help maintain an upright position, and keep loads closer to the body. https://imgur.com/a1LqGW
3. Listen to your body: if you are tired, take a break! If you are working up in weight, make sure that you rest 90 seconds before trying again.
4. Take the tension out of the bar before initiating lift. In other words, remove the slack that will cause a lurch at the beginning of the movement. This will decrease your risk of musculotendinous strain.
5. Gradually increase weight (maximum 2.5 lbs per week increase for upper body, 5 lbs per week increase for lower body)
6. If you are not sure if you can add more weight to your next set, see if you can repeat the exact same set one more time with great form. If your body is fatigued by this point, then you also know you should not increase weight yet.
7. Build tempo strength under tension before going explosive. You should be able to do a compound movement at slow speeds first, to show that you can control it. Plus, eccentric strength is a great way to stimulate strength, so it will put you ahead of the game when you start to work towards more explosive power movements. Example: you should be able to do an eccentric front squat at the same weight as a power clean.