When high-in­ten­sity work­outs cause harm

The Denver Post - - LIFE & CULTURE - By Danielle Dou­glas-Gabriel

Phys­i­cal ther­a­pist Karena Wu couldn’t help no­tice a trend in pa­tients visit­ing her New York City of­fice this year. Many were un­der age 35, en­joyed stren­u­ous work­outs and were suf­fer­ing im­mense hip pain.

The mil­len­ni­als had pushed them­selves in en­durance races such as the Tough Mud­der or weekly CrossFit and meta­bolic con­di­tion­ing classes that placed wear and tear on their bod­ies, she said. And with lit­tle down­time be­tween rou­tines or ad­her­ence to proper form, they were putting the long-term health of their hips at risk.

“A lot of mil­len­ni­als are do­ing all of these high-in­ten­sity ex­er­cises that are great for the men­tal and phys­i­cal com­po­nents of health, but if you’re not as con­di­tioned as you think, you’re go­ing to put ex­ces­sive stress on the soft tis­sue and the joint,” said Wu.

It’s not un­com­mon for ac­tive young adults to ex­pe­ri­ence some joint pain, but or­tho­pe­dic spe­cial­ists worry that reg­i­mens that rely on heavy weightlift­ing or in­tense aer­o­bic ex­er­cises are caus­ing more hip in­juries. There are no de­fin­i­tive stud­ies that cor­re­late the two, but re­search in the Jour­nal of Orthopaedic & Sports Phys­i­cal Ther­apy says high-in­ten­sity ac­tiv­i­ties ap­pear to in­crease the risk of hip os­teoarthri­tis, a de­gen­er­a­tive joint dis­ease.

What’s more, spe­cial­ists at the Ohio State Univer­sity Wexner Med­i­cal Cen­ter have re­ported a rise in cases of young adults with femoral ac­etab­u­lar im­pinge­ment, a con­di­tion that oc­curs when the ball of the fe­mur fails to fit se­curely into the hip socket. High levels of ac­tiv­ity, they say, can cause the plate to fuse in an ab­nor­mal shape and re­sult in a hip im­pinge­ment.

Shane Nho, an or­tho­pe­dic sur­geon at Rush Univer­sity Med­i­cal Cen­ter in Chicago, re­calls a spike in hip, shoul­der and knee in­juries as CrossFit gyms sprung up sev­eral years ago. These days, he said, pa­tients are com­ing in with hip ail­ments from high-in­ten­sity in­ter­val train­ing, even some barre classes.

“We prob­a­bly see at least a cou­ple pa­tients a week with in­juries re­lated to those types of in­ten­sive classes,” Nho said. “The types of work­outs these guys are do­ing ... they’re do­ing it at all costs, de­spite poor form, me­chan­ics, fa­tigue or their ac­tual base­line level of con­di­tion­ing.”

Neu­ro­mus­cu­lar im­bal­ances, or weak­ness in cer­tain mus­cle groups, are often the root cause of the pain that Nho’s pa­tients ex­pe­ri­ence, he said. If pa­tients come in as soon as they start feel­ing dis­com­fort, he said, it’s eas­ier to con­nect them with the right phys­i­cal ther­a­pist to im­prove their sta­bil­ity and flex­i­bil­ity.

Hips are built to with­stand tremen­dous force, but they need full range of mo­tion to work prop­erly, hence the im­por­tance of flex­i­bil­ity and sta­bil­ity, Wu said. She en­cour­ages her clients to do yoga or at­tend a Pi­lates class if they are dead set on phys­i­cally tax­ing work­outs.

“Flex­i­bil­ity is crit­i­cal in try­ing to pre­vent in­juries,” she said. “The body has a ten­dency to overem­pha­size larger mus­cles be­cause they are eas­ier to ac­ti­vate, so some­times they get a lit­tle overused and smaller sta­bi­liz­ing mus­cles get un­der­used. You cre­ate an im­bal­ance.”

A weight-room reg­u­lar since high school, Ni­ran­jan Nag­wekar, 28, fig­ured there was no need to spend much time warm­ing up be­fore squat­ting 250 pounds. But as the New Yorker ramped up his lift­ing, he started feel­ing a deep pain in his left hip.

“For the long­est time, I thought I just had tight hip flex­ors, so I started stretch­ing a lit­tle more, but the pain per­sisted,” Nag­wekar said. “I didn’t feel much dis­com­fort walk­ing or sit­ting down, so it was kind of a strange thing to ex­plain to a doc­tor be­cause they were like, ‘If you could walk, you could sit, you’re fine.’ But I couldn’t lift as much as nor­mal.”

It turns out Nag­wekar had de­vel­oped a hip im­pinge­ment. Doc­tors rec­om­mended surgery, but he de­cided to opt for phys­i­cal ther­apy.

Nag­wekar be­came a pa­tient five months ago at Wu’s Ac­tiveCare Phys­i­cal Ther­apy, where he was guided through mo­bil­ity ex­er­cises in­volv­ing foam rolling, core con­di­tion­ing and stretch­ing with re­sis­tance bands.

“I’m back to about 80 per­cent ca­pac­ity,” Nag­wekar said. “Any kind of power lift­ing that re­quires dy­namic move­ment of the hips takes me a lit­tle longer. My hips don’t move as flu­idly as be­fore, but I can still do them.”

CrossFit is a great work­out, but flex­i­bil­ity is crit­i­cal to pre­vent in­juries. Den­ver Post file

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