Fitness

Shin splints. Knee pain.  There are many forum threads posted by cc'ers who are starting to get into shape, and getting injured in the process. 

This post includes tips for avoiding overuse injuries as you get into shape.  Please bear in mind that I'm not a medical or fitness professional. Just someone who is vulnerable to overuse injuries and has learned to how to avoid them through trial, error, and learning.

I was a runner in high school and college, and was constantly getting overuse injuries.  I get overuse and joint injuries from all kinds of physical activity -- running, cycling, swimming, weights, yoga. You name it, I get injured doing it. Shin splints, shoulders, knees, ankles, hips, whenever I try a new activity, I feel it in the joints or get some other overuse strain. (This may be genetic, there are relatives on both sides of the family who have had hip replacements or hip surgery.)  It wasn't until my early 30s that I learned how to exercise without chronic pain.

Here are the principles that I've learned: 

Build up slowly.

Many people getting into shape try to exercise intensely, as much and as soon as they can. This is a mistake, and often leads to injuries that set them back.

* Start with short duration, low intensity activity.  Walk or go easy on an elliptical trainer. 
* Build slowly. When you build up, don't increase your mileage by more than 10% per week.
* Build endurance before intensity. You should feel comfortable with at least 30 minutes of your chosen activity before adding intervals.

Get good gear.

If you are running or using an elliptical trainer, make sure you have good shoes.  Go to a specialized store, if you can, not a large chain superstore or mall outlet -- a place where people know how to fit shoes. 

If you are cycling, make sure your bike is a good fit for you, and is adjusted for your body. Go to a good bike shop where people know how to fit bikes. It is definitely worth the money you will spend to not have to take weeks off and require medical care. If you are cycling, you do *not* need an ultra-fancy bike to get into good shape, but you do need a bike that is a good fit for you.

Don't work through pain.

If you have joint pain, or acute muscle pain, then stop.  Either do activities that don't aggravate your injury (if you have a hurt wrist, walking is ok but tennis is not). Or take the day off.   Rest until the injury is better. Don't try and work through the pain.  Many people who are eager to get into shape are fearful of taking time off and being set back. The setback will be worse if you get more seriously injured.  If it hurts a lot, or hurts for more than a few days and doesn't get better, go see a doctor. 

Body alignment is critical.


If you are doing the same physical motions over and over again, it is critically important to have good body alignment and form, or you will get injured again and again.  Yoga with a good teacher is excellent body alignment training.  Other good resources include the Egoscue method (see link below), and Pilates (I can't speak about Pilates from personal experience.)  In addition to general body alignment training, get specialized coaching in your sport or gear (cycling, running, swimming, etc.). If you are a gym member, ask for an instructor to review your form. 

Rest.


You may want to start with 3 days of exercise per week, and build up to 4-6. After an intense workout, take the day off, or exercise very lightly. 

Summary.

By following these principles, you are less likely to get injured. And if you do get injured, you will be more likely to quickly recover and pick up your exercise routine.

Following these principles is *not* the most efficient way to burn fat and calories right off the bat.  If you are already basically fit, have good body alignment, and good gear, then dive right in, and start to do interval training and lift heavy weights. 

But if you are getting back into shape after being sedentary, then following these principles can keep you from a serious setback that makes your progress much slower overall.

Resources:

Runners World 10 Laws of Injury Prevention
http://www.runnersworld.com/article/0,7120,s6 -241-285--7638-0,00.html

Egoscue Method:
http://www.amazon.com/Egoscue-Method-Health-T hrough-Motion/dp/0060924306/ref=pd_bbs_sr_1?i e=UTF8&s=books&qid=1200890719&sr= 8-1

 

I have some joint issues. (i.e. arthritis in my feet and left knee and I dislocated my right knee 2 months ago)

I'm nervous to start doing leg weights again (besides curls).  I can no longer do the leg press at least to my full potiental.  Last year I was doing 500 lb.  I developed arthritis about 2 weeks later.  Now I'm scared to do the leg press or squats at all, let alone the weight my muscles can actually lift.  I'm feeling a little discouraged.

Does anyone have suggestions?

I used a Stairmaster machine for the first time today--it seems like it will give me a good hard workout, but I am concerned about the effect on my 56-year-old knees.  I currently do not have any problems at all with them, but I wouldn't want to do anything that will show up in the future.  Any opinions about the Stairmaster?  Thanks! 

hi sconry, given your conditions and injuries, it would be best to get a doctor's advice before starting a weight program, and to work with a physical therapist or trainer with rehab experience who can teach you how to exercise in ways that don't aggravate the problems.

reinebee, the two tips I'd have are to start slowly in terms of intensity and time, and build up gradually. A common cause of injury is to dial it up to fast. Also, mix it up.  Don't use stair master all the time. Alternate with bike, rowing machine, treadmill, etc. Crosstraining helps prevent injury too.

hi alevin, thanks for all the great advice in your post.  can you elaborate on the anterior shin exercises you mentioned?  i am prone to shin splints and am really trying to do it right this time (2 weeks of running so far without shin splints, but some minor anterior shin irritation when i first hit the treadmill, eventually goes away)

thanks!

 

 

For all of you who are injured try getting into a pool.  It is a great way to get exercises.  I had ankle surgery 3 months ago...spent 3 weeks on crutches and 2 in a walking boot.  My doctors recommendation was get in the pool and do some pool runinng or water aerobics.  Of course, you need to make sure that you don't stress the injury anymore.  I am almost back to full activity which includes running.

hi, diana,

here is a page with some recommended exercises for shin splints

http://www.medicinenet.com/script/main/art.as p?articlekey=85023

Used-ta-could-do-it! is my favorite excuse coming from the newly injured.

 

Hmm, don't try exercising at the same level as a previously sedentary, but now very enthusiastic 40-something that you used-ta-could-do when you were an athlete in tip-top shape as a 20-something! Eeeease into it! :-)

 

Ease into it gently/progressively enough, and you'll be doing all that sexy stuff you used-ta-could-do in due time! Yeah, I said sexy! :-D

I have some sort of back injury that may or may not be related to exercise - but I do know that walking, even on the treadmill seems to make it worse. I used to use the treadmill four days a week - fast walking at an incline, and I have found that my weight loss has stopped since i stopped exercising. Would doing upper body weights help with the weight loss? Something about metabolism increase??

On shin splints - another cause of them is improper arch support. If you are running then I also highly recommend going to a running store and getting fitted for shoes and then consider inserting arch supports from the store. 

I broke my tibia when a stress fracture went to a full fracture. It was the most pain I have ever been in - I was in a "bootie" for 6 weeks. 

It was a blessing in disguise because through rehab I learned how to prevent shin splints injuries 

Some other things that helped: 

1. sit on a chair and put her heel on the floor and write all the letters of the alphabet with your big toe - switch and do the other leg. 

2. Use a foam roller and lie on your side to "release" your anterior tibialis. It hurts like heck but works wonders.

3. Our gym has a tibia weight machine - I put on 30lbs and use it. 

4. Ice Ice Ice - prevent inflammation - If you have bone issues do not use ibuprofen or naproxen at least that is what my ortho had told me - check with yours.

5. Walk on your heels while you make dinner - don't slip.. ;-)

Hope this helps. Always talk to your doctor before doing anything that might inhibit your recovery.

Thanks.

any suggestions for recovering from plantar facilitis and preventing it?

I really want to try to work up walking a mini-marathon - but this darn foot is side tracking me.

Well, I started the Couch to 5k program and just finished my first week. I'm not in horrible shape. The first week was intense, but manageable, I went about 2.3 miles (intervals of 60s run, 90s walk).

The problem. After the second day of running (thursday) my knee started to ache. That knee has always given me trouble, I think I injured it as a kid. My knee didn't recover this morning like I hoped. I went running anyway. Well, it gave me a bit of trouble today, but I made it the full 2.3 miles. I know I probably shouldn't have done it.

My knee feels fine right now. It doesn't hurt, but at certain angles it acts up. It's not pain, just a really dull ache.

My running shoes are old and they suck. I know getting some nice new ones will help a ton. I think I tend to underpronate, so I plan to get some special shoes to help. I also thought wearing one of those knee braces while I run might help.

Ergh... I'm suppose to start my second week of the 5k program on Monday, but if my knee still bothers me I probably won't do it, which sucks... If it doesn't go away by then may I should see a therapist.

First of all, rest til the pain goes away.  Don't try and run through it.  You may need more recovery time.   Second, get new shoes.  Third, if it still hurts go to a doc/sports med/therapist.

my stupid thing is my ribs always get out of place. i could sneeze too much and one would pop out of place. sometimes i wouldn't even notice until i do a specific exercise or stretch. i have scoliosis in my lower back so that doesn't help anything either.  and my hips sometimes gets out of place. this has been going on since i was under 10 (i think).  nothing is ever really 'set' with my bones & joints. i do stretching, strengthening, go to a therapist, went to a chiro, etc. it seems to be just something i have to live with.

but xeonicus, please, please get some new shoes. believe me, running is much more fun.

What you wrote is really, really good advice, thanks for that!

I tend to be one of those people that want to do everything at once, so I exercise too much, and then stop doing, because of course it's no fun exercising when everything hurts. And whenever I try to 'take it slow', and start with easier things, I feel that it's not enough and not worth the effort because it won't do anything...

Thanks for a great post. I just had a baby 9 weeks ago. I used to run 2 miles, 3 times a week. I loved it. Now I'm finding it very hard to push thru the "work" of getting back in shape. My knees are bothering me, and I think it's because I am running almost every day, over-doing it a bit. My right elbow also hurts, not sure if that's related to running or related to weights I've been doing with my arms.

What's the healthiest way for me to get back to my 2 miles a day, or perhaps more like 3 or 4 so I can lose weight? I do better if I have a specific spot that I run/walk to daily. I've been walking 4 miles, with a bit of running in between, 5 days a week for 3 weeks. It's not sustainable...god help me, I push myself too hard. I just want to feel that "runners hi" again and I want to lose my pregnancy weight!

Any suggestions from similarly obsessed people would be helpful!

Liz

lizmoise, running every day is surely overdoing it. Start with a mix of running and walking, and increase the amount of running very gradually.  Cut back on the running to only walking til your knees stop hurting.  It is aggravating to have to go back and to progress slowly but it's more aggravating to be injured.  Many people here swear by the couch to 5k program (google for it). 

The best way to increase the weight-losing properties of walking and running is to increase intensity - after your knee stops hurting!  Add hills and intervals (but not every workout). Do a mix of high-intensity and low-intensity workouts in a week. 

with the weights, what exercises make it hurt? if you do weights at a gym, as someone to give you advice on form, to avoid injury. Also ask for variants of exercise that don't cause the pain, use exrx.net to look yourself. If you are doing machines, consider doing the same exercise with free weights. Machines are often the wrong size for women which is bad for biomechanics.

Stretching is the *second* thing you do. First is an easy warmup routine to get the blood flowing like running in place, 40 jumping jacks, 40 jump ropes, etc. That gets the blood flowing and the heart rate up.

Next you do your stretching excercises, and they should be specific to the workout routine you are doing. For example, it make *no* sense to do arm stretches if you are primarily running marathons - stretch your legs and back out first.

Next you do your exercise routine.

Lastly, you do a cool down routine which is more stretches and a light aerobic workout. Shake it out, walk it out.

As a Tae Kwon Do student, that is how we are taught to avoid injury and decrease muscle recovery time.

 Do not under any circumstance ever static stretch before strength training. Static stretching reduces muscle strength by about 25-30% for 3-4 hours, so static stretching of a muscle prior to exercise is a good way to reduce the training effect and possibly injure yourself.

 Dynamic flexibility/mobility drills are okay, but no static stretching before working out, ever. Save it for after.

A great place to exercise for people with weak joints is the TUB!  I've been able to build up some of my weak areas using the tub.

Arms: Place hands on either side without slipping. Lever yourself up and down. You can have water in the tub or out of it. I squat (on balls of feet usually) with my feet under me and can have the arms in front for a typical pushup and in back for a tricep pushup. Use the legs to lighten the load on the joints until the arm muscles are able to take the load.

Knees: (One of my weakest points, particularly when the knee is fully bent.) I squat with feet flat, holding myself balanced with my hands on either side of the tub and do small raises (2-4 inches) in the range I need to work, paying attention to that the joint does not take too much effort by using my hands to remove some of the weight on the knees. This really helped rehabilitate the areas around my knees.

Massage: I massage my troublesome areas during the bath. Along with the trouble spots I also massage the muscles and areas leading into and supporting those spots. Started this when I had a broken foot. Also did it with a broken ankle. And continue to support my knees which now do a good job supporting me.

One easy way to exercise with minimal impact on joints or backs is water aerobics. I did it while I was pregnant with my first baby, and boy, did it help! Also, consult a physical trainer for tips and workout routines just for you. A 35 year old male is going to need something different than a 25 year old woman, i would think.