I always try to walk through the gym with my invisible blinders on, trying to avoid seeing all the scary things most people are doing out there.  Though well intentioned, many are paving the way to injury as they dedicate themselves to fitness.

 It is these enthusiastic exercisers who often arrive at the doctor or physical therapist’s office in pain after embarking on a fitness program.  Whether they are working out independently or with personal trainers, whether in yoga classes or in spinning, there is a common denominator.  Most suffer from overuse injuries.  Many say that they had done these same exercises for years without a problem.  Why now?  Others say “I love my trainer, he is great, but…” Still more comment: that “nothing hurt while I was doing it (but afterward…)”.  Then there are many versions of a favorite of mine, they go something like: “it didn’t hurt much”,  “it was only uncomfortable (or sore, or achey) but not painful…” Well, it’s no wonder so many people are getting hurt in their quest to get fit! 

It might be that exercises you should not have been doing, but got away with doing for years, have finally caught up with you (like behind neck pull-downs, deep dips or military presses).  Maybe you were doing an exercise incorrectly all along (for example, were you doing lunges with your knees in front of your ankles or squats with them forward of your toes?).  Or, maybe your trainer isn’t as good as you think he is.  Could it be that you ramped up your program too quickly?  Or did you ignore the pain until it became chronic?

The First Step is to Recognize Pain (however mild it may be)
Why do so many of us ignore symptoms?  Maybe we just can’t admit we are getting older and don’t have the capacity we used to.  We may start a program with too much intensity!  Maybe the “no pain, no gain” adage many of us grew up on is rearing its ugly head.  Let’s agree to bury that one.  There are only two “good hurts” in my book.  One is with a firm but not excruciating massage.  The second is as a result of fatiguing a muscle when strengthening (without eliciting or exacerbating pain/symptoms in your joints or other related areas).  Even muscle fatigue is only good if not taken to an extreme.  Remember, generally the aftereffects of strengthening won’t be felt for about 24 hours.  If at that time (or earlier) your muscle fatigue is so great that you, for instance, have trouble descending stairs, then you have overdone it.  If your knee hurts during the last five reps of a set of squats, you are setting yourself up for injury.  If your form suffers after the tenth rep but you insist on straining to a count of fifteen, you are also setting yourself up for an overuse injury.  Trust me, the quality of your form is far more important than the number of reps you do.  Likewise, you have an overuse injury in your future if you up your training in a radical, rather than a gradual, way or you strengthen a muscle group to a limit of fatigue on a daily basis. In all these cases you are placing stresses on your body that it will not be able to withstand without breaking down.  It is as simple as that.

Muscles Must Rest After a Workout
To explain further about the need for muscles to rest on alternate days, it is key to note that strengthening to a point of fatigue means that on a microscopic level you are causing some (desirable) breakdown of the muscle fibers.  It is the healing of this disruption that you must permit to occur on your “off” days.  This healing builds up the muscle fibers and strengthens them.  Pushing your limits on a daily basis can cause uncompensated and cumulative breakdown of a muscle; hence, an overuse injury.

Know Your Limits & Address Predisposition to Injury
Each person’s limits are different.  Each muscle’s limit is different.  Each individual’s predisposition to injury is also different, and that point requires consideration when discussing overuse injuries.  First and foremost, look for a balance between the right and left sides of the body – a balance of joint range of motion, muscle strength and flexibility.  Research has shown that a deficit of greater than 10% from one side to the other is one factor that predisposes to injury in sports.  Recognize that most of us have at least a slight imbalance due to dominance – we are right or left handed/footed.  Next, look for any deficits with respect to normative values for these same parameters.   How much motion is a joint supposed to have?  How strong or flexible should a muscle be? Restricted joint mobility, muscle weakness, or a lack of muscle flexibility (which is different from joint range of motion) can all predispose to injury.  Poor posture, alignment issues, past injuries and their repercussions also make us more vulnerable to new injuries.  Identifying and addressing these factors is crucial to our wellbeing.  BEFORE we ramp up our activity levels.

The Value and Danger of Rest to Ease Symptoms & Restore Function
One reason many go on to have chronic musculoskeletal complaints is that we are in denial and put off getting the proper care.  Rest alone may enable us to feel better.  Rest and anti-inflammatories may make us feel “even better,” but they are not addressing all the causes of our complaints.  In fact, weak muscles may even get weaker due to the de-conditioning that comes with disuse (better known as rest).  This is called disuse atrophy.  Restricted joints may lose more mobility from disuse – by not putting a joint through its normal ranges of motion, its lubrication is diminished.  In addition, scarring down of the connective tissues (especially in the presence of swelling) may occur, further limiting motion.  Tight muscles that are not stretched may become tighter with inactivity (and with age).  Rest may give us a false sense that all is right in the world; that we are back to normal.  Just get back on the court however, and you will soon see that rest alone was not the answer.  Rest alone just enhances our vulnerability and we are even more prone to recurrence, and then to more chronic complaints or even to further damage.  The same is likely if we take an injection of cortisone and think that it is safe to go back to sports because the pain is gone.  In each of these scenarios, nothing, NOTHING, was done to address the causes of the injury.  YIKES!

Part II of this Series will focus on working with a personal trainer.  Is that part of the problem or part of the solution?