The pulldown is considered a very safe exercise. It’s often included in the early stages of rehab after shoulder and back injuries. There are a few precautions, such as avoiding the behindthe- neck variation, especially if you have neck and shoulder problems. Another thing to avoid: Don’t let your arms stretch out completely and then relax. Trying to get the “extra” stretch can be harmful.

That makes the weight act as traction and can stretch the ligaments in your shoulder. I’ve discussed these precautions in this space before.

I saw a new pulldown injury recently. A recreational trainee enjoyed weight training and set up a nice home gym. He also played a fairly aggressive game of tennis. He usually played four times per week for 90 to 120 minutes each session. He used the Western style of hitting, which can cause a great deal of rotation in the hip and knee. He began to develop pain along the inner border of the knee and below the knee. It began to interfere with his tennis game, so he switched to more weight training and less tennis.

He kept increasing the poundage on pulldowns, dumbbell rows, dumbbell presses and all the rest of the exercises, especially since he didn’t have the energy drain from tennis. The knee pain lingered. An MRI revealed a tear of the cartilage inside the knee joint; however, that tear didn’t anatomically correlate with his pain and with the fact that he could perform squats with 250 pounds and walk up stairs without knee pain. His heavy weight training continued.

I became suspicious that the guy had an irritated nerve where the pain was—the infrapatellar branch of the saphenous nerve, to be exact. It’s a nerve that doesn’t supply any muscles. Due to the intermittent results of previous treatment, I advised him to see a chronic-pain specialist, Edward Carden, M.D., at Diagnostic and Interventional Spinal Care in Marina del Rey, California. Dr. Carden blocked the nerve with a local anesthetic, and the pain improved. We now knew the pain was being generated outside the knee rather than inside the joint. The first block was designed to last a few days to see if it helped at all. The pain returned after a few days, and we used a longer block that could last three weeks or more.

During that time the patient could not play tennis or squat, but his heavy upper-body training continued. When the patient went to perform pulldowns, he felt the knee pain again. As it turned out, his home pulldown machine was different from many professional and commercialgym machines.

Most of the commercial models have a large crossbar and/or pad to slide your knees under. It usually comes from the main part of the machine attached to another bar that’s parallel to the floor. The home pulldown machine had a vertical bar directly under the pad that held the thigh pad and bar in place.

When the trainee performed heavy pulldowns, his inner thighs pulled into the vertical bar, which was square-tube metal. He was irritating the nerve with tennis, but he was also irritating it higher on his thigh by compressing it against the pulldown machine. I’ve worked in sportsmedicine for many years, but that injury was new to me. Dr. Carden had seen it previously but as a result of different causes, including surgery. Since then we have used a long-term block of the nerve done with a radiofrequency procedure, and the trainee is without symptoms, enjoying tennis and weight training.