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P90X: Is It Really For You?

Well, I just saw another shoulder injury yesterday that was related to the P90X system.  My poor patient was a mid-50's businessman whose previous workouts consisted of lifting the Triple-Cheeseburger with Extra Bacon at the local McWendyKings...  The P90X Systemhttp://www.assoc-amazon.com/e/ir?t=medinplawor-20&l=btl&camp=213689&creative=392969&o=1&a=B000TG8D6Ihttp://www.assoc-amazon.com/e/ir?t=medinplawor-20&l=bil&camp=213689&creative=392969&o=1&a=B000TG8D6I appealed to his sense of going after what you want, he was ready to make some changes in his life, so he bought it and commenced.

He noticed immediate gains in strength and in muscle size (Rule #5).  He also noticed a little twinge in his right shoulder, which he promptly ignored and pushed through, violating Rule #4.  He stuck to the system as published and even did extra workouts because he was so pumped about his progress (Rule #2).  After a few weeks his right shoulder was getting worse; it was hurting during the workouts and aching badly at night, even waking him from sleep.  

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Infuriated at his stupid, girlie shoulder, he came to see me for a quick fix.  After three visits of the usual stair-step progression of treatment and investigation, he went for the dreaded MRI of his shoulder.  Luckily, he did not have a rotator cuff tear, but the tendons in his shoulder were severely inflamed.  Turns out, he had not been resting the shoulder as instructed while we were treating it; he was still "pushing through" the pain.  It was at this point, as I  was in the middle of giving him the verbal smack-down for being a knuckle-head, when these 5 rules just came out of my mouth.  That happens to me sometimes; I'm not sure where this stuff comes from, but I'm not complaining.

Now don't misunderstand me, I think the P90X System is a fine way to get back into shape.  It is a little on the aggressive side for my taste, especially for folks who have been sedentary for years, but other than that I think it is fine.  It has a very motivated tone which speaks to many professionals who used to be athletes, but who, for the last 20 years, have been scoring mental/business points instead.  This person's usual all-or-nothing attitude that has brought success in business, often leads to injury when getting back into shape.

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There are 5 rules you must follow if you want to stop being a soft, weak 40-something or 50-something without injury.  If you are a 20-something, you can scoff at these recommendations and proceed.  If you are a 30-something, you might want to pay a little more attention.  But, if you have a sprinkling of gray hair, that is supposed to be evidence of wisdom; (use it!) after 40, you must go slower initially or you will hurt yourself.  So, here are The Rules for getting back into shape after 40:

1. You can get back into great shape after 40, you just can't do it all today!  I even tell 80-somethings they can become athletes again, but it has to be very slowly; it's gonna take time.  Your body is bad out of shape and out of practice and just cannot get to where you want to be in the allotted 30 minute sit-com time-frame.  Patience and persistence are what's needed, not blind motivation.

2. You must give your body more time to recover than you did in your teens/twenties.  It just takes more time for your body to repair the damage of a workout than it used to.  You can get there, but it will take more time and patience than back then.  There is no secret supplement or stretch that allows you to break this rule.  This is not a thought, or a suggestion, this is a Rule.

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3. Your nutrition (or lack of it) matters much more now than in your teens/twenties.  I can remember exceptional high school athletes with beautiful bodies, who lived on Twinkies, Cheetos and Coke.  Somehow, their amazing teenage body was able to turn that crap into muscle.  Well, after 40, you can forget that.  If you don't feed your muscles, tendons and ligaments healthy stuff, you are guaranteed an injury.

4. You CANNOT ignore pain in a joint or tendon like you did in your teens; you have to listen to your body.  Pushing through pain is something every former athlete is familiar with.  It works a lot more often for teens and twenties than it does for forties/fifties.  A little muscle soreness is one thing, but you just cannot ignore pain in a joint or ligament after 40 or you will suffer.  That's not to say you should stop, it just means you have to listen to your body and know when to adjust, or ask for help.

5. Muscles respond much quicker to increases in exercise than tendons and ligaments, thus the danger of injury.  Imagine a raw piece of meat.  The muscle is red, right?  That means it has an excellent blood supply.  So, after a workout your muscles are engorged with blood bringing healing nutrients, so your muscles recover in a few days.  Think of the tendons, what color are they?  White; and that means they have a very poor blood supply.  Ligaments have such a poor blood supply that we theorize they get some of their nutrition from the fluid in the joint itself.  So after a hard workout - which stresses your tendons just as much as your muscles - your poor tendons and ligaments just sit there with their little white self, waiting as the healing nutrition merely trickles in.  Thus, your muscles respond, grow and heal much quicker when stressed than do your tendons and ligaments.  Ignoring this fact after 40, is a guaranteed injury.  After 40, you have to slow down the pace of your increases in both resistance and duration so that these white structures have time to recover as well.  

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Oh, and my 50-something businessman with the achey shoulder?  Well, he actually heard my Rules and took them to heart.  He took his medicine, he rested the shoulder much more (while continue to work the rest) and his thankful shoulder responded and was well about 6 weeks later.  He is now looking better than his somewhat jealous doctor...  Four to eight weeks is the usual amount of time you have to rest a ligament or tendon injury before starting to push them again.  You can see how that would cut into your progress; better to prevent the injury by following the 5 Rules.

I really want you to get back into great shape.  There are mirror-reasons for doing this, but more importantly there are the medical-reasons.  Just remember, after 40, the limiting step is not how quickly your muscles respond, but how quickly your tendons and ligaments can recover.   Now go get busy!



  1. Well, personally, I don't think P90X is for anyone. You left a comment on a blog I don't regularly update anymore, but I do have a new one. I'm the author of a book called "The Theory of Fat Loss" and I run a blog. Recently, I just did a 3 part series critically examining the effectiveness (or lack thereof) of the P90X system using the exercise and training principles that I outlined in my book. Here's Part 1, a post where I discuss the theory of absolute intensity.

  2. I hear your concern, and think some of it is well-founded. I have had some patients, however, make stunning progress with P90X. 40-plus year olds just have to be more careful, give their bodies longer to respond, and longer to heal.

  3. P90X, on the other hand, is designed with a different purpose. The nutrition plan is designed to help you change your body composition, not just just lose weight. Which means you will be eating to build muscle, not just lose fat. It's designed with a heavy dose of resistance training, again so that you build muscle, not just lose fat.
    Perfect Radiance

  4. MBF - You are correct. Those over 40 should just remember that tendons and ligaments regenerate and strengthen much more slowly than muscle does. So do your P90X, but listen to your joints...

  5. Also in case you didn't know, the "X" is for "extreme". The precursor to P90X is P90, and is I believe more appropriate for more overweight individuals or those that have not exercised seriously in years.

    Wonderful blog, by the way.

  6. Also, you should be aware that the "X" is for "extreme". The precursor to P90X is P90, and is I believe more appropriate for the heavily overweight, and those that have not exercised seriously in years.

    Wonderful blog, by the way.