References  :

Health Fitness Instructor’s Handbook (chapter 25, pg 393-419)

ACSM’s Resource Manual for Guidelines for Exercise Testing & Prescription

Coverage      :

• Risks of exercise
• Risk factors for injury
• Treatment of acute injuries
• Prevention of injuries in the fitness facility

A. RISKS OF EXERCISE

Some of the main risks of exercise include:

Cardiac events. In clients with known cardiovascular disease or in some apparently healthy exercisers, exercise that exceeds the heart’s capacity to respond may result in chest pain that improves when exercise is stopped (angina), or in cardiac arrest due to a heart attack (myocardial infarction). In the latter, the exerciser will complain of heavy, crushing pain in the center of the chest, clutch the front of his chest, and may have cold sweats as well. Both conditions should be treated as emergencies.

Breathlessness. Exercisers who complain of increasing or sudden difficulty in breathing may be having an asthmatic attack. These individuals are usually aware of their condition and should have brought their own medication with them. There are some individuals who are not known to have asthma but have an allergic reaction that manifests as an exercise-induced asthma. These people should be reviewed by a doctor. Do note that their “asthma” improves as they exercise more regularly.

Musculoskeletal injuries. Physically active people often develop injuries of their muscles, joints and bones. These may be acute (a new injury) or chronic (a condition that has lasted for some time). Examples of such injuries include:

 

1. Acute injuries

• Muscle contusion (following a hard knock on the muscle)
• Bruising/hematoma (of the skin, muscle or joint)
• Muscle strain (eg. “pulled” hamstrings muscle)
• Joint sprain (eg. ankle sprain)
• Bursitis, a painful swelling around a joint (eg. the knee) due to overuse or trauma
• Fracture (usually following direct trauma or a fall)
• Stress fracture, from excessive impact (eg. jogging, running) before the body can adapt
• Dislocation (eg. shoulder after a fall or during sports)

 

1. Chronic injuries

• Neck ache due to chronic strain or poor posture, but also possibly due to degenerative condition of the cervical spine
• Back ache due to overuse, but also possibly due to degenerative condition of the lumbar spine
• Plantar fascitis, inflammation of the ligament in the sole of the foot and producing heel pain
• Metatarsalgia, due to impact on the front of the foot and causing pain over the ball of the foot
• Carpal tunnel syndrome, resulting in numbness and tingling in the hands, often waking the person up at night
• Anterior knee pain, possibly due to altered leg biomechanics or degeneration of the patella
• Rotator cuff strain/sprain, resulting in shoulder pain and ache

 

Heat injuries. Also known as heat-related disorders or heat illness, these are due to an imbalance between the heat generated by the body during exercise, and the ability of the body to shed this heat. 3 types of heat injuries are encountered, representing a continuum of severity of heat disorders:

• Heat cramps, commonly affecting the gastrocnemius/soleus and abdominals. Inadequate acclimatization and fluid/salt intake predisposes a person to heat cramps
• Heat exhaustion, resulting in headache, weakness, profuse sweating, and feeling faint or nauseous.
• Heat stroke, a potentially fatal condition. The individual shows signs of cerebral inflammation including irritability, confusion, bizarre speech and behavior, loss of sweating, and loss of consciousness or coma

Other medical conditions. Hypoglycemia (low blood sugar level) may affect those who have not maintained a good nutritional status (eg. missed their breakfast). They may have dizziness and may feel like fainting (syncope). Some individuals feel light-headed after they change body position suddenly or if they have low blood pressure. They may also feel like fainting.

 

B. RISK FACTORS FOR INJURY

People are more prone to injuries if they have or are exposed to certain risk factors, as follows:

 

Intrinsic risk factors

• Medical conditions like high blood pressure, heart disease, asthma, osteoporosis, etc
• Past injuries that may not have healed properly or completely, and which may have weakened the structure (eg. a muscle) or created some laxity in a joint (eg. an ankle)
• Biomechanical abnormalities causing excessive stress through joints (eg. scoliosis, pronated feet, knock-knees)
• Lack of past experience with exercise or low levels of physical fitness, resulting in tendency towards overuse and over-exercise

 

Extrinsic risk factors

• Training or exercise errors, including excessive or sudden increases in training volume (frequency, intensity, duration)
• Improper and unsafe exercises, such as the “banned” exercises (pg 161-164, AIC course book)
• Environmental factors such as training surface (too hard, slippery, etc), excessive heat/humidity, dark exercise areas
• Improper equipment choices (eg. wrong footwear, insufficient foot support) and unsafe equipment (eg. poorly maintained exercise equipment)

 

Successful prevention of injuries depends on recognizing risk factors and adopting a fitness facility & training approach that aims at managing and minimizing risk to exercisers and staff.

Fitness professionals may want to incoporate a Risk Factor Template as part of their health assessment file for new clients. This will help to protect the client, fitness professional and the fitness facility ensuring a comprehensive assessment of individuals who are going to be engaging in physical exercise. This will also allow the fitness professional to be aware of possible injury risks, and to advise clients and exercisers on injury prevention measures.

C. TREATMENT OF ACUTE INJURIES

It is important to provide proper treatment of injuries in order to reduce the chance of serious consequences that may threaten the life of the exerciser or the function of the injured area. Proper treatment also

• Allows the best chance for injury recovery and healing
• Returns the individual to exercise as early as possible
• Increases the confidence of the individual in his instructor and the exercise facility.

This table summarises the correct treatment of common injuries seen in exercisers:

 

Injury	Treatment
Chest pain (angina or heart attack)	Stop the exercise Exerciser to take his/her medication Send the person to a doctor or hospital
Breathlessness	Stop the exercise Loosen tight clothing, if possible Exerciser to take his/her medication Consider sending the person to see a doctor
Sprain/strain	Stop the exercise Follow the RICES protocol REST the injured part ICE the injury using a bag of ice cubes, alternating between 15-20 minutes of application to the injured part, and 2-3 hours of no ice. Continue icing over the first 24-48 hours COMPRESS the injured area to prevent further injury and reduce swelling. Use a first aid bandage or elastic support. ELEVATE the injured part to reduce swelling SUPPORT the injured area with a bandage or joint support
Heat injury	Stop the exercise Move the person to a cool, shaded area Loosen and remove all unnecessary clothing (if possible) Cool the person as quickly as possible (wipe down with cold water, cold drinks, direct a fan at the person) Refer to hospital A&E dept if no improvement

After an injury, the injured person must return to exercise with some degree of caution. It is wise to :

• have a doctor’s recommendation on when return to exercise can take place
• re-start exercise at a lower level than that at the time of injury
• gradually progress the exercise back to its original level (FIT)
• set realistic goals on return to exercise to prevent frustration and ensure maximal injury recovery, with reduced risk of further injury.

The fitness professional will also benefit from:

• Maintaining CPR skills currency
• Being trained in first aid and sports first aid
• Knowing their limitations and not trying to manage an injury when they are not qualified to do so
• Providing sound advice to their clients on correct injury management and exercise safety
• Advising clients to consult a doctor as soon as possible when they are injured (n.b. a sports medicine-trained doctor is beneficial as their qualifications are directly relevant to exercise and sports injuries)

D. INJURY PREVENTION

 

Injuries may be prevented if careful attention is given to the risk factors for injury, and developing a means to reduce these risk factors. A table of preventive measures demonstrates that successful injury prevention is a shared responsibility of the exerciser, the instructor, and the fitness facility.

 

Responsibility	Prevention Measures
Facility personnel	all staff (instructors, administrative) should receive training on recognition of injuries specific training currency in First Aid & CPR increased vigilence high quality of instruction & professional practice
Exerciser	proper medical clearance & advice on exercise self-reporting of illness or injuries that may limit exercise participation responsibility regarding meals, medication encouragement to seek advice if unsure of health
Facility operations	safety awareness & injury prevention policy operating procedures for responding to injury or emergency standing instructions for reporting & treating injuries planned emergency numbers, evacuation system injury/emergency drills for all staff
Equipment	choice of effective but safe, reliable equipment equipment fault reporting system active equipment maintenance program emergency/FA equipment available & in good order (eg. FA kit, EAD, stretcher, ice, fire extinguisher)
Environment	Good lighting in all exercise areas Flooring considerations (eg. impact, non-slip) Clear evacuation & emergency routes Good housekeeping
Legal matters	Comprehensive documentation of health & fitness assessment, medical clearance, declarations Waiver of liability as part of facility contract Informed consent to participate in exercise Injury & incident reports
Risk factor management	Refer to sports physician for biomechanical & medical conditions advice Correct training principles (type of activity, progression, FIT) Equipment choice (gym, shoes, surfaces) Specific: hydration, medication Prompt & proper injury management6