One of the most common complaints from class participants and individual clients is that they try something, and they get injured. Injury and pain associated with exercise is one of the more common reasons an individual does not adhere to an exercise program.
Injury at some point in our lives may be inevitable to a degree, hopefully on a small scale. After all, our bodies decline to a degree in functionality as we age. What was once considered easy (I believe I ran my first race as a teenager without socks on and walked away unscathed), becomes a much more treacherous feat as we get up there in our years. Some people seem simply more prone to injury than others based upon genetics, body composition, or otherwise. The human body is quite complex and therefore so is injury prevention. There is limited research on the differences between body compositions, hormones and how it relates to injury. One research study found that estrogen has a dramatic effect on musculoskeletal function. Results of the study concluded that where estrogen improves bone and muscle function, in tendons and ligaments estrogen decreases stiffness, and this directly affects performance and injury rates. It was reported that “high estrogen levels can decrease power and performance and make women more prone for catastrophic ligament injury.” Therefore, a person’s tendency toward injury is highly individualistic, and in a woman, may even be affected by the point in their monthly cycles. Men’s likelihood for injury may be increased simply because men are more likely to participate in team sports and power training, although many women do as well.
According to an article published in Orthopedic Reviews, the most common injuries seen by personal trainers during sessions were:
- lumbar muscle strain (10.7%)
- rotator cuff tear/tendonitis (8.9%)
- shin splints (8.1%)
- ankle sprain (7.5%)
- cervical muscle strain (7.4%)
The study was unable to identify specific causal factors in participant injury. Do these injuries result from variability in education, certifications, and experience amongst trainers and therefore their approach? Or is it simply a matter of body mechanics, and the person being more prone to injury despite correct techniques? Or a combination of both factors?
Thankfully, injury prevention can be more easily monitored 1:1 than in a group. Therefore, a trainer that coaches in compliance with guidelines for increasing stability before mobility, focuses on developing core musculature, and progresses from simple techniques without load to more progressive loads will help prevent injury. In other words, establishing good postural control and correct form first before weight loading is a well-accepted beginner’s program to resistance training. However, in group exercise or small group training settings, this becomes much more difficult for an instructor or trainer to monitor when they are literally outnumbered. Also, many group exercise formats are fast paced, allowing less time for attention to form. When a participant tries to rush to keep up with the pace of small group training or a class, the risk of injury may increase.
An article published in 2017 investigated injuries related to exercise (both with and without equipment) among the general population of U.S. adults. Results indicated that injuries (as reported by ER visits) increased from 2006-2015 (no difference in injury rates for equipment vs. non equipment users). However, there were limitations of this study. ER visits as compared to clinic or outpatient visits were not investigated. Also, how much the increase in injuries was simply a result of increase in exercising individuals was also unclear. Another study published by the Sport and Fitness Industry Association did report more people are participating in exercise and fitness activities, particularly in aerobic activities (including use of stationary exercise machines), running and jogging, strength training activities as opposed to organized sports. However, this study was dated 2009-2012. Based upon these studies, one could speculate that increase in participation in exercise also increased likelihood of injury.
What’s a fitness professional to do? It may feel impossible to know all the ins and outs of a particular body you are training to best prevent injury, especially if you are in a group setting. However, there are many guidelines to provide a participant that can increase their awareness of their own body. See the attached free brochure for your participants, provided by FitSwop.com, and feel free to distribute this to class participants. If you cannot talk to each individual participating in a group training, you can leave these by the door or pass them out!
Tips to avoid injury:
- Strengthen muscles. Conditioning exercises strengthens muscles used in more dynamic activities. In other words, a strong core helps prevent injuries during sports play or that kickboxing class.
- Take time off. This does not necessarily mean be sedentary (going from active to sedentary can actually increase risk of injury). On “rest” days, mobility is still key to decreasing stiffness in the worked muscles. If you are sore, take a walk!
- Form over speed. If you feel “sloppy” because the moves are so fast, this increases risk of injury.
- Do not push through pain. If you feel discomfort, stop immediately.
- Avoid heat illness by drinking plenty of fluids BEFORE (often forgotten), during, and after exercise.
- Increase flexibility. Stretching is unfortunately often rushed at the end of a class or session. Stretches should be held for 15-30 seconds each and should not feel painful. See here for an excellent set of beginner stretches to begin doing on your own daily after exercise, or a warm shower/bath.
- Know your body’s limits and respect them. Each of us has exercises that our body does not prefer. Trust your instincts and listen to your body.
Finally, foam rolling has been much embraced by the fitness industry, but specifics on how to do self-myofascial release should be shared with participants prior to completion. Otherwise, participants may miss out on the benefits. Explaining the “why” behind foam rolling is especially important, considering many participants consider it uncomfortable and may resist it without knowing the reasons for it. Check out this excellent blog post from NASM, and share with your clients!
Chidi-Ogbolu N1, Baar K1,2,3. “Effect of Estrogen on Musculoskeletal Performance and Injury Risk.” Front Physiol. 2019 Jan 15;9:1834. doi: 10.3389/fphys.2018.01834. eCollection 2018. Retrieved from PubMed.
Deaner RO, Geary DC, Puts DA, Ham SA, Kruger J, Fles E, et al. “A sex difference in the predisposition for physical competition: Males play sports much more than females even in the contemporary” U.S. PLoS One 7(11):e49168. 2012.
Fredericson, M., Moore, T. “Muscular Balance, Core Stability, and Injury Prevention for Middle- and Long-Distance Runners.” Phys Med Rehabil Clin N Am 16 (2005) 669–689.
National Public Radio, Robert Wood Johnson Foundation, Harvard T.H. Chan School of Public Health. Sports and health in America. 2015.
Sports and Fitness Industry Association. 2013 sports, fitness and leisure activities topline participation report. 2013.
Sheu, Y., Chen, L., Hedegaard, H., “Sports and Recreation Related Injury Eipsodes in the United States, 2011-2014”. National Health Statistics Reports. Office of Analysis and Epidemiology. 2016 Nov 18; 99.
Waryasz GR1, Daniels AH1, Gil JA1, Suric V2, Eberson CP1., “Personal Trainer Demongraphics, Current Practice Trends and Common Trainee Injuries.” Orthop Rev (Pavia). 2016 Oct 3;8(3):6600. eCollection 2016 Sep 19. Retrieved from PubMed.