Preventing exercise-related injuries

With summer upon us, even champion couch potatoes are having thoughts of getting in shape. The widely accepted benefits of regular exercise are an increased fitness level, improved mental attitude and improved physical appearance. But what are the risks of exercise? Perhaps an understanding of factors associated with exercise-related injuries can help prevent those injuries.

A properly designed exercise program will minimize the likelihood of injuries and attrition. Factors to take into consideration when designing an exercise program are: goals, current fitness level, age, any associated medical conditions, previous orthopedic injuries, interests and constraints. These factors should help define specific exercise parameters, such as mode of exercise (running, step aerobics, competitive sports), intensity, duration and frequency.

Most orthopedic injuries are caused by a training load that is too great, that increases too rapidly or that occurs too frequently. Those who have been sedentary and have not exercised at least two times per week over the past month should begin an exercise program at a low level and gradually increase the duration and intensity. A low-level exercise program should feel like a mild or moderate level of exertion during exercise and produce minimal muscle soreness the day after exercise. Those who have had a previous orthopedic injury need to be sure their strength and function are back to full potential before engaging in strenuous exercise. If there are residual symptoms such as pain and swelling, it is important to be selective in choosing the mode of exercise. For example, if ligamentous laxity has resulted from previous knee or ankle sprains, a non-weight-bearing exercise such as biking would be a better choice than a weight-bearing exercise such as running. People who have had previous orthopedic injuries are more likely to sustain an injury during regular exercise than people who have no history of prior injuries.

Injury rates are highest for competitive team sports and running. In competitive team sports (such as student-faculty softball games), the exercise intensity, duration and frequency are not easily controlled, resulting in too great an exercise dose and possible injury.

Conditioning exercises are beneficial as a primary mode of exercise or as an adjunct to team sports or aerobic exercise. Generally, most people need to target the lower back and hips for flexibility and strengthen the abdominal muscles, the muscles on the front of the thigh (quadriceps) and the muscles that pull the shoulder blades down and back (parascapular muscles).

However, the specific muscle groups to be stretched and strengthened can be individually assessed. To increase flexibility, apply a static stretch to the correct muscles, hold the position for about 30 seconds without bouncing, and repeat the stretch five times. Strengthening exercises should be started at light weights so that two or three sets of eight to 10 repetitions can be completed with effort but without strain. Over time, repetitions at these weights will become easier, and the weights will need to be gradually increased.

Adolescents, the elderly, those with a history of heart disease or heart disease risk factors such as smoking and hypertension, and those over the age of 35 and sedentary should check with a physician before beginning a regular exercise program. A well designed, consistent exercise program will provide maximum benefits with minimal risks.

Brenda Greene is a physical therapist, board certified orthopedic specialist and instructor in the Division of Physical Therapy, Department of Rehabilitation Medicine.

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