In a perfect world, medications would never produce side effects,
operations would always be successful, and the best movie would
win the Oscar. In that world, Harvard Men’s Health Watch
would be in every mailbox, and exercise would continue to prevent
disease and prolong life without causing any aches and pains. For
better or worse, perfection can never be achieved in the real
world. It’s a wonderful world, and exercise is wonderful for
health, but people who exercise do run a risk of injury.
Although exercise rarely triggers serious heart problems, they
must be the first concern for everyone who works out. To protect
yourself, get a check-up before you start a serious exercise
program. Listen to your body for warning symptoms such as chest
pain, a racing or erratic pulse, undue shortness of breath, and
light-headedness, and get help if you experience any of these
Although cardiac problems are infrequent, musculoskeletal woes
are relatively common. A study of 6,313 adults who exercised
regularly found that 21 percent developed an exercise-related
injury during the course of a year. Two-thirds involved the legs;
the knee was the most frequently injured joint.
It sounds grim, but it’s not. For one thing, injuries are much
more common with intense exercise and competitive sports than
with moderate exercise done for health. For another, people who
exercise actually have a lower long-term risk of disability than
sedentary people. A 13-year study of 370 exercisers age 50 to 72,
for example, found that exercise was linked to a reduced risk of
disability and a lower death rate, even among elderly folks who
engaged in running, a high-impact activity.
Injuries do occur, but many are preventable, most are mild, and
the majority will respond nicely to simple treatment at home. An
old runner’s adage boasts, “I have two fine doctors, my right leg
and my left.” It’s true for disease prevention, but for injury
treatment you’ll also need your head and your hands. And you
should know when to consult a health care professional.
Prevention. It’s always the best
treatment. Here are a few key tips:
Work yourself into shape slowly. It’s the most important
element of prevention, particularly for “weekend warriors”
who may be tempted to go all out without preparing themselves
properly. It’s a growing problem, particularly for the baby
boom generation; in fact, doctors have coined a new
diagnosis, “boomeritis,” for the phenomenon. Use a graded
exercise program to get into shape gradually, and then stay
in shape the year round.
Warm up before each exercise session and cool down
Stretch regularly; exercise makes muscles strong, but they
also get tight and short — stretching preserves flexibility
and reduces the risk of injury.
Use good equipment; it’s particularly important to have
supportive, well-fitting shoes for weight-bearing activities.
Use good technique; a few lessons or a little coaching can
improve your mechanics as well as your performance.
Don’t overdo it. Fatigue and dehydration impair
concentration, often leading to a misstep or fall. Overuse is
the major cause of injuries; give your body a chance to rest
and recover after workouts, particularly when you’re first
getting into shape. Alternate hard sessions with easier ones.
Vary your routine so that you use different parts of your
body; some people, for example, might walk one day, play
tennis the next, and garden the third. A day off now and then
doesn’t hurt, either.
Recognition. If prevention fails, early detection is the next
line of defense. Be alert for symptoms. A bit of soreness and
stiffness is normal, but pain, swelling, diminished strength or
mobility, and discoloration of the skin is not. Spot small
problems before they become big ones. If your problem seems
small, treat it yourself. But if you don’t improve — or if you
have a major injury — get expert help.
Common injuries: An exerciser’s guide
Many sports injuries feel the same, but there are important
differences among them. Here is a glossary of some common
Sprains. Injuries to ligaments, the
fibrous connective tissues that connect one bone to another. In
first-degree sprains, the ligament is stretched; in second-degree
sprains, some fibers are torn; in third-degree sprains, most or
all of the fibers are torn. In general, first-degree sprains
produce only pain and swelling, second-degree injuries are often
accompanied by weakness and bluish discoloration due to bleeding,
and third-degree sprains produce severe weakness and decreased
Strains. Injuries to muscles or
tendons, the fibrous tissues that connect muscles to bones.
Commonly known as muscle pulls, strains also come in first-,
second-, and third-degree varieties. Like sprains, strains are
usually caused by a misstep or fall that places excessive force
on a tendon or muscle, so that fibers are stretched or torn.
Tendinitis. Inflammation of a tendon,
often caused by overuse or poor body mechanics. Pain is the major
symptom, but warmth, swelling, and redness may occur. The pain is
typically most severe at the start of exercise; it eases up
during exercise, only to return with a vengeance afterward.
Fasciitis. Inflammation of the layer of
fibrous tissue that covers many muscles and tendons. Overuse is
often to blame. A common example is plantar fasciitis,
inflammation of the sole of the foot, which plagues many walkers
Bursitis. Inflammation of the small,
fluid-like sacs that cushion joints, muscles, or bones like
miniature shock absorbers.
Arthritis and synovitis. Inflammation of a joint (arthritis) or
the membrane that surrounds it (synovitis). Like bursitis, joint
inflammation often occurs without being triggered by exercise,
but both problems can also result from overuse or trauma. Pain
and swelling (“water on the knee,” for example) are common
Dislocations. Often very painful and
disabling, dislocations occur when bones slip out of their proper
alignment in a joint. A deformity is often visible, and the joint
is unable to move properly. Although some athletes attempt to
realign (reduce) a dislocation themselves, it should be done by a
physician or highly experienced trainer or therapist.
Fractures. A disruption in the
continuity and integrity of a bone. Except for broken toes and
stress (hairline) fractures, nearly all fractures require skilled
Contusions. Bleeding into tissues
caused by direct trauma — the “black and blue.”
Muscle cramps and spasms. Unduly strong
and sustained muscle contractions that can be very painful (the
“charley horse”). Gentle stretching will help relieve cramps;
hydration and good conditioning help prevent them.
Lacerations and abrasions. Cuts and
scrapes; small ones can be managed with soap and water and
Band-Aids, but larger ones may require special dressings or
sutures. Tetanus shots are not necessary if immunizations have
been kept up to date with boosters every 10 years.
Self-treatment: The price is right
Use a five-point program to handle your injuries; the key is
PRICE: Protection, Rest, Ice, Compression, and
Protection. Injured tissues must be
protected against further injury. Protect your small injuries by
applying bandages, elastic wraps, or simple splints. Something as
easy as taping an injured toe to its healthy neighbor can do the
job. See your doctor for problems that require precision splints
Rest. Injured tissues need time to
heal. It’s an obvious principle, but once you’re hooked on
exercise you may be tempted to ignore it. Don’t give in to
temptation — you’ll shortchange yourself with shortcuts. But you
can rest selectively; you may have to give up tennis while your
serving shoulder recovers from tendinitis, but you can still
walk, jog, or hike. In a curious way, an injury is often a
blessing in disguise, forcing you to diversify your workouts and
acquire new skills.
Ice. It’s the cheapest, simplest, yet
most effective way to manage many injuries. Ice is an excellent
anti-inflammatory, reducing swelling and pain. For best results,
apply an ice pack for 10 to 15 minutes as soon as possible after
an injury. Repeat the ice treatment each hour for the first four
hours, then four times a day for the next two to three days.
Protect your skin with a thin cloth, and don’t allow your skin to
become red, blistered, or numb. After 48 to 72 hours, switch to
heat treatments, using the same schedule and principles.
Compression. Pressure will help reduce
swelling and inflammation. In most cases, a simple elastic
bandage will suffice; it should be snug but not too tight.
Remember that swelling may develop slowly hours after your
injury, so you may have to loosen your wrap. Another trick is to
place a small piece of foam rubber directly on the injured area
before you wrap it; this will allow you to put gentle pressure
where it’s needed without constricting an entire joint or limb.
Elevation. It’s a simple strategy that
enlists the force of gravity to drain fluid away from injured
tissues, reducing swelling, inflammation, and pain. Keep your
sore foot or other limb up on a hassock or put a pillow under it
in bed; elevating an injured area will help you get back to Earth
PRICE is the key to the early management of most kinds of
injuries, but you may also need medication for pain or
inflammation. Acetaminophen (Tylenol, other brands) may be the
best choice for the first day, since it will reduce pain without
increasing bleeding. After the first day or two, consider aspirin
or another nonsteroidal anti-inflammatory (NSAID) such as
ibuprofen (Advil, other brands) or naproxen (Aleve) to fight
inflammation as well as pain. NSAIDs can irritate the stomach and
cause bleeding; for safety’s sake, take them with milk or food.
Prolonged NSAID use can lead to other complications, so use the
lowest dose that works and always follow directions.
The PRICE program relies on applications of cold and then heat,
often supplemented by anti-inflammatory medications or pain
relievers. Instead of an ice pack or warm pack, you can rub in an
ointment that will make your tissues feel cool or warm. And you
can also buy liniments, gels, and ointments that contain
anti-inflammatory medications. Topical anti-inflammatories are
available without a prescription, and they are much safer than
oral anti-inflammatory medications. Anti-inflammatory ointments
are very popular with patients, but doctors have been skeptical.
However, a British meta-analysis of 86 trials involving 10,160
patients concluded that these ointments can reduce pain in acute
injuries (such as sprains and strains) and chronic conditions
(such as arthritis) — about a third of patients improved, but
their relief was only modest to moderate.
Liniments can be messy or irritating. Some have an unpleasant
odor and many are expensive. If you want to use a liniment, start
with one that contains an NSAID. But no matter what brand you
select, be prepared for one side effect not measured by the
British scientists: disappointment. Liniments are not cure-alls.
Even if they reduce pain, they won’t help heal injured tissues.
For that, you’ll need time, rest, and conventional medical
therapy. So if a liniment helps, use it, but only as part of a
complete program of protection, rest, and physical therapy.
The next step: Rehabilitation
Your pain is gone and your swelling is down — but your treatment
is not yet over. Instead, plan your rehabilitation and return to
exercise with the same care that you used to treat your injury.
As a rule of thumb, give yourself two days of rehab for each day
of inactivity due to injury. Start with gentle range-of-motion
exercises, and then gradually increase your weight-bearing
activities. When you are comfortable, consider building up your
tissues with graded resistance training using calisthenics, light
weights, or resistance equipment such as Cybex or Nautilus. If
all goes well, you can be stronger than before your injury, thus
reducing your risk of reinjury.
Don’t neglect stretching exercises to improve your flexibility.
Use heat or massage to warm up your injured tissues before you
start your rehab exercises; afterward, apply ice to the area to
reduce inflammation. The judicious use of aspirin or other NSAIDs
may also facilitate your rehabilitation program.
You can manage many injuries yourself, but don’t be stubborn. If
you have a major injury — or if your nagging woes don’t clear up
— get help. An experienced exercise buddy who’s been there and
done that may be all the help you need. Primary care physicians
can handle many exercise-induced problems, but more difficult
issues require orthopedists, physical therapists, and sports
podiatrists. In many centers, these specialists come together in
sports medicine clinics.
The most dangerous thing about exercise is not doing it. True,
injuries do happen — but don’t let the threat of problems become
an excuse for taking to your couch. Instead, take the simple
steps that will reduce your risk of exercise-induced injuries,
become able to spot problems early, learn how to handle minor
injuries on your own, and be prepared to get help when you need
it. It’s easy to overcome simple injuries — but very hard to
treat the major illnesses that stem from lack of exercise.