This article originally appeared in the September 1985 issue of AB with the title, “Injuries Can Cripple Your Fitness Center.”
A facility manager approached me after one of my recent lectures on fitness center and aerobic dance injuries, incensed that I dwelled so heavily on the legal ramifications of such injuries.
“Our business is getting people fit and healthy,” he exclaimed, “and avoiding negligence lawsuits is a cold and impersonal motivation for providing safe and effective exercise facilities.”
Obviously new to the management world, he had yet to learn that knowledge is worthless without the motivation to use it. I’ve found in my travels that most fitness facility entrepreneurs are waiting for their first lawsuit before they wise up and do a facility safety makeover.
The Causes of Injuries
Fitness and recreation center injuries can be traced to six causes:
- Exercise equipment that is poorly designed
- Exercise and recreation facilities that are poorly designed
- Poorly qualified instructors
- Inadequate or faulty supervision
- Inadequate or faulty screening and assessment of new members to identify those at risk
- Prematurely high training or competition intensity in unprepared members (insufficient fitness for tasks attempted)
Preventing Exercise Injuries
The Selection of Well-Designed Exercise Equipment
Manufacturers, forced by the new rigors of competition in a rapidly expanding marketplace, are making equipment safer, more effective and tougher. Several have hired consulting “ergonomists” and industrial engineers to ensure that designs accommodate the staggering diversity of human anatomy and mechanics. Several, of course, are waiting for their first lawsuit, or in fact are in the midst of several. What should on look for in “smart” exercise equipment?
First and most importantly, is the body asked to perform an unnatural or dangerous movement? Are the limbs taken, or might they be taken, through and uncomfortable range of motion?
Take the common weight-stack pullover machine, available from at least 10 manufacturers, as an example. The range of motion available in many of these units, reaching as much as 240 degrees, far exceeds safe limits for the shallow and easily injured shoulder joint.
A few equipment manufacturers now provide “range-of-motion (ROM) limiter” on their machines. By restricting the extension that has damaged so many shoulders and other joints, these ROM limiters, when available, should make a significant impact on injuries caused by overstretching.
For equipment without a built-in limiter, try this trick:
With an instructor kneeling at the weight stack holding a second selector pin, have the member bring the pullover machine bar to a comfortable, overhead position. (Elbows will be slightly forward of the head, hands probably right at the head.) When the instructor inserts the second pin into the first hold showing above the unused weight stack, the bar can no longer travel further backwards.
This range-of-motion-limiting trick will work on every machine, though it is most commonly seen on pullover and leg extension units.
Body Must Be Stabilized
Is the body so poorly stabilized that the exercise movement will put the lower back at risk? Several machines unintentionally force repeated arching of the back while distant muscle groups are trained. If a strength machine is designed to isolate a muscle group, movement in all other body parts—especially the lower back—should be severely or completely controlled.
Do members of all heights, limb lengths and sizes fit the equipment comfortably? This is more than a matter of comfort—straining to fit a small body into a machine made for football linemen is a frequent cause of injury among women.
some machines should be avoided entirely, a point acknowledged by manufacturers who are slowly introducing machines downsized for smaller women and men. The pullover machine is again a good example, with its elbow pads frequently too wide for most women and anyone under 5 feet 6 inches.
Does the machine require an explosive movement? Debates about the value of explosive training for sport aside, the practice is undoubtedly a major cause of injury. A smart fitness director will totally forbid explosive movements in the facility, for impact forces can exceed 1,000 pounds and most of it usually finds its way to the neck and lower back.
Beware of Dangerous Quirks
Does the machine have any quirks which could, in a worst-case scenario, cause harm? Marring an otherwise fine aerobic training tool, the skis on the NordicTrack cross-country ski simulator by PSI are not fixed in their tracks. I have seen three falls in the past five years where the skis have been launched backwards when the user fell through lack of skill or concentration.
Pair this problem with the placement of a skier not eight feet from a lap pool in a facility I visited recently and you have a nightmare lawsuit just waiting to happen.
Believers in the benefits and otherwise low risks of indoor cross-country skiing can give the two ski simulators by Fitness Master Inc. a try.
Equipment purchases must be based on hands-on experience and thoughtful analysis. Bring along some friends too, preferably one about four foot eight and one about six foot eight.
Flooring Often the Culprit
The Design of Safe Facilities
Perhaps the most common contributor to fitness and recreation center injuries on the facility side is flooring, both in wet and exercise/aerobic areas.
Slips and falls around pools and showers can be largely prevented through the intelligent selection and proper installation of a surface, or the application of a clear, high-friction substance.
There’s also no substitute for the strictest possible enforcement of “no running or horseplay” rules.
Standing water on the pool deck is an invitation to disaster: proper drainage helps, and immediate attention by pool staff is a must.
In the fitness center, it’s the aerobic dance floor that’s most often blamed for the high injury rates. A wide range of choices is now available in suspended or padded floors, making a concrete subsurface lass hazardous and litigation-inspiring.
Using the quite times before or after your facility’s operating hours, do a thorough examination of the state of affairs.
In what condition are the stairways and bannisters, the carpets and flooring, the drainage in wet areas, the exercise equipment, the electrical fixtures? In a worst-case scenario, what might go wrong?
And don’t forget to check out the grounds of your facility. Falls from unshoveled and unsanded winter snowfalls lead the list of preventable outdoor injuries.
So used to seeing your facility that you’ve become blinded to its flaws? Bring in a qualified outsider to cast a critical eye.
It Pays to Hire Quality
Poorly Qualified Instructors
Even the simplest and safest tools can be misused. It’s up to you to ensure that your facility’s exercise tools are used correctly and safely.
While most machines are safe when used in the manner intended, the same machines can, when used incorrectly, cause surprisingly severe soft-tissue injuries.
Reason number one for equipment-related exercise injuries is poor instruction of the new member. Certainly, the fact that most manufacturers’ instruction manuals are either sketchy or nonexistent contributes to the confusion, but causes aside, there are ways to ensure good instruction.
- Pay for good quality instruction. There is a near-perfect correlation between the size of the salary and the quality of work in a fitness center employee. Minimum-wage instructors may start off like winners, but almost always evolve into minimum-care workers.
Scrimp and save everywhere you can to pay the highest possible wages, or offer the best profit-sharing plan, or reward with the best premium items. However you do it, remember that rewarded workers are better workers.
Where can good instructors be found? Not every center needs to conduct a lengthy search for master’s degree exercise physiologists. The physical education department of local colleges are probably the best source for less expensive but motivated and trainable fitness instructors.
The two premier aerobic dance certification groups, the Aerobics and Fitness Association of America (AFAA) and the International Dance and Exercise Association (IDEA) are good sources for qualified aerobic dance instructors. Potential instructors holding certification from these agencies arrive with no guarantees, but at the least are evidencing their motivation levels.
- Seek out and hire outside authorities to do inservice sessions with your staff. It would be safe to venture a guess that every city with a population over 10,000 has a local physical therapist or master’s degree of Ph.D. exercise physiologist who knows equipment and training techniques.
Contact the American College of Sports Medicine in Indianapolis for ACSM members in your community who might be of assistance. A half-day seminar might set you back several hundred dollars, but if you choose your consultant wisely, the result will be a staff that is not only well-trained but all teaching the same way.
It’s not unusual for fitness center members to be shown five ways to use a machine by five different employees. A good consultant will come armed with either clearly written handouts on equipment use or copies of some of the excellent books on equipment use and training. Such books are, in fact, an option for those who cannot or will not use an outside consultant.
- Create a library in your facility or better yet, invest a few more dollars and buy each of your instructors copies of relevant books. Reading should be both required and rewarded—and incentive systems might be developed to make sure that what is read is put into practice.
- Create (perhaps with an outside consultant) both a staff manual and a member manual that contains training tips and equipment use information.
- If manufacturers provide you with poor-quality instructional signage, buy or create something better. While most people may not read instructions, good signage may help the few that do and will be a sign of good intent in court.
- Give a book or books as a membership premium. Yes, as an author I do have an ulterior motive her, but there’s no better way to augment what your instructors teach a member than with a good book. Publishers are glad to open new accounts, and book discounts in the 25 to 50 percent range are common for multiple purchasers.
Inadequate or Faulty Supervision
I’ve separated instruction from supervision because in many clubs, new members are cared for and closely watched for a week or two and then left on their own.
What was once proper form degenerates rapidly to some hybrid training technique based on what they see others doing incorrectly. In a fitness-center version of the “telephone game,” members can be found a matter of weeks into their programs demonstrating sometimes-comical but usually dangerous training techniques.
What to do? The answer’s the same: money talks.
Instructors must know that you are watching, that you care and that you’re willing to reward competent and vigilant supervision. Again, use your wiles if hard dollars can’t be used as motivational tools.
Being a skier, my favorite example comes from Club Sports International, a fine Denver-based group that builds and operated major racquet and fitness facilities. CSI uses weekends at a company-owned ski resort condominium to reward employees.
Other groups use gift items that can be obtained at low cost from the thousands of companies in the premium business. I am continually amazed at how many fitness center instructors purchase exercise equipment for home use.
Arranging special discounts, or even giving equipment as a reward for excellent service, would sit very well with most of your employees.
Harking back for a moment to the question of how you can be motivated to use these suggestions. There’s one additional reason besides litigation-avoidance and altruism: the enormous marketing value you will get from high-care, quality employees.
Why are people in New York, Chicago and Los Angeles paying $1,000 a year and up for exercise? There are of course a host of contributing factors, but one that always emerges among the top three is good instruction and continuing supervision. Every center can install chrome machines and fancy lighting; too few actually take care of their members Those that do make money.
Stop Trouble Before It Starts
Inadequate or Faulty Screening and Assessment of Members
One highly effective way to prevent fitness center injuries and medical emergencies is to identify at-risk clients when they first join your club.
Such a process should always include, at the very least, a professionally prepared and carefully taken medical history. This questionnaire is then effectively augmented by fitness testing and, where economically feasible, a screening by a physical therapist.
A physician-signed release form, clearing the member for physical activity, will protect both you and the member. Will an “informed consent” form signed by the member, that acknowledges the risks of exercise, protect you in court? Very simply, it can’t hurt.
our medical questionnaire must elicit accurate information on the current medical condition of the member and his or her immediate family. Is the member presently suffering from any conditions that might affect participation in physical activity? Call his or her doctor.
I’ve been a consultant in several court cases where the failure of an employee taking a medical history to follow up on critical information helped decide the suit.
Is the member taking any drugs (prescription or otherwise)? Call his or her doctor. Several coronary care drugs (the beta blockers, for example) prevent the heart rate from climbing much above 130 beats per minute. An employee not aware of this would, in efforts to bring a member into the now-unattainable target heart rate zone, be risking serious trouble.
Is the member at risk of coronary heart disease because of a combination of coronary risk factors? (Smoking, family history of heart disease, obesity and inactivity being the top four.)
Are there previous orthopedic problems (broken bones, surgeries, etc.) that might restrict members’ activities? Have an employee review the completed questionnaire with the member present to that questions can be answered, blanks filled in, and details obtained.
Should you require a full, physician-supervised stress test for all adult members, or those meeting specific risk criteria? With the cost of such a test ranging from $150 to $300, ad with its less-than-terrific accuracy, few facilities are trying this. The combination of a good medical history and fitness test battery will probably identify those members who should be counseled to get a stress test.
Prescribing Safe Exercise
Why bother with a pre-participation fitness test battery? The primary reason is your resulting ability to write a personalized exercise prescription that will let the member work out at safe and effective intensities.
One of your major worries as a facility owner/manager is a coronary emergency, and while these can’t be totally eliminated, the identification of low-fitness individuals with shaky medical histories can help. As noted above, even full-blown stress tests are only 60 to 70 percent effective at detecting heart disease.
To provide sufficient data for an exercise prescription, your test battery should include strength, aerobic power, anaerobic power and flexibility components. An easily administered yet comprehensive test battery might include that following:
- Submaximal work capacity test on a bicycle ergometer to measure aerobic capacity;
- A Wingate test on a bicycle ergometer to measure anaerobic power (basically a 30-second, all-out sprint);
- A selection of strength measures (with existing strength equipment in your facility or using separately-purchased devices) to test the torso and extremities; and
- A selection of flexibility tests using a tape measure, a ruler and several easily-built devices.
You might consider devoting the member’s first two sessions to the test battery, and charging an initiation fee to defray expenses. Besides aiding you in providing safe exercise prescriptions, test results are great motivators, providing numerical and tangible evidence that your programs are doing their job.
Many of the more expensive fitness centers are utilizing the services of a physical therapist to prescreen members for orthopedic problems. The stability of the joints and the integrity of the musculoskeletal system, once subject to professional scrutiny, are no longer potential injury-causing question marks.
Too Much, Too Soon
Prematurely High Training Intensity
Even given good equipment, facilities, instruction, supervision and assessment, the average member will confound you nine times out of 10 by training too hard the moment your instructors turn their heads. This will be your most difficult injury-prevention task, and you instructors must be ever-vigilant. Too much, too soon, too fast is a major contributor to fitness center injuries, clearly deserving a heading of its own in this discussion.
In closing, go ahead—make my day. Prove me wrong in guessing that 95 percent of you will be thoroughly impressed by the advice offered here, yet do nothing about it.
About the Author
Michael D. Wolf, Ph.D., is president of International Fitness Exchange, a New York City-based consulting firm for the corporate and commercial fitness industry. He was formerly research coordinator for Nautilus Sports/Medial Industries, Inc., and an assistant professor at New York University.