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Five Red Flags of Exercise

February 2024 - Ana Karim, PT - Queen City Pelvic PT

Often clients will ask me about the exercises they should be doing and ones they should be avoiding. That’s a tricky question because there are many factors to consider! Here are just a few I consider:

 Do they have enough strength, flexibility, and endurance?

 Do they already have types of exercise they like to do or want to get back to?

 Are they able to coordinate their breath with activity and exertion?

 Where are they in their recovery after surgery, delivering a baby, or with managing pain?

In my practice my primary goal is to ensure that clients have the foundational exercises that will teach them how to breathe, how to find stability before mobility, how to build balance between muscle groups, and how to build endurance. From there, I move toward assisting them to re-integrate into the types of exercising they enjoy or want to return to. At that point, I want to equip my clients with the ability to discern the level of intensity and difficulty they can manage as they return to the gym, to the group fitness class, or to their home routine. This is where I introduce them to the 5 Red Flags of Exercise!

These flags are meant to help a client decide for themselves if the exercise or activity they are doing needs modifications or needs to be avoided a while longer or all together. Empowering clients to recognize these flags for themselves means that in a fitness class, if the instructor isn’t helping participants make modifications, my client can feel confident they know their bodies and respect its present limitations! It also empowers clients not to worry about what everyone else is doing!


Red Warning Flags blowing in the wind
Pelvic Health Red Flags for Exercise

So, without further delay, here are the 5 Red Flags of Exercise that indicate it’s time to modify, stop, or avoid an exercise or activity:

  1. There’s pain! Sharp, persistent pain while doing exercise is not good! Check your form, intensity, load, or speed. If you modify these and there’s still pain, it’s time to stop or seek help!

  2. You pee or poop on yourself and can’t control it! This means there is a problem with strength, coordination or endurance of the pelvic floor muscles, hip, muscles, and abdominal muscles. Consider lightening the load if using weights, reduce the intensity and speed, check your form. If you modify in all of these ways and still pee or poop on yourself, it’s not good exercise for you at this stage. You may need to really back up and work on the fundamentals.

  3. You feel pressure down through the perineum or pelvic floor! For women there may be a sensation of something falling out of the vagina or that the pelvic floor is heavy or bulging out and down. For men, they may feel pressure or bulging through the perineum, rectum, and anus. This pressure usually is an indication that you are not managing your intraabdominal pressure well and not using the pelvic floor muscles and abdominal muscles in coordination with your breath to give you stability and support from the bottom up. You may need to check on your breath patterns, slow down so you can focus on engaging your pelvic floor, or reduce the intensity or load.

  4. You notice you are holding your breath! Not only is holding your breath not good for getting much needed oxygen to your lungs and to the rest of your body, but as you’ve read above it can impact how you are able manage pressure through your abdomen and into the pelvic floor. If you are holding your breath or straining to perform an exercise, the load may be too heavy, your intensity or speed are too high or too fast, respectively. (One caveat here—with competitive weightlifting, holding the breath may be necessary to add stability. BUT you still must learn how to use the pelvic floor muscles correctly to avoid leakage or pressure through the pelvic floor!)

  5. You cannot keep correct form! Whether you are doing a deadlift, a burpee, a jumping jack, down dog, or a plank, if you are not able to keep correct form, you are likely going to injure yourself or feel pain. There’s no shame in lowering the weight, slowing down the burpee, bringing the knees down for a plank, using blocks for the yoga pose, or doing stepping jacks and gradually building back up to correct full form. You can choose to do a different version of the exercise or activity as long as you can keep good form. How empowering!

Red warning flag
One of these red flags should remind you to adjust, modify or pause an exercise.

The next time you go to exercise, pay attention to these flags. If you find that you can’t figure out how to modify your exercises, need help problem-solving, need attention to the fundamentals, or just want to be pro-active in avoiding injury and dysfunction, give one of us a call. We’d love to help!

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