Any physical activity is associated with an injury-risk, irrespective of one's level of participation or experience.
Anyone who pursues a workout at any level is better off having some fundamental knowledge about injury-risk, which in turn would help adopt a preventive strategy.
In this article, illustrated by his case studies, Dr. Hemant Kalyan addresses some FAQs about what injuries may commonly occur during a workout and how to prevent them.
1. What injuries can occur in common day-to-day exercises, such as walking, running, yoga and gymming?
Injuries during common day-to-day exercises such as walking, running, yoga and gymming fall into two broad categories- overuse injuries and acute injuries.
Overuse injuries often occur as a result of doing too much too soon or using a faulty technique or equipment. Shin splints, tennis elbow, wrist tendinitis, and painful conditions in and around the knee-cap are some common examples of overuse injuries.
Acute injuries are the result of a fall during the activity and can occur randomly. Ankle sprains, knee ligament injuries and injuries to the shoulder stabilizers are common acute injuries.
2. What should be the first course of action if there is an injury?
The simple dictum to follow as a first course of action in case of an injury is an easy-to-remember acronym -“RICE”.
R- stands for Rest to the injured part, by immobilizing it or limiting motion.
I- stands for Ice application, using a gel pack ideally or with a bag of frozen peas or ice-cubes in a towel, if a gel pack is not handy.
C- is for compression to the area- using an elasticated crepe bandage or equivalent. Finally,
E- is for elevation- in the case of an upper limb injury, the hand should be above the level of the heart and for lower limb injuries, the foot and ankle should be above the hip level.
3. What does pain indicate? Who should be extra careful?
The old exercise adage “No pain, no gain” is not always true.
While there is no doubt that some soreness or discomfort will be a part of most new exercise programs, the unpleasant pain sensation following exercise is a warning symptom that is not wise to ignore.
Pain often means tissue damage or accumulation of toxins in the part of the body being exercised.
Those individuals 40 and above, people exercising after a break of many years and those with previous medical conditions need to be extra careful while starting a new activity, and would be well-served by seeing a qualified professional beforehand.
4. How do overuse injuries occur?
Overuse injuries occur most commonly due to rapid increases in the intensity or duration of a workout, poor pre-participation preparation, or failure to recognize a dormant pre-existing problem, which gets flared up after starting a new unaccustomed activity.
Illustrative Case Study:
Sriram, (name changed for patient confidentiality) was a talented middle-distance runner, who had brought back a gold-medal for Karnataka in the 800m event during the National Junior Athletic meet during his school days. He was identified by the National Athletics Coach as a potential elite athlete, but bowed to family pressures to give up his promising athletic career to do his CA and join the family firm.
In November 2015, he received an invitation to a run at a reunion with his old athletic buddies to be held in January 2016, and was excited at the prospect. He was however, aghast when he discovered that he now weighed 87 kg, a good 23 kg more than his weight during his college days, and was determined to get in shape for the reunion.
Sriram realized it had been almost two decades since he had done any athletics and decided to follow his old 800m training routine in right earnest, since there were just six weeks to go before the reunion. On his first day of training, he clocked 3 minutes 34 seconds for 800m while running on the road, a good 1 minute 14 seconds away from his minimal acceptable target timing. He decided to go on a 1500 Kcal/day crash diet, do an hour of gym training and was eager to reach his target time at the earliest. Things went well for the first week, when he first noted a pain in his shinbone after running 600m. He remembered his coaches’ words- “No pain, no gain Sriram”- and decided not to be a sissy and “run through the pain”. After 3 days, the pain started to appear after running 400m, and two days later, after at 300m. The next day, he was unable to complete even 500m, and decided to rest it for 2 days. When he resumed training, the pain reappeared after 300m, so he consulted a nearby doctor who advised complete rest and a painkiller.
Disheartened at the prospect of missing the reunion, he came to me with the plea to “somehow make him run at the event two weeks later”. Upon evaluation, I found he had a stress fracture of his shinbone, and had no choice but to ask him to skip the event. In association with a sports physio and fitness trainer, we designed a 6 months step-wise running program for him after recovery from his stress fracture.
Sriram now weighs 67 kg, is thrilled with his physical condition, did an 800m run in 2 minutes 18 seconds, and is looking to break the 2 -minute barrier!
Sriram is thankful for putting him back on track with a properly paced step-by-step approach to reclaiming lost fitness!
5. How do acute injuries occur ?
Acute injuries often happen because of lack of warm-up, incorrect technique or the use of sub-standard equipment.
Illustrative Case Study
Ranagaraj (name changed for patient confidentiality), is a team leader working with a leading IT firm at Whitefield. 3 months ago, he took his team on an outing at a resort north of Bangalore. As part of the team-building exercise, a game of volleyball was organized for the group. Eager to show off his prowess at the game acquired during his college days, Ranga got into the activity with involvement and enthusiasm, and was thrilled to score five times as his team won the first game. Midway through the second game, Ranga balanced on his right leg while trying to lunge and retrieve an opponent’s smash, but unfortunately landed up twisting his knee and had to be helped off the court.
When he came to consult me, he said “Doc, it was stupid of me to play in sandals and go for that shot which I had not tried in two decades!” It turned out that he had injured the Anterior cruciate ligament of is right knee, and needed arthroscopic surgery, from which he has now made a complete recovery.
Rangaraj has this advice to offer others in a similar situation- “When you are playing a game you used to be good at after several years, condition yourself, use proper gear and don’t try any fancy moves beyond your present skill level!”
6. Is it important to plan a workout?
The cliché “To fail to plan is to plan to fail” holds true in workouts as well.
Define goals clearly, set a timetable to achieve the exercise goals in gradual sustainable increments and review the workout progress periodically to gain the most mileage from your workout.
A balanced general fitness program would include elements of cardio, resistance and flexibility exercise, with mandatory warm-ups and cool-downs. A 6 days a week program with one day to allow the body to recover is a good plan. During the 6 days, on two days emphasize cardio, on another two days strength training and flexibility on the remaining two days.
A variety of exercises retains freshness and prevents injury, and the plan may be repeated every week, rather than doing the exact same activity each day.
7. When can one resume routine exercises after an injury? What care should be taken by someone who is injured once?
Enthusiasm often gets the better of common sense when it comes to resuming exercises after injury.
Your body signals are often accurate-listen to them! Be sensitive to pain on activity and unusual fatigue and soreness after resuming exercise- these may be symptoms of an injury that needs medical help.
As a general thumb-rule, most simple acute injuries take three weeks or so to recover and common overuse injuries will take approximately three months to recover spontaneously.
Do consult a medical professional if natural recovery does not take place during this timeframe.
A previous injury is a red flag, and in almost all situations, a repeat injury, even a seemingly minor one, needs proper evaluation.
8. How would a fitness trainer help?
Unsupervised exercise would often not produce the desired result in the planned time frame, would likely increase injury-risk and may lead to giving up on a program in frustration. Ill-advised advice from self-styled “trainers” trying to “impress” their clients with “instant” results would produce the exact same result.
A certified Fitness trainer would have the requisite knowledge and perspective to plan a workout program to help achieve the exercise goals, pace the program sensibly, recognize early signs of injury and monitor the progress of a workout plan.
9. Are there some risky yoga poses that should not be done without supervision or training?
While yoga is a wonderful exercise form, which is generally safe for all age groups and fitness levels, it is not without its risks.
Sirsasana, or headstand, can cause severe neck and shoulder injuries, and can lead to catastrophic spinal cord injuries in a worst-case scenario.
Another commonly used pose, the vajrasana, can damage the cartilage of the knee-cap if a person has pre-existing softening of the cartilage or mal-alignment, or if maintained for inadvisably long periods, can compromise the circulation in the foot.
Injuries at all levels are best prevented by following the mantra of careful preparation, meticulous warm-up, getting professional help if there is a known medical condition and making gradual, sustainable increases in an exercise program.