Advertisement
How To Prevent Injuries & Train Smarter In Midlife, According To Orthopedic Surgeons
We've spent too long talking about fitness as a way to shrink ourselves. But if you're in midlife—or anywhere close—it's time to flip the narrative. Strength is the goal. Vitality is the reward. And your workout? It should be built to support both, not break you down.
That's the philosophy of orthopedic surgeons Miho Tanaka, M.D., and Vonda Wright, M.D., who joined us on the mindbodygreen podcast to share how women in their 40s, 50s, and beyond can train not only harder—but smarter.
The secret? Learning to work with your body's physiology instead of fighting it.
1. The real reason injuries happen more in midlife
As estrogen declines in midlife, we lose a natural anabolic (muscle-building) hormone that once made it easier to maintain strength and recover faster. That shift affects everything from how we build muscle to how resilient our tendons, ligaments, and joints are under load.
But here's the empowering news: "We can build muscle and do build muscle," says Wright. "We just have to train with more intention."
Start here:
- Prioritize progressive overload. Light weights and high reps won't cut it. Choose a weight you can lift with good form for 4–6 reps, and work up from there.
- Include total-body strength work twice a week. One compound lift (like a bench press or squat), plus 3–4 sets of accessory exercises, and core work every time.
- Build in recovery. More isn't always better—smarter is. Rest is when your muscles actually rebuild.
2. Train your core like it's your injury prevention plan (because it is)
You don't need a six-pack to be strong. But you do need a stable core to stay injury-free—especially as you age. "The pelvis is the center of the universe," Wright explains. "If your core is strong, your whole kinetic chain becomes more efficient and less injury-prone."
A weak core can cause a ripple effect of poor mechanics through your hips, knees, and ankles. That's why Wright adds core work to every single workout.
Here's what to add to your routine:
Incorporate planks, dead bugs, bird dogs, and other stability moves that emphasize control and posture—not speed or flashy reps.
3. Never skip the warm-up (or the cool-down)
One of the biggest injury risks in midlife? Jumping into workouts without priming your body first. "We need to warm up our joints, increase circulation, and fire up the neuromuscular system before loading the body," says Tanaka.
Stretching alone isn't enough—and static stretches before lifting can even increase injury risk. Instead, think dynamic warm-ups that get your body moving through a full range of motion.
Wright's go-to warm-up strategy:
- 5 minutes of light cardio (brisk walk, bike, row)
- Dynamic movements like walking lunges, leg swings, arm circles, and bodyweight squats
- Activation exercises like glute bridges or banded monster walks
As for stretching? Save the static holds for after your workout, when your muscles are warm. This is the time to work on flexibility, release tension, and help your body shift into recovery mode.
4. Rethink cardio
Wright sees too many women stuck in a cycle of chronic HIIT classes, where "high-intensity" becomes high stress on the body—and the brain. "They're not actually hitting the intensity they think they are, and they're exhausted, cortisol is high, and they're constantly injured," she notes.
Instead, she recommends adopting a pro-athlete approach:
- 80% low and slow (zone 2 training) to build endurance and metabolic flexibility.
- 20% true high-intensity intervals to improve VO2 max and stimulate fat burn.
Try her sprint protocol once a week:
- Warm up
- Sprint all-out for 30 seconds
- Walk or slow jog for 1–2 minutes
- Repeat 4–6 times
This isn't about being fast—it's about getting your heart rate into the upper zone and training your cardiovascular system efficiently.
5. Eat to support strength, not restrict it
If you're underfueling, you're setting yourself up for injury. Not only does inadequate nutrition slow recovery, but it also puts your muscles, bones, and connective tissues at risk.
Wright emphasizes protein-first nutrition—divided into four or five "feedings" throughout the day—to fuel muscle growth and repair.
Her formula:
- Three meals with at least 30g of high-quality protein
- One to two protein "feedings" like whey protein isolate shakes
And no, carbs aren't the enemy. Complex carbs support energy, recovery, and hormone health. Think: sweet potatoes, beans, oats, and avocado.
6. Be hormone-aware
One of the most overlooked aspects of injury prevention? Understanding how hormones shift throughout life. As estrogen declines, so does its support for muscle repair, bone density, and ligament integrity. For women, this is particularly critical when it comes to knee injuries.
Women are twice as likely to tear an ACL—and hormone fluctuations like increased levels of relaxin may be partly to blame. Tanaka's advice? Don't ignore the science; adapt your training.
Here's what she recommends:
- Strengthen your hamstrings to balance dominant quads.
- Focus on hip and glute activation to stabilize your knees.
- Train with proper landing and cutting mechanics to avoid injury during sports or workouts.
The takeaway
You don't need to train like you did in your 20s to be strong in your 40s, 50s, and beyond. You just need to train smarter.
That means eating enough to build, lifting heavy to stay resilient, sprinting for heart health, and listening to your body's evolving needs. Because the goal isn't to shrink yourself—it's to stay strong, capable, and injury-free for the long haul.
This is your strongest chapter yet.