As Millennials flock to High-intensity Workouts, Hip Pain Follows

hip pain

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.Photo published for As millennials flock to high-intensity workouts, hip pain follows

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, owner of ActiveCare Physical Therapy.

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 ActiveCare, where Wu has guided him 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.”

@DaniDougPost on Twitter

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A 20 Minute Workout for the Incredibly Busy

In many ways, our society creates the flawed, more-is-better time perspective. At many jobs, you’ve got to “put your time in.” You can work efficiently or not, but you still need to be at work for the required number of hours in the workday. You can’t get promoted to higher levels until you’ve been there a certain number of years, when instead it should be the quality of the work that is the dominant factor. We even sell personal-training sessions and fitness classes based on time. Admittedly time is important for planning our schedules, and we must know the hard stop times of meetings, sessions and most calendar events.

However, when it comes to the general idea of exercise, even the U.S. government’s physical activity guidelines confuse people by recommending 150 weekly minutes of moderate-intensity activity or 75 weekly minutes of high-intensity activity. No one—not even most health and fitness professionals—tracks this or knows how this works in a practical way.

All of this points to one thing: An overemphasis on how long a workout is and a bias toward more time being better. Sometimes we bail on a workout because we don’t have enough time to do what we planned. Life can be relentlessly demanding of both our time and energy and leave us with less time than we’d like for many things. Yes, this even happens to me from time to time. It happens to all of us.

What is the fix? With a few simple ingredients you can make a workout fit the time you have instead of feeling frustrated trying to fit a 60-minute workout into a 20-minute window.


  1. Movement-based Training: Starting with the ACE IFT model as a foundation, consider the five major categories of movement:
    1. Bend and lift (squat or deadlift-type movement)
    2. Single-leg/lunge
    3. Push
    4. Pull
    5. Rotate
  2. Movement Speed: Normal, fast and slow (relative to your “normal” speed, which is the speed you move when you aren’t paying attention to your speed of movement)
  3. Total-body Movement: Provides more of a “lung challenge” than a muscle challenge
  4. Shift or Asymmetry (Optional): Using a shift in the center of gravity or moving an external load asymmetrically to provide a more dynamic experience (e.g., alternating dumbbell overhead press)


Start with these five movements, use a speed of movement that is appropriate for you and mix in some total-body movements somewhere. Add body shifts or asymmetry to your taste, preferences and goals. Combine all the ingredients for the available time you have and you’ll wind up with a complete, “fully cooked” workout.


20-Minute Workout

Movement Samples
Bend-and-lift Squat – any variation Deadlift * Kettlebell Swing
Single-leg Squat/Lunge Side Lunge * Step-back Lunge TRX Single-leg Squat
Push Push-up – any variation Shoulder Press * Chest Press
Pull Dumbbell Row * Pull-up Close-grip Pull-down
Rotation TRX Side-plank Rotation Latera Rolling Plank * Torso Offset Crunch
Total-body Movements Funky Jumping Jacks* Squat-thrust/Burpee Kettlebell Get-up

*Displayed in infographic

How to Do It

It is best to use time-based sets because our goal is to ensure we are staying within our 20-minute parameter. However, if you are unable or disinclined to use time-based sets, use the rep-based method shown and simply stop when you hit 20 minutes of workout time. If using equipment, get it out and get it ready because there’s not much stopping once you start.

For Each of the 5 Primary Movements:

  1. Fast: 10 seconds (or 10 reps)
  2. Slow: 15 seconds (or 5 reps)
  3. Follow for all moves, allowing 5 seconds to transition between each move = 2.5 minutes
  4. Finish with 1 total-body move – perform for 60 seconds
  5. Rest for 30 seconds
  6. Total time for one circuit = 4 minutes
  7. Repeat 4 more times (with option to switch to other movements for successive circuits)

If you only have 10 minutes to work out, perform two circuits plus the first 4 moves of a third circuit to hit the 10-minute mark and then stop.

Why This Works

This workout is complete from a movement-based training perspective, so whatever time you have available will provide a benefit. From a time perspective, no matter where you are when you stop, you’ve hit all the moves at various speeds and will have experienced a workout that both feels challenging and provides a benefit to your entire muscular and cardiovascular systems.

Choose Your Busy

I often say that life is a choice between “busy and unfit,” and “busy and fit.” Everyone is busy. Removing the barrier of “enough” total workout time allows everyone to choose “busy and fit!”

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Prominent Surgeon Pleads with Parents to give Young Athletes a Break


I can’t recall a single friend of mine growing up from elementary school through high school who had to have surgery to repair an injury that could be attributed to overuse. Sure, there were some torn ACLs, a few broken bones and some severely sprained ankles — heck, most of my front teeth were knocked out — but nobody was going in for Tommy John surgery to fix a frayed ligament that resulted from throwing a curve ball all summer in elementary school.

My how things have changed.

Nowadays it’s not abnormal at all for a middle-schooler to come in for a surgery to repair a repetitive stress injury, and world-renowned Alabama-based doctor James Andrews — orthopedic surgeon to the stars — has had enough.

“I’m trying to help these kids, given the epidemic of injuries that we’re seeing. That’s sort of my mission: to keep them on the playing field and out of the operating room,” Andrews said. “I hate to see the kids that we used to not see get hurt… Now they’re coming in with adult, mature-type sports injuries. It’s a real mess. Maybe this book will help make a dent.”

Here are some other interesting nuggets from Andrews’ interview with the Plain Dealer:

“Specialization and “professionalism” are leading to a spike in youth injuries

Specialization leads to playing the sport year-round. That means not only an increase in risk factors for traumatic injuries but a sky-high increase in overuse injuries. Almost half of sports injuries in adolescents stem from overuse.

Professionalism is taking these kids at a young age and trying to work them as if they are pro athletes, in terms of training and year-round activity. Some can do it, like Tiger Woods. He was treated like a professional golfer when he was 4, 5, 6 years old. But you’ve got to realize that Tiger Woods is a special case. A lot of these kids don’t have the ability to withstand that type of training and that type of parental/coach pressure.

The whole youth sports system has gotten out of control

The systems out there in youth sports, particularly travel ball, have been important financial resources for the people who run them. Parents spend a fortune keeping their kids in a year-round sport, with travel and everything else. What’s happening is, the tail is wagging the dog. The systems are calling the shots: If your son or daughter doesn’t play my sport year-round, he or she can’t play for me. Never mind that your kid is 12 — I need year-round dedication.

Simply giving kids a little bit of a break could prevent most of these injuries

Kids need at least two months off each year to recover from a specific sport. Preferably, three to four months. Example: youth baseball. For at least two months, preferably three to four months, they don’t need to do any kind of overhead throwing, any kind of overhead sport, and let the body recover in order to avoid overuse situations. That’s why we’re seeing so many Tommy John procedures, which is an adult operation designed for professionals. In my practice now, 30 to 40 percent of the ones I’m doing are on high-schoolers, even down to ages 12 or 13. They’re already coming in with torn ligaments.

Give them time off to recover. Please. Give them time to recover.

There’s a lot more that can be gleaned from Andrews’ interview, and the full post at The Plain Dealer is worth a read.

But the bottom line is, as the summer wraps up and the school year begins, this might be a good time to give the superstars of tomorrow a break, and let them just be the kids of today.

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Why You Should Be Lifting Heavy

 Insanity is often described as doing the same thing over and over, yet expecting different results. This definition could apply to many traditional fitness enthusiasts, who have followed the same workout program for years and wonder why they have stopped experiencing results.


The general adaptation syndrome describes how the human body responds to an exercise stimulus. There is the shock phase, when the exercise stimulus is first applied. This is followed by an adaptation phase of approximately eight to 12 weeks, where the body experiences its greatest response to the exercise stimulus. This leads to the exhaustion phase, when the exercise program stops having the desired effect. This is the basic science behind periodization, which is the practice of adjusting workout intensity on a regular, systematic basis to avoid plateaus.

One sure way to break through a plateau is to change some or all of the variables in the workout program. These variables include: exercise selection, intensity, repetitions, sets, rest interval, tempo (speed of movement) and frequency (the number of exercise sessions in a specific period of time). To stimulate almost immediate changes in your body, increase the amount of weight (thereby increasing the intensity) you use in your workouts. If you find yourself not making any gains or simply want a different exercise program, here are six ways using heavy weights can help you make the changes you want to see in your body.

1. Lifting heavy can cause muscles to grow.

Heavy resistance can recruit and engage more of the type II muscle fibers responsible for generating mucoalitionscle force. When you lift a heavy weight, you may feel your muscles shaking. This is because your nervous system is working to engage more motor units and muscle fibers to produce the force required to move a weight. Type II muscle fibers are generally responsible for the size and definition of a muscle, so activating more of these fibers can lead help provide immediate results.

2. Lifting heavy improves intramuscular coordination, which is important for improving overall strength.

Intermuscular coordination is the ability of a number of different sections of muscle to work together to produce a movement. Intramuscular coordination is the ability of the fibers that comprise a particular muscle to work together to generate a force. Because it requires more force to contract a muscle, using a heavy resistance can improve the intramuscular coordination in a specific section of muscle, which will also help you become more efficient at generating strength.

3. Lifting heavy can help muscles get stronger without getting bigger.

Sarcoplasmic hypertrophy describes how the sarcoplasm of a muscle increases in size as a result of lifting weights at a moderate to high intensity for a higher number of repetitions (e.g., 10 to 15). Myofibrillar hypertrophy describes how muscle fibers become thicker and denser in response to strength training. Using heavy weights focuses on myofibrillar hypertrophy, resulting in muscle that is thicker and stronger, but not necessarily larger. When lifting an optimal amount of heavy resistance, you should only be able to perform five or fewer repetitions while maintaining good form.

4. Lifting heavy weights can help reduce your biological age.

If you’re over the age of 35, you should definitely be using extremely heavy resistance two to four times a week for periods of four to eight weeks at a time. When adult males hit their mid-30s, they will naturally produce less testosterone unless there is a stimulus that causes the body to produce it. Testosterone is a steroid hormone and is responsible for repairing damaged muscle fibers, which can increase the size and strength output of a muscle. Heavy resistance training is one type of stimulus that can cause males to produce testosterone and help increase bone density, both of which are important markers of biological age. Heavy resistance training can also help women over the age of 35 increase their levels of growth hormone, which is important for developing lean muscle and burning fat.

5. Lifting heavy can help increase your resting metabolism.

One pound of skeletal muscle expends approximately 5 to 7 calories a day at rest. Adding 5 to 7 pounds of muscle can increase your resting metabolism (how efficiently your body produces and uses energy) up to 50 calories a day. This might not sound like a lot, but over the course of a year that is a difference of approximately two-thirds of a pound of fat that you can burn while doing absolutely nothing.

6. Lifting heavy stuff makes you look really cool.

Which gives you bragging rights amongst your friends. The downside is that you will have more requests to help friends or family move furniture, but that’s just the price you have to pay for being ridiculously strong.


Using heavier resistance can be intimidating, because it is a lot harder and the applied force will cause muscle damage. (This is one of the ways that muscles grow; to learn more about muscle growth click here). One side effect of lifting heavy is delayed onset muscle soreness, or DOMS. If you have ever felt DOMS, you know how uncomfortable it can be. While it seems counterintuitive to perform light activity when you’re sore, it can help you recover quicker, which will enable you to do the higher volume of exercise necessary for building muscle and making changes in the body.

Machine training can be the safest approach for using extremely heavy weights. For best results, plan on using weights that make five repetitions incredibly challenging (you should not be able to do a sixth rep) and change your program after 10 or 12 weeks so that you’re changing the stimulus to your body.

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