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Joint Health: What gets you hurt?...Under-doing and Over-doing

A Physical Therapist’s perspective.

We all know about the weekend warrior that has no time for exercise during the week and on the weekends will go crazy and end up with some sort of injury. Most of the time we think that “rest” is the cure-all to any injury. But anyone who has had a nagging injury that has not gone away despite adequate rest time will tell you otherwise. Yes, over-doing can be bad, but under- doing can be just as detrimental. There needs to be some sort of balance.

The way our bodies grow and heal is through movement and stress. Sometimes mental stress can be a helpful motivator such as a deadline to help you finish that project on time. Too much mental stress though can lead to fatigue, depression, anxiety etc. Our joints respond in a similar way. Some movement is good and is actually restorative but too much can break us down and cause injury.

When we move our joints, like your knee or your shoulder, two major things happen. The first is that blood flow is directed more towards the muscles and the surrounding tissues. The second is that synovial fluid is circulated in the joint. You can think of synovial fluid as the oil of the joint. It helps lubricate the surfaces and makes joints move with less effort. So how do we know what's the right amount?

The pain versus activity curve (above) places pain on the vertical axis and activity on the horizontal axis. Our joints tend to respond to movement following this pattern. Again, over-doing is not good and under-doing is not good. Most people tend to know what overdoing is. "I ran 12 miles even though I haven't run in 4 months. But I just felt good while doing it" or "I know raking all the leaves in my yard was too much work on my back but I just needed to get it done so I did it anyway". Overdoing is often less frustrating for us because we understand that something happened and now I feel a certain way. Under doing can be the opposite and is often more frustrating.

I've had many patients come to me and say "my back hurts more, but I didn't do anything this weekend". But that's not really possible right? You existed, so you had to have done something. Sitting on the couch watching TV is doing something. Driving to a family member’s house in Connecticut is doing something. We often don't connect the dots on the under doing side of the curve and our joints become stiff and sore. This makes movements less appealing and even painful.

What we want to find is the thriving zone. That part of the curve between under-doing and over-doing. The activities that are in the thriving zone might be different for everyone. It will also fluctuate based on how much you do. When I provide this chart to a patient the main goal is to help every individual understand their body and start a framework to understand how all actions affect your joint health. Try this yourself by drawing the Pain v. Activity curve as above and write down in the boxes the things in your day that fit each one. As you continue to think this way, you will recognize that your thriving zone will get bigger the more time you spend in it.

This is why keeping a consistent training program is important for your health. When we do push our limits with exercise (which is a good thing), it is important to also remember to give our joints easy movement that is not over-doing or under-doing. For instance. After a heavy leg day, ride the stationary bike for 10 min with no resistance. After a heavy arm day, do some bent over rows with very light weight. Any gentle movements that can be done to keep you in the thriving zone and facilitate joint healing and movement will help you stay healthy and able to continue moving in the long run. Understanding how your body responds and being mindful of it will keep you healthy as you work towards your goals!


Steve Vitale is a AAOMPT Fellowship and Kaltenborn trained Physical Therapist with Professional Physical Therapy at the Allston-Brighton Location at 1300 Soldiers Field Road Allston MA 02135.

For more information on joint health and helping you find your thriving zone, Please visit or reach out to him directly


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