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A few years ago a strange thing happened at the end of a hike. My heart suddenly felt fluttery. Was I having a heart attack? I couldn't be. I was young, healthy, and strong enough to cover three miles of tough terrain. I must have just overdone it, I decided.
But the next morning, my pulse still wasn't right, so I called my doctor. She said to come in at once. Fortunately the EKG showed that it wasn't a heart attack; the problem was a minor thyroid imbalance. I was lucky, but the experience was an eye-opener.
Even if you exercise and are keyed into your body, you can still misread its warning signals. In fact, "young, fit women often tend to ignore them," says Ed Laskowski, MD, codirector of the Mayo Clinic's Sports Medicine Center in Rochester, Minnesota. But some aches and symptoms could be more serious than you think. Here's the heads-up on six scenarios that are likely to trick you.
Scenario: Although your routine hasn't changed, suddenly the pounds are dropping off.
Your downplay: I've broken through a plateau. Woo-hoo!
Doctors' double-take: However welcome, "unexplained dramatic weight loss is unusual and cause for concern," warns Steve Rosenbaum, MD, an assistant professor at Baylor College of Medicine in Houston. One serious possibility is diabetes. In the United States, 11.5 million women over age 20 have types 1 and 2, but about a quarter of them don't know it yet. Because we've heard so much about how weight gain leads to the disease, you may not know that weight loss is also a symptom. Your body, unable to convert food into energy, begins to use up its stores of fat. Along with that weight loss, though, comes the risk of diabetic coma or even death.
What to do: There are predisposing factors, like being overweight and having a family history of the illness, that make you more likely to develop diabetes, but anyone can get it. So if you notice a steady, unexplained drop of 10 to 20 pounds or 10 percent of your weight over a period of six to eight weeks, check in with your doctor. If you've also been unusually hungry or thirsty, if you suddenly feel exhausted all the time, or if you constantly have to pee, she'll want to do a fasting blood test or a hemoglobin A1c test to determine whether you have diabetes. If you do, you'll be put on a plan, including a healthy diet, regular exercise, and possibly medication, to help you control your condition.
Scenario: The ab workout you started doing is giving you a six-pack -- and also nagging back pain.
Your downplay: It's just new-program pangs; eventually it'll go away.
Doctors' double-take: Your routine could be developing your abdominal muscles unevenly, says Marty Jaramillo, owner of New York City-based I.C.E. Sports Therapy and a FITNESS advisory board member. There's been an explosion of core conditioning classes, but in trying to meet their clients' demands, many instructors overemphasize belly busting. The result: The side and back muscles, which secure and stabilize the spine, become weak. "The imbalance feeds on itself," Jaramillo explains. "You compensate by using the stronger muscles in front more, and the situation spirals until you end up injured."
What to do: A lot of things can cause back pain, so take a close look at your workout: Generally, you should be spending the same amount of time -- that is, doing an equal number of sets and reps -- on the front, back, and sides of your core. If you have been too ab-focused, Jaramillo recommends trying the plank and its variations to work your sides and obliques. Crunches that have an element of rotation will also work your obliques. (You don't have to stop doing crunches unless you have significant pain.) It should take six to eight weeks for your core to even out; when it does, "you'll see your balance, posture, stamina, and endurance improve too," Jaramillo adds.
Scenario: Your breast is reddish and sore to the touch.
Your downplay: Time for a new sports bra. This one is chafing me.
Doctors' double-take: Even if there's no lump, that irritation can indicate inflammatory breast cancer, says Sandhya Pruthi, MD, director of the Breast Diagnostic Clinic at the Mayo Clinic in Rochester, Minnesota. This form of cancer, which can target young women, accounts for 1 to 5 percent of all breast cancers in the United States, and it's so fast moving and aggressive, it can seem to appear overnight.
What to do: Don't take chances, and don't worry about overreacting. Especially if your breast is warm or if a lump has developed, get to an ER or urgent-care center pronto. To rule out an infection or abscess -- both of which need immediate medical attention in their own right -- the doctor will probably prescribe antibiotics first. If the irritation doesn't start disappearing in two or three days, it may be cancer; a breast specialist will recommend a diagnostic mammogram, and you may need a breast biopsy. Even if you're facing the worst-case diagnosis, early detection "means that the cancer was likely found before it spread to other parts of the body," Dr. Pruthi says. Treatment may include chemotherapy, surgery, and radiation.
Scenario: You begin coughing during your cardio routine -- about 20 minutes into it every time.
Your downplay: All that breathing through my mouth! I need a water bottle.
Doctors' double-take: You could have adult-onset asthma, also called reactive airway disorder (RAD). "We usually associate wheezing with the condition, but a dry, persistent cough during exercise can also be a symptom," says Elizabeth Paras, MD, an emergency-room physician at New York-Presbyterian Hospital in New York City. In fact, coughing during your workout, when your lungs are working hard, could be your only symptom. Nobody has pinpointed a single cause of RAD, but airborne irritants such as secondhand smoke and mold seem to play a major role. Left untreated, RAD can sabotage your workouts by stopping you from going all out -- or worse, send you gasping to the ER.
What to do: Start clocking that cough. "If it always happens when you hit mile three on the treadmill or once your heart rate reaches 160, say, then it's probably not incidental, and you should have your doctor give you a simple, noninvasive pulmonary function test," Dr. Paras says. If you have asthma, you will be given antiallergy meds containing antihistamines to control your symptoms or, if your condition warrants it, an inhaler that will let you control the problem and start powering through your workout again.
Scenario: Yoga has done wonders for your stress, but the backs of your knees feel tight and tender.
Your downplay: I need to stretch more before class to keep my muscles loose.
Doctors' double-take: Actually, all of those stretching poses may have overly loosened your joints. Women's muscles and ligaments don't hold their joints in place as securely as men's do. "Overstretching can be all too easy then," Jaramillo says. As a result, your muscles and ligaments may get injured and inflamed, putting you at risk for a serious sprain.
What to do: Pay attention to where it hurts when you stretch your hamstring. "You should feel it in the whole length of the muscle," Jaramillo says. "If it's only in the knee, you're probably hyperextending." The good news is that you likely don't need a doctor. Just "be mindful about your form when stretching and be careful not to push your knees past their normal limits," Dr. Laskowski advises. Not sure what those boundaries are? A physical therapist or sports trainer can give you pointers as well as exercises to help you strengthen your muscles and ligaments.
Scenario: You're heading into the last mile of your run when you feel a weird twinge in your chest.
Your downplay: I'm exercising. My heart is just pounding very hard.
Doctors' double-take: Well, no. We know now that when women have heart attacks, they may not experience classic chest pain. But some do have it. "Running is like a medical stress test," Dr. Paras says. "If your heart hurts consistently during your routine, it may be failing that test."
What to do: Before you jump to any scary conclusions, Dr. Rosenbaum recommends pressing the area with your hand. If it hurts to the touch, you probably strained the muscles of the outer chest wall. This can happen in any number of ways: doing push-ups incorrectly or twisting while getting into a car. One or two days of rest, some ibuprofen, and a soak in a hot bath and you'll be fine. But if you can't find a sore spot, if the pain radiates or is so intense that you have to stop what you're doing, or if you also feel dizzy or breathless, take an aspirin and get to the ER fast.
Originally published in FITNESS magazine, May 2010.