Exercise Caution First in Keeping Fit, Physical Therapists Warn

A 38-year-old woman, eager to get into shape after having a baby, put on some old tennis shoes and joined an aerobics class. But after one workout, she developed such painful shin splints that she hobbled into the office of a physical therapist for relief.

A 28-year-old man, an experienced jogger, decided he would tackle a longer distance and completed a half-marathon, about 13 miles. A week later, he suffered excruciating pain along the outside of his right knee and turned to a therapist for help.

A 42-year-old Las Vegas hotel executive who joined a health club to improve his physique began lifting the heaviest weights he could, not bothering to ask for instruction or evaluation. Soon after, he developed extreme pain in his right shoulder and elbow, which was diagnosed as acute tendinitis. After relieving his pain, a therapist designed a weight program suited to the executive’s individual needs.

However good their intentions, as more people attempt to be more physically fit, more and more newborn athletes are limping or groaning their way into physical therapists’ offices to repair the damage, according to physical therapists who specialize in sports injuries.

With aerobics instruction as accessible as the local video store and health clubs springing up on every other corner, there are lots of opportunities to get in shape. But there are also plenty of opportunities to injure joints and muscles if people do not recognize the unique needs and peculiarities of their bodies, said therapists meeting recently in Anaheim for the national convention of the American Physical Therapy Assn.

“One would think it’s people who are involved in tremendously long endurance events and extensive training are the ones with the injuries, but it’s not the case,” said David Tiberio, assistant professor of physical therapy at the University of Connecticut.

People who are just beginning exercise programs are “very susceptible” because they are putting an unusual amount of stress and force on tissues and bones that normally don’t get worked that hard, he explained.

“You’re not immune if you run only a couple miles a week,” Tiberio said.

The common injuries are heel spurs, shin splints, knee ailments and sore joints; the common mistake is exercising too much, too quickly, having designed their own cardiovascular workout regimens without receiving advice on proper footwear or exercise conditions, therapists warned.

These newborn athletes make a mistake when they embark on fitness programs without being checked out first for physical irregularities that may not bother them when they walk to the corner store but which suddenly cause pain when they sprint there, the therapists said.

Injury is “probably the most common reason people give for quitting an exercise program,” Tiberio said. Yet injury--or fear of it--is not justification for returning to a sedentary life style, he added. There is no reason to believe that the fitness craze will lead to a nation full of “cardiovascularly fit cripples,” because it has been proven that small increments of exercise actually strengthen muscle and bone tissues, he said. “Sitting around is the worst thing you can do.”

A healthy response to injury is to find out what went wrong and design an exercise program that will prevent the injury from happening again, Tiberio said, adding that physical therapists can help.

Physical therapists are capable of doing more than relieving pain; they can also prevent it, if people about to embark on an exercise program seek advice and evaluation beforehand, said physical therapist Robert R. Huhn, director of a sports fitness and rehabilitation center in Santa Barbara.

“Say a gal starts out with aerobics. She gets herself a leotard and puts on some old tennis shoes. But in the first class she finds she can’t keep up. She gets shin splints and says, ‘This isn’t for me,’ and she quits. That could have been prevented,” Huhn said.

If she had sought out advice first, a physical therapist would have evaluated her for possible foot abnormalities--”problems that didn’t give her any trouble before. But now the minor problems are not so minor,” Huhn said. A physical therapist would have instructed her on the proper footwear for her individual bone structure and activity and possibly prescribed an exercise routine to increase her flexibility and ready her for the demands of aerobics, he said.

For example, the new mother who came to Huhn with painful shin splints suffered after an aerobics class was found to have a common foot abnormality called forefoot varus, a condition where the row of toes--which should lay down flat--are angled so that the big toe is lifted.

Huhn said the woman’s shoes were inappropriate and, in fact, special footgear was needed to accommodate her problem. An exercise regimen was designed that started her on a bicycle so that there was no stress on her feet, before she returned to aerobics, he said. However, she was advised to stick to “light aerobics,” with no jumping.

The runner who was in pain after running a half-marathon was found to have the varus condition in both the toe and heel area, Huhn said. He had been rotating his foot to compensate for the bone abnormality, and it affected the muscles in his leg, Huhn said. The extra distance in the half-marathon “was the final blow,” he said.

After the runner’s pain was reduced with treatments of ice, ultrasound and high-frequency electric current, special footgear was designed and a walking regimen was ordered, Huhn said. In time, the walking was replaced by infrequent and short runs, which gradually were increased in frequency and duration.

Forefoot varus and its counterpart, forefoot vargus--where the toes are angled with the little toe upward--can account for a wide range of sports injuries, from the heel up to the hip and back, because the ankle, leg and hip bones adjust to accommodate the abnormality, therapists said.

That condition or any of a variety of orthopedic abnormalities can go unnoticed and cause no pain or discomfort until unusual stress--that is, exercise--is started, Tiberio explained.

“There is always stress on these tissues,” but jogging on ungiving concrete sidewalks, doing aerobic dancing or jumping on slab floors or doing exercise under even ideal conditions accentuates the stress, Tiberio said.

The body is “like a dam with water,” he explained. The dam can tolerate certain increases of water, “but if you keep adding to it and adding to it, it finally spills over.”

The most common exercise mistake people make is “too much, too fast,” said orthopedic and sports therapist D. Keith Kleven, director of the Las Vegas Institute of Physical Therapy and Sports Medicine.

“Today, moderation isn’t a popular word. But extremes aren’t needed for someone to be physically healthy,” said Kleven, who counts former heavyweight boxing champion Larry Holmes and many Las Vegas entertainers and dancers among his clients.

Overdoing it is a problem, even for the experienced exercise enthusiast, he said. He treated a 25-year-old woman who had been running for a while but, after participating in only two 10-kilometer runs, suddenly resolved to enter and finish a half-marathon.

After about six miles, she started started feeling pain in her knee and hip, and although it intensified, “she ran through it,” Kleven said. Two days after finishing the race, she hobbled into Kleven’s clinic, barely able to walk.

She was suffering from extreme muscle and joint inflammation, which was aggravated by her running in pain, he said. As she altered her posture and pace to accommodate the pain, she added new stresses to her body, Kleven suggested.

Today, the woman is running marathons, but it took a year of slowly building up to the distance, under Kleven’s guidance.

An exercise program must be molded to a person’s unique needs and physical requirements to be fun and successful, yet many people resist therapists’ efforts to individualize an exercise program, he said, adding that the people feel peer pressure to lift heavier weights or run harder and longer to keep up with or surpass their colleagues.

That is one of the inherent risks of joining an aerobics class, Huhn said. “There’s a problem individualizing it (exercise) when you’re in a group of 60 people,” he said. Add to that the fact that many classes have participants running and jumping on hard, ungiving surfaces, and the possibility for injury is increased, he said.

The physical therapist is uniquely qualified to design exercise programs because he or she can assess potential joint and muscular problems and prevent painful injury, Tiberio and Huhn advised.

California is one of 10 states nationwide that does not require a patient to get a doctor’s referral to see a physical therapist.

But the public thinks of a therapist as someone who treats pain, not as someone who relieves it, Tiberio acknowledged.

“Our profession has to be more aggressive about promoting what we can do,” he said. “We have to shift from sick care to health care.”

Despite their campaign, the therapists recognize that most people will embark on exercise without a physical evaluation first. So they advise people, in general, to begin at a moderate pace, perhaps starting with a walking regimen before tackling more strenuous exercise.

“The body responds well to small increments and it responds poorly to sudden increases,” Tiberio said. “And when the body starts hurting, back off.”

“ ‘No strain, no gain’ is not the case,” Huhn warned.

The therapists would not recommend one form of cardiovascular activity over another because it is important for the person to enjoy the exercise in order to stick with it, they said. Each form of cardiovascular exercise--running, rowing, bicycling, skating and aerobics--has its own benefits and risks, they pointed out.

At the therapist’s convention, Tiberio and Huhn presented a daylong session on injuries associated with cardiovascular exercise, which ended with a film of more than a dozen former heart patients who last year rode bicycles from Los Angeles to New York City during a 12-day relay.

The inspiring film showed the largely elderly men, members of Cardiac Cyclists Club, pedaling through the desert of New Mexico, the hills of West Virginia and storm-drenched streets in Pennsylvania before riding into New York City’s Central Park.

Follow-up studies on the club members, who participate in weekly rides ranging from 15 to 200 miles, indicate that their chances of dying of heart disease have decreased by 35% to 45% of the predicted rate for heart patients, physical therapist Randy Ice, the club’s director, said.