Why So Many Aerobics Injuries?
Thursday, March 01, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
A recent New York Times article quotes aerobics teachers and devotees saying they now have painful, chronic injuries from years of aerobics classes. Why did this happen?
I receive frequent e-mails from aerobics instructors, many only in their 20s and 30s, saying they are too old to continue teaching because of pain and injuries from teaching. I am older than their parents. At the schools and clubs where I teach classes, teachers and trainers are often absent, or replaced, because of herniated discs.
The Times article quotes major aerobics spokespeople, attributing the injuries to jumping on "concrete floors in bad tennis shoes," and related how former well-known-names in the aerobics industry now teach low impact classes. The article continued, "A lot of people doing aerobics back then can no longer do any jumping whatsoever. They have problems with their backs, feet and hips."
Conventional "impact activities" are not the problem.
- In the years I spent in the lab studying injuries, seeing patients, and teaching students, I have found that the problem is not that impact must be avoided. I see patients who are instructors of Pilates, stretch, yoga, rowing, martial arts, and Alexander technique for degenerating joints. It is simple misuse.
- It is not that people are doing the exercises "wrong" but the movements themselves.
- If you saw someone bend over at the waist or hips to hoist a suitcase or child, you know it is bad bending and it hurts the back. The same people will bend over the same way to lift weights in a gym or do yoga stretches. It is the same disc-injuring bending in all cases.
- The post Common Exercises Teach Bad Bending gives interesting examples from a class that is "low-impact." Wear occurs on the lower back and neck discs regardless of how expensive and engineered the aerobics shoes.
- The post Are You Making Your Exercise Unhealthy? shows you how to put the knowledge of bad positioning together in your mind with how people are exercising, to realize it is not rocket science when people have pain, even though they "do their exercises."
You can run, jump, walk without jarring impact
- Many people walk with higher impact than a good martial artist will kickbox.
- Many people are unnecessarily restricted from favorite sports and told to walk instead, based on the fallacy that running or tennis is necessarily higher impact, instead of looking at how heavily they clomp around letting spine, hips, knees, and ankles sag and grind.
- One story with helpful links is told in You Can Fix Your Own Knees.
- Another is Walking Softly Benefits Olympic Wrestler
What about body weight?
- Many of my obese patients with knee pain stand and walk with their knees in sagging positions. This is not a consequence of their body weight.
- When I show them to simply hold their knee from knocking inward (or outward) by using their own muscles to hold straight, the pain quickly goes away. They say that they can then, for the first time, *do* any real exercise to lose weight.
- Lightweight people can have the same knee and other pain. They may move heavily without good shock absorption or hold joints in angled painful ways.
What About Shoes?
- Common myth are that you must wear "supportive" shoes, and that flexible soft shoes cause injuries.
- Hard shoes increase shock and load on your ankles and knees.
- Supportive shoes reduce or prevent the natural stretch on the plantar fascia and Achilles tendon that you ordinarily get with bare feet or soft flexible shoes. Tightness and risk of injury rises.
- Supportive shoes decrease your need to balance and stabilize yourself, reducing your own abilities.
The post When Did Health Become Thinking Out of The Box? explains more of why you don't have to have pain from exercising or even long sitting while studying (or watching TV). I don't take people away from their favorite activities when injured. I even use their sport as rehab, showing them how to do it in healthier ways so that they can do more, lift more, and run more than before, not less. Health care should not be "Limit to the patient to limit the pain."
Read Inspiring Patient Stories on my web site - how patients fixed their own pain and could do more than before.
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Labels: ankle, disc, fix pain, hip, injury, knee, martial arts, planter fasciitis, shoes, yoga
5 Comments:
At Tuesday, July 31, 2007 1:44:00 PM,
The Lethological Gourmet said…
I'm an aerobics instructor and am, for the most part, very healthy and haven't had any injuries. Except for one, and it put me out of commission for several months (plus the time after that to get back up to speed). I got plantar fasciitis. I talk about this at great length on my blog (my experience and how it affected me). http://steppin-up.blogspot.com/2007/07/plantar-fasciitis.html
My question now is, because I'm an instructor and rely on the income of my classes, I'm basically trying to manage the chronic condition so it doesn't flare up again. This means I try to keep my foot on the bench, rather than hanging off the back, and I try to limit high impact moves (like jumping) in my kwando class. I regularly do heavy lifting. Is there anything else I should be doing besides limiting high impact and making sure to stretch regularly?
At Thursday, August 02, 2007 2:25:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
To Lethological Reader (Raina), I checked your fasciitis story on your site. Doing a few stretches then going back to poor foot mechanics the rest of the day will not help (as you have found).
Common Achilles and fascia stretches are not effective. Carefully, gently, substitute:
Better Achilles Tendon Stretch
and
Healthy Toe Stretches. Stretch the whole bottom of the foot; don't just pull the toes.
No need to limit "high-impact." You are supposed to employ shock absorption through your leg and hip muscles and landing technique so that even high jumps are soft landings. A good martial artist will leap from a height with less impact than most people walk. Full contact kicks properly done should not stretch the fascial attachment.
Walking toe-outward is a common fascial tightener. It may be "natural" with tightness, but makes problems. Doing a few stretches then walking poorly will not undo the tightening, and is not fitness as a lifestyle. Walking with feet parallel and facing ahead gives a natural built-in stretch to the bottom of the foot with each step (hip, knees, and feet both face ahead so that the knee does not twist).
Letting ankles pronate (arches flatten) is another fascial strain. See the post Arch Support Is Not From Shoes. Keep weight evenly on the sole, not inward in the arches.
Hard sole shoes and some fasciitis braces stop the sole from stretching, so stop the pain from the stretch, giving the false impression that the injury is lessening. It is a vicious cycle of shortening and continuing the source of the injury. Injections briefly make the area more prone to injury. Pain killers allow you to continue the injury process without pain telling you that it is wrong. Several kinds interfere with healing. You also mentioned wearing heels, which shortens the fascia and Achilles.
The book Fix Your Own Pain Without Drugs or Surgery (www.DrBookspan.com/books) has a section on fasciitis, the many unhealthful lifestyle contributors, and simple lifestyle fixes to build into daily life and the classes you teach. Fasciitis can be quickly stopped. It does not have to be chronic. Use good mechanics to allow it to heal and be functional.
At Monday, October 15, 2007 4:53:00 PM,
The Lethological Gourmet said…
Thank you for the excellent advice you have given, Dr. Bookspan. I barely have trouble with my foot now, though it twinges now and then. I've definitely incorporated more stretching into my daily routine, and have focused on walking properly and wearing the right footwear.
I came across the following article about strengthening the foot, ankle, and fascia: http://wellness.ndsu.nodak.edu/fitness/Events/marathon/footDrills.pdf.
Would you recommend incorporating these exercises into my normal routine? Are these valuable for strengthening or will they create other problems?
At Friday, November 30, 2007 6:54:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Hello, Lethological (Raina) Good work. We can completely fix this up. Make sure that you bend right every time you reach for anything and you will get a free built in functional Achilles and fascia stretch every time - Bending Right is Fitness as a Lifestyle and Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending. Keep heels down.
"Right footwear" should not mean being captive in a stiff shoe, as often prescribed for fasciitis. I think you mean not wearing the heels so much?
Sorry for slow reply. I have been working on this as posts for you, but until then don't do the toe in or out walking. Toe out walking is one way to not get a stretch on the fascia. I know it is supposed to be a strengthener, but it is not functional and you want to train healthful walking position. Heel and toe walking is fun and ok. Strengthening will put a stronger lock on a paper door. The key is to strengthen in ways you need. Keep me posted, send photos to make your success story. I will be posting more on Achilles.
At Tuesday, August 19, 2008 6:13:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Here is more on fasciitis - Plantar Fasciitis Part I.
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