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How to Avoid Injury: Q&A With Sports Medicine Physical Therapist

As a Sports Medicine/Orthopedic Physical Therapist, Exercise Physiologist, NSCA Strength & Conditioning Specialist, Pilates/Yoga Instructor, and World Fitness Competitor of 15 years, Dr. Meredith Butulis enjoys helping people build strength with longevity via podcasts, books, seminars, and clinical practice. 

As a physical therapist, Meredith has extensive experience helping her clients prevent and recover from exercise related injuries. Below are Meredith’s tips for avoiding injury and keeping your body at optimal performance. Meredith’s name may be familiar as I recently sat down with her to talk about ways to make time for health and fitness for people with busy schedules. In case you missed that podcast, listen to it here.


Dr. Meredith Butulis

1) In your experience, what are the leading causes of exercise related injury? Is it related to lack of nutrition/hydration, fatigue, overextending the body’s range of motion, putting too much stress on a muscle by lifting too much weight, etc? 

While research suggests fatigue as the #1 cause of many injuries, I’d also add muscle imbalances as a #1 cause. 

I often see fitness enthusiasts of all ages and backgrounds become patients because they have not yet learned about “the right muscle, for the right job.” Sometimes people copy movements, but compensate which muscles perform the movement. Eventually, that leads to injury. 

It is much safer to practice muscle mindfulness by learning about form and feeling the proper muscles activating before adding loads to a lift, or distances to endurance activities like running. 

2) What are your recommendations for people at all levels of fitness to prevent injury during a work-out or even throughout their daily activities such as carrying groceries, or lifting salt to put into the softener? 

In general, there are 4 safety tips that can apply to most lifting situations, whether it be groceries, rock salt, or barbells:

  • Keep loads close to the center of the body
  • Hinge at the hips instead of rounding the low back
  • Pre-engage the core and glutes by squeezing them consciously before lifting
  • If muscles feel like they are tightening up subconsciously as you keep lifting, take a pause; they are often trying to communicate their fatigue

3) For those that are competing in a marathon or a long bike race (as examples), what are your recommendations for managing the fine line between pushing one’s body through discomfort but knowing when to hold back to avoid injury? 

Endurance racing is difficult, as adrenaline takes over. Adrenaline often masks discomfort, pain, or other signals your body is trying to send you. 

When initially training for the events, be sure to have a schedule that gradually builds distance over several weeks to months. Also, make time for a rest day and 1-2 days of cross training to help counter the muscle imbalances from running, biking, or swimming. Cross training does not need to be heavy weight lifting. It can be yoga, Pilates, or a home exercise program that helps re-balance your glute and core activation with joint mobility. 

Racing is actually a team activity. Build a crew and listen to them. They are responsible for helping you with race day pacing, fueling, and safety. Trust them and realize that your judgement on race day has been altered. They will help you stay on course safely.

4) Once an injury has taken place, what are your tips for staying positive and avoiding frustration throughout the recovery period? 

There are definitely characteristics and actions that determine which people get better quickly. Those that get better quickly tend to:

  • Shut down activity of the injured area almost immediately until they have a diagnosis to guide a way forward
  • Ask “how/when can I,” instead of focusing on “can’t”
  • Stay active by developing a plan to move and condition safely without pushing the injured structures
  • If there is a race or competition come up, practice visualizing or watching video of themselves carrying out proper technique
  • Only speak of the injured area in the positive. For example, “I know my knee can support me; we can’t jump yet, but every week, I can feel it getting stronger.” 
  • Take active ownership in conducting the safe activities and avoiding the activities that provoke the injury

5) For general health and wellness, is there a specific expertise or type of workout that you recommend for the busy person who has limited time but wants to maintain a healthy level of fitness? In other words, is there a single workout or activity that is fully comprehensive and hits the key areas, such as running or swimming? Or do you recommend that a person continuously modifies and changes their workouts and activities? 

For busy people with limited time, here are 10 tips to stay active, healthy, and fit:

Pick something accessible that you enjoy. Preferably, select 2-3 types of activity that use various muscle groups. If you aren’t sure what kind of activity you enjoy, try different things until you see what fits you. Keep it accessible. For example, if you love ninja style workouts, but your closest ninja gym is a 3 hour drive, pick something else for your regular weekly plan and save the ninja gym as a once-in-a-while treat.

Decide what is realistic on a consistent basis in terms of time per workout, days per week, and location. Then, subtract a day from that. The day you subtracted is your make up or bonus day. For example, if you can workout 20 minutes, 5 x/week, commit to 4 days/week. If you have time the 5thth day, that is a reward to yourself, or make up day if you had to cancel one of your other days that week. 

Whatever you commit to doing, even if it is 15 minutes, 3x/week, ink it into your planner. It is a commitment to yourself, and it does not get cancelled. Communicate your commitment to your wellbeing to anyone that vies for this time, whether it is family, friends, colleagues, or others. For example, I workout at work. I arrive 90 minutes early and put my headphones in for the first 60 minutes of this time. My co-workers know that if my headphones are in, it is my time, so they do not interrupt. However, it is my responsibility to verbalize this commitment at times when distractions come up. 

If you have access to a gym, sign up for classes, small group, individual, or virtual training. These options offer consistency and accountability, which most people need to stay on track with fitness. 

If you don’t have access to a gym, plan for that. Create a set of home or travel-proof workouts that can go with you. They could be body weight only, or use bands. Write your programs down and store them in your cell phone for quick reference wherever you are. 

Keep gym clothes with you at all times, in case the opportunity to be active arises. For example, I have an old pair of sneakers and set of workout clothes that I rarely use under the floorboard in the trunk of my car. When I forget my gym clothes, I know where to find the back up. 

Find an accountability buddy and share your commitment with them. Ask them to text you, call you, show up and workout with you, or whatever works for the two of you. Reciprocate for them too. I often text my significant other the number of pull ups I did in my back day workouts, as a commitment to not only showing up, but also committing to progress reps over the previous workout. 

Some variety is key to avoid overuse. For example, if you like weight lifting, divide your program into splits. i.e. back/biceps, chest/triceps, legs, shoulders/core. Each of the 4 days is a different workout. If you like running, make time to include a day of yoga, Pilates, weight lifting, or swimming. 

Make time for foam rolling, massage, or other efforts to help counteract the repetitive muscle strain from activities like computer work or driving. Even 5 minutes a day of your own foam rolling and corrective home exercise program can help. You can sprinkle efforts throughout your day too. 

Sleep, nutrition and hydration are the fuel that keep you operating.

Recovery. Sleep, nutrition, and hydration are the fuel that keep you operating. Trying to push through hard workouts under highly fatigued conditions often leads to injury that can sideline your efforts. If you are exhausted, don’t cancel your workout. Show up and stick with walking or other slow-paced recovery type activities. 

Featured photo by Kelly Sikkema on Unsplash

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