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Exercise at Your Own Risk

by Tamer Issa, PT, DPTExercise Injuries

Wouldn’t it be great if you could prevent exercise related injuries before they happen?  Typically, a person comes in to see an outpatient physical therapist to address a specific pain problem that hasn’t gone away and has now resulted in a loss of function that is meaningful to them.  Unfortunately, self-determination coupled with the “wait and see” approach won’t work in all cases.  As an outpatient physical therapist, I tend to hear a common backstory from my patients as to how they ultimately ended up seeking physical therapy treatment due to an exercise related injury.

Physical Therapist:

“So what brings you in today?”

Patient #1: Time To Get In Shape!

“Well, I wanted to get in shape, so I decided to start an exercise routine at the gym. I was doing cardio on the bike and treadmill. I started lifting weights with the machines. Then a month later my shoulder started to hurt. I tried to continue exercising by lessening the weight, but certain exercises just continue to bother my shoulder and it seems to be getting progressively worse.”

Patient #2: Born Again Runner!

“My knee pain is preventing me from running. I decided that I wanted to run a marathon this year. I joined a running club. I followed a training schedule and I was running 3-4 days a week, roughly 20-30 miles per week. My knee started to bother me and it got worse over time. Now I can’t run a mile without having to stop. That’s why I’m here.”

Sound familiar?  There is a lot of information that is missing from these two cases that may explain why these folks end up experiencing pain and movement dysfunction, but let me explain what these cases have in common. 

Good Intentions

Most people join a gym, start an exercise routine, or sign up for a sport league with the best of intentions. Whether it’s a new year’s resolution to improve their health, they’ve gained a few pounds that they would like to lose, they miss the competitive nature of a sport, or they just want to fight against the physical decline that comes with aging.  Rarely do people know what exercises are best suited for them or which exercises can even be harmful.  Unfortunately, once injured, many become discouraged and may even discontinue exercising altogether due to pain, physical dysfunction and frustration.

Understanding an Individual's Body History

Muscle Imbalances

Most people lack the understanding of how one’s genetic predisposition to acertain body type, childhood physical development, previous injury and a lifetime of acquired muscular imbalances significantly influence the likelihood of future injury. I will attempt to explain each of these factors simply. 

Every person has a genetic predisposition to be of a particular body type (future blog post).  Some are predisposed to being tall and lean, short and stocky, too stiff, overly flexible, etc. Knowing your own body type allows you to understand why certain activities, exercises, or sports may or may not be a good choice for you.

Our childhood development, especially that first year of life, influences our future posture and physical development.  This includes the amount and type of physical activities that we participated in as children, teenagers and adolescents. 

Previous injuries, surgeries, and pain can lead to compensatory movement patterns that adversely affect our ideal posture and optimal physical capabilities.

Lastly, muscular imbalances acquired from years of physical, emotional, and environmental factors will affect the load, stress, and tension on certain parts of our body which predisposes us to future breakdown and injury.

We are all physically different and our history has contributed to this fact. A better understanding of how your unique physical make up and an improved sense of body awareness can help you make better decisions as to what you choose to do to stay physically active without increasing the likelihood of possible injury.

Proactive vs. Reactive


Most of the time, as in the examples above, people come to us after they have been in a significant amount of pain long enough to concede that they actually need medical assistance.  By this time, they may have lost the physical ability to do the things they love to do.  This is a reactive response that is all too common in our healthcare system.  Many orthopedic conditions that develop over time are the end result of excessive load and strain on parts of the body that simply couldn’t take it anymore. The result is degeneration, inflammation and pain that manifest into a host of common orthopedic problems like, arthritis, tendonitis, painful trigger points, spinal disc herniations, repetitive strain injuries, and so on. 

Once a person begins physical therapy, the key to treatment success is to identify and address the underlying causative factors that may have contributed to the wear and tear resulting in injury.  There are a multitude of factors involved in dysfunction ranging from simple and isolated to complex and pervasive.  A few examples of risk factors include a leg length discrepancy, poor breathing function, a weak core, poor coordination, unstable feet, weak hips, unstable shoulders, and poor posture but this list goes on. However, if you can identify and address your own physical vulnerabilities, you can minimize your risk of injury and improved performance will be in your future.  

What's the Alternative? 

As mentioned above, the key is to identify and address the underlying causes first before engaging in an exercise routine or a new sport.  Does this take time, cost money, and delay your ability to do what you want? Yes, it does! However, you may find this to be a better alternative than having to cease an activity and spend the time, energy, and money to get back to your pain-free functional state.

I encourage you to become educated about the current state of your body.  Practice yoga, stretch daily, get regular massages, or see a physical therapist that will likely assess your posture as a starting point. 

Be committed to the process of being active and healthy and not simply on an endpoint. This will require self-awareness and knowledge about your baseline physical capabilities.  Before joining that boot camp, or running that first marathon, it may just be worth your while to work with a highly skilled personal trainer or a physical therapist just for a few months to assess and address your functional movement ability.



So, Let’s Change the Conversation

Physical Therapist:

“So what brings you in today?”


“I want to get back in shape.  I was thinking about joining a boot camp class, but I am not sure if it is the best thing for me at this point in my life.  I need your help in knowing what types of exercises are best for me.  I need your help in identifying my underlying issues that may contribute to the possibility of injuring myself.  I want to do this the right way.”


Check out Dr. Tamer Issa's book, Freedom From Neck & Back Pain- Learn to Live an Active Life Without Fear of Pain