Better and Not Broken
January has arrived, and with the new year comes a sudden surge in fitness participation. January’s well-intentioned training efforts produce many of the physical therapy patients we treat in February and March. Fitness folks that morph into physical therapy patients travel remarkably similar paths. For those returning to exercise, I have some suggestions that will keep you in the gym and out of the clinic.
Choose Joint Friendly Exercises
Many of the training tools in the typical fitness facility limit movement to one joint. Seated knee extension, prone leg curls, seated shoulder abduction, and seated hip abduction wedge the body into artificial alignments in an effort to place load on one muscle. Older, overloaded, and previously injured joints poorly tolerate this style of training. The stress on tendons, ligaments, and articular cartilage creates the pain problems we treat in physical therapy.
The biomechanics of movement spread load across multiple joints. Compound whole body movement patterns are better choices than artificial joint isolation activities. The essential movement patterns are squat, lunge, push, and pull. Find two or three well tolerated exercises for each movement pattern and slowly add load. Stay far away from training activities that create joint pain.
Many fitness folks have been told they need an intense training regimen. In the older and / or deconditioned population, this approach overwhelms recovery capacity and sends the participant to the PT clinic.
Approach training sessions as if you were trying to get better at a sport. Seek better performance and not just a feeling of fatigue. Ideally, you begin your fitness efforts with an evaluation that identifies weak areas and a plan to train them away. Your practice sessions should make you better and not beat up.
Resolve Pain Problems
If you have a pain problem, make resolution of that pain the primary goal of your fitness routine. It is not uncommon for fitness participants to use non-steroidal anti-inflammatory medication and analgesics to get through a workout. The presence of pain alters the neural control of movement and blunts the effectiveness of training. Medicating to manage pain during an exercise session has far reaching health implications. Resolving neck, shoulder, lower back, and hip pain removes an enormous impediment to your progress. A consistent habit of exercise is the most powerful medicine we can prescribe for pain relief. Take the proper type / dose of exercise and symptoms resolve. Take the wrong type / dose and things get worse.
Almost universally, the people we see in the physical therapy with a fitness inflicted pain problem are unable to walk for any distance. They can motor from the house, to the car, and into the clinic, but that distance is often the far end of their capacity. They have gait deficits; a limp, a lean, or a wobble that becomes more pronounced as they fatigue. Greater distances give them a variety of symptoms from pain to nausea. If they do any fitness walking, it is the gait destroying, hanging onto the console of the treadmill variety. Very often, these patients are unaware of how serious a problem they have.
Walking is the primal survival skill necessary for a quality lifespan. If you doubt this statement, go visit the local nursing home. Restoring the ability to walk will require some “walking lessons”–not unlike swimming lessons. Find a coach, therapist, or trainer who can create a routine that resolves the weakness and renews the work capacity you need to walk community distances. I have no research data, but my decades in the clinic and gym have revealed that good things start to happen when the patient / client can perform a non-stop walk for 25 minutes. Perform a walk enhancing training routine three times a week for eternity.
Michael O’Hara PT, OCS, CSCS