3 Myths I See Every Day in Physical Therapy

Zachary Walston

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As a physical therapist, I hear a lot of exercise myths. To challenge health misinformation, I have to keep up with all of the BS written on social media and blogs. It can be overwhelming and frustrating.

This article won’t address all of the myths seeping into gyms, physical therapy clinics, and home computers, but it can serve as a starting point.

Myth #1 — Your posture and form matters

“Don’t round your back”, “Lift with your knees, not your back”, and “keep you back straight” are among the most commonly used phrases for “injury prevention.” When looking at the research, these phrases fail to hold water.

Lifting with a rounded low back is not asking for a back injury. A recent study reviewed over 4500 articles to determine what the current body of research has to say about lifting with a rounded low back. Here is what they concluded:

“There was no prospective association between lumbar spine flexion when lifting and the development of significantly disabling low back pain. There was no difference in peak lumbar flexion during lifting between people with and without LBP. Current advice to avoid lumbar flexion during lifting to reduce low back pain risk is not evidence based.”

Translation: lifting with a rounded low back does not cause or maintain low back pain.

The postural model does not hold up to rigorous research. There is no ideal position for standing, sitting, or squatting. No research to date has identified a level of stress that is too much for our bodies to handle, particularly regarding sitting or standing.

Our bodies are resilient. Bending your neck to look at a phone, slouching your shoulders in a sitting position, and rounding your back to lift something off of the floor is not dangerous. The added forces do not cause damage.

Some studies show the spine is in a more stable position when flexed. Flexing the back shortens the distance you have to bend your hips and knees to improve the length-tension relationship allowing you to produce more power. Essentially, rounding your back can allow you to use physics in your favor.

Perfecting mechanics and form can help with force production to lift more weight. In that sense, form is important. But when it comes to injury risk factors, don't worry about maintaining a specific position. I never worry about posture in my clinics and you don’t need to in the gym.

What about the reverse of static positioning?

Myth #2 — You have to stretch to improve flexibility

If you want to become more flexible, what is the best approach? Stretching? Yoga? How about lifting weights.

According to recent research, resistance training can be as effective as stretching for improving flexibility. How? Our bodies adapt to the stresses we put on them. 

If we perform resistance training through a specific range of motion, over time our body adapts to the motion. For example, if you want to improve hip mobility, deep squats with weight are effective. You get the added benefit of improving cardiovascular and metabolic health, building muscle, and increasing bone mineral density.

The only time I implement stretching in the clinic is if the patient requests it. If you stretch for enjoyment, I’m all for it. If you stretch to improve mobility, you will be disappointed in the results. Static stretching alone only produces short-term changes.

But we shouldn’t discredit the enjoyment factor of exercise.

Myth #3— No pain, no gain

No pain, no gain” might be the worst phrase ever uttered in the gym. Asking the question, “Is it soreness or pain?” is a close second. At the end of the day, both pain and soreness are unpleasant. Both pain and soreness are deterrents to exercising.

Pain is not necessary to obtain benefits from exercise. Though exercise does need to be challenging, as our bodies adapt when they are pushed, pain doesn’t have to be part of the equation.

Delayed onset muscle soreness — also known as DOMS — is the prototypical soreness experienced after exercise. The more you exercise, the less DOMS you experience due to something known as the repeated bout effect. If you are experiencing significant soreness after each exercise, your recovery is likely insufficient. You either need more rest between exercises, changes to your diet, more or better quality sleep, or a more gradual increase in exercise intensity.

Research shows that our motivation, interest, and enthusiasm toward exercise can influence both the likelihood of sticking with the exercise program and the amount of success you experience. Pick exercises you enjoy. It’s not all about the physical benefits.

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I am a physical therapist, researcher, and educator whose mission is to challenge health misinformation. You will find articles about health, fitness, medical care, psychology, and professional development on my site. As the husband of a real estate agent, you will also find real estate and housing tips.

Atlanta, GA
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