Whenever I speak at fitness industry events, I always tell my fellow fitness comrades that they must do everything in their power to elevate the profession.  I live in both the “rehab” and “training” world daily.  I can tell you unequivocally that the words “personal trainer” do not garner tons of respect in the medical community in many cases.

I will share a personal story from my professional work experience this week that illustrates why.  Yesterday, I evaluated a new patient (45 y/o male) who just underwent an ACL allograft reconstruction and medial meniscectomy for  a medial meniscus tear.  See the image below for an illustration of an ACL tear.


When I asked the patient how his injury occurred he replied, “I tore my ACL doing a plyometric workout with the personal trainer at my work.”  Ouch!  Naturally I wanted to know more.  So, I pressed him for more information – things like:

  • What kind of plyometrics
  • How many
  • Were they at the beginning or end of the session
  • How long had you been doing them

Let me tell you that a lot of therapists would not have asked these questions.  They would have moved on in the evaluation, dismissing this trainer as an incompetent fitness pro in their mind.  The fact of the matter is that bad things do happen at times even when we are doping everything just right so I like to give people the benefit of the doubt in most cases.

However, some of his answers led me to believe this particular trainer needed further education.  My client said the entire 30-40 minute workout was plyometrics. He was doing single leg multi-directional hops, but actually tore the ACL during a broad jump.  He mentioned he had only done a handful of the workouts before getting injured.  The kicker was when I asked him if anyone else in the class had been injured, and he remarked that another man recently tore his Achilles tendon.

Now, I try not to be too judgmental, BUT I want to use this situation as a teaching point for fitness professionals and consumers.  I want to briefly point out a few things with respect to this incident and training adult clientele:

  1. Plyometrics are an advanced form of training and should not in my opinion be used as general conditioning for extended periods of time or an entire workout for middle age people not participating in high level sports
  2. Plyometrics should only be done after a thorough dynamic warm-up to ensure that soft tissue is prepared for maximal stretch and impact
  3. Plyometrics should always be done in the beginning of the session (in this case it was the only modality used) as it is very fatiguing and requires a high energy output
  4. Plyometrics should always be done in a slow deliberate progression with emphasis on low intensity, low volume jumps prior to progressing to high intensity, high volume training – I recommend starting with only 40-60 foot contacts initially to gage the client’s response to the modality.  Single leg hopping is a much higher demand activity as it places the entire body weight on one leg.  This is not an appropriate “class drill” as it requires such a high level of skill and teaching/supervision.
  5. In my opinion, plyometrics are contraindicated for clients with previous knee injuries, surgeries (e.g. meniscus repairs – this client had one in each knee already prior to this injury) arthritis, or instability because the risk over time outweighs any reward in the short term

I could go on, but I think you probably are getting the point.  What would I do differently?  Well, without seeing one of this trainer’s sessions it is hard to say for sure.  But, clearly with an ACL and Achilles tendon rupture, the class design is flawed.  While I am not saying all 45 y/o clients should never do a single plyometric activity, I am saying you should think carefully before doing such on regular basis or as the singular focus of the session.

It bears mentioning the client I am seeing is a rather athletic and fit 45 y/o male as well who on appearance would seem able to do such things.  The take home message here for consumers and trainers is really twofold:

  1. Designing an exercise program really is an exact science and every movement and load imposes significant force on the body
  2. Exercise is repetitive and as such the cumulative effect may have undesired consequences if it is not applied properly and customized to meet the capacity, demand and goals of the respective client

My goal is to prevent these types of injuries and elevate the fitness profession by speaking, writing and sharing experiences like this.  If you are a client or trainer reading this, never hesitate to post a question on my blog as I want to help you stay fit and prevent injuries at all times.