Study Unit

Preventing Injury
By Nancy Berkoff, R.D., Ed.D., C.C.E.

About the Author

Dr. Nancy Berkoff is a registered dietitian and certified chef with more than 25 years of experience in the health and wellness field. She holds a bachelors degree in nutrition and food technology, a masters degree in nutrition education, and a doctoral degree in vocational education. In addition to her academic degrees, Dr. Berkoff is a European-trained chef and a Fellow of the Institute of Food Technologists. Dr. Berkoff began her fitness and nutrition career in high school, when several of her relatives were diagnosed with hypertension secondary to sedentary lifestyles and poor diet. It was up to her to plan menus and prepare appealing foods for them. Eventually, word spread about her cooking prowess, and Dr. Berkoff was selected to provide nutritious and hydrating snacks for her high school fencing and tennis teams. As a result, her career in fitness and nutrition was born. Since then, Dr. Berkoff has taken her love of fitness and nutrition to several Olympics and Special Olympics, where she has served as a food coach. She currently works closely with personal trainers, professional sports trainers, lifestyle coaches, and personal chefs to design and coordinate food and fitness regimens.

Exercising feels good. Getting hurt doesnt. Participation in any fitness activity presents some risk of injury. Fitness professionals should do everything possible to ensure that their clients are exercising safely. If a client does become injured, its the fitness professionals role to suggest that the athlete receive proper therapy and treatment. In this unit, youll explore some common fitness injuries and learn how to prevent them. This unit is an overview of fitness safety. Fitness professionals should consider adding first aid and CPR certification to their list of qualifications. When you complete this study unit, youll be able to
Explain why pain does not equal gain Detail how sports injuries may hurt for a lifetime List the five commandments of injury prevention Propose a plan for decreasing exercise injuries Compare and contrast safety requirements for specific activities, such as running, skating, swimming, and cycling Plan how to exercise the rest of the body in case of a specific injury Explain how fitness professionals should respond to minor and major injuries Suggest appropriate footwear and surfaces for running to prevent injury Recognize symptoms of common injuries

Preview

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Contents

THE FIVE COMMANDMENTS OF INJURY PREVENTION BECOMING TEFLON-COATED TO INJURY

Preventing Preventing Preventing Preventing Running Injuries Bicycling Injuries Skating Injuries Swimming Injuries

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15 19 20 22

FIRST AID IN A BOX

Major and Minor Injuries Sprains and Strains Risk Factors for Back Pain Recovery

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27 29 32 32

SELF-CHECK ANSWERS

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Preventing Injury

THE FIVE COMMANDMENTS OF INJURY PREVENTION

Many people think that grunting and groaning during workouts and suffering with aching muscles is the way to fitness. By now you should know that the no pain, no gain school of thought has been totally discredited. However, theres no escaping the fact that gains make pain more likely. Overexertion can cause injuries. People dont set out to hurt themselves, but, sometimes, things happen. However, most injuries dont just happen. But a vast number of injuries are completely preventable if people follow fitness safety basics. Most injuries involve damage to soft tissues, usually pulls or strains. Fit muscles are stretchable and bendable, which usually makes them pretty forgiving. But you have to know and respect their limits, not only to avoid short-term pain and inconvenience, but also to prevent future pain. Many injuries can have long-term ramifications, both physically and economically. Doctors speak about seeing patients all the time who complain about injuries they got 25 years ago. If you avoid injuring muscles, youll likely avoid damaging tougher parts of the body as well, such as bones, tendons, and ligaments, now and in the future. As a fitness professional, youre the safety guru. Here are some thoughts to pass along to your clients for their health and safety:

1. Start with a medical check-up. Anyone who hasnt exercised in a long time should have a medical exam before starting a fitness program (Figure 1). A health care professional can offer precautions if preexisting conditions are present, such as a high cholesterol level or high blood pressure or a bad knee or a weak back, that would make some exercises dangerous. If possible, discuss the type of exercise youre planning on doing with your health care professional.
FIGURE 1Always consult a medical professional before beginning a new fitness program.

2. Variety is the spice of life. To avoid overuse injuries that come from repetitive exercise, vary your exercises from day to day and season to season. By choosing fitness workouts that vary the area worked and the activities of joints and muscles, youre not likely to overstress any one of them. Mixing it up is especially important if your sport of choice is especially trying to your joints, such as basketball, jogging, or aerobics.
2 Preventing Injury

Varying your exercise routine also strengthens opposing muscle groups, which reduces the chance of injury (Figure 2). For example, serious walkers and runners inevitably build strong hamstrings, but they tend to have weak quadriceps. This imbalance can cause a variety of problems. The hamstring can exert tension on the tendons and ligaments around the knee, for example, causing inflammation. By including exercises that build the quadriceps, such as weight training, cycling, rowing, or calisthenics, this imbalance can be avoided. No matter how much you love running,

FIGURE 2Try to vary your exercise routines to strengthen opposing muscle groups.

Preventing Injury

swimming, or biking, you might become bored. By mixing up your choice of exercise, you can avoid boredom and overuse injuries. And youre more likely to stick with your exercise routine! 3. Exercise year-round. Your exercise program should include strength, flexibility, and aerobic training. By staying strong, flexible, and in good cardiovascular shape year-round, youre less likely to injure yourself during any one season. Muscles serve a vital role in stabilizing joints. Yearround conditioning strengthens muscles to prevent unwanted or extreme movements. The knee joint, for example, relies on all the muscles around it to provide stability. Strengthening the muscles around the knees can help prevent some injuries. Some athletes believe that participation in a sport during the season maintains cardiovascular fitness year-round. Depending on the sport, this might not be true. If you participate in a specific seasonal sport, such as softball, incorporate an aerobic exercise program into your fitness routine year-round (Figure 3). Your goal should be to condition yourself year-round so that youre able to participate effectively and enjoy your sport. Put another way, you should be in shape to play the sportnot play the sport to get in shape. 4. Train for your sport. Part of maintaining year-round conditioning is to prepare all the parts of your body for your sport or fitness exercise of choice (Figure 4). This includes training the muscle groups and energy systems (think: anaerobic versus aerobic) required for the sport. For example, a runner would want to work on general lower-extremity muscle flexibility, power, and strength, in addition to aerobic conditioning, but a defensive back in football would want to ensure that foot speed and agility are optimal, along with excellent short-burst (anaerobic) capabilities. Everyone who exercises regularly should be tuned into the condition of his or her body and recognize subtle changes, such as aches, pain, stiffness, favoring

Preventing Injury

FIGURE 3By changing your sports activities and exercise routines with the seasons, you can stay in good condition year round.

one part of the body over another, or fatigue. These signs wont always be obvious, but its wise to become attuned to these signals, because they might help you avoid injury. Also, be sure that you train using the appropriate equipment and protective gear. An important aspect of preseason conditioning is training at an intensity thats below the competitive level. Youre more likely to maintain and enjoy a conditioning program thats comfortably paced and progresses in intensity, frequency, and duration as the competitive season nears. Preseason goals might include increasing speed, power, agility, balance, coordination, and the ability to concentrate and relax. Interval training, which involves short periods of activity (i.e., stair climbing, weightlifting, calisthenics, or other exercise activities, such as sprinting), can build speed, strength, and power. This type of

Preventing Injury

FIGURE 4To maintain year-round conditioning, a runner might choose a fitness routine that includes exercises to increase lower-extremity muscle flexibility.

training involves working hard for short periods in the middle of an aerobic workout. Running bursts of 50 yards of so after every mile during a long running session constitutes interval training. You can slowly increase the number of sprints in the workout, as well as the distance and speed of the sprints. Interval training can help you prepare to participate in activities that require intense effort, such as sprinting, as well as support aerobic conditioning during soccer games. If youre just starting an interval-training program, ease into each activity to help prevent injury, and keep your intervals short to avoid fatigue and overuse injuries.

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5. Develop mental skills. Mental readiness for sport and fitness should be part of every year-round conditioning regimen (Figure 5). Both the mind and the body need to be conditioned. A mental-conditioning program can help you to relax and focus. Practice relaxation techniques and imagery. Studies have shown that a number of psychological factors can predispose an athlete to an acute injury.
FIGURE 5Its important to be mentally prepared to participate in sports and fitness regimens.

Each of us has an optimal arousal level that works to enhance our athletic performance. Translated, this means that different people have different mind-sets for the competition and intensity of exercise or sports. If youre overly psyched out by the importance you place on how many repetitions you can do or how many games you win, or if the environmental conditions in which you must perform arent ideal (its too windy/cold/hot), your psychological state could detract from your performance and put you at risk for injury. If youre already injured and are still attempting to engage in activity, this, too, can be a distraction that puts you at greater risk. Too much arousal causes increased muscle tension and attention deficits, which detract from coordination and flexibility and increase the risk of sprains, strains, and

Preventing Injury

other injuries. Fear of competition, fear of failure, and other distractions have caused many athletes to lose their focus, leading to errors that lead to injury. Its important to develop mental concentration and relaxation skills to cope with lifes stresses. How you respond to competitive stress may be a predictor of how likely you are to be injured. Relax and enjoy is the right mind-set for fitness and exercise, not kill the enemy.

Preventing Injury

Self-Check 1
At the end of each section of Preventing Injury, youll be asked to pause and check your understanding of what youve just read by completing a Self-Check exercise. Answering these questions will help you review what youve studied so far. Please complete Self-Check 1 now.

1. What are some common causes of exercise-related injuries?

__________________________________________________________ __________________________________________________________
2. How can mental alertness help to prevent injuries?

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

Check your answers with those on page 37.

Preventing Injury

BECOMING TEFLON-COATED TO INJURY

By now you know that people have a tendency to overexercise, overstretch, and overcompete. These can all lead to overtraining-related injuries. Guide your clients through the following steps to ease their way into enjoyable fitness programs that theyll be able to continue for a long time. Progress gradually. Nobody likes being told to take things easy, but you cant safely rush fitness. Pushing the body harder than its ready to be pushed results in damage, whether its tiny tears that make your muscles sore or larger traumas, such as lower-back spasms (Figure 6). This is a critical point to remember for anyone beginning a new fitness program. Many marathon coordinators will tell you that people with the least amount of training have the most injuries.
FIGURE 6Proper training and gradual progression will help you avoid injury.

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Warm up. Without question, inadequate warm-up is the major cause of injury, says Allan M. Levy, M.D., team physician for the New York Giants and partner at the Sports Medicine Center in Fort Lee, New Jersey. Muscle fibers are like rubber bands: When theyre cold, theyre stiff and liable to tear. Warm muscles are not only more pliable, but they also contract faster and become stronger (Figure 7). Higher body temperature also lubricates joints and improves muscle cells ability to convert oxygen and glucose to energy. Warm up just enough to raise your body temperature about two degreesenough to break into a light sweatby doing light calisthenics, jogging, riding a bike, or walking briskly.
FIGURE 7Warmed-up muscles are pliable and less likely to tear.

Use safety gear. A lot of injuries come from a lapse of common sense, such as not wearing a helmet when performing sports that call for one. People offer many reasons given for forgetting the helmet: loving the feel of the wind in their hair, not having anywhere to put it when they arent using it, not wanting to look dorky. The same goes for leg and kneepads, cushioned mats, and so on. Call a local emergency room and get what will be the frightening statistics on the number of cracked heads and other broken body parts they see every year that could have been prevented by the proper safety gear (Figure 8).

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FIGURE 8Safety gear is an essential part of injury prevention for many sports and activities.

Learn the right moves for the right activities. Many fitness professionals will tell you that if their clients took the time to acquire the fundamental skills and understood the basic forms and techniques of their activities, the vast majority of sports injuries would vanish. See the following box for a list of what not to do.

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AVOIDING INJURY DURING EXERCISE

DONT DO THIS Deep knee bends Ballistic stretches Use ankle weights when running or walking Twist quickly at the waist Twist the knee Complete head/neck rotations Hold breath for more than three to five seconds Use equipment you havent been trained on REASON Causes undo strain to knees Damages muscles and tendons Damages muscles and ligaments Could damage vertebrae Could damage the meniscus and ligaments Damages vertebrae Could cause fainting Could cause all kinds of damage to you and the equipment!

When muscles talk, listen. Working through pain doesnt earn you any points, and it could lead to lifelong injuries. If pain persists, then somethings wrong, and you need rest or treatment. Know that feeling a little bad might come with the territory; that first 10 minutes of aerobics or the first turns around the track might not feel wonderful. Thats understandable. Learn to distinguish between your bodys Id rather be in bed feeling and the Im going to fall apart if you continue to do this to me feeling. Watch the temperature. You dont need to smash or twist your body to get it into trouble. Theres also danger of damage that starts from the inside out. Let your body temperature swing too far to either end of the thermostat and youll face potentially deadly problems. Hypothermia occurs when a low internal body temperature interferes with the bodys ability to regulate vital processes, such as metabolism and the heartbeat. One risk for hypothermia is getting wet, which vastly increases heat loss in the cold. Wear clothes that wick moisture away from the body rather than holding it close to the skin (Figure 9). Polypropylene underwear is better than cotton in cool weather. Another key factor is loss of energy. When youre active, body heat generally makes up for lost warmth, but you should head for shelter once intensity, and with it body heat, begins to decrease.

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FIGURE 9When you exercise in extreme temperatures, be sure to stay hydrated and to wear clothes that wick away moisture.

Heat exhaustion is a supply-and-demand problem: Muscles and skin, which compete for fluids from the blood, become depleted in extreme heat and/or humidity. Obviously, avoiding exercise in extreme heat or humidity will prevent problems. Schedule hot-day activity before 10 A.M. or after 3 P.M. Wear loose-fitting clothes, drink lots of fluids, and realize that muscle cramps, goose bumps, fatigue and lightheadedness are some of the first signs of heat-related trouble. Youve learned about some general fitness safety areas. Lets take a look at some particular activities and identify their specific safety needs.

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Preventing Running Injuries

Running doesnt sound that hard: Place one foot in front of the other. However, the repetitious movements involved in running sets up a chain of events from head to toe. Be a tiny bit out of alignment at either end, and your entire body can be affected. Physical therapists and chiropractors are guaranteed a steady flow of runners year-round. Freeze a picture of a runner in midstride and what will you see? A person whos airborne. A person whos about to land on one foot with all his or her body weight, multiplied two to three times by the forces of gravity and forward momentum. With this kind of hammering, its no surprise that a study following participants in an Atlanta 10-K race for 10 years found that 53 percent of the participants reported injuries. You can do a number of things to lessen the chance of injury while running. Add some walking. Walking is much easier on the muscles, joints, and tendons than running (Figure 10). Alternate a fast walk for five minutes with a light run for five minutes, then walk again. The next time you go out, alternate running seven minutes and walking five, gradually increasing your intensity. Youll be building on endurance and helping to strengthen muscles without all the banging and gravitational pulling. Wear properly fitting, properly designed running shoes. Running is one of the few sports that really needs activityspecific footwear. Running shoes cushion the impact of planting your feet and help keep you rolling smoothly from one stride to the next. Think smooth and soft surfaces. Try to run on even surfaces. Running on a potholed path is an invitation to ankle twists and sprains. Also, when possible, run on soft surfaces such as dirt, lawn grass (dont get caught!), or packed gravel, which cushion the stresses of running more than hard surfaces, such as asphalt or concrete.

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FIGURE 10Alternate running sessions with a fast walk or light jog to lessen the impact on your muscles and joints.

Train, dont strain. Six months of consistently running 50 miles per week will allow steady progress. A few weeks at 60 miles may result in an injury. While recovering from the injury, you lose training time; you lose a significant part of the fitness gained in prior months. You often have to start from scratch. The following are some signs of overtraining: feeling tired; not sleeping well; repeated illness, such as sore throat, colds, flu, and cold sores; swollen lymph glands; and weight loss. Stress or fatigue can express itself in your running speed your pace might decrease for a given effort.

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Safety Down Below: Shoes and Surfaces Look for the following characteristics in a fitness shoe: Solidly built but lightweight shoe, made of material that breathes Flexible front (where the toes go), with enough room for the toes Acceptable width, with enough room for the metatarsals Properly fitting arch support Sufficient support for the back and the sides of the foot Exercise surfaces must meet the following criteria: Shock-absorbing Provide stability Provide a uniform surface Easy to clean (its for exercising bodies, after all!) Nonskid

Many running injuries can be reduced through proper warm-up, conditioning, footwear, and running surfaces. The following box offers additional tips on running safety from the U.S.A. Track and Field Association, the Road Runners Club of America, and the American Orthopedic Society for Sports Medicine.

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Running Safety Plan a progressive running program to prevent injuries. A five-minute warm-up (which should raise your temperature by two degrees Fahrenheit) followed by stretching exercises is essential before starting a run. Following the run, stretching again is important, because microtears that may have occurred will heal better. During hot weather, running should be scheduled in the early morning or evening hours to avoid heat exhaustion. Dont run when pollution levels are high. Be sure to have adequate rest between training sessions. Start your run with the body feeling a little cool, because body temperature will increase when you start running. You can lose between 6 and 12 ounces of fluid for every 20 minutes of running. Drink 10 to 15 ounces of fluid 10 to 15 minutes prior to running and every 20 to 30 minutes along your route. Weigh yourself before and after a run. For every pound lost, drink one pint of fluid. In cool weather, youre less likely to get chilled if you run into the wind when you start running and run with the wind at the finish. Run in the shade if possible, and avoid direct sun and blacktop. If exposed to the sun, apply at least SPF 15 sunscreen. Wear sunglasses to filter out UVA and UVB rays, and wear a hat with a visor to shade your eyes and face. In high altitudes, runners should gradually acclimate themselves to lower oxygen levels, by slow, steady increases in speed and distance. When selecting a running shoe, look for good shock absorption and construction that will provide stability and cushioning to the foot. Make sure that theres a thumbnails width between the end of the longest toe and the end of the shoe. Buy shoes at the end of the day, when the foot is the largest. Sixty percent of a shoes shock absorption is lost after 250 to 500 miles of use, so people who run up to 10 miles per week should consider replacing their shoes every 9 to 12 months. Excessive clothing can produce sweating, which causes the body to lose heat rapidly and can increase the risk of hypothermia. Instead, dress in layers. The inner layer should be material that takes perspiration away from the skin (not cotton); the middle layer (not necessary for legs) should be for insulation and absorbing moisture (cotton is okay here); the outer layer should protect against wind and moisture (nylon). To avoid frostbite in cold weather, dont have gaps of bare skin between gloves and jackets, wear a hat, and cover the neck. Petroleum jelly can be used on exposed areas, such as the nose. (Continued)

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Running SafetyContinued Dont run at night, but if you run at dusk or dawn, do wear reflective material. Dont wear a headset or jewelry while running. Run with a partner. If alone, carry identification, or write your name, phone number, blood type, and medical information on the inside sole of your running shoe. Let others know where youll be running, and stay in familiar areas, away from traffic. Have a whistle or other noisemaker to use in an emergency, and carry change in case you need to make a phone call. Whenever possible, run on a clear, smooth, resilient, even, and reasonably soft surface. Avoid running on hills, which increases stress on the ankle and foot. When running on curved surfaces, change directions in forward movement, so that you have even pressure on both feet during the run.

Preventing Bicycling Injuries

There are between 800 and 1,000 bike-related deaths a year, according to the Automobile Club of America, and thousands of nonfatal bicycle accidents that result in permanent injuries. You can ensure your safety while riding a bicycle in a number of ways (Figure 11). Wear a helmet. Many cycling deaths are the result of head injuries sustained in crashes. Insurance against this horrible injury comes in two parts. The first, of course, is not to take your head for a ride while your helmet hangs out in the trunk of your car. The second is not to crash. Keep loose items (knapsack straps, extra shoes, sweat shirts, etc.) out of bicycle spokes and chains. If youre riding on the pavement, watch out for unexpected obstacles, such as opening car doors; if youre off-road, keep your speed within your abilities. Pedal fast. Straining against the resistance of a high gear could make you more susceptible to overuse injuries. Spinning at lower gears reduces strain and propels you more efficiently. Save the high gears for when you have sufficient speed to keep each pedal moving at the recommended 80 to 100 revolutions per minute for nonracers and 100 to 150 for racers.

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FIGURE 11Many bicyclerelated injuries can be avoided by wearing a helmet, pedaling at a high gear, ensuring a proper fit, and supporting your back.

Get fitted. One size does not fit all when it comes to cycling. If you do a lot of riding, its common to experience knee and back pain from improper positioning on the bike. Ask a cycle shop mechanic to check the position of your saddle, handlebars, and pedals. Support your back. The leaned-over stance used when riding road and mountain bikes can strain the lower back. To shore up your torso, strengthen your abdominal muscles (which provide most of the spines support) with abdominal exercises such as crunches two or three times a weeks.

Preventing Skating Injuries

Before taking up in-line skating, make sure your primary medical bills are paid, says the owner of the Skaters Edge shops in Philadelphia and director of the Sport and Competition Council of the International In-Line Skating Association (IISA). The most recent IISA figures put the annual injury tally at 76,000. According to the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) in Atlanta,

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almost 70 percent of in-line skating injuries are fractures, dislocations, sprains, strains and avulsions (large tears). You can avoid becoming a skating statistic by following a few simple rules. Wear a helmet. Does this sound familiar? Head injuries are very, very bad things. Dont stop with the helmet. Be sure youre well padded (Figure 12). If you can fall on it, bend it, twist it, or scrape it, it should be padded. The wrists account for 40 percent of skating injuries, a rate four times higher than the nextmost-common injury site, the elbow. Research by the CDC shows that wearing wrist protectors cuts the odds of injuries such as lacerations, sprains, and strains considerably. The other parts of the recommended ensemble are elbow and knee pads.
FIGURE 12Wrist and knee pads, in addition to helmets, are essential components of in-line skating safety gear.

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Take a lesson from fitness professionals. A backward fall is the most dangerous kind, and its the most common for beginners. Learn how to brake, stride, glide, and fall. These are four areas every skater needs to know how to do. Taking a lesson at the start will improve your safety chances enormously. Keep your head up. Looking at the horizon helps your sense of balance and keeps your center of gravity over your toes. If you watch your feet, you completely throw off your balance. Stay off the streets. If you dont have a local park to skate in, take to the access roads that feed corporate or industrial parks, which are largely traffic-free after-hours and are usually laid out in circular paths or loops.

Preventing Swimming Injuries

Each year, almost 150,000 swimming-related injuries are treated in hospitals, doctors offices, clinics, ambulatory surgery centers, and hospital emergency rooms. The American Academy of Orthopedic Surgeons offers the following tips to prevent swimming injuries. Always take time to warm up and stretch. Research has shown that cold muscles are more prone to injury. Warm up with jumping jacks, stationary cycling, or running or walking in place for 3 to 5 minutes. Then slowly and gently stretch, holding each stretch for 30 seconds. Learn how to swim, and dont swim alone. Swim in supervised areas where lifeguards are present. Inexperienced swimmers should wear lifejackets in the water. Dont attempt to swim if youre too tired, too cold, or overheated. Avoid diving into shallow water. Approximately 1,000 disabling neck and back injuries occur each year from people diving headfirst into water thats too shallow or too murky to see objects.

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Make sure you can see the bottom. Swim in a pool only if you can see the bottom at the deepest point; check the shape of the full diving area to make sure its deep enough. Dive only off the end of a diving board. Dont run on the board, try to dive far out, or bounce more than once. Swim away from the board immediately after the dive, to allow room for the next diver. Make sure theres only one person on the board at a time. When swimming in open water, never run and enter waves headfirst. Make sure the water is free of undercurrents and other hazards. Watch for flooding. Dont swim in a lake or river after a storm if the water seems to be rising or if theres flooding, because currents may become strong. The clarity and depth of the water may have changed, and new hazards may be present. Check the forecast. Check weather reports before going swimming to avoid being in the water during storms, fog, or high winds. Because water conducts electricity, its dangerous to be in the water during an electrical storm. Alcohol and water dont mix. Alcohol not only affects judgment, but it also slows movement and impairs vision. It can reduce swimming skills and make it harder to stay warm. Know first aid. Be knowledgeable about first aid and be able to administer it for minor injuries, such as facial cuts, bruises, or minor tendinitis, strains, or sprains. Be prepared for emergency situations. Have a plan to reach medical personnel to treat injuries such as concussions, dislocations, elbow contusions, wrist or finger sprains, and fractures.

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Self-Check 2
1. Outline the steps you can take to help prevent exercise-related injury.

__________________________________________________________ __________________________________________________________
2. Why is running so hard on the body?

__________________________________________________________ __________________________________________________________
3. Identify at least five ways to avoid injury while swimming.

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

Check your answers with those on page 37.

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FIRST AID IN A BOX

Even with the best of training and the exercising of caution, accidents happen. Fitness professionals need to be ready for them. In addition to certification in first aid and CPR, youll need some tools of the trade. Keep a first-aid kit well stocked and accessible whenever youre working with clients (Figure 13).
FIGURE 13Always keep a well-stocked first-aid kit on hand in case of injuries.

Heres what to include, as recommended by Eric A. Weiss, M.D., associate professor of medicine at Stanford Medical Center and board member of the Wilderness Medical Society. To provide relief: Ibuprofen tablets (e.g., Motrin, Advil) for reducing inflammation from sprains and strains and reducing the pain of headache and sunburn (Note: Be extremely cautious in offering even over-the-counter medication to clients.)

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 Benadryl or other antihistamines for hay fever, poison ivy, rashes, and bee stings Pepto-Bismol or Imodium (if allergic to aspirin) for sudden stomach trouble Aloe vera gel for minor burns and frostbite Second-skin dressings, such as moleskin for blisters For cleaning: A 10 cc irrigation syringe with an 18-gauge catheter tip for use as a squirt gun to flush dirt and microorganisms Neosporin or another triple-antibiotic ointment (singleuse packets are more convenient than large tubes) Antiseptic towelettes with benzalkonium chloride for swabbing For patching: Sterile dressings (2 2, 3 3, and 4 4 inch) Sterile eye pads Sterile gauze bandages Assorted adhesive bandages Elastic bandages Wound-closure strips or butterfly closures for pulling wound edges together Tincture of benzoin to help adhesive bandages, woundclosure strips, and moleskin all stick better For technical assistance: Tweezers Tape Safety pins Blunt-tip bandage scissors, for cutting cloth Waterproof matches

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 A pencil and writing paper in a sealed plastic pouch Small first-aid book Epi-Pen, for injecting a single dose of epinephrine in case of severe allergic reaction to bee stings or food (prescription required) Latex surgical gloves and CPR Microshield to protect against infectious diseases such as AIDS If youre located in a permanent facility, you might also want to have blankets, backboards, a folding wheelchair, and canes on hand. These take up room and tend to get lost in the shuffle of moving offices or cleaning. If you have a permanent space, you might want to hang instructional posters, such as for the Heimlich maneuver or basic first aid. The American Red Cross and the American Heart Association are good sources for posters and other informational materials. Many public facilities are beginning to stock portable cardiac defibrillators. You might want to inquire about training with these. If youre a staff member in a mixed-use facility, such as a school or recreational camp, you can be guaranteed that you, as the fitness professional, will be relied upon in time of emergency, to use this type of equipment.

Minor and Major Injuries

Fitness professionals are expected to respond to many different types of injuries. Every fitness professional should have firstaid and CPR training. Many common fitness injuries are minor, such as sprains or pulls. RICE is the most commonly used treatment for such minor injuries: R = Rest; immobilize the injured area. I = Ice; a common treatment is to apply ice for 15 to 20 minutes at a time over a 3-hour interval. In a pinch, use a bag of frozen vegetables or a can of frozen juice, wrapped in a towel, in the place of ice. Be careful not to leave ice on for too long. Dont let the skin come into direct contact with ice.

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 C = Compression; light pressure can help relieve some pain and swelling. Dont compress too tightly or for too long a time period. E = Elevation; elevation slows the circulation to the injured area and may help to relieve swelling.
COMMON INJURIES
INJURY Open wound Break in skin, bleeding Cold skin, rapid or weak pulse, pain in injured area, rapid breathing, vomiting, no bleeding Aches and pains along the tibia, including swelling, bumps, and tingling Pain in the ball or heel of the foot (inflammation of the connective tissue in the bottom of the foot) Pain in the heel, especially after periods of rest Pain at point of injury, with more pain brought on by exercise Pain in the lower part of the leg, above the ankle Pain, swelling, bruising, and hot spots at the ankle Pain, swelling, and buckling of knee Pain and tightness at the back of the thigh, difficulty walking or bending to touch toes Severe pain, swelling, urge to cradle arm close to the body Sharp pain when reaching overhead from the shoulder Soreness or pain at wrist and forearm Syncope (fainting), uneven pupils, seizures, slurred speech, impaired vision, weak, fast pulse, nausea, pale or flushed skin, bleeding from nose, ears, or mouth SYMPTOM

Closed wound

Shin splint

Plantar fasciitis

Heel bruise Stress fracture Achilles tendonitis Ankle sprain Torn meniscus Pulled hamstring Dislocated shoulder Rotator cuff syndrome Epicondylitis (golf or tennis elbow) Head injury (VERY SERIOUSSEEK IMMEDIATE EMERGENCY ATTENTION)

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In addition to being able to handle minor injuries, a fitness professional should always be prepared for emergency situations. Being prepared includes having an emergency kit on hand (and communicating its location to clients and staff) and being certified in first aid, CPR, rescue breathing (formerly called artificial respiration), and the Heimlich maneuver. The American Red Cross and your local fire department are good resources for information on emergency training and stocking an emergency kit. When an emergency occurs: Stay calm and keep others calm. Quickly survey the situation. Dial 911 or call for emergency assistance immediately. Secure the victim and reassure him/her. Be ready to give emergency personnel information about the victim and the injury.

Sprains and Strains

Sprains and strains are among the most common injuries in sports. You should be very familiar with how to recognize and treat such injuries. A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone with another. Ligaments stabilize and support the bodys joints. For example, ligaments in the knee connect the upper leg with the lower leg, enabling people to walk and run. A strain is a twist, pull, and/or tear of a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone. A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position and overstretches, and, in severe cases, ruptures the supporting ligaments. Typically, this injury occurs when an individual lands on an outstretched arm; slides into a base; jumps up and lands on the side of the foot; or runs on an uneven surface.

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Chronic strains are the result of overuseprolonged, repetitive movementof muscles and tendons. Inadequate rest breaks during intensive training precipitates a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction. Professional and amateur athletes and the general public can sustain this injury. People at risk for the injury have a history of sprains and strains, are overweight, and are in poor physical condition. All sports and exercises, even walking, carry a risk of sprains. The anatomic areas most at risk for a sprain depend on the specific activities involved. For example, basketball, volleyball, soccer, and other jumping sports share a risk for foot, leg, and ankle sprains. Soccer, football, hockey, boxing, wrestling, and other contact sports put athletes at risk for strains. So do sports that feature quick starts (hurdling, long jump, running races, etc.). Gymnastics, tennis, rowing, and golfsports that require extensive grippinghave a high incidence of hand strains. Elbow strains frequently occur in racquet, throwing, and contact sports. Although the intensity varies, pain, bruising, and inflammation are common to all three categories of sprainsmild, moderate, severe. The individual will usually feel a tear or pop in the joint. A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely or separate from the bone. This loosening makes the joint nonfunctional. A moderate sprain partially tears the ligament, producing joint instability, and some swelling. A ligament is stretched in a mild sprain, but theres no joint loosening. Typical indications that a sprain has occurred include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. In severe strains, the muscle and/or tendon is partially or completely ruptured, often incapacitating the individual. Some muscle function will be lost with a moderate strain, where the muscle/tendon is overstretched and slightly torn. With a mild strain, the muscle/tendon is stretched or pulled, slightly. Common strains include back strains and hamstring muscle strains.

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Back strain. When the muscles that support the spine are twisted, pulled, or torn, the result is a back strain. Athletes who engage in excessive jumping (during basketball, volleyball, etc.) are vulnerable to this injury. Hamstring muscle strain. A hamstring muscle strain is a tear or stretch of a major muscle in the back of the thigh. The injury can sideline a person for up to six months. The likely cause is muscle strength imbalance between the hamstrings and the muscles in the front of the thigh, the quadriceps. Kicking a football, running, or leaping to make a basket can pull a hamstring. Hamstring injuries tend to recur. Rest, ice, compression, and elevation (RICE) usually will help minimize the damage of a strain or sprain. Its important in all but mild cases for a medical doctor to evaluate the injury and establish a treatment and rehabilitation plan. A severe sprain or strain might require surgery or immobilization followed by months of therapy. Mild sprains and strains may require rehabilitation exercises and activity modification during recovery. No one is immune to sprains and strains, but here are some tips developed by the American Academy of Orthopedic Surgeons to help reduce your injury risk: Participate in a conditioning program to build muscle strength. Perform stretching exercises daily. Always wear properly fitting shoes. Nourish your muscles by eating a well-balanced diet. Warm up before any sports activity, including practice. Use or wear protective equipment appropriate for that sport.

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Risk Factors for Back Pain

Back pain is very preventable. Look over the following list and see how you can relate it to your clients to prevent them for acquiring back pain. Poor posture Weak lower-back muscles Lack of flexibility in lower back Lack of flexibility in hamstrings Using quick, sharp jerking movements when exercising Repeated bending from the waist Osteoporosis Improper lifting techniques

Recovery
You or your clients might suffer an injury while working out, on the job, or at home. After an injury, it can take time to get back into a regular fitness routine (Figure 14). Following an injury, a person experiences both psychological and physical stages of healing. Psychologically, a person experiences shock, realization, acknowledgment, and coping, followed by the setting of specific minor and major goals for return to exercise. Physically, a person must progress through the stages of initial pain, swelling, and loss of the previous level of control of the injured limb or body part. Once healing has occurred through surgical/nonsurgical means, the person faces the challenge of reestablishing strength, balance, coordination, and confidence to a minimum level thats deemed safe and appropriate for return to exercise.

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FIGURE 14At some point in your career, youll likely need to create a targeted fitness regimen for an injured client.

A major injury must be evaluated and diagnosed by an appropriate health care professional or specialist. Once the symptoms seem to have cleared or the medical staff feels its safe to return to activity, the person can then gradually return to full capacity. Depending on the injury, a physician might suggest the use of protective padding, bracing, or other modifications to protect the injured area (Figure 15).

FIGURE 15Injured clients may be instructed by medical professionals to use protective padding or bracing to protect the injured area.

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When a body part is injured, it should be rested. But, if approved by a health care professional, the rest of the body should be kept in shape. If possible, cardiorespiratory fitness should be maintained. People spend a lot of time getting the cardiorespiratory system in shape to handle various levels of exercise. When a person is sidelined by an injury, cardiorespiratory fitness can decrease rapidly. The fitness professional should attempt to coordinate with the health care professional for alternative activities that allow the client to maintain existing levels of cardiorespiratory fitness. Depending on the nature of the injury, a number of activities can be used to maintain cardiorespiratory fitness. When theres a lower-extremity injury, non-weight-bearing activities should be incorporated. Pool activities provide an excellent means for injury rehabilitation. Cycling also can positively stress the cardiorespiratory system. Of course, no activity should be taken without the approval of the medical staff. Strength, balance, and hand-eye coordination can be maintained while recovering from a specific injury. Swimmers with upper-extremity injuries might use a stationary bike or climb stairs. They can work on trunk balance using a large medicine ball, in addition to performing their daily upper-extremity physical therapy routines. Runners with a lower-extremity injury can utilize a UBE (upper-body ergometer, which resembles a bicycle for your arms). If the lower-extremity injuries arent severe, an elliptical transporter or stationary bike can be utilized in addition to performing the appropriate lower-extremity rehabilitative exercises. This equipment also provides cardiovascular conditioning for people with upper body injuries. For handeye coordination, anything from throwing darts to shooting pool can be useful in stimulating the neuromuscular pathways (yes, you have permission from your fitness professional to shoot pool!). In general, return to a regular fitness program can be outlined by a health care professional. Guidelines should be sports specific; for example, runners should be on a walk/run program, and advance as tolerated and as indicated by performance and any symptoms. Once an

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injured person is cleared for regular activity, the basic rehabilitation program should be performed on a maintenance basis. Once an injury has healed, the goal is to stay healthy and prevent reinjury. However, to prevent reinjury, you have to understand why or how the injury occurred in the first place. If the injury occurred because of inadequate conditioning, then attention should be paid to more conditioning. If an injury occurred because of poor form, then the focus should be on improving and mastering the correct technique. If the injury occurred because the person has musculoskeletal problems, such as lower-extremity malalignment or congenital abnormalities, that werent appropriately supported through the use of braces or orthotics, then the use and condition of those devices should be evaluated. If an injury cant be explained and seems to have just happened, then the person should continue with a maintenance rehabilitation program three days per week that includes exercises and activities that aided in his or her recovery and return to fitness. Some of the best advice for staying healthy and preventing injury in the first place is to stay well conditioned and to exercise with controlled intensity. This includes consistently having good nutrition, good emotional balance while working out, endurance, and neuromuscular function and strength.

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Self-Check 3
1. What should a first-aid kit include for patching?

__________________________________________________________ __________________________________________________________
2. How might a person maintain cardiovascular fitness when an arm or leg is injured?

__________________________________________________________ __________________________________________________________ __________________________________________________________

3. How should an injured client return to a fitness program?

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

Check your answers with those on page 38.

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Self-Check 1
1. A no pain, no gain mentality, overtraining, lack of knowledge about particular activities 2. Studies have shown that a number of psychological factors might predispose an athlete to an acute injury. Different people have different mind-sets for the competition and intensity of exercise or sports. If youre overly psyched out by the importance you place on how many repetitions you can do or how many games you win, or if the environmental conditions in which you must perform arent ideal (its too windy/cold/hot), your psychological state could detract from your performance and put you at risk for injury. If youre already injured and are still engaging in activity, this, too, can be a distraction that puts you at greater risk.

Answers
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Self-Check 2
1. Progress slowly; warm up properly; wear safety gear; learn the right moves; dont overwork; pay attention to signs of hypothermia/hyperthermia. 2. A person whos running lands on one foot with all of his or her body weight, multiplied two to three times by the forces of gravity and forward momentum. With this kind of hammering, its no surprise that injuries occur. 3. Any five of the following: Always take time to warm up and stretch; learn how to swim, and dont swim alone; dont attempt to swim if youre too tired, too cold, or overheated; avoid diving into shallow water; make sure you can see the bottom; dive only off the end of a diving board; when swimming in open water, never run and enter waves headfirst; watch for flooding; check the forecast; alcohol and water dont mix; know first aid; be prepared for emergency situations.

Self-Check 3
1. Sterile dressings; sterile eye pads; sterile gauze bandages; assorted adhesive bandages; elastic bandages; wound-closure strips or butterfly closures for pulling wound edges together; tincture of benzoin for making adhesive bandages, wound-closure strips, and moleskin all stick better 2. When theres a lower-extremity injury, non-weightbearing activities should be incorporated. Pool activities provide an excellent means for injury rehabilitation. Cycling also can positively stress the cardiorespiratory system. Of course, no activity should be undertaken without the approval of the medical staff. 3. Once an injury has healed, the goal is to stay healthy and prevent reinjury. However, to prevent reinjury, you have to understand why or how the injury occurred in the first place. If the injury occurred because of inadequate conditioning, then attention should be paid to more conditioning. If an injury occurred because of poor form, then the focus should be on improving and mastering the correct technique. If the injury occurred because the person has musculoskeletal problems, such as lower-extremity malalignment or congenital abnormalities, that werent appropriately supported through the use of braces or orthotics, then the use and condition of those devices should be evaluated. If an injury cant be explained and seems to have just happened, then the person should continue with a maintenance rehabilitation program three days per week that includes exercises and activities that aided in his or her recovery and return to fitness.

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Self-Check Answers