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Takeaway Points:

The common belief is that injury is something that can be avoided with specialized training, but that is otherwise very common.
In reality, injury is less common than people think, and while there are things we can do to help avoid injury, the effect is small.
To a certain extent, injury really is just an unavoidable side effect of exercise.
What should you do to avoid injury? How should you train around existing injuries? The topic of best methods is addressed.

(Author’s note: injury is not my specialty as a fitness coach, and you should never trust my word over that of a physical therapist. This post is not intended as a replacement for consultation with a physical therapist, especially if you are dealing with injury.)

The common perception of injury is that it’s related to a lot of active methods you can use to “prevent” injury. The reality is that injury is unpredictable - and if it were predictable, it wouldn’t be nearly so prevalent or devastating. Injury is always a kind of unknown unknown, which is to say that injuries by definition are a kind of risk that isn't completely predictable, and are thus always likely to be surprising.

The first and most important predictor of injury is previous injury. Once you are injured, there’s a much greater chance that this injury will reoccur. This is particularly likely if you’re someone who doesn’t take it easy with activity after an injury - until the injury is fully healed, you need to be particularly careful not to re-injure yourself. When training, you may need to decrease intensity on exercises which aggravate existing injuries, or swap them out for exercises that don’t aggravate these injuries while still allowing you to get in productive work for the relevant muscles.

Can we predict injury? Not really.

The FMS (functional movement screen) is a simple test that used to claim to be able to predict injury rates. However, the research has generally shown that the FMS is unreliable and unlikely to have much predictive power. Likewise, other simple tests and screens like this are also unlikely to work.

As I mentioned above, injury is an unknown unknown - if you could simply train or use certain methods that would perfectly prepare your body for injury, you would never be injured, and yet even the best athletes in the world are regularly injured despite all the work they do to avoid it. The fact that people continue to get injured regularly means that we don’t have any methods that are 100% effective in terms of predicting or preventing injury.

The best method we have for understanding injury is the concept of injury rates per thousand hours. The more injuries we see in 1000 hours of training, the more “risky” we can say that this kind of training is. While we don’t have any data on many styles of training simply because of the great diversity of training styles out there, we do have good data on quite a few kinds of exercise.

I know that when I was starting out, I would see all these posts about how you had to do X or Y or Z to prevent injury. I also remember tons of scaremongering articles about how powerlifting would destroy your joints, bodybuilding would destroy your shoulders, and so on. Surprisingly, training in the gym is incredibly safe. Even strength sports, which require more intense training than the average gymgoer, have very low injury rates compared to most other sports. In contrast, the simple act of running has a much higher injury rate than most strength sports. You’re even more likely to injure yourself in virtually any field sport, where you’re unable to predict force demands and bodily contact from other players.

Training in the gym is actually surprisingly safe. In my first few years of training clients, I only had a single client who injured themselves directly as the result of a workout, and it happened to be a pretty small strain. I’ve only had one major injury and two smaller injuries as a result of serious training for over a decade, in part because I’ve been lucky and in part because I got smart about not doing dumb stuff that would make these injuries worse.

But this makes sense - in the gym, we have almost complete control over how much load we’re applying, what the demands of the exercise will be, and so on. We can very carefully adjust the variables of intensity, frequency, duration, repetitions, and rest periods to ensure that we’re getting in a good workout that’s right in the sweet spot of “appropriately challenging” between “not challenging enough” and “too challenging and likely to cause injury”. Gyms are safe because we can predict and control the demand we're about to put on our bodies.

In contrast, when moving heavy objects in real life, you don't get to carefully "choose" how much weight to move, or how long you get to spend moving it - you just have to get it done. When playing football, you can't predict how you're going to get tackled. When running on a wooded trail, you can't predict when you'll accidentally slip on a rock and twist your ankle. The more unknowns there are, the easier it is to end up hurting yourself.

Injuries aren’t necessarily something you can prevent - they’re just sort of something that happens, given enough training. The biggest way to increase your chance of getting hurt is simply to rack up more hours of training, no matter what you're doing. The best way to avoid injury is to focus on activities that have lower injury rates (working out at the gym) and avoid activities that have higher injury rates (higher impact activities like running and jumping, field sports [especially those with high degrees of player to player contact]), or simply to reduce the amount of time you spend training. (See, for example, some of my posts on training efficiency: here, here, here, and here.)

But since you can’t avoid training entirely, injury is a part of the equation - there is inherent risk to exercise. You can’t predict that maybe, some day, you’ll go into the gym, your brain won’t properly fire the neurons just right, your muscles won’t be 100% coordinated, and you’ll fumble a weight or strain something.

I remember a job I once had where my boss assured clients that “no one gets hurt here” because we used various stretches and mobilizations. He was also someone who insisted that “injuries in the gym are very common otherwise”. Meanwhile, I saw our clients at that job injure themselves left and right because he was constantly asking them to lift weights that were way too heavy for them, and that they were completely unprepared for. He would also continually throw clients with hip, knee, and ankle issues into programs involving a lot of high intensity plyometric jumps. Somehow, he was completely oblivious to how injured his clients were!

It’s true that there are things that can increase our risk of injury, and we want to avoid these. My old boss is a prime example of that. I would say that the biggest risk that a lot of people face from exercise is just being too aggressive and overconfident - loading up new exercises too heavy, too quickly - or simply doing high impact activity without their bodies being adapted for it yet.

Once while travelling I went into my temporary gym to workout, and I witnessed a trainer working with a teenager for the first time. The trainer immediately had the teenager max out on a barbell deadlift, even though he had never deadlifted before and had terrible form. The kid was straining himself, getting up ugly single after ugly single until he hit 165 as his max, at which point the trainer excitedly clapped him on the back, telling him that now they had his max and could throw him directly into a periodized strength program.

This is another example of the kind of poor activity that’s likely to cause injury - going too heavy, too soon, before the technique is developed and before the body is adapted to the exercise. Oddly enough, form isn’t even really a huge factor in injury (contrary to what you’ve been told), so long as you’re not like, royally screwing it up.

Another big part of avoiding injury is just learning to work around existing aches and pains to avoid making them worse. If you’ve got bad hips, knees, or ankles, then jumps and running (both of which are high impact) should be avoided. If exercises bother you, you need to find a way to either limit the weight or modify the exercise until it doesn’t hurt anymore. BFR is also a good method for getting in a serious workout while managing an injury. In some cases, managing an injury does just mean you have to grit your teeth and avoid training those muscles for a while - no matter how much it sucks to take time off.

Ultimately, I’m not an expert on injury, aside from what I’ve picked up in over six years in the industry and thanks in part to a healthy dose of intellectual curiosity. However, I would like to direct you to some better resources on the topic of training and injury, which you can find here:

There's an old joke about getting injured from training that I heard from somewhere when I started training: that training will mess up your body, injure you, ruin your joints - that not training will do the same, but worse. At the end of the day, you've got to use it or lose it, and while training carries with it the risk of injury, so does lying around in bed.

How Do We Get Injured?

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How Do We Get Injured?

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