MAT T CURRIER, SPT, AND BRIANNA DEBIASI , SPTUI C DEPARTMENT OF PHYSICAL THERAPY

Injury Prevention and Safety in Exercise

Why worry about injury?

According to the Center for Disease Control, each year about 3 million people visit the emergency room due to exercise related injuries.

One injury can make you at risk for more injuries later on.

Injuries can lead to time off work and other important events

Injuries can prevent you from staying active

Physical Activity Readiness

Before starting a new exercise routine answer these questions (Physical Activity Readiness Questionaire):1) Has your doctor ever said that you have a heart

condition and that you should only do physical activity recommended by a doctor?

2) Do you feel pain in your chest when you do physical activity?

3) In the past month, have you had chest pain when you were not doing physical activity?

4) Do you lose your balance because of dizziness or do you ever lose consciousness?

Physical Activity Readiness

5) Do you have a bone or joint problem that could be made worse by a change in your physical activity?

6) Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

7) Do you know of any other reason you should not do physical activity?

Physical Activity Readiness

If you answered YES to any of these questions, talk with your doctor before starting to increase your physical activity.

If you are older than 65 years, you should still talk to your doctor even if you did not answer YES to any of the questions.

Your doctor can help you create safe exercise guidelines and give you ideas of what you can or cannot do for exercise

Start Gradually

One of the most effective ways to prevent injury when starting or changing an exercise routine is to start gradually.

Know your fitness level and do not attempt to exceed it.

Slowly increase the intensity and duration of your workouts.

Start Gradually

Use the “talk test” to monitor how hard you are exercising During exercise, try talking to someone or recite the

“Pledge of Allegiance” You should be able to hold a conversation with

someone while exercising This indicates you are exercising at a “moderate”

intensity If you are unable to talk, you are most likely

exercising too hard, especially if you are just starting an exercise program

Listen to Your Body

“No Pain, No Gain” is not a good motto!Pain is how your body tells you something is

wrongIf you start to experience aches or pain in

your joints or muscles, stop exercisingIf you are too sore or tired from a previous

workout, take the day off or reduce the intensity of your next workout

Rest is a very important part of injury prevention Be sure to have one or two days of rest from exercise

every week.

Warm-Up

A good warm-up before exercise is very important to prevent injuries

Warming up has three purposes: Increase body temperature Increase heart rate and blood flow to muscles Increase flexibility for activity

A proper warm-up can also help reduce soreness after exercise

Warm-Up

Warm-up Guidelines 5-10 minutes light exercise such as walking, jogging,

biking Slow and easy pace If doing an activity, do movements similar to what you

will be doing for exercise For example, if doing Zumba do some of the moves slowly

and lightly. If lifting weights, warm-up with light weights. You should start to break a sweat!

Cool-Down

Doing a cool-down after your workout is also important

The cool-down helps return your body function back down to its normal resting level

A proper cool-down after exercise can help reduce the risk of lightheadedness or dizziness, abnormal heart rhythm, or muscular injuries.

Cool-Down

Cool-down guidelines 5-10 minutes of light activity Stretching, especially focused on the muscle groups

used during exercise.

Resistance Training

If you are only doing aerobic exercise, consider adding some resistance training (weight training)

Benefits of resistance training: Increased bone strength and density Increased size and strength of connective tissues such

as tendons and ligaments, This reduces risk of sprains and strains

Reduce risk of muscle injuryGaining strength is a very effective way to

reduce your risk of injury

Hydration

Maintaining hydration before, during and after exercise is crucial for safe activity

Before exercise Drink 16-20 oz of water at least 4 hours before

exercise Drink 8-12 oz of water 10-14 minutes before exercise

During Exercise Drink 3-8 oz of water every 15-20 minutes when

exercising

Environment

Exercise causes our bodies to produce heat, which must be given off, mostly through sweat.

In hot or humid environments, the body’s ability to regulate body temperature is diminished.

Use caution if conditions exceed 80° and 45% humidity

Wear white or light colors, fabric that wick sweat, and a hat

Allow up to two weeks for your body to acclimatize to exercise in the heat

Environment

Exercise in extremely cold weather can also be dangerous

Cold weather puts you at risk for hypothermia or frostbite

Use caution when the temperature is below 40°DO NOT exercise outside if the windchill is below

-19°Wear several layers of light clothing, rather than

one heavy garmentCover your hands, feet, nose, and ears with

gloves and a hat.

Equipment

Use shoes that are meant for the activity you are participating in Wear basketball shoes for basketball and running

shoes for runningMake sure your shoes fit wellFor sports, use proper equipment that is in

good conditionWear a helmet while bikingWear clothing that does not restrict

movement

Injury Prevention Summary

Check with your doctor to make sure it is safe to exercise.

Start to exercise slowly and progress graduallyListen to your body!Always do a warm-up and cool-downStay hydratedGet proper restUse caution when exercise in very hot or cold

weatherUse proper shoes, clothing, and equipment

Types of Injuries

Acute Injuries Injuries that happen suddenly, for example an ankle

sprain from jumping and landing badly. These include sprains, strains, concussions, etc.

Chronic injuries Prolonged injuries that develop over time, usually as a

result of poor technique or overuse without enough rest These include injuries such as shin splints and tennis

elbow 50% of all sports and exercise related injuries are

overuse injuries These types of injuries are more likely to be seen in activities

such as aerobic exercise (running, walking, biking)

What Do I Do if I Am Injured?

First, remain calm and assess your situationNext, determine if you need more assistance

or need to call 911Depending on the injury, you will take

different steps to treat the injury

How to Control Bleeding

Stop the blood flow by applying direct pressure to the wound

Use gauze if you have it, but a cloth will work If the blood soaks through the gauze, add

another layerNEVER TAKE OFF A LAYER OF GAUZE while

the injury is still bleeding. It may make the bleeding worse.

Wound Care

Wounds can take longer to heal in people with diabetes

If you have a wound, first rinse the wound with waterDon’t use hydrogen peroxide, soap or iodine, you may

irritate the woundUse an antibiotic ointment and apply a sterile

bandage or band aidUse soap around the woundChange the bandage daily and inspect your wound

for signs of infectionDon’t let the wound dry out and keep it covered If the wound is not healing, contact your doctor

Broken Bones

If you have broken a bone: Call 911 or go to the emergency room. Don’t try to straighten the extremity. Try not to move the extremity Put ice on the injury Elevate the extremity

Head Injuries

If you fall and hit your head or collide with something, you may have a head injury

You may not bleed from your head, but if you do, stop the bleeding with the tips from the previous slide

Even if you do not bleed from the injury, you could still be seriously injured

Signs of a Serious Head Injury

Watch for the following signs of serious head injury and get help right away if you or the person injured: Becomes very sleepy Behaves abnormally Develops a severe headache or a stiff neck Has unequal pupil size in the eyes Cannot move their arms or legs Loses consciousness even if for a few seconds Vomits more than once

Strains and Sprains

Sometimes you may pull a muscle or sprain a ligament

If this happens, practice P.R.I.C.E Protect the injury by not moving it too much or by putting a

brace on it Rest the injury Ice the injury for no more than 15 minutes

If you have poor sensation in the area, make sure to check your skin while icing often

Compress the area with a bandage, but make sure to make not make it too tight

Elevate the area to reduce swelling as often as possible You may also take ibuprofen like Advil to help with pain

Injury Care Summary

Be smart. Contact 911 or get help if you need itFor cuts and abrasions, stop the bleeding with

compressionRemember that wounds can take longer to heal and

to contact your doctor if your wound is not healing well

If you break a bone, call 911 or go to the hospital. Do not try to straighten or move the injured body part

Be cautious with any head injury and seek help if you think you may have a serious injury

Practice P.R.I.C.E for strains and sprains

Diabetes and Exercising

CONSIDERATIONS

Blood Sugar and Exercise

Exercising will lower your blood sugar by making your cells better at using insulin to take up sugar

Exercising will also make your cells take up blood sugar without using insulin

Over time, you may lower your A1C with regular exercise

What Does This Mean for Me?

Check your blood sugar before and after each time you exercise to understand how YOUR body reacts to exercise

Always be ready to treat low blood sugar (hypoglycemia) with a sports drink, or regular soda or a snack in case of emergency.

Call your doctor with any questions about starting a program

How Do I Know if I Have Low Blood Sugar?

Some signs and symptoms of hypoglycemia include: Shakiness Nervousness Sweating, chills, clamminess Confusion or delirium Rapid, fast heartbeat Lightheadedness or dizziness Nausea

Important Recommendations for Exercise

For those with:

Heart Disease High Blood Pressure

DO • Perform moderate activities like walking, daily chores, gardening.

• Perform moderate lifting and stretching.

• Perform activities in a moderate climate

• Perform most moderate activities such as walking, moderate lifting with light weights and high repetitions.

DON’T • Exercise in extreme hot or cold temperatures!

• Perform very strenuous activities like heavy lifting or straining.

• Perform very strenuous activities like heavy lifting or straining.

For those with:

Decreased sensation in the legs or feet:Peripheral Neuropathy

Problems with fainting or dizziness:Autonomic Neuropathy

DO • Perform light to moderate activities like walking, cycling or chair exercises that are low impact.

• Perform activities in a moderate climate

• Make sure you have good footwear and CHECK YOUR FEET EVERY DAY.

• Talk to your doctor before starting an exercise program.

• Once cleared, perform light to moderate walking or weight-lifting.

DON’T • Exercise in extreme hot or cold temperatures!

• Perform exercises that require a lot of standing or walking long-distances.

• Exercise while you have a foot injury or open sore.

• Perform exercises that require too many position changes.

• Exercise in extreme hot or cold temperatures!

For those with:

Poor blood flow in your legs:Peripheral Vascular Disease

Osteoporosis or arthritis

DO • Perform light to moderate activities like walking, cycling or chair exercises that are low impact.

• Rest often while exercising

• Make sure you have good footwear and CHECK YOUR FEET EVERY DAY.

• Perform moderate daily activities like walking, water exercise and resistance exercises.

DON’T • Perform high impact activities

• Perform high impact activities

• Perform activities that require you to bend over

For those with:

Kidney problems:Nephropathy

Eye disease:Retinopathy

DO • Perform light activities like walking, daily chores, gardening and water exercise.

• Perform most low impact activities such as walking, biking or water exercise.

DON’T • Perform very strenuous activities like heavy lifting or straining.

• Perform very strenuous activities that may jar your head.

• Hold your breath while lifting or pushing.

• Keep your head down while exercising.

Other Things to Consider

Aside from walking and lifting weights, water exercise in a pool is a great way to get aerobic activity and feels great on the joints and muscles.

In one study, exercising for an hour while alternating slow and fast walking in 3 minute bouts was shown to have a greater effect on blood sugar.

Summary

Check with your doctor before starting an exercise program

Keep good track of your blood sugar before and after exercise

Make sure you are exercising and keeping in mind other medical issues you may have

Try the pool for a great way to exerciseHave Fun!

References

About.com First Aid. How to Treat Broken Bones. http://firstaid.about.com/od/breaksandsprains/ht/06_FxTx.htm. Accessed June 8, 2014.

American College of Sports Medicine. “Basic Injury Prevention Concepts.” http://www.acsm.org/access-public-information/articles/2012/01/10/basic-injury-prevention-concepts. Accessed June 8, 2014.

American College of Sports Medicine. “Selecting and Effectively Using Hydration for Fitness.” http://www.acsm.org/docs/brochures/selecting-and-effectively-using-hydration-for-fitness.pdf. Accessed June 8, 2014.

American Diabetes Association. Exercising with Diabetes Complications. http://www.diabetes.org/food-and-fitness/fitness/get-started-safely/exercising-with-diabetes-complications.html. Accessed June 8, 2014.

Canadian Society for Exercise Physiology. “PAR-Q and You.” http://www.csep.ca/cmfiles/publications/parq/par-q.pdf. Accessed June 8, 2014

References

Corbin CB, Welk GJ, Corbin WR et al. Concepts of Physical Fitness, Active Lifestyles for Wellness. McGraw-Hill Humanities/Social Sciences/Languages; 2006.

Center for Disease Control. Preventing Injuries in Sports, Recreation, and Exercise. http://www.cdc.gov/ncipc/pub-res/research_agenda/05_sports.htm.

Karstoft K, Christensen CS, Pedersen BK, Solomon TP. The acute effects of interval vs. continuous walking exercise on glycemic control in subjects with type 2 diabetes: a cross-over, controlled study. J Clin Endocrinol Metab. 2014. Epub.

Medline Plus. Head Injury-First Aid. http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm. Accessed June 8, 2014.