Question from bumbbles21

I am trying to go from being a 40 lb.-overweight, almost complete non-exerciser, to a sprint tri by next year (Seattle women's Danskin). However, I keep having pain in my knees, ankle, or hip that stops me from exercising for several days - killing my momentum and having me feel like I'm not making any progress. Are there stretches or weight training or something I should be doing? Should I try to lose weight first? I'm sure that my extra weight is aggravating things. Lastly, how do I know how far to "push through pain?"

Answer from Daryl A. Rosenbaum, MD

Member AMSSM

Congratulations on your new commitment to exercise! Remember, when it comes to starting a new exercise program, you can’t achieve all of your goals in the first week or month, but you can delay them due to training mistakes during this period. The best way to ensure success is to start slowly and then gradually build the intensity and duration of your activities as your fitness level, strength, and technique adapt and improve.

A good rule of thumb to follow is the 10-15% rule: increase the duration of your exercise by no more than 10-15% per week to give your body time to adapt to your new training demands. It may mean starting off more slowly than you would like, but following this rule significantly reduces your risk of injury---which can really derail your fitness goals!

As for losing weight, a study done at Wake Forest University in 2005 showed that for every pound lost, there was a four-fold reduction in loading forces on the knee. Less force on the knee probably means less risk for pain and injury at the joint. One way to shed some of the excess weight without stressing your knees is to focus on non-weight bearing activities like biking and swimming. Depending on your progress, you may want to add an elliptical trainer to your program before progressing to walking, and then to running, as running is the activity that puts the most load on the knees. Stretching is also key.

Many athletes don’t realize that, in addition to providing movement, muscles help absorb the shock that occurs across the knee, ankle, hip, and even spinal joints with every step. Tight muscles are more prone to strains, tendonitis, and general soreness. So improving strength and flexibility can decrease the likelihood of pain and injury. Yoga or simple calisthenics can be a great way to stretch and strengthen muscles with less chance of overloading them as compared to using weights. Again, the key is to start slowly.

A physical therapist or a well-trained and experienced personal trainer can be helpful in getting you off to a good start. Remember, it is never a good idea to “push through pain.” In general, pain or soreness that only occurs after activity is less concerning than symptoms that develop during exercise, but don’t ignore recurrent or persistent symptoms. Consider a visit to your doctor to be sure that what you are feeling isn’t the sign of an underlying injury or condition that could be made worse by exercise.

---Daryl A. Rosenbaum, MD