By Kenan TrebincevicLegs of a young man running

was not surprised when a new University of Pittsburgh study suggested people with back pain try physical therapy before spine surgery, since it’s cheaper and less risky. I was similarly unsurprised to learn that new articles in JAMA insist that working out 150 hours a week is optimum for health.

As a 34-year-old, obsessively-fit Manhattan physical therapist for the last decade, I’ve seen many cases in which the hips, knees, ankles, and spine can be protected; hurt can be alleviated before trauma happens; and medical intervention can be avoided with the right exercise and attitude. But my busy, Type-A patients–many urban athletes–need to pay better attention if they don’t want to pay me a visit.  

I learned the importance of fitness the hard way, when my family escaped Bosnia during the Balkan war, and was offered shelter in the U.S. in 1993.  Luckily, my father, Keka, a sports trainer, taught my brother Eldin and I how to eat, train, and treat our bodies well–even in the worst circumstances.  Our good fitness habits helped us recover faster than many immigrants. Eldin is also a Manhattan physical therapist, and Dad, at 75 years old, still works out with me at our Astoria, Queens gym six hours a week.  

Before the warm weather seduces weekend warriors who’ve been sedentary all winter to run six fast miles in the first hour,  here are seven steps to keep you out of my office this season.

1. TAKE A STAND:   Before you even consider a real workout, try a week of getting up–for at least five minutes every hour. Walk around your work area, move your back and legs, pick up a package yourself instead of ordering a messenger, or walk the stairs instead of taking the elevator.  This is especially important for commuters who cram into subways, busses, trains, and planes. Recent studies show people who sit 40 hours a week have an increased risk of diabetes, cancer, and heart problems.  Not standing enough restricts blood circulation and causes clots that can kill you.  Get a smart phone app or Apple watch to increase the number of daily steps you take. 

2. SITTING UGLY: If you must sit for long periods, make sure you’re sitting well and tall.  Hunching over leads to discomfort, loss of normal back curvature, and disc herniation.  Elevate your chair–at home and the office–so your feet are on the floor and your thighs point downward and are not parallel to your seat to prevent slouching.  If the chair has no back rest, roll a small towel in burrito fashion and place it under your behind in a U-shape. This will pull your rear off the seat, giving you a small arch in the back to take needed stress off of your muscles and discs. Sometimes just getting a sturdier chair or repositioning its height can save your health. 

3. STRETCH DAILY: In Miranda Esmondes-White’s new book ™Aging Backwards,∫ the author, a former dancer,  insists that 30 minutes of careful stretching  will make you look and feel younger. Try Pilates, yoga, meditation, PT, or an exercise class with a friend, whatever will make it more likely that you continue on a regular basis. Hip-flexor and hamstring stretches are the most important to increase joint flexibility. 

4. VISIT THE WATER COOLER, NOT THE DONUT CART:  Stay hydrated with the healthiest fluid in the world: Water, at least eight glasses a day.   While vegetable smoothies and fruit juices have vitamins, they also contain a ton of calories.  Beware all soda (including diet, which has rightly been called ™Devil Juice,∫) and sports drinks filled with too much caffeine and fructose sugar.  If you must eat junk food, allow yourself one meal and dessert a week, after a workout, and then get back to a better regimen. 

5. WEAR IT WELL: It looked funny on the big screen when Reese Witherspoon’s ™Wild∫ character hurt her feet from hiking in inadequate hiking shoes.  Yet wearing the wrong gear accounts for one third of all the aches, pains, and sprains I see in my office. Get the right walking, running, or cross-training sneakers–and not for the third year in a row. Investing in something as minor as Orthotics–or another shoe insert–can prevent plantar fasciitis and other future injuries.  Don’t constrict your lungs and stomach in clothes that are too tight for you out of vanity. For cycling, have your bicycle fitted and get bicycle shoes and a helmet. If you can’t afford it, you can often rent or borrow what you need.  Yes, I know, it may ruin your selfie. But helmet hair looks a lot better than brain damage. 

6. START EXERCISING SLOWLY:  By Labor Day, my client Susan was swimming one mile in an hour.  So the next Memorial Day, she assumed she could start where she left off–and hurt her back and shoulder before it was even June.  I’ve overshot too.  One afternoon, post-college, thinking I was still in my top running shape, I decided to race a high school sports star in the 100-meter dash (though my mother warned me not to) without a proper warm-up.  Sure enough, I came back limping, with a hamstring strain my mother refused to pamper. 

No matter your age or fitness level, it’s best to begin slowly and work up momentum.  Every marathon starts with the first mile. If you must exercise for an hour and a half on your first day out, cross train so you do a mix of walking, running, elliptical machine, or weights. That way you won’t stress out one muscle and ruin your whole summer before it starts.  With weight lifting, vary duration, loads, sets, and repetitions. Always build endurance first, before strength.  Progress the load on your joints and heart by getting on a stationary bike or elliptical machine prior to your run. Which is more important: losing a few pounds or losing your motor function for six months? 

7. WHEN IN DOUBT, SEE A PROFESSIONAL:  When you age or hurt yourself and have to heal, your routine must change along with your mindset.  Susan was shocked to hear me say that someone over 40 should usually not be swimming a mile, kickboxing, and speed walking every single day for more than an hour.  She needed a full 24-hours off in between intense workouts to avoid hurting herself.  You have to re-evaluate your goals every few years, be realistic, and stop thinking, ™I used to be able toº∫

If you’ve had any kind of breaks, tears, disc problems, or surgery in the past, visit your doctor, a physical therapist, personal trainer, nutritionist, or exercise physiologist BEFORE you embark on a 100-mile hike in the Alaskan wilderness where, despite an urbanite’s impulse to call in for anything, they will not be making house calls.   Ask to see somebody’s credentials, and get references from friends and colleagues.  Slow down and start right to have a fun, active, and pain-free season.  Following these guidelines, I’ll be seeing you on the trail this summer, and not on my midtown table.

Kenan Trebincevic is the co-author of a memoir, “The Bosnia List,” Penguin 2014. He works as a physical therapist at Performance Physical Therapy in Midtown. To contact him, email [email protected]

Photo by Eldin Trebincevic.

Photo by Eldin Trebincevic.

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