A geriatric physical therapist explains when exercise can become too much of a good thing for seniors

Both my parents have been athletes all their lives. Their combined track record includes hockey team captaincy, multi-day cycle treks and regular triathlons.

My mother, in particular, is still raking in medals in her mid-60s and runs or hits the gym nearly every day.

Impressive, right? But being a highly active senior does have drawbacks, such as persistent aches and pains, chronic injuries and repetitive strain.

It’s something that Casey Lee, a board-certified geriatric physical therapist at ATI Physical Therapy, sees regularly through her work with active senior clients.

“They’ve been active and healthy all their lives, and they want to keep moving, exercising, playing, jumping, hiking, swimming, biking, pickleballing etc.—until the day they die,” she says.

“From an aging physiology standpoint, this is usually a very good thing. But, as my clients get older, their aches and pains get louder and more prevalent. A day without some kind of pain, ache, or stiffness is rare.”

Lee zeroes in on one particular issue. “The pain-inducing culprit with highly active adults is often repetitive stress without proper recovery,” she says.

Using the example of someone who plays pickleball religiously, Lee explains that they will only be working the muscles and running through the movement patterns needed for that particular sport.

“This is a recipe for repetitive overuse injuries like chronic tendinopathies, joint degeneration, spinal pain and stiffness.”

But Lee has two easy tips to help reduce aches and pains and stave off injury.

1. Diversify your movement

“The great news for this highly motivated and physically active group is that with a few activity modifications and a tailored exercise program, they really can have more pain-free days,” says Lee.

She explains that while she can’t promise total relief, she encourages her highly active clients to diversify their daily movements to support tissue resilience and adaptability. This looks like mixing up training rather than doing the same exercise all the time.

“A healthy and comprehensive exercise program should always include cardiovascular conditioning, strength and balance training, and tissue restoration,” she says.

If you’re not sure what this looks like for you, she suggests speaking to a physical therapist (use the American Physical Therapy Association’s ChoosePT website to fine one near me). They are trained to identify any gaps in your training to ensure that you have a well-rounded program that leaves space for you to recover.

“There’s a common misconception that you have to wait for a problem to occur before you can see a professional,” says Lee. “This is not true. Physical therapists play a role in injury prevention.”

2. Prioritise sleep

As well as varying the types of movement, Lee stresses the importance of recovery with rest days and, in particular, getting enough good-quality sleep.

“Sleep plays a critical role in immune function, tissue healing, pain management, cardiovascular health, cognitive function, learning and memory,” says Lee.

“If we are not sleeping, we are not healing.

“As we age, our sleep quality worsens, with over 20% of adults over 65 reporting trouble staying asleep. Clinically, this presents as ‘everything hurts and nothing helps’.”

Lee says that sleep problems can be incredibly frustrating, but challenges those struggling with them to think about sleep differently.

“I want you to think about sleep like a non-negotiable medical intervention,” she says.

“If you had a medical condition that required you to take a specific medication routinely to stay alive, you would make absolutely certain you followed the prescription schedule without deviation.  I want you to think about sleep just like that.”

She adds that good sleep hygiene is key. Try adding consistent bedtimes and wake-up times, and set yourself up with an evening wind-down routine.  

If you struggle with pain that keeps you awake, a physical therapist can help you troubleshoot your sleep posture. More complex sleep issues will need the attention of a doctor or sleep specialist.

Casey Lee

Casey Lee has worked with aging adults as a geriatric physical therapist for almost 20 years. She has developed successful health and wellness programs for skilled nursing facilities, independent and assisted living communities, and PACE programs.