Exercising Caution : Experts Warn That Aerobics Can Lead to Pain, Injury

The energetic, relentlessly upbeat commands of the instructor, the throbbing beat of the music, the support of a roomful of sweaty peers--all combine to make aerobics class a favorite mode of exercise.

But even as they help tone muscle and burn fat, the same factors can also contribute to pain or even permanent injury. Incorrect instructions, inappropriate music and simply trying to move like everyone else in the room can cause problems, says Ginny Miller, director of outpatient physical therapy at St. Joseph Hospital in Orange and Irvine, who frequently sees the results of those errors.

“A lot of people will come in for physical therapy,” she says, “and say something like, ‘I don’t understand, I was doing neck warm-ups just the way the instructor told me, following the music, and then I had this pain.’

“They get injured because they’re being taught to exercise incorrectly. You don’t do neck warm-ups, or any kind of warm-ups, quickly. And too many times they’re following the beat of the music, and it’s too fast.”

Even an experienced aerobics instructor can make serious mistakes, Miller says: “Just because they’re experienced doesn’t mean that experience lends itself to knowledge.”

Some common mistakes:

* Quick, choreographed warm-up moves, instead of slow, gradual, individualized stretches. This popular method can be especially risky for neck stretches and shoulder circles, Miller says.

* Deep knee bends. The risk of knee and hip injury far outweighs the benefit.

* Full sit-ups. They can harm the lower back and are gradually being replaced by less problematic, and more effective, abdominal crunch exercises that do not require a person to sit up entirely. One form of abdominal crunches keeps the small of the back pressed to the floor while shoulders are raised and knees are up and bent.

* Toe-touches with legs spread apart, reaching hands alternately toward the opposite toes. “That’s not a good position,” Miller says. “It’s not good to do when you’re lifting something, and it’s improper body mechanics at any time. As you get older, it’s more likely to get to you.”

Miller says she sees the results of these and other exercise mistakes frequently in her patients. But the problems are not limited to aerobics class.

Trendy exercise equipment and accessories in other areas of the gym can also lead to injury. Stair-climbing machines, for example, can provide not only a good aerobic workout but tone leg muscles--but only if the user takes small steps, as if pedaling a bicycle. Too many users, Miller says, assume they’ll benefit more by taking larger steps.

“I work with a lot of osteopathic doctors,” Miller says, “and they hate the (stair-climbing machine) because people don’t know how to correctly use it. They take these big giant steps, like two steps at a time, and it causes a lot of knee and hip injuries.”

If you are trying to burn fat as well as build muscle mass, it may be better to attack those goals one at a time rather than in combination.

True aerobic exercise burns fat: moving fast enough to raise the heart rate for a sustained period. But building muscle is best done more slowly and carefully.

One of Miller’s current patients, for example, is being treated for elbow pain. “She’s been doing free weights with very fast repetitions,” she says, “and she overcompromised her joints, just because of the fast movement.”

Combining aerobic movements with portable steps can also cause problems.

“Too many people hyperextend the knee, standing on the joint itself with no muscle support,” she says. “Using a step can be a good way to work out the quads and glutes and hamstrings (leg and buttock muscles), but if you use the joint instead of the muscles, you can wear out your knees real quickly.”

Another problem with using steps is that even those who exercise correctly with them risk injury before and after by using improper posture to pick them up, according to Rita Joseph of the Professional Fitness Instructors Assn. of Orange County.

In the association’s newsletter, Joseph wrote recently about the dangers not only of picking up steps improperly, but even such simple hazards as improperly bending over to tie a shoelace. (Kneeling is the correct position.)

Regimentation of aerobics classes or other group exercise activities can also be a problem, Miller says, because it does not take into account individual pre-existing conditions. And the flow of activity combined with peer pressure can make it awkward to skip or modify certain exercises.

“People should not be ashamed or embarrassed to do just what feels comfortable for them,” she says. “Peer pressure in an exercise class can make them do things that will compromise their well-being.

“People have to become more attuned to what they’re doing instead of looking around at the rest of the class. It may be better to do an individual program, or take only part of a class and then go do something else, like riding an Exercycle for the rest of the workout.”

For the average person, low-impact aerobics are not only a good exercise starting point but a good finish. Only those who are in peak condition and who have been exercising for years should graduate to high-impact aerobics, Miller says, and then only if they have no existing injuries or conditions that could be made worse by the pounding.

Age also has to be taken into account. Even if you look and feel young in your mid-30s, “your body is more vulnerable than it was when you were 26,” Miller says.

How can you tell whether the directions you get from an instructor are not right for you? The first step, Miller says, is to abandon the “no pain, no gain” myth.

“If it hurts, don’t do it,” she says.

Miller also suggests looking for an instructor who has had some kind of training or certification, such as that available at local community colleges. Organizations such as the Professional Fitness Instructors Assn. of Orange County also work to help members stay informed and keep up with current medical wisdom on various aspects of exercise.

“Consumers are becoming more aware now and asking what kind of background these people have,” Miller says.