PHYSILIFE

Let’s look into a bit more detail on what exactly is happening here and how best to address this problem. 

Too much too soon

Primary reason these injuries happen is because of unaccustomed sudden stress. I see most of these injuries arising while performing Zumba, HIIT, or similar kind of high impact activities. While jumping the load on the legs is multiple times over the bodyweight. Joints and muscles need to absorb these stresses to land safely. While children, athletes and active individuals develop strength and coordination to perform perfect landing, people who are out of practice may injure themselves in the process.

In many gyms the members train in a group exercise format. While a regular exerciser performs the routines easily a rookie (or someone who is joining after a significant break) has to push him or herself beyond their capacity to keep up. The unseasoned muscles give up sooner or later and that’s when the injury happens.

Choose wisely

Most of these injuries can be prevented with few sensible choices. Choose your workout level appropriately. Some gyms let you select from a variety of workouts. Many a time we end up picking an exercise that is too hard for our level of fitness. Ideally in the first 6 weeks of workout one just needs to concentrate on establishing a routine of being active. During this period avoid choosing a high impact activity. Also in any half decent gym there are trainers. Sit down with them, explain your present health status and decide what should be an appropriate and safe level of exercise for you to start with. Then stick to the plan.

Rest to recover

I see a lot of people overlooking the importance of recovery time. One of my patients, a 37 years old lady & a mother of two lovely kids, had developed plantar fasciitis (heel pain) after attending Zumba classes everyday for 3-4 weeks. She found the hard way that one can be overdosed on exercises too.

Many of us fail to recognise the importance of adequate rest in developing and maintaining a healthy body. A beginner should exercise only three to five times a week and at moderate intensity. A daily workout plan consisting of same type of exercise every day can be a recipe for disaster.

The patient informed me that her gym provides a monthly subscription plan where she is free to choose as many classes as she wish. She registered for Zumba everyday to maximize the ROI! In such a situation it would be wise to adopt the strategy one uses in a buffet dinner. While the food is unlimited the capacity of our body is not. 

Shoes

While doing exercises like Zumba, HIIT or aerobics the most important exercise equipment you must focus on is the correct pair of shoes. The right pair reduces the joint stresses, improve stability and overall has a significant contribution in injury prevention. Also if you are jumping, running, jogging or dancing the surface on which you are performing these activities is of utmost importance. Hard surface like concrete road or tiled floors significantly increases the impact forces which can produce injury over a period of time or at once. Ideally a gym floor should have shock absorbing mat. Otherwise the importance of the shoes increases further. Mind you, a single pair of footwear is usually not appropriate for different kinds of workout.

Other features

Hydration is an important yet often overlooked factor. Not drinking enough water leads to cramps and injuries. Inadequate or incorrect warm up and cool down is another contributor to gym induced injury.

Treatment

Most of these injuries fall under the categories of ligament sprain and muscle strain. Typical treatment consists of periods of rest (sometimes along with plaster/sling/braces) and medication, alongside supervised physiotherapy with a well designed protocol. The initial phase consists of pain and inflammation control, followed by graded exercises to regain mobility, strength and coordination. Sometimes adjuncts like tape, dry needling or cupping etc are used to accelerate the healing process.

Recurrent injury

In my clinical practice at HSR Layout what alarms me is the number of recurrent injuries I encounter: Patients who seemingly have recovered go back to gym only to return with same injury again. The commonest reason for this is not completing the rehabilitation process. Majority of us consider ourselves recovered when we cease to have pain. However, getting back to pre injury levels need a lot more effort. Let’s take the example of Amit (name changed) at 30 years with 92 kg weight and 6 feet height he is on the heavier side but far from being obese. Amit had injured his left ankle while performing body weight based high impact exercise. He seemingly got alright with few days of rest in an ankle brace and went back to gym, once he felt his ankle is back to normal. But within a few sessions he got the same injury once again. Unfortunately this pattern repeated a few more times.

Why does this happen? Muscles, ligaments and other soft tissues not only provide structural stability, but they also have important sensory function. Consider a simple example: you performing side stepping in a stepper.  While stepping down your body needs to calculate the exact angle at which the ankle is placed and how much it needs to move to have a safe landing angle. Brain instructs the muscles to contract just enough to reach that angle. This must happen within the short span between when your foot leaves the step till it reaches the floor. When the ankle ligament is injured the important sensors ‘forget’ how to make measurements and calculations efficiently resulting faulty landing and re-injury.

Amit needed to go through the process of re-learning of movement. After the initial hands on treatment sessions were over he learnt the exercises and practiced at home. Periodical revisions were done where I increased the challenges. Within a few weeks he completely recovered and could join back in gym. It’s been over two months since then and he reports steady progress in his gym and no recurrences.

To sum up

Gym induced injuries are becoming increasingly common and a multitude of factors are responsible.With common sense and sensible choices these can be prevented. In most cases the recovery is 100%. Trust your physiotherapist for the NOC before you return to the activity to prevent recurrence. Finally do not push your body beyond capacity. Rome was not built in a day. It is impossible to build a six pack over night but very much possible to get hurt trying.

About the author

Dr Subhanjan Das (PT)

BPT, MPT (MSk & Sports), CMP(NZ), Diploma in football medicine (FIFA)

Consultant Physiotherapist of Apollo & Reliva Clinic, HSR Layout, Bangalore

Contact: +91 8967549104

Dr Subhanjan Das (PT) has over 14 years of clinical and 12 years of academic experience.  A friendly professional with lots of patience and skilful hands, Dr Subhanjan has worked with thousands of his patients for instant relief of pain and rapid return to activities.  He has treated elite athletes for recovery, injury prevention and performance enhancement.

Dr Das is specialized in Orthopaedic and sports physiotherapy and has keeps himself updated with the latest advancements in the field of physiotherapy. He has undergone training on advanced orthopaedic techniques such as Dry Needling, Mulligan Concept, McKenzie method, Pilates, Cupping therapy, McConnel and kinesio  taping from the best faculties around the world.

Dr Das has taught in 5 universities across India and has trained physiotherapists in 50+ workshops within and outside India.