What Exercise Should Be Avoided?

by Mitch Hauschildt, MA, ATC, CSCS

As with most of my blog posts, I look for things that strike me as interesting, odd or irritating to write about each week.  This past week, I viewed an interesting video on social media that I couldn’t help but comment on.  I won’t share the video here, because I think that is unprofessional and might cause some negative feelings on either side of the discussion.  But I do want to discuss it for a minute.

The video was a simple informational/marketing video that was shot and published by a physical therapy clinic.  It featured what appeared to be a very nice physical therapist speaking about exercises that she sees as problematic (“Exercises your physical therapist wants you to avoid”).  When asked what exercise or exercise(s) people should avoid when they go to the gym, she explained that an overhead press causes impingement and leg extensions cause chondromalacia so they should be avoided.

I’m going to try to resist my urge to go into my irritation with the actual video itself as she presented an exercise that she deems as a safer alternative to the overhead press that actually takes someone’s shoulder into a much greater degree of impingement than an overhead press if you really understand how the joint moves.  And, I won’t get into the chondromalacia conversation.  While I don’t love leg extensions for a lot of people, to say that it is the cause of those chronic changes is a strong statement that isn’t supported in the literature.

My greater annoyance with the video, and a lot of other videos/posts/statements that are often made by therapists, clinicians, athletic trainers, and other health care providers is on a much higher level.  While I do like some exercises more than others, I firmly believe that there is NO SUCH THING AS A BAD EXERCISE.  Seriously.  There aren’t bad exercises.  It isn’t the exercise’s fault.  There are no bad exercises.  I hope that is clear.

However, there are bad times and situations to implement specific exercises.  To use the video’s examples, let’s look at a loaded overhead press.  I do agree with her that if someone has poor scapulo thoracic mechanics, that an overhead press could cause impingement in the shoulder.  Does that make an overhead press a bad exercise?  No.  It means that we might want to consider alternative exercises (not an upright row) to perform during the phase in which they are working to correct scapulo thoracic mechanics.  If someone has good posture and good mechanics, then the overhead press is a perfectly legitimate and high quality exercise.

I personally don’t love the leg extension for my patients because, for most of them, it doesn’t match up with how they perform their sporting activities.  But, if I were to train MMA fighters who actively extend the knee as part of their kicking technique, then the leg extension is a completely appropriate exercise.

We need to get past blanket statements about exercises and groups of exercises that they are “bad” or shouldn’t be used.  There is a good tool and time for every situation and intervention.

Further, we need to stop trying to tell people what they should and shouldn’t do with regards to their activities.  I have written about this before.  It’s not our job as clinicians and therapists to tell people that they shouldn’t run, lift, Crossfit, or whatever.  If that makes them happy, our job is to help them do it.  We can and should advise them on the risks, but at the end of the day, if they want to keep going, we need to stop talking about it and help them enjoy their favorite activity.

Exercises are the problem.  There are lots of them out there and feel free to be creative and make up your own.  Have fun.  There’s no such thing as a bad exercise.  Just a bad implementation of the exercise.  Think through things and adjust as needed to fit their situation while you are helping them.  Then let them get back to enjoying life.