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Exercising to Avoid Injury

How a balanced body can keep you active for the long-term

By Taylor Smith | Photos courtesy of

When people begin to exercise, they may correlate high-intensity and discomfort with physical “gains” and progress. This misleading way of thinking has led to countless injuries. What many people do not realize is that pain is our body’s way of signaling an imbalance and the potential for serious injury.

Recovering from an injury can also be a sliding scale of pain in terms of the ability to maintain previous activity levels. Typically, a sliding scale of injury could equate to taking a week off from weightlifting due to some slight tenderness versus being unable to walk after tearing a hamstring in a skiing accident. Surgery is generally the last resort, as most people will choose rehabilitation and physical therapy as their preferred recovery route.

Even if a person is meeting with a physical therapist and diligently doing their take-home exercises and routines, it is usually unrealistic to return to a previous “normal” right away. For some severe injuries, full range of motion may never completely return. This is sometimes seen in former long-distance runners who, at one point or another, overtrained and continued to run through injury, resulting in painful strains and tears of pivotal muscles. Another example is extreme weightlifting and body building that places strain on the lower back.

By Dr. Adrienne Jensen of Activcore Physical Therapy & Performance.

When considering a person’s notion of an athlete, it’s important to keep in mind new athletes, athletes of different abilities, and senior athletes. As Dr. Adrienne Jensen of Activcore Physical Therapy & Performance says, “I will define an athlete as anyone who is participating in a consistent exercise program [and] working towards a goal.”

Jensen is a center director and physical therapist at Activecore, located at 800 Bunn Drive, Suite 102 in Princeton. Upon entering Activcore, visitors are immediately struck by the bright, light, open space and the numerous Redcord suspension systems.

“While we are able to address the painful area with manual therapy, stretching, dry needling, and other modalities, we can utilize Redcord suspension and equipment to identify muscle imbalances and movement recruitment patterns to determine and restore balance to the body [and] to eliminate compensation and overuse,” says Jensen. “We are also trained in functional movement assessment, which further helps to identify the cause of a problem rather than just treating where the pain is.”

The Redcord system of fabric cords suspended in the air. (Photo courtesy of Activcore Physical Therapy & Performance)

Activcore benefits from a wide array of expertly trained physical therapists. When meeting a new client, Activcore aims to match that person’s physical issues with an equally knowledgeable trainer. Jensen says, “we have a team that is trained in a diverse set of skills including vestibular and concussion rehab, functional movement, pelvic health, low pressure fitness, strength and conditioning, yoga, and even more.”

Physical therapists are commonly referred to as PTs. The phones at Activcore are always staffed so that new clients can start on their own path towards meeting their ideal PT. “We have the time and know-how to address the whole athlete and identify all the contributing factors to a problem, or refer you to the right provider in our community if it falls beyond our scope or practice,” says Jensen.

Activcore’s in-house trainer can also introduce whole body conditioning and strength training to someone who has no need for physical therapy but doesn’t yet have their own personal trainer and/or exercise routine.

My own experience as a patient at Activcore was that it felt very lively and youthful compared to most PT facilities. Clients ranged in age and issue and all of the equipment looked brand-new and very clean. I went to Activcore because both of my hip flexors and hamstrings were strained and weakened from overexercise, to the point where I was having trouble walking. My PT introduced me to the Redcord, which is essentially a system of fabric cords suspended in the air. I was then guided through exercises that forced me to engage areas of muscular weakness while my PT literally “shook” the cords to counteract my attempt to hold a position by myself.

My PT also guided me in developing and strengthening my pelvic floor muscles, a key area that I had overlooked throughout my running career. I learned that the pelvic floor muscles essentially stitch you together and reinforce a person’s core and abdominal strength. Pelvic floor muscles also impact hip posture and positioning. As I worked with my PT, I quickly became aware that I had lost seemingly all of my lower body flexibility due to my injury. My hip flexors were so tight I could barely walk toe-to-toe in a straight line.

The importance of hip flexibility is imperative to anyone seeking to be a lifelong athlete. Hip flexibility will aid a person in any sport, at any time in their life. Yogic stretches are a wonderful introduction to opening up the hip flexors. The majority of these resemble some form of a squat. My favorite pose is the garland pose. To perform it, begin by standing with your feet partially wider than your hips (your feet should also be pointing slightly out). Now, begin to lower your body to the ground, so that your tailbone is pointing towards the earth. Bring the arms and hands into prayer position in between your legs and see how long you can hold the pose. It may be extremely uncomfortable (and humbling) at first, but the longer that you hold the pose, the more likely you will be able to sink further and further into the ground while exhaling deep breaths.

By A trigger foam point roller.

My PT taught me about the benefits of a trigger point foam roller (an object that I still use daily). In contrast to a typical foam roller, trigger point foam rollers will massage your muscle tissues with greater effectiveness as they more closely mirror a therapeutic massage. Your PT can show you how to use the bumps and grooves on the foam roller to apply pressure to your most tender areas. Now, several years later, I believe that it continues to counteract the onset of injury.

I was also impressed by the Theragun, a handheld deep tissue massaging device. My PT used it on both hamstrings, and I was shocked by the immediate sensation of it breaking up scar tissue and improving blood flow to both areas. Finally, each appointment included time in front of a full-body mirror where I could practice balance routines. Before leaving the program, I was given access to the exercise routines online.

According to Jensen, many of the injuries that walk through Activcore’s doors are preventable. The highest number of injuries are a result of doing something too fast, too quickly, and with a high amount of intensity. Other issues center around poor athletic form causing muscular imbalances. Overuse injuries are also quite common as most people do not want to change or reduce their workout routine even if they are experiencing pain. More serious injuries are referred to as traumatic injuries, which are very hard to prevent because they can happen in a sporting event or some other competition setting. It could be a collision with an opposing teammate, or the turn of a foot, and the athlete is benched for the rest of the season.

Thankfully, Jensen says that most injuries can be recovered with the right knowledge. In fact, the longer that an athlete stays sidelined, the greater the risk of giving up the sport or activity forever. Traumatic injuries can also be associated with fear of playing again.

Just imagine the emotional impact of falling off a horse or losing consciousness in a wrestling match. Positive encouragement and psychological well-being are a part of recovery, as well.

Dr. Peter Panagakos at Princeton Foot and Ankle treats a range of foot health issues. He also shows athletes of all varieties the connection between good podiatric care and athletic longevity.

Most athletes use their feet in some way and while runners, tennis players, and basketball players clearly need healthy feet to compete, a good podiatrist can also serve the more typical athlete who suffers from heel pain, arch support, and ingrown toenails. Panagakos prescribes orthotics to help those with foot or ankle deformities. He also works in conjunction with physical therapists and the geriatric communities to prevent falls. When it comes to those living with diabetes, Panagakos says, “We assist the diabetic population in obtaining diabetic insoles and shoes, which can prevent injuries and wounds. We assist in amputation prevention in this specific population.”

Surgeries that may help a person who is suffering from significant or worsening foot pain are bunion surgery and ankle arthroscopy with ankle reconstruction. Panagakos remarks, “We see some very large bunions that can impede people from wearing shoes, even wide athletic shoes. We perform a new bunion surgery called Lapiplasty, which has excellent results.”

Ankle arthroscopy with ankle reconstruction is especially seen on basketball players, but can affect all athletes. “An old ankle sprain or twisting injury can loosen the ankle ligaments and make then weak,” says Panagakos. “This causes the ankle to give out.” His team will tighten and reconstruct the ligaments of the ankle so that athletes can return to performing at their pre-injury level. This is a significant improvement in athletic science and recovery.

An obvious concern for athletes who are seeking to exercise long-term, without injury, is choosing the right size and style of athletic footwear. Good footwear can reduce, counteract, and prevent unnecessary blood blisters, loosing toenails, heal pain, plantar fasciitis, and Achilles tendon issues. Going to a specialty athletic store and being fitted in person will ensure an accurate shoe size.

Depending on the sport, many athletic experts will recommend going a half size up to account for the feet naturally swelling during exercise. It is also necessary to have a wide and comfortable toe box so that your toes are not constantly rubbing against the tops of your shoes — that is a sure-fire way to lose some toenails!

For those with the ability to try their new shoes on in person, pay attention to the heel and bring your own pair of athletic socks (which also affects the fit). If the heel of the shoe doesn’t seem to stay in place and is sliding up and down even when walking, that model of shoe is not for you.

It’s often said among power walkers, hikers, and runners that cycling and recycling your shoes every six months is ideal. By nine months most people will notice a reduction in cushioning and traction. If you continue to exercise on shoes that are entirely worn out, there is an increased chance of injury or irritation.

Another suggestion is to buy multiple pairs of shoes once you find the exact brand, model, and size that you like. This is ideal because you will not have to go through the frequently painful process of trying to break in a new style or model of shoe. Even running around the block with a poorly fitted new sneaker can result in blood blisters and general soreness.

So, when it comes to considering how best to exercise for longevity (pain free), rather than immediate muscle gains or weight goals, try to think in terms of how your body was designed to move.

We weren’t designed to sit in office chairs and car traffic for upwards of eight hours a day, but we are designed to rotate our hips, sink into deep squats, and roll our shoulder blades down our back.

Do what feels natural and think in terms of mobility, and you will definitely prolong your lifespan as an athlete and as an active person.

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