In my last article, we touched upon the most common upper body injuries that I see in my practice. In this installment, we'll discuss the most common lower body injuries I see from lifting weights. For the sake of this article, we'll also include the lower back as part of the lower body.
First, let's cover some basic terms:
1-Sprain: Overstretching (partial or micro-tearing) of a ligament (connective tissue connecting bone to bone)
2-Strain: Overstretching (partial or micro-tearing) of a muscle or tendon (connective tissue connecting muscle to bone)
3-Disc: A fibrocartilaginous disc serving as a cushion between all of the vertebrae of the spinal column
4-Bulging Disc: A bulging disc is one that extends beyond its normal position. The normal position of the disc corresponds with the edge of the vertebra to which it is attached. Usually, bulging discs don't go any further than 3mm out from the edge of the vertebra. Bulging discs are also called prolapsed discs. They are not to be confused with disc herniations. In a herniation a tear in the annulus (outer covering of the disc) allows the nucleus pulposus (central jelly-like portion) to escape. Bulging or prolapsed discs are not always painful.
5-Tendonitis: Inflammation of a tendon
7-Tear: Complete rupture or avulsion of a structure, usually a tendon or ligament
8-Hernia: an abnormal protrusion, or bulging out, of part of an organ or tissue through the tissues that normally contain it.
The most commonly injured body part in weightlifters is the low back. The low back and spinal column are placed under a lot of stress during compressive movements. Any weighted standing or seated. Squats and deadlifts are the usual offenders, but even a simple un-weighted movement, usually bending and twisting, can result in injury. Far and away, the most common injury, in humans-- lifters and non-lifters-- is a lumbar (or low back) strain. It usually occurs as a sudden tightness during a movement, but it can also present later the same day or even 1-2 days later. Symptoms include, pain, decreased motion, and spasm. Typical treatment involves rest, ice & heat, and anti-inflammatory medication. Massage and chiropractic care are helpful in the later stages. If recurrent, physical therapy and core work are necessary.
Sciatica is a condition in which the sciatic nerve gets compressed, resulting in pain in the buttocks and referred pain down the back of the leg. Treatment is the same as a strain, but with gentle stretching.
More severe are bulging discs, which can be asymptomatic, but when symptomatic can result in back or leg pain, numbness, tingling, weakness, and loss of sensation. In severe cases, one can lose bowel or bladder function. Treatment ranges from simple therapies you'd use for a strain all the way to epidural steroid injections, physical therapy, pain management, and finally, surgery. Common prescription anti-inflammatory medications include, but are not limited to, ibuprofen and naproxen. Prescription doses of ibuprofen can be reached by taking 3 or 4 over-the-counter ibuprofen, as well. In fact, after taking two over-the-counter naproxen you'll get you fairly close to prescription dosages.
In my practice, bodybuilders with hamstring injuries are fairly common. A hamstring strain or a "pulled hamstring" as it is sometimes called is a tear in one or more of the hamstring muscles (semimembranosus, semitendinosus, and biceps femoris). Symptoms of a hamstring pull can include sudden sharp pain at the back of the leg during exercise, pain on stretching the muscle (straightening the knee while bending forwards), pain on contracting the muscle against resistance, and swelling and bruising in the hamstring muscle group. 
It's vitally important that treatment for a pulled hamstring starts immediately following injury. The most important phase for treatment is the first 48 hours post-injury. In this time, the following can be carried out by the athlete themselves: Cold Therapy, R.I.C.E (Rest, Ice, Compression, and Elevation) technique, and early mobilization of the injured lower limb. Early mobilization is vital for the correct rehabilitation of the muscle. This includes stretching and strengthening exercises throughout the pain-free range of motion. These techniques can aid with decreasing the swelling on the injured area.
A hernia, or protrusion of organ tissue or material, through its connective tissue or muscle can take many different forms. Most common in men is the inguinal hernia. These occur along the pathway of the spermatic cord. The left and right femoral canals and left and right inguinal canals are the two points on each side of the body where inguinal hernias occur. With men, an inguinal protrusion may descend all the way into the scrotum. Most hernias (inguinal, femoral, umbilical and abdominal) occur when excessive pressure is placed on a weakened muscular region. Improper lifting or strenuous, repetitive, training are common reasons that hernias occur. Excessive weight around the mid-section can also place undue pressure and downward pull on muscle and organs. This can then result in weak muscle groups bearing tremendous loads they were never intended to support. This, ultimately, leads to herniation. Many hernias can also come from a genetic weakness in the abdominal wall. Age or previous surgeries are other factors implicated in the occurrence of a hernia.
The best way to prevent a hernia is by controlling bodyweight, exercising with appropriate weights in the gym, and when lifting heavy, brace the abdominals appropriately, maintain a strong core, and when necessary use a weight belt. A tight, strong core, acts as a natural weight belt supporting the abdominal and lower back regions. When a hernia does occur, it can present as a large or small bulge that's sometimes only visible when straining. This bulge can be painful, or painless. It's important to remember that newly discovered hernias should always be examined by a physician to rule out strangulation (pressure on the "hernia contents" that may compromise blood supply and cause ischemia, and later necrosis and gangrene, which can become fatal. The easiest way to rectify a hernia is to have it surgically repaired.
Quadriceps tendonitis causes anterior knee pain, just above the superior pole of the patella. Any activation of the quads will cause discomfort in this area. Quad tendonitis can be quite painful, usually after, but not during exercise. Treatment is usually ice and anti-inflammatory meds...but more severe cases can require therapeutic ultrasound, or prolotherapy. Recurrent cases are usually due to foot mechanics, and may require custom orthotics.
Knee pain that occurs around the knee cap or on the outside (lateral) border of the patella can be a 
condition called Patello-Femoral Pain Syndrome, Patellar Tracking Syndrome, or Chondromalacia (Runner's knee). The patella normally glides in a groove on the anterior surface of the femur and "tracks" within this groove as a person flexes or extends the knee. Since the patella floats and should track down the middle of the femoral groove, proper tracking is essential to remain pain free. If some force pulls the patella out of this track, the patient will experience pain. When this force continues to pull the patella out of its track for a long period of time, the patient will develop Patello-Femoral syndrome. This condition is caused by a breakdown of the cartilage under the patella and is very common in athletes who do a lot of running, jumping, and squatting. If left untreated little fragments of the cartilage will begin to break off. Chondromalacia will eventually result in a complete loss of the cartilage lining beneath the patella. In severe cases, athroscopic surgery is necessary to remove the fragments of degenerate cartilage.
What pulls the patella out of the groove in the first place? Usually it's the quads themselves, since many new lifters have poorly developed vastus medialis (tear-drop), and the remaining muscles naturally pull the patella laterally. This is also seen commonly in females after puberty, as the increased Q-angle, due to hip widening, results in the same problem of pulling the patella laterally. This can be calmed with ice and anti-inflammatory medications, but the only true fix is slow deliberate weight lifting to balance the vastus medialis.
The iliotibial band is a band of connective tissue that runs from a small muscle on the lateral (outside) hip-also known as the tensor fascia lata-- all the way down to the lateral knee joint. It's most commonly irritated in runners who pronate, or cyclists due to the fixed pedal position. I will mention it here, because I have treated it several times in bodybuilders who amp up their cardio in preparation for a contest. The pain is always worse during the activity and on the lateral aspect of the upper leg. Stretching can prevent this issue to begin with, and foam rollers and ice can treat it before it becomes a nuisance.
Finally, on the inside of the knee below the joint, there lies a small bursa (fluid filled sac) known as the pes 
anserine bursa. It's called the pes anserine or "goose's foot" because it's a point on the inner knee where the tendons of the sartorius, gracilis, and semitendinosus muscles come together in what looks like a goose foot. This area can become inflamed from overuse. This usually occurs during flexion of the knee (hamstring curls) with the foot in an internally rotated position. I saw this recently in a guy who insisted on doing lying hamstring curls with toes touching and heels 6-8 inches apart. I treated him with corticosteroid injections and heresponded very well.
Lower body injuries finish up The Most Common Injury Series. Feel free to drop by my forum Q&A to suggest future topics for Bodybuilder Medicine. Medications, Steroid side effects, Sports Medicine, and even contest prep are all topics I'm willing to discuss.
Anthony F. Human, D.O.
General Practice/Sports Medicine
Active Healthcare & Rehabilitation
Human Conceptz Contest Prep and Off-Season Services
678-689-8103
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