Risk vs. Reward: Reduce Risk of Injury Without Reducing Results

As personal trainers and fitness instructors we manage risk all day. Designing workouts that deliver results, while keeping clients safe. Leading classes while managing different fitness levels. Every workout, no matter how short, heavy, long, or light, comes with risk. The truth is, every decision we’ve ever made or ever will make has at least some inherent risk. But how can we balance risk vs. reward with regard to client fitness?

We can sometimes intuitively project the risk of our actions versus the rewards. A 300lbs back squat can give us strong legs, or, it could injure our back. A long hike can give us a strong heart, or a snake bite. Maybe a particular client should spend a few months developing hip flexibility or core strength first, before loading up the squat bar? Or maybe the client should expect only two pounds of fat loss per month instead of striving for five? The infinite variables involved in every action can sometimes make it difficult to discern if the risk is worth the reward. But research in economics, psychology, and behavioral sciences can help.

Injuries and Stats

According to the National Safety Council (NSC) 468,000 injuries, sustained during exercise, were recorded in the U.S. in 2019. This includes injuries from various pieces of equipment and non-equipment injuries. The NSC recorded over 2.5 million sports-related injuries in 2019 from a number of other categories as well, like basketball, football, cycling, and swimming.  Youth seem to lead the board in instances of injury. This makes sense, as children usually participate in many more hours of sports and physical activity than adults. It’s important to note that playground-related injuries are also included in the NSC report.

But in the past two decades there has been a significant increase in the number of injuries for persons who are 45 years of age and older. This coincides with the over 10% increase in the amount of Americans who are exercising in general which might lead to the conclusion that rate of injury has only increased a small amount, while the overall outcome has increased by quite a bit. Muscle pulls and sprained ankles are among the most common types of exercise-related injuries, so are shoulder and knee injuries, shin splints, and tendinitis (webMD). Since 2012 there has been an even more notable increase of exercise-related injuries. According to a 2019 article in The Journal of Sports Medicine and Physical Fitness, this increase was closely correlated with an increase in interest in HIIT exercise. 

Economic theory, like Goodhart’s Law, dictates that when one measure of a system is changed (in this case, the intensity of exercise) the other measures will be affected (for instance, the safety of that exercise). What can, and should, fitness professionals do to help curb the incidents of injury for their clients, and the community in general? Understanding risk, reward, and everything in between can help answer that question.

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Risk vs Reward

Through the lens of classic economics, humans make decisions by weighing the value of potential losses, versus the value of potential gains, better known as risk vs. reward. If the gain from an action equals more than the loss, then the choice is made to pursue that particular action. This theoretically takes into account, among many other variables, all of the potential outcomes, all of the missed opportunities (opportunity costs), and the assumption that all value is empirical, or at least comparable in some way. In reality, humans don’t work this way.

What really happens when people make decisions is that they reference the things in their memory that are most prevalent, adjust based on their environment and community, and make a choice (Khanemman).

For example, if rock climbing has been on someone’s Instagram feed a lot, or they saw a documentary about Yosemite recently, they live near the mountains, and have a friend who climbs, they might make a decision to pursue rock climbing as a means of exercise. Rock climbing, although generally safe, requires a lot of special equipment, requires dangling from ropes, and has a huge learning curve. The risks are undoubtedly higher than moderate weight training and walking around the park, but only on paper. What’s more difficult to quantify is that person’s motivation, available resources, and social identity.

The nuance of decision-making relies quite often on various environmental factors. What type of people are in the subject’s “circle”. Although pilates, yoga, and obstacle course racing are all equally as effective a workout, the subject might emotionally or psychosocially identify with one more than the others.

But there are still more blatant factors that we recognize when making decisions, usually to our benefit. Does the workout require the participant to dangle from 50ft in the air? It’s easy to see that as riskier than doing a low-impact pilates mat class. Sometimes the line between low and high risk can be less obvious. Performing 30lbs overhead bar presses can potentially be more dangerous than a downward dog…or not!

Determining the best practices for our clients can require that we take the time to do proper assessments of strength and mobility. Taking the time, maybe even multiple sessions, to determine max strength. And perhaps most important, determining what kind of workouts the client is comfortable, and most focused during.

Possibility vs Outcome

Rock climbing is again, a great example, for measuring the two factors that makeup risk: possibility and outcome. In the rock climbing vernacular the difficulty of climbing routes, both indoor and outdoor, are rated on a unique scale from 5.0-5.16. Each route is rated, based on some subjective, comparable attributes, by the climbers themselves. Depending on the skill level of each climber a 5.7 might be difficult and pose the risk of falling, or it might be as easy as climbing a ladder. The individual climber can assume what the possibility of a fall will be. This rating system, however, does not suggest what will happen if the climber does actually fall.

This is where outcome comes in. Often a climber will be secured by a safety rope attached to the rock above them. If they fall, the rope catches them, providing a reasonable degree of safety. But in other circumstances, a climber will secure the rope to “anchors” on the wall as they climb. This is known as “lead climbing” and can still be relatively safe. If the anchors are set four feet apart, then the climber has the potential to fall eight feet.

Here’s where risk gets more complicated. If there is a jagged rock 7 feet below the climber, the outcome can be a broken spine. Rock climbers usually apply an X  to a rating to demonstrate that there is a particularly risky fall. So a 5.7X has a low risk of falling, but a high risk of injury if someone does fall. Conversely, a 5.13 will be hard to accomplish, but the fall might be perfectly safe.

When it comes to programming workouts for classes and clients, the possibility and impact of injury should both be considered. 

Reduce the risk of injury by:

• Warming up properly
• Establishing balance + fundamentals of movement early
• Using proper equipment
• Safety checking equipment regularly
• Spotting clients and paying attention
• Communicating clearly with clients
• Maintaining a clear exercise area to reduce trip and fall accidents
• Ensuring proper form is followed at all times

Providing a physically and emotionally safe, comfortable workout for our clients is our top priority. But providing a challenge and results is important too. Set a strong foundation for healthy movement and performance, and continue to provide professional attention and you can significantly reduce the risk that your clients face during workouts.

 

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References:

https://www.iii.org/fact-statistic/facts-statistics-sports-injuries

https://www.cdc.gov/nchs/data/nhsr/nhsr099.pdf

http://apppm.man.dtu.dk/index.php/Impact_and_Probability_in_Risk_Assessment

Injuries sustained during high intensity interval training: Are modern fitness trends contributing to increased injury rates? February 2019The Journal of sports medicine and physical fitness 59(7) DOI:10.23736/S0022-4707.19.09407-6  Brianna Siracuse, Nicole Rynecki

https://www.webmd.com/fitness-exercise/guide/workout-injuries-prevention-and-treatment#1

Kahneman, Daniel (2011). Thinking, Fast and Slow. Farrar, Straus and Giroux. ISBN 978-1-4299-6935-2. Retrieved March 10, 2016.