The foundation to any sport is the shoes the participant wears. As in running or other sports technological advances in design have led to a much more stable, high-performance shoe (Fig. 29.1). Additional changes in design have led to the newer breed of shoe known as the cross-trainers. These shoes permit the participant to perform aerobic dance while engaged in minimal short-distance jogging. With increased running incorporated into the routines, combined with lateral and back-peddling dance movements, the cross-trainer is a vital part of the aerobicizer’s standard foot wear.

One of the most important factors in injury prevention in step/bench aerobics is the keen observation of the instructor. Most aerobic instructors agree that technique is very important in the avoidance of dance injuries and that repetition is dangerous.

A study conducted of aerobic dancers has shown that an aerobic dance routine performed at a cadence that was extremely fast (over 128 beats per minute) did not allow for the participant to secure his/her entire foot on the bench. This can cause the foot to hang over the edge of the bench, causing strain or an enthesis of the Achilles tendon, as well as the posterior tibial tendon or the peroneal tendons. This can also lead to a strain of the medial or central bands of the plantar fascia, or the intrinsic musculature of the plantar aspect of the foot [1, 2]. Additionally, an over the top step off the bench can lead to a number of overuse impact injuries. These can include stress fractures of the lesser metatarsals, navicular as well as the tibia or fibula, sesamoiditis, tarsal tunnel syndrome, or the interdigital neuroma formation. Biomechanical considerations, and the use of prefabricated insoles or custom foot orthoses, may be needed for these foot conditions. If the participant extends the foot too far backward off the bench, hyperextension of the ankle with concomitant traction of the Achilles tendon can occur. If left undetected, and with repetitive loading, a chronic Achilles tenosynovitis, paratendinitis, or insertional calcinosis can develop. Knee alignment is also crucial in relation to the lower leg, as well as the placement of the foot on the bench. It has also been reported that striking the floor from the bench with repetitive impact can cause chondromalacia patella, patellofemoral joint syndrome, or chronic posterior shin splints [2]. It is imperative that the aerobics instructor surveys the participants before initiating activity to determine if any have pre-existing overuse injuries, or if there is a high risk for developing an injury. A pre-dance evaluation by the sports medicine foot specialist can determine—using visual or computerized gait analysis—if the participant is at risk for developing an overuse injury. Recommendations on flexibility stretching, proper shoe gear selection, and improved range of motion to foot, ankle, and knee can be made.

Older instructors who have been teaching for over 10 years, and have taken the proper certifying courses, seem to teach safer classes and know how to prevent the pitfalls of overuse injury. On the other hand, inexperienced younger instructors who have not yet developed those supervisory skills may be more likely to induce injury to participants.

There are a number of factors that can help lower the incidence of these overuse injuries: certifying instructors, carefully selected music (pacer per minute), smooth choreography, cueing to the beat of the music, as well as the participants taking the class. The predicament for the instructor is to choose between a safe and an efficient workout, while providing for an aggressive and challenging one that could lead to an overuse injury [2].

Prevention of injuries for the aerobic dancer athlete should be a concern for the sports medicine specialist. These aerobicizers train at high levels and often ignore the potential for injury. Many may actually dance through an injury similar to runners who run through an injury in order to continue to participate and avoid downtime. Many of these participants may have physical or psychological disorders (i.e., amenorrhea, anorexia nervosa, osteoporosis—the “female triad”) which can have serious repercussions when they first begin an aerobics class. The sports medicine specialist should be on the alert when interviewing the patient during the history taking, since any one of these diagnoses can render clues as to the underlying injury. Extreme weight loss, and/or stress fractures (particularly in the young female athlete), should raise suspicion for the sports medicine practitioner to look beyond the easily definable diagnosis and consider referral to the appropriate specialist [1, 3].

In a preliminary investigation by Ross of 329 participants surveyed, 153 claimed that they had suffered some discomfort or pain due to step/bench aerobics, whereas 163 claimed that they were symptom-free [1, 2]. Of those injured, 43 claimed that they had sought treatment by a foot specialist. Shoes seem to be another consideration, with 105 responding that they had some problem with their shoes (i.e., blisters, improper fit, not enough support, cutting off circulation, irritation), while 197 denied any problems with their shoes. The most common sites for the incidence of injury were the (1) knee, (2) calf, (3) Achilles tendon, (4) foot, and (5) shin.

Instructors interviewed during the study made the following recommendations: