There are times during your fitness journey where you will find yourself inhibited physically, due to an injury to your body. How do you deal with it, and is it something you can just “push through”, or an injury that will derail your fitness plans momentarily?
If someone taking your fitness class has an injury, what do you recommend for them?
A multitude of common sports injuries may crop up. It’s important to recognize how to deal with the participant’s injury based on what limitations they may have received from their doctor. If at any time a participant complains of pain or issues, the first step is to refer them to a physician. After they get the clear to come back to class, here’s where you step in, as a group fitness instructor (GFI).
SPRAIN: A sprain is an acute injury to a ligament caused by sudden trauma to the joint. Although they can occur anywhere, it’s most common at the ankle or knee joint. Sprains are rated in degrees. 1st degree is mild. 2nd is moderate, and 3rd is severe. When you have a sprain, you’ll feel pain, swelling, discoloration, loss of motion, loss of use. Sprains can heal, but the length of time depends on the severity of the sprain.
– Choose an exercise that won’t involved the injured area until the symptoms of the sprain are mild or no longer present.
– Slow steps to reintroducing activity that involves the injured area.
– Avoid movement near the areas of the injury.
LATERAL ANKLE SPRAIN: This injury occurs when the foot is inverted down forcefully during a workout. Damage to the talofibular ligament is most common, but the calcaneofibular ligament can also be involved. The injury can range from being a slight tear to stretching of the ligament, or complete ruptures.
– Limit motion to a pain free range and intensity.
– Remind the participant to continue with the activity only when a doctor gives the OK.
– Avoid cutting, jumping, or lateral movements until the ankle is healed.
– Encourage work outs that are nonimpact to minimize ankle discomfort.
– Do closed-chained work outs, like squats and lunges, according to how much the ankle can tolerate.
– Make sure the participant’s footwear is appropriate for class.
– Use lateral movements cautiously on carpet or uneven surfaces.
STRAIN:Often called a muscle pull, is an injury to a muscle, usually caused by overworking the muscle.Strains can either be acute and occur suddenly, or gradually develop over time from overuse. Symptoms are pain, loss of motion, and reduced strength. Swelling and discoloration are often hard to see, depending on where the strain is located and how deep within the muscle the injury has occurred. Gentle muscle activity helps by assisting with circulation and reduced deep swelling.
– Avoid ballistic exercise until the symptoms are mild or no longer present.
– Gradually build up the intensity of the work outs.
– Gentle stretching of the muscle before and after exercise helps.
– Move the area in a pain free range of motion.
ANTERIOR CRUCIATE LIGAMENT (ACL Tear): The ACL lies in the joint capsule of the knee. It attaches to the femur and the tibia. Injuries can be caused by rapid deceleration, like a basketball player stopping suddenly, or by a direct blow to the knee that will cause the knee to hyperextend. ACL injuries can range from a partial tear to a complete rupture of the ligament.
– Do not allow a participant with an ACL tear to attend class until given the OK by a medical professional.
– Avoid cutting, jumping, sprinting, kicking and pivoting unless approved by a doctor or PT.
– Watch for difficulty with balance or movement. Provide safe modifications.
– Encourage participation in group cycling or swim classes if it’s OK with the doctor.
– Put in additional stretching of the lower extremity muscles before and after class.
ANTERIOR SHOULDER INSTABILITY: This is a weakness in the anterior wall musculature that allows the humeral head to dislocate anteriorly. This condition can be cause be a fall or blow to the shoulder. Sometimes there is a gradual onset of muscle weakness and progressive damage to the anterior structures.
– Limit motion
– Be very cautious during all movements that place the shoulder in an externally rotated position, even with stretching.
– Avoid military shoulder presses behind the neck, pec flys, lat pulldowns or wide grip chest presses because stress can be placed on the anterior shoulder.
– No stretching of the anterior shoulder.
POSTERIOR SHOULDER INSTABILITY: Although less common, this injury can occur. These type of dislocations are rare, usually causes by an outstretched hand during a fall. Sometimes, throwing a ball or the serving for tennis can cause this type of injury. Pain is caused when following through after throwing or making a swinging motion. Repetitive activities like bench pressing or push-ups can stretch the posterior shoulder capsule, causing instability.
– Positions of shoulder flexion, internal rotation and horizontal adduction should be minimized or avoided.
– Rowing movements are important exercises.
– Activities like push ups, are to be avoided. Bench pressing as well. If someone wants to continue with these work outs, providing a wider base with your hands can help.
– No stretching of the posterior shoulder.
SHOULDER STRAINS AND SPRAINS: These types of injuries occur when the soft tissue structures get stretched or compressed. Strains involve a tendon, while sprains involve a ligament. These injuries can lead to rotator cuff tears if not dealt with correctly. These injuries are common in young individuals who participate in overhead activities like tennis, baseball and swimming. It[‘s common, with local pain at the shoulder that radiates down the arm. Lifting objects or reaching overhead can aggravate the condition. There may be swelling and tenderness at the shoulder, and pain and stiffness.
– Avoid overhead and across the body movements, or anything that places the hand behind the back.
– Focus on stretching the major muscle groups around the shoulder to restore proper length to these muscles.
– Teach overhead activity modifications like avoiding fully extending the arms and positioning the arms so they are more in the front of the body vs. being in line with the shoulders.
OVERUSE CONDITIONS: Tendinitis, Bursitis, and Fasciitis fall under this category. All of these conditions are caused by overusing certain areas of the body.
With tendinitis, the tendon is inflamed. This usually happens at the shoulder, elbow, knee or ankles. If a participant starts out with a new work out routine too fast, the tendons cannot handle the new work load and this results in an irritation that causes swelling. Tendinitis is causes by repeated stress with not enough time to recover. Symptoms are pain, swelling, and loss of movement.
With bursitis (which I have experienced in the past) the bursa sac around certain joints will swell. Acute trauma, repeated stress, muscle imbalance, or tightness on top of the bursa can all cause it. It typically effects the shoulders, hips and knees. I had hip bursitis due to the mileage I ran during my training for marathons. My left hip was severely affected.
IT Band Syndrome: This is a repetitive overuse condition that causes the illiotibial band to rub against the lateral femoral epicondyle. This is a common syndrome for runners, cyclists, volleyball players and weight lifters. Risk factors are overtraining, improper footwear or equipment use, changes in running surface, muscle imbalance, and failure to stretch correctly. People with this condition will report having a gradual onset of pain , tightness and burning at the lateral aspect of the knee during work outs. The pain might be localized or radiates to the outside of the knee and up to the outside of the thigh. The pain might feel sharp and stabbing. Snapping, pooping or pain might be felt too when the knee is flexed and extended.
– Exercises should focus on regaining flexibility and strength at the hip and lateral thigh.
– Those with ITBS may not tolerate higher loading activities like lunges and squats, unless at a 45 degree angle.
– Aquatics might be beneficial.
Fasciitis is inflammation in the connective tissue called fascia. This usually occurs in the bottom of the foot towards the heel, called plantar fasciitis. Poor gait and improper footwear seem to be the biggest reasons for this.
– Avoid high repetitive activity or doing too much with the site of injury.
– If the lower area of the body has been affected, avoid jumping.
– Be careful with ballistic movements like kicking and punching.
– Check that the shoes you wear are the right fit.
– Allow for enough rest between work out sessions.
– Steer clear from heavy strength training and always try to maintain proper technique.
ACHILLES TENDINITIS: This is a common injury in athletes as well as the active population. It’s most commonly seen in runners, gymnasts and dancers, as well as track and field, volleyball, and soccer. It can cause a partial or complete tear of the Achilles tendon if not taken care of. Pain is felt about 2-6 cm above the tendon into the heel bone. There is usually morning pain that causes a sharp or burning sensation, and increases with work outs. Rest helps, but as the conditions worsens the pain is constant and interferes with daily living.
– A gradual, pain-free return to activity
– Overstretching of the tendon can cause irritation. Stretching to the limit that does not cause pain is appropriate.
– Taking time to load the tendon with eccentric activity, like heel raises on the edge of a platform can be helpful.
– Gaining back calf flexibility is a key component.
SHIN SPLINTS: Also known as tibial stress syndrome, it’s theorized that shin splints are a microtearing of the attachment of muscles of the lower leg on the tibia. Pain is the major symptom. Shin splints are an overuse injury cause be constant loading of the lower leg accompanied by weak musculature. Runner will get this quite often. If there are weak foot arches involved, this can contribute to the onset of shin splints.
– Avoid constant impact on hard surfaces.
– Don’t drastically change the amount of impact in a class.
– Use shock-absorbing surfaces.
-Encourage additional stretching of the lower legs.
– Put in extra warm-up time before class.
– Double check that participants are wearing proper shoes for class.
CARTILAGE DAMAGE: Cartilage is a dense, protective connective tissue that covers bones and helps aid the gliding of two bones against each other. When there is damage to cartilage, it’s usually done to the knee. The most common knee cartilage injuries is to the menisci. The menisci provides shock absorption, stability, and lubrication. Damage to the menisci is usually caused by degeneration or by trauma. Symptoms are stiffness, clicking or popping of the knee, giving way, or catching and locking. There may all be joint pain, swelling, and muscle weakness. Damage to the patella in the knee may also happen, causing chondromaliacia. This is a softening or wearing away of cartilage behind the patella, causing swelling and pain. Chondromalacia can be caused due to overtraining, or poor running style, sudden changes in training surface and lower extremity muscle weakness.
– Avoid high rep activity or heavy loading of the lower areas of the body.
– Steer clear of deep squats, cutting, pivoting or twisting.
– Doing closed chained movements, like squats and lunges, can be done from a 0-45 degree angle, and then moved to a 90 degree.
– Open chained like straight leg raises, or side lying work can be done at any time, but knee extensions should be kept between 60-90 degrees until the participant gets the green light from their doctor.
BONE FRACTURES: Bone fractures are caused by either low or high impact means. Low impact, like a short fall or repeated trauma to a bone region, can result in a stress fracture. Stress fractures can occur in distance runners, track athletes or court sport athletes. Stress fracture symptoms are progressive pain that is worse when weight is put on the area, focal pain, pain at rest in some cases, and local swelling. High impact trauma can occur from car accidents, or during high-impact sports like football. These injuries often require immediate attention.
– Immobilization of the area.
– A gradual return to working out, focusing on low-impact.
– Easy balance and functional work outs.
When an injury occurs, healing begins immediately. The body goes through three phases: inflammatory, which can last for up to 6 days and causes swelling; proliferation, which can last up to 21 days, the wound filling with collagen and other cells to form a scar; the remodeling stage, which can last for up to 2 years. This begins the remodeling of the scar, rebuilding bone and making the tissue stronger. If you are working out during this time, you want to be careful to not cause re-injury. If you have an injury that is pre-existing, a medical assessment from a doctor is needed.
If an injury occurs while instructing a class, it’s important to use the PRICE method in order to protect the injury: Protection of the area, Rest, Ice should be applied every hour for 10-20 minutes, Compression to minimize local swelling, and Elevation of the area 6-10 inches above the level of the heart will also help with swelling. If someone presents with: pain in an affected area, immobilization of muscles and connective tissue, joint swelling from trauma or disease, presence of osteoporosis or rheumatoid arthritis, and history of prolonged corticosteroid use, a fracture site that is healing, soft tissue injury or post-surgical conditions, a doctor’s note is required before continuing on with group fitness classes.
Some factors that are associated with injury are:
Flooring/Exercise Surface: The flooring we work out on needs to absorb shock to reduce the negative effects on the bones and joints. Repeated jarring can cause stress fractures and tendinitis. Also, depending on the type of work out will depend on the type of flooring you are on. Carpeting isn’t so great for high impact aerobic classes, but will work great for floor-based classes like yoga. Hard wood flooring works great for boot camp classes, but not so great for pilates, unless on a mat.
Footwear: The right shoes can make all the difference. Shoes can provide cushioning, support, and flexibility.
Equipment: If equipment is improperly set up, or used in the wrong way, injuries can happen.
Movement Execution: Not following the choreography correctly can lead to injury.
Class Intensity and Frequency of Participation: A participant might be working out in a class at a higher fitness level than they may be ready for, and this can cause fatigue and overexertion, increasing the risk of injury. Also, if someone attends class too often, they don’t give their bodies enough time to recover and rest up from the work outs. Cross training might be a good suggestion. Overtraining is a concern, causing sleep loss, elevations in resting heart rate and injury.
Pre-Class Evaluation: There are 3 on the spot indicators that can help a GFI gauge a participant’s limitations. AGE- Older participants may need more modifications. POSTURE- Poor posture is associated with muscles being short and tight, and others long and weak. Range of motion is then limited. Proper movement is difficult. Modifications might be needed. NEW PARTICIPATION- Anyone new will is learning the routines and the movements. Newbies need more attention and should be watched during class.