PT on the Net Research

Avoiding Pain and Injury in Group Classes


Learning Objectives:

  1. The reader will learn about the most common injuries group fitness attendees experience and what causes them
  2. The reader will learn three assessments they can teach to group fitness classes to help attendees uncover their individual musculoskeletal imbalances
  3. The reader will learn a series of corrective exercises they can teach to group fitness classes to help attendees alleviate their aches and pains and reduce the risk of injury while they work out

Many fitness professionals believe that in order to assess and correct someone's musculoskeletal imbalances you need to work one-on-one with them.  While this is conventional practice, many assessments and corrective exercises can be applied in a group setting to help numerous individuals at once improve their function and alleviate aches and pains. This article outlines three assessments and a series of corrective exercise warm-up strategies that can be used at the beginning of any exercise class/workout to ensure your participants remain free from pain and injury.

Common Goals

Group fitness classes are a fun, dynamic, affordable and social way to help people reach their fitness goals.  However, instructors have to consider so many variables like planning and executing each work out, cueing the group, coaching individuals who need help with technique or motivation, safety concerns, arranging music and organizing equipment that not all participant movement dysfunctions can be addressed and/or corrected as they arise.  The warm-up stage of a group fitness class, however, provides the perfect opportunity for instructors to utilize assessments and corrective strategies to help attendees address underlying musculoskeletal imbalances before they work out.  Doing so minimizes the chances participants will get injured as they exercise and maximizes their potential for reaching their fitness goals.

Common Injuries

A typical group fitness class contains weight-bearing exercises involving multi-planar movements like squats, lunges, running, jumping, bending, twisting, throwing, pushing and pulling. Yet most people have musculoskeletal imbalances and movement dysfunctions caused by past injuries/surgeries, lifestyle habits, stress, occupation, handedness, sports, and exercise choice (McGill, 2002).  When these imbalances/dysfunctions are combined with the dynamic and impactful movements of mainstream group fitness classes, it can lead to serious problems as other parts of the body have to overwork or compensate.  As a result, pain and  injuries such as plantar fasciitis, Achilles tendinitis, runner’s and jumper’s knee, meniscus tears, hip bursitis, sacroiliac joint dysfunction, disc degeneration and herniation, rotator cuff problems, tendinitis and muscle strains are not uncommon experiences for participants of group classes (Whiting, et. al., 1998).

Common Causes

There are many common musculoskeletal imbalances that can lead to pain and/or injury.  Three of the most problematic imbalances are found in the ankles, hips and spine.  Below you will find an explanation of these imbalances, a simple assessment for each you can use to uncover issues, and a list of corrective exercises you can incorporate into your class warm-up to help participants eliminate musculoskeletal and movement imbalances before they work out.

Imbalance #1 - Lack of Dorsiflexion

Running, squatting, jumping, bending and reaching forward all require the ankle to bend forward (i.e. , dorsiflex).  This bending movement of the ankle helps the knees and hips to flex and ensures tension is transferred throughout the body.  However, if the ankle cannot bend forward, this limits knee and hip flexion which can lead to injury.  Additionally, if the ankle cannot bend forward, it must rotate excessively inward instead to transfer the weight of the body from above.  This inward rotation of the ankle causes excessive rotation of the knees, hips, pelvis and lower back which can lead to pain and dysfunction in any of those areas (Price & Bratcher, 2010).

Imbalance #2 - Lack of Hip/Leg Extension

The hip/leg complex needs to be able to extend during movements such as stretching in yoga, lunging (i.e., upward facing dog, warrior poses), running, and arching your back to reach over your head.  If the hip/leg is unable to travel behind the torso (i.e., extend) effectively, then the structures of the knee, lower back, shoulders and neck have to take up the slack and can get injured as a result (McGill, 2002).

Imbalance #3 - Lack of Thoracic Spine Rotation

Rotational movements of the torso when the feet are in contact with the ground, such as when dancing, running, throwing a medicine ball, changing direction, and executing wood chopping-type exercises all require the thoracic spine to be able to rotate to create momentum as well as to help dissipate stress throughout the entire body.  If the thoracic spine cannot rotate sufficiently, the force generated by the rotation of the legs and opposing swinging of the arms (and/or equipment being held) is transferred to the structures of the lower back and shoulders. Over time, this can cause strain and/or injury (Cook, 2010).

Group Assessments

The following assessments should be performed at the beginning of each workout.  Coaching your clients to evaluate their own body and the mobility of the structures being assessed enables you to direct them to the warm-up exercises best suited for their individual needs.

Assessment #1 - Asssessing Dorsiflexion

Coach class attendees to kneel on their left knee and place their right leg forward so the knee of their right leg sits directly over their right ankle (use a pad or mat under the knees if necessary).  Instruct class members to gently push their right knee forward as far as they can comfortably without letting their right heel come off the ground (see Picture 1).  As they are bending their right knee forward, ask them to evaluate the ease with which their knee can come forward over their right foot (i.e., dorsiflex).  Then have then perform the assessment on their left side.  Instruct them to make a mental note of which side (or both, as the case may be) feels tighter or is more difficult to do. If you are conducting your class indoors, coach your attendees to do this near a wall so they can place their hands on it for balance.  Participants who find it challenging to bend their ankle (and knee forward) lack dorsiflexion.


Picture 1: Assessing Dorsiflexion

(Note: indoor version shown with hands on wall)


Assessment #2 - Assessing Hip/Leg Extension

Coach class attendees to lie on their back with their right leg straight and reach their right arm over their head until it touches the ground.  Then have them hug their left knee to their chest with their left hand (see Picture 2).  Instruct participants to make a mental note of the amount of space between the back of their right leg and the ground, the arch on the right side of their right lower back, and the ease with which their right arm can go straight over their head to the ground.  Repeat the assessment on the opposite side of the body and then have them evaluate which side (or both, as the case may be) they find it more difficult to get their leg in contact with the ground without overarching their lower back or turning their leg outward.  If anyone experiences shoulder pain when lifting their arm above their head, simply tell them it is acceptable to bend their arm slightly; this will help the shoulder feel better. Participants that cannot place their leg straight on the ground without overarching their lower back or bending the knee lack adequate hip/leg extension.



Picture 2: Assessing Hip/Leg Extension

Assessment #3 - Assessing Thoracic Spine Rotation

Coach class attendees to lie on their back with their knees pulled up to their chest and their arms out to the side. Instruct them to lower their bent legs to the left side of their body and evaluate if their right shoulder comes off the ground when they do this (see Picture 3). Then have them switch sides and lower their bent legs to the right side of their body and see if their left shoulder comes off the ground.  Have them make a mental note of which shoulder comes off the ground (or both, as the case may be).  Participants whose left shoulder comes off the ground lack the ability to rotate their thoracic spine to the left, while participants whose right shoulder comes off the ground, lack the ability to rotate their thoracic spine to the right. This assessment can be made easier for participants by having them place a foam roller or similar piece of small/light equipment between their knees as they drop their legs to one side.



Picture 3: Assessing Thoracic Spine Rotation

Group Corrections

To encourage better mobility in those areas of their body that your attendees have gauged to be problematic, begin your class warm-up with some self myofascial release exercises on the soft tissue surrounding the joint/structures in question (Rolf, 1989).  The most simple and effective way to perform these exercises in a group setting is to use a tennis ball.  Inexpensive and easily transportable, you can either provide a tennis ball for each of your attendees or instruct them to bring their own to class.  As time is limited before a class, it is not necessary for attendees to perform all the tennis ball techniques outlined below.  Rather, instruct each person to perform the exercises that are unique to the imbalances they discovered about themselves during their self-assessments. Once attendees have completed their self-massage exercises, they can perform the stretches for their specific imbalance.  You can then then proceed with your usual full-body class warm-up.

Watch the video below to see demonstrations of each assessment.



Following are a number of corrective exercises designed to address each of the imbalances discussed above.


Exercises to Improve Dorsiflexion

In order for the ankle to bend when the knee is also bent, the soleus muscle must be flexible. The quadriceps muscles must also be flexible to allow the knee to bend with the ankle.  As such, soleus and quadriceps flexibility is imperative to improving dorsiflexion.


Tennis Ball Self-Massage Techniques
Tennis Ball Under Calf Tennis Ball On Quads
Place ball under calf and massage any sore spots for 1 to 2 minutes each leg. Place ball under front of thigh and massage any sore spots for 1 to 2 minutes each leg.

Stretches
Soleus Stretch Quadriceps Stretch
The kneeling assessment that was performed to assess dorsiflexion can also be used to stretch the soleus muscle. Grab right ankle with right hand to stretch the front of the thigh. Use a balance aid if needed. Tuck pelvis under while pulling foot toward the butt. Repeat on other leg.

Improving Hip/Leg Extension

The hip flexors and gastrocnemius must be flexible to allow the extended leg to travel behind the body correctly when the foot is in contact with the ground (i.e., hip/leg extension).


Tennis Ball Self-Massage Techniques
Tennis Ball Under Calf Tennis Ball On Hip Flexors
The same self-massage technique used for the soleus (above) can be used for the gastrocnemius since both calf muscles lie on the back of the lower leg. Place ball under front of hip/abdominals and massage any sore spots for 1 to 2 minutes each side.

Stretches
Gastrocnemius Stretch Hip-Flexor Stretch
Stand in a split stance with feet pointed forward.  Tuck pelvis under and gently lunge forward keeping the heel of the back foot in contact with the ground. Kneel with one foot forward and tuck pelvis under. Raise the arm of the leg you are kneeling on to increase the stretch.

Improving Thoracic Spine Rotation

The oblique muscles wrap around the torso from the rib cage to the pelvis. They must be flexible to allow thoracic spine rotation.


Tennis Ball Self-Massage Techniques

Tennis Ball on Abdominals Tennis Ball On Back of Ribcage
Place ball on front of the torso anywhere between the top of the pelvis and bottom of the rib cage. Massage any sore spots for 1 to 2 minutes. Place tennis ball to the side of the spine on mid- to upper back. Massage any sore spots for 1 to 2 minutes each side of spine. Do not place ball directly on the spine.


Stretches

Diaphragmatic Breathing Lying Rotation Stretch
Take 10 diaphragmatic breaths to help stretch and mobilize the rib cage and thoracic spine before working out. The assessment for the thoracic spine rotation can also be used as a stretch to help improve mobility of the torso.

Conclusion

Empowering the attendees of your group classes to learn how to assess and improve their musculoskeletal condition before working out can not only help them alleviate their daily aches and pains, but decrease the likelihood that they will injure themselves in your class and increase their chances of succeeding.

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