Are you exercising up an injury? Are the benefits of exercise worth the risk of injuries and death? - Cover Story

Are You Exercising Up an Injury?

Millions of Americans sat glued to their television sets, watching the 1988 World Series. Orel Hershiser pitched, Dave Parker stuck out, and the Los Angeles Dodgers won the World Series! Elated, Hershiser knelt and thanked God for the victory.

But in the spring of 1990, a somber Hershiser sought help from the team physician for increasing pain in his shoulder. A partially torn rotator cuff, suffering from years of wear and tear from pitching, required surgery and one year of rehabilitation. America awaits to see whether the recipient of the 1988 World Series Most Valuable Player and Cy Young awards will be back pitching.

Four years earlier, millions watched Joan Benoit win the first Olympic women's marathon, almost three months after surgery on an injured right knee. During the same race, Gabriela Andersen-Schiess experienced heat exhaustion. And in the 3,000 meter race, Mary Decker sustained an injury to the thigh after being bumped by another runner. This ended her hopes of a medal, a battle she had fought since 1976, when a series of injuries kept her out of the Olympics.

Jan. a 36-year-old manager, had not exercised for a year when she resumed her exercise program to lose weight and lower high blood pressure. On her first walk she covered three miles in 35 minutes. Pain along both shins sent for help. Pam, a coworker, used lunchtime to exercise. One day Pam forgot to warm up before beginning a brisk walk. Suddenly she felt a sharp pain behind the knee, which radiated up to her neck. Her physician treated the muscle spasms with medication for 16 days.

More and more Americans are "getting physical." What fuels the motivations to reject a sedentary lifesyle? The burning desire to look young and feel good. But out of America's obsession come the injuries that are associated with exercise and sports.

The extent of the problem. Every year, almost half the runners in the United States report injuries serious enough to interrupt their running program. In a survey of runners preparing for the Los Angeles Marathon, David Nieman, D.H.SC., found that almost 21 percent reported at least one injury during the month before the race.

The knee is the most common site of injury for the runner. It is also at greatest risk of injury for participants in the latest exercise fads, bench aerobics (repeated stepping up and down on a bench) and stair climbing. These activities add four to six times the body weight to the knee.

Three out of four aerobic instructors and nearly half of the student report injuries. Almost 80 percent of the injuries involve the lower extremities. Bicycling injuries account for at least 1,000 deaths and 500,000 emergency room visits each year. Amazingly, a recent study by Dr. McCarroll and colleagues at the Methodist Sports Medicine Center in Indianapolis found that 62 percent of the amateur golfers surveyed had sustained one or more injuris. The back was the most common injury site.

The well-publicized sudden deaths of college basketball star Hank Gathers and running furu Jim Fixx sadly illustrate there is also a small risk of dying during exercise. A literature search for reported cases of sudden death during the past 50 years found 271 cases of patients who had died during or following some form of exercise. Most people who die suddenly during exercise have underlying heart disease, experiencing warning symptoms that are often ignored.

Causes of injury. Overuse is the number one cause of exercise-related injuries. For example, beginners who exercise longer than 30 minutes and more than three times a week increase the risk of injury. The "no pain, no gain" theory is a fallacy. Other reactors associated with developing injuries include poor equipment, anatomic abnormalities, and faulty exercise style (running style, swing mechanics).

Prevention.

Whatever the exercise or sport, all are at risk of injury, and safety is the key to preventing injuries.

Sun protection. Sunburn is a common injury that accounts for 500,000 new cases of skin cancer every year. Ninety percent of all skin cancers occur on parts of the body not usually covered by clothing, such as the face, tips of the ears, hands, and forearms. It is best to avoid exercising outdoors between 10:00 a.m. and 3:00 p.m., when the most damaging ultraviolet B(UVB) radiation peaks. however, if you must exercise outdoors, especially during the heat of the day, apply a water-proof sunscreen, with a sun protective factor (SPF) rating of 15 or higher, 20 minutes prior to going outdoors. Wear a loose-fitting long-sleeved shirt and hat, even on cloudy or overcast days. It is also good to wear sunglasses. Besides protecting the eyes from sunburn and cataract formation, sunglasses shield the eyes from wind, rain, dust, and insects, and they improve perception and prevent wrinkles.

Awareness. to prevent injuries, exercisers must be in tune with their bodies. Table 1 describes symptoms that signal that exercise need to be stopped. The beating and rape of young investment banker in New York City's Central Park two years ago underscores the importance also of staying aware of one's surroundings. Walking against theflow of traffic and bicycling with the flow of trafic enhances one's awareness. In addition, the wearing of headphones during exercise is strongly discouraged. Further tips may be obtained from the Road Runners Club of America by calling (703) 836-0558.

Flexibility and strength. Many exercise specialists believe that weak and inflexible muscles and joints are more prone to injuries. Stretching and strengthening are essential to any training program. Stretch after the aerobic workout when muscles and tendons are warm. Stretch slowly and easily, without bouncing movements. After stretching, strengthening muscles through calisthenics such as sit-ups, push-ups, and lifting weights.

Environment. Weather is an important factor to consider when exercising. Temperature, humidity, and wind influence the occurrence of heat injuries and hypothermia (Table 2). The most effective defense against heat is hydration. Drink water before, during, and after exercising. To adapt to heat, exercise lightly over a two-week period. On the other hand, humans are less able to adapt to prolonged exposure to cold; therefore, warm clothing becomes critical to protect against hypothermia.

Use caution when exercising in the rain or at night. Under those conditions the vision of motorists may be diminished; wear a white neon-colored clothing. When riding in the rain, bicyclists must also slow down, extend their cornering, brake early, and beware of slick spots.

Training. Training is individualized. Before beginning an exercise program, see a physician and have a treadmill EKG stress test if you're at high risk for heart disease (Table 3). Next, select the appropriate exercise. For example, walking or swimming minimize the impact on joints for the obese and those with arthritis.

Beginners need to exercise three times a week (two weekdays and one weekend day) for 10 to 20 minutes at a pace that allows them to talk without becoming breathless. Running and walking must be in a heel-to-toe fashion. Gradually increase the distance, at no more than 10 percent of the previous week's distance. Aerobic dancers should begin with low-impact exercise and substitute walking in place of jumping. For those who exercise five days a week or more, include alternative forms of exercise such as bicycling, tennis, or rowing along with walking or running.

Failure to warm up and warm down for at least five minutes before and after the aerobic workout may result in injuries or death. Light activity during the warm-up allows the heart to adapt to the increased work load; during the warm-down, it allows for a gradual decrease in heart rate, and prevents blood pooling in the lower extremities, which would bring on dizzines or irregular heartbeats.

Your Equipment. Shoes are vital to most forms of exercise. They must be appropriate to the exercise and the individual, and in good repair. Aerobic dance shoes need more cushioning in the ball of the boot and more leather in the uppers for side-to-side support. On the other hand, the entire sole of running shoes requires cushioning. Allow at least one-fourth to one-half inch of space between the longest toeand the end the of the shoe; the front of the shoe must be roomy enough to wiggle the toes. When you're breaking in new shoes. Dr. Fox, author of Save Your Knees, recommends cutting running mileage by 10 percent for one week.

Exercise equipment must be in proper working order. Helmets are necessary equipment for bicycling and other dangerous sports.

Treatment of musculoskeletal pain and injury. Pain or swelling with or without discoloration is a sign of injury. Immediately treat with rest, ice, compression, and elevation (RICE). The purpose of RICE is to control swelling and minimize pain to bring about a rapid and complete healing. A technique used by coaches and trainers is to place an injured foot or hand in a wastebasket full of ice water for several minutes. Compression is accomplished by applying an Ace bandage. Heat should not be used during the first 48 to 72 hours following injury. If the injury is extremely swollen or painful and does not respond to ice, seek medical attention.

Conclusion. Are the benefits of exercise worth the risk of injuries and death? When S-A-F-E-T-Y in exercise is used along with a lifestyle that includes adequeate rest, good nutrition, stress management, smoking cessation, and following medical advice, the risks are minimal and the benefits great.

Kathy S. McFarland, D.H.Sc., M.P.H., M.N., R.N., is director of employee health services for an insurance company. She lives in Altadena, California.

COPYRIGHT 1991 Review and Herald Publishing Association
COPYRIGHT 2004 Gale Group