It was a seemingly normal workout: a high-powered circuit of pull-ups, push-ups, and squats. "Difficult, yes, but done in 20 minutes," says Shari Becht, a 40-year-old chef in Highland Ranch, Colorado. Seventy-two hours later she knew something was seriously wrong. "I couldn't believe how big and heavy my arms looked," she says. They were so swollen and sore she could barely straighten them, and her fingers tingled. Worried, Shari rushed to her doctor, who did blood work. "The next afternoon, I got a call saying, 'We have a hospital bed waiting for you,'" she remembers.
Shari was diagnosed with exertional rhabdomyolysis, a condition brought on by intense activity in which muscle fibers break down and release electrolytes and proteins into the bloodstream. One of the proteins, myoglobin, can occur in such high concentrations that it overwhelms the kidneys, which can lead to kidney failure or death. Shari spent three days in the hospital hooked up to a saline IV drip to flush her kidneys. Two years later the experience is still fresh: "My biceps have damaged muscles cells and still swell up sometimes, so I avoid working them now because I'm terrified of getting rhabdo again," she says.
Even though Shari's experience is an extreme example, workout injuries routinely happen. Each year, more than 174,500 women end up in the ER with an exercise-related injury, according to the most recent government data. "Everyone gets hurt at some point, no matter what activity they choose," says Lewis G. Maharam, MD, a sports medicine doctor in New York City. "Most commonly, it's from doing too much too soon or from moving your body in a way it's not accustomed to."
With so many of today's hard-core fitness trends focused on pushing you past your limits, it's easy to get carried away. We asked experts for advice on avoiding the risks of the most popular workouts to ensure that your routine is all gain and no pain. Follow this guide to stay safe and sweat happy.
Active Threat: Overuse injuries
A review study in the British Journal of Sports Medicine found that up to 80 percent of recreational runners who log more than three miles a workout eventually suffer a lower-body injury, such as hip pain, runner's knee, shin splints, and tendinitis. Ramping up mileage too quickly, overtraining, and pushing past aches are often to blame.
Another common mistake is choosing the wrong shoes, which can throw off lower-body alignment, says Dr. Maharam, who is the author of Running Doc's Guide to Healthy Running. And while many runners swear by minimalist shoes, making the transition to them too quickly stresses the bones in the feet, which can cause fractures, a new study shows.
Workout Rescue: Increase your mileage by 10 percent every week or, if switching from the treadmill to outdoor running, cut your mileage in half and then build up by 10 percent. Get fitted for shoes at a running specialty store, where there are experts on hand to do a gait analysis.
Active Threat: Knee injuries; strained muscles, tendons, and ligaments; lower-back pain
Last year, yogis everywhere let out a collective Om-M-G when author William Broad asserted in his book The Science of Yoga that yoga headstands and other poses could cause strokes. It's possible: dropping your head back too far can kink and injure the major arteries that feed the brain, injure a blood vessel, and trigger a stroke, says Kathleen Summers, MD, PhD, the founder of TheYogaDr.com. Luckily, that's very rare.
The biggest threat in any yoga class by far is your ego, especially when you push yourself to keep up with everyone else. That kind of overzealous attitude is common in today's increasingly athletic and competitive yoga classes and may lead women to pretzel themselves into extreme postures, Dr. Summers says. It's one reason more than 10,000 people were treated for yoga-related injuries in 2011 — nearly double the number in 2007 — according to the most recent government data. Meniscus tears (from knee-twisting lotus poses), lower-back pain (forward bends can put pressure on and herniate disks), Achilles tendon tears (from squatting), and rotator cuff injuries (from flowing sequences that put weight on the hands) are common injuries, researchers at the University of British Columbia found.
Another concern: "Many instructors physically push students deeper into poses, which is dangerous because by the time you squeal ouch, they may have stretched you far enough to damage ligaments and tendons," says Roger Cole, PhD, a certified Iyengar yoga teacher in Del Mar, California, who has a doctorate in health psychology.
Workout Rescue: Find a happy balance between slacking off and Super Yogi. While in a pose, you'll notice specific muscles, like your hamstrings, stretching. It will feel mild at first, then as you push deeper, the sensation will build in intensity from moderate to strong, to painful. "Stop deepening the stretch at the mild to moderate stage," Cole says, and hold the pose while maintaining your alignment. Don't bend your neck to extremes, and avoid rolling it from side to side when it's flexed or extended. Tell the instructor before class that you would prefer not to be touched or guided into poses.
Active Thread: Rhabdo, muscle strains, ligament tears, stress fractures
CrossFit is jam-packed with exercises — squats, pull-ups, box jumps — done at a high intensity, at a fast pace, and with little rest. There's a lot of room for error, and much of it stems from inexperience.
"You're doing complex, difficult, dynamic, and explosive multijoint exercises in CrossFit that are demanding on the body and require the proper technique," says Scott Levin, MD, an orthopedic surgeon in Mount Kisco, New York. He frequently sees muscle strains, particularly in weak or untrained hamstrings and calves; torn ligaments and stress fractures are also on the rise because of CrossFit-type workouts, a study in Current Sports Medicine Reports found.
While Shari Becht's case of rhabdo stemmed from a workout she did on her own, the condition "has been anecdotally associated with extreme exercise programs like CrossFit," says Francis G. O'Connor, MD, a professor of military and emergency medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and an expert on rhabdo. The CrossFit community is on alert. In 2011, the CrossFit Journal noted "in recent months, there have been a few incidents of rhabdomyolysis ... some of which could have clearly been avoided with more precaution and concern for our newest ... members."
One possible culprit is the pressure on participants to increase intensity and weight too soon. Ultimately, you're responsible for going at your own pace, but you're only as good as the coaches at your gym, says Noal DuBois, the founder of CrossFit Defined in Chicago. "Some gyms celebrate the amount of weight you lift over proper technique and form or brag about how hard their workouts are," he says.
Workout Rescue: Find a good CrossFit gym by asking if they have an "on ramp" program, which introduces you to new movements, teaches form and position, and analyzes any flexibility issues you may have. "Your coach should be invested in you and your well-being and know about past injuries," DuBois says. (Check Yelp.com reviews to get a sense of the prevailing attitude at the gym.) Each exercise should be modified to match your ability. For example, start practicing Olympic lifts (a move in which you lift a barbell from the ground to your shoulders and then overhead) using a PVC pipe before you progress to an unweighted barbell and, finally, to a weighted one. "If your form breaks — your knees fold in toward each other or your back rolls in — it's too heavy," DuBois says.
Although rhabdo is rare, it can happen after just one workout, so know these signs: cola-colored urine, severe muscle soreness, swelling beyond what's normal, and a limited range of motion (for example, you can't lift your arms over your head). If you experience any of these symptoms, see a doctor stat. To prevent rhabdo, don't push yourself beyond your abilities. Skip your workout if you're sick (especially if you have aches, chills, or a fever) and resume it slowly after an extended break, as a recent illness may make rhabdo more likely, Dr. O'Connor says. Strength-train the same muscles no more than three days a week to allow them time to recover. And don't pop any performance-enhancing dietary supplements (especially those with caffeine); they may increase your risk of rhabdo.
Active Threat: Getting hurt by a weight, joint injuries, muscle strains
There was a 63 percent increase in weight-room injuries among women over a 12-year period (17 percent higher than in men), a 2010 study found. Dropping dumbbells or smashing body parts with them accounts for 75 percent of cases. Weight machines can be a hazard as well. "They're designed to fit men's bodies, which can throw off a woman's form when she's using them," says Robert Forster, a physical therapist in Santa Monica, California. "And research shows that, in general, females have less upper-body strength and a smaller bone structure than men do to support weight, which puts them in positions that strain muscles when they lift."
Workout Rescue: Whether you're using free weights or machines, start small (if everyone in class is picking up 10-pound weights, don't be shy about grabbing eight-pounders), ramp up gradually by increasing the number of reps before upping the weight, and keep movements slow and controlled. If you have questions, talk to a trainer at your gym. And avoid the following, which Forster says are downright dangerous.
SKIP: Knee-extension machine Extending the knee from such a flexed position creates compressive forces between the back of the kneecap and the thighbone, eventually wearing down cartilage there. Worst-case scenario: osteoarthritis.
TRY: Leg-press machine or squats They evenly distribute forces throughout your lower body to take pressure off your kneecaps.
SKIP: Behind-the-neck lat pull-down The pull-down motion forces shoulder joints to work in poor alignment; leaning forward strains neck muscles.
TRY: Lat pull-down done right Lean back slightly and pull the bar down to the front of your chest.
SKIP: Seated torso twist This exercise puts excessive pressure on lower-back disks, so much so that it can cause a disk herniation.
TRY: Straight-arm lifts To target your deltoids, stand holding free weights, arms by sides, with thumbs pointing up, then raise weights to shoulder level in front of your body. Do push-downs on the lat machine to work your triceps.
Active Threat: Knee and pelvic pain
Because it's low impact, indoor cycling is one workout that rarely sends patients limping into doctors' offices. The main danger is a knee injury; this type of cycling triples the risk of suffering one, a study in the Scandinavian Journal of Medicine & Science in Sports found. Knee joints repeatedly flex and extend during pedaling. If a kneecap doesn't track just right in its groove, patellofemoral pain syndrome, or runner's knee, can occur, explains Edward Laskowski, MD, the codirector of the Mayo Clinic Sports Medicine Center in Rochester, Minnesota. "But as long as you set up your bike in the right position, you should stay pain-free," he says.
That's advice Jacqueline Farrell Fish, 40, of Washington Township, New Jersey, wishes she had gotten. She furiously pedaled through an entire class with her seat too high — and tore her quads. "It took almost a year for them to heal completely," she says.
Errors in saddling up can also strain your back, neck, and shoulder muscles, and even your pelvis. If your handlebars are too low, your pelvis is forced to tilt toward the seat, resulting in pain and even numbness, a recent study in the Journal of Sexual Medicine found.
Workout Rescue: Follow this bike setup advice from Lauren Bruker, an indoor-cycling instructor for SoulCycle in New York City.
- Stand alongside the bike, facing the handlebars, and raise your knee 90 degrees. The seat height should be level with the spot where your thigh meets your hip.
- Adjust the distance from the front tip of the seat to the handlebars so that it's the length of your forearm.
- Set the handlebars level with the seat.
- Get on and start pedaling slowly. Any soreness in your back or knees is a sign that you need to readjust.
Down and Dirty — and Dangerous
Tough Mudder. Spartan Race. Warrior Dash. Muddy adventure races are the latest way women are testing their physical and mental mettle. Packed with obstacles like barbed wire, frigid waters, and fire, these events bring major bragging rights and serious risks.
"They are extreme obstacle courses that you need to specifically train for, even if you're already athletic," says Sabrina Strickland, MD, an orthopedic surgeon at the Hospital for Special Surgery in New York City who has treated injuries in female adventure racers. In April a 28-year-old man died during a Tough Mudder in West Virginia; three deaths and injuries resulting in paralysis have occurred at events by other organizers. No wonder most of these races have so-called death waivers that you need to sign to participate.
Still want to do one? "Don't be afraid to skip an obstacle or drop out of a race entirely if you don't feel safe," Dr. Strickland says.
Enter at Your Own Risk
Rob Dickens, the chief operating officer for Rugged Races, a nationwide 5K mud run with 50 percent female participation, breaks down the obstacles you may face during a race — which will be listed on the waiver you'll sign — and offers tips for conquering them safely.
Waiver Warning: Thick smoke and open flames
Translation: Prepare to jump over fire. Run fast (if you're too slow, it'll be hard to clear) and keep your eyes on the ground in front of you to avoid rubble that can trip you up — and into the flames.
Waiver Warning: Traversing muddy areas
Translation: You'll crawl through mud pits or pipes filled with the stuff. Wear tight-fitting athletic clothes (baggy duds create drag or get snagged, slowing you down), shoes designed for off-road running, and sports sleeves to protect your arms from sharp rocks and sticks.
Waiver Warning: Contact with barbed wire
Translation: Yes, you will be crawling under real barbed wire. Through mud. Stay down on your belly.
Waiver Warning: Erratic coparticipant behavior
Translation: These races can bring out the worst in people who thrive on the testosterone-fueled vibe. Competitors acting crazy? Get out of their way and report them to event staff.
Waiver Warning: Collisions with other participants
Translation: Before jumping from climbing obstacles — like 12-foot barricades and 40-foot cargo nets — look down and make sure a fellow racer isn't beneath you; get out of the way quickly when you land.
Originally published in FITNESS magazine, July/August 2013.