Most of us have a particular body part that may twinge when we exercise, or after we finish. When that happens, you know you didn’t warm up properly.

For me, it’s my outside left thigh. Without going too techy, it’s the vastus lateralis muscle, the outer part of the quads, which sits directly under the IT band.

I soon realise when my warm-up hasn’t done the trick. I certainly know if I skipped it altogether.

My squats become impossible as the pain in my thigh gets sharper with each one. Sometimes, the strain can hurt for days, which stops me doing further deep leg work over several sessions.

I mean, it’s easy to do. When you’re short on time, or just have a low boredom threshold (like me), skipping the warm-up feels like something you can get away with. Until you can’t.

And for midlifers and older, the warm-up actually becomes an essential part of the routine. I’ll explain later why this is so.

My right hamstring is another body part that can go ‘ping’ if I don’t warm up well. To the point now that I’m often more in a rehab drill with my hamstrings rather than doing the work I want to do.

So, take heed. Do as I say, not as I do.

Though sometimes, pain may be an over-use or over-training issue rather than a warm-up issue, and if you’re unsure, it’s worth getting it checked.

What does a warm-up actually do?

Before we exercise, we need to prepare the muscles and body for action. A warm-up helps raise the body temperature and heart rate, and that increased warmth and blood flow makes the muscles more flexible and pliable.

You’ll often hear the term to “activate” the muscles from trainers. And the same movements will also be helping the joints, by circulating the synovial fluid that keeps them lubricated.

A key purpose of warm-up is to help reduce injury risk. One review of footballers found that a structured 20-minute warm-up before play could reduce injury risk by around 39% (Thorborg et al, 2017). That’s quite a significant figure!

It also helps with the mind-body connection, too. Have you ever felt that your first set of an exercise can feel hard, and not quite ‘together’, but the second set is often much easier and more coordinated? My clients used to report this to me all the time.

It’s not just that the body has warmed up, but the brain also knows what it’s doing by the next set.

Because of the improved neuromuscular connection as well as the more flexible muscles and lubricated joints, range of motion is often increased, too. This improves performance during the ‘main act’: the training session.

Why is a warm-up more important in midlife?

We’ve all felt it. That little bit of ankle stiffness that never used to be there. Those low back niggles that seemed to appear overnight. The aching hips that haunt you through the night after a hard squat session.

Middle age and menopause bring with them a host of new considerations. Don’t you just know it?

A review which looked at musculoskeletal symptoms as women transition between perimenopause and menopause said that more than 70% of women will experience them, and for 25%, they will be significant (Wright et al, 2024).

As oestrogen declines, we lose elasticity in our tendons, muscles, and ligaments. They can become stiffer and slower to recover, making women more prone to strains and injuries.

Movements we used to breeze through might impact us differently now. For example, gluteal tendinopathy, which often shows up as hip pain at night, becomes much more common during this phase of life, and deep squats can sometimes aggravate it.

There are more examples but we would be here all day. Suffice to know that changing bodies have changing requirements in training.

And this includes men, too. With age can come more aches and niggles across joints and soft tissue, as well as slower recovery. Of course, it’s not a reason to stop, but just a reason to spend more time on warm-up.

As we age, our heart, lungs and muscles also take a little longer to get up to speed at the start of exercise. A gradual warm-up gives them time to catch up, rather than asking them to go from nothing to full effort straight away.

So. Here you have it. Hopefully I have convinced you to take more time on this in future.

How to warm up properly

Firstly, your warm-up needs to be appropriate to what you are doing in your session, whether it’s strength or cardio.

For example, if you are going for a run, then you will want to warm up the legs, hips and ankles, as well as increase your heart rate before you run.

If you are doing strength training and you’re on an upper body day, then you will want to mobilise and warm up the shoulders, neck, arms and back.

My strength training is pretty much always total body, I never do just legs or just upper body, so my warm-ups need to cover a few bases.

Your pre-workout movements need to reflect the movement patterns of your main workout. So you know you’re doing floor push-ups? Then some light wall presses will come in handy.

You’re going to be doing barbell back squats? Then try some deep goblet squats as a warm-up, pausing at the bottom of the squat for a few seconds.

Be aware though, the standard advice of long held static stretches pre-exercise is fairly outdated now. We now know they don’t prevent injury (Thacker et al, 2004), and holding a stretch for more than a minute can even sap your strength and power (Chaabene et al, 2019).

A warm-up that helps you move through the exercises you’re about to do is the better choice. Save the long stretches for your cool-down.

My takeaway tips to warm up better and improve your training:

Bearing in mind that your warm-up will look different depending on what you’re doing, and there are infinite possibilities for training, I can’t be specific about which warm-up routines are right for you. But following the advice below will help you go far:

• Make your warm-up non-negotiable. It’s not an optional extra, but an essential part of your training session.
  

• Plan your warm-up activities according to what your session will look like. Doing single leg work? Make sure the ankles and legs get some prior movement. Glute work? Try some light step-ups before the main action.
  

• Midlifers need to spend more time on warming up. Take 10-15 minutes instead of five. Your body will thank you, I promise.
  

• Make your warm-up dynamic, not static. It shouldn’t be heavy, but flowing movement patterns rather than holding static stretches.
  

• You’ve spent the time warming up, remember to cool down later when your main session is over! Also important, but let’s save that for another article.
  

What’s your warm-up story? Please do share in the comments. I’d love to know.

Leave a comment

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Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

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In Part 1, we looked at the fear of getting bulky. In Part 2, the habit of stretching an achy back. This week, it’s perhaps the most deeply held myth of all, certainly among women: that thinner means healthier.

Like many women, I have spent years yo-yo dieting on one weight-loss regimen or another. As a journalist, I used to write for diet magazines like Weight Watchers and Slimming World, and I’ve followed every diet going myself.

Invariably, as time wore on, my weight would creep back up. I’d blame myself, eat more for a while, then try another diet.

My goal in life was to be as thin as possible. I only managed it for short bursts, but I was on never ending diets. Plus, I had an extremely unhealthy relationship with food. That’s a story for another article.

This one is about how the belief that ‘being thinner is always healthier’ can cost women. Specifically, their bone health.

I ended up with osteopenia, which is low bone density. There’s good evidence that repeated dieting and under-eating can take a toll on bone. I believe years of crash diets and poor nutrition may have played a part in my bone loss, among other factors.

Let me be clear, though: I’m not saying weight doesn’t matter, because it does. Actually, let’s name it: excess fat, rather than ‘weight’.

A healthy ‘weight’ is good for your heart, your joints and your bones. But ‘healthy’ and ‘as thin as possible’ are not the same thing.

Why thin seems like healthy

It’s easy to see why we treat ‘thin’ and ‘healthy’ as the same. Decades of social conditioning and diet culture has convinced us that it must be so.

When we lose weight, friends tell us how great we look because we shed a few pounds. We may get “Oooh you look sooo trim” but we will never get “oooh, you look like you have strong bones.”

Newspapers and magazines report on the weight loss and weight gain stories of celebrities (usually women) as if it actually matters. Social media influencers share their ‘thinspiration’, posting filtered bikini shots while sipping a green smoothie. From the outside, it looks like a healthy lifestyle.

The fitness industry doesn’t help, either. Much of it relies on people’s insecurities about weight for business, so you see programmes galore built on extreme weight loss regimes promoted as a health ideal. They advertise ‘12 week transformations’ with before and after pictures of successful clients.

What they don’t show is how many people regain the weight, or more, afterwards. The evidence is fairly established. On average, more than half of lost weight is regained within two years, and more than 80% by five years (Hall & Kahan, 2018).

There are many reasons for this, but what matters for this article is that people often end up in perpetual cycles of losing and gaining weight. Like being too thin, this yo-yo cycle is also not healthy.

Shall we look at the evidence?

I want to be clear that this isn’t about thin-shaming, nor, of course, is it about fat-shaming. I’m just here to share the facts.

One of the biggest health risks for older women is osteoporosis. One in two women over 50 will break a bone because of it (Bone Health & Osteoporosis Foundation). And among older women, it’s the thinnest who are most at risk, compared with their peers of a normal weight.

According to Harvey et al. (2025), underweight women had more than twice the risk of hip fracture compared with women of a healthy weight. Part of that was down to thinner bones.

But even when the researchers compared women with the same bone density, the underweight women were still around 70% more likely to break a hip. Being underweight was also linked to higher death rates.

A large study of almost 60,000 people found that a BMI of 20 carried almost twice the risk of hip fracture of a BMI of 25 (De Laet et al., 2005). The risk rose most sharply at the low end of the BMI scale.

Does this mean people with obesity have stronger bones? They tend to have higher bone density, partly because of the extra load their skeleton carries. But obesity does not protect against fracture. Rather, it changes where fractures happen.

Compston et al. (2011) found that women with obesity had more ankle and upper leg fractures, though fewer wrist fractures.

Another interesting piece of the puzzle comes from a study of heart health. Srikanthan et al. (2021) found that women with high muscle mass and higher body fat had a 42% lower risk of dying from heart disease than women with low muscle and low fat.

What this research points to is the protective power of muscle, which is much harder to build when you’re focused on staying thin. The aim is a healthy weight (not too thin, not carrying too much body fat) and then to train for strength and muscle.

So what is a healthy weight?

We all need some fat. It does several jobs, and for women that includes helping to regulate hormones. What matters is how much fat we carry compared with lean tissue, not how big or small the number on the scales is.

That’s especially true once we start strength training, because the number on the scales may not change much, or may even go up, while body fat comes down. One of my former PT clients dropped two dress sizes without the scales budging. The scales can be very deceptive!

Most of us don’t have access to a DEXA scan, which can measure fat and lean mass fairly accurately. Therefore, a good, accessible indicator is your waist.

NICE advises adults with a BMI under 35 to keep their waist to less than half their height. So if you’re 5ft 4in (64 inches), aim for a waist under 32 inches. Measure halfway between your lowest rib and the top of your hip bone.

The NHS has a handy calculator tool.

Most health and fitness professionals now recognise BMI (body mass index) as a crude tool. It can’t account for body composition, and I’ve known people with very muscular, lean physiques who still register a high BMI, because muscle is denser than fat.

So take BMI with a pinch of salt, and check your waist.

Lose weight slowly to lose weight safely

The diet and fitness industries never say “Lose weight responsibly” the way the alcohol industry has to say “Please drink responsibly.”

Helping people manage their weight, where needed, is part of a PT’s remit. But because everyone loves a quick fix, many PTs are under pressure to get fast results with clients, and that isn’t always the best option.

The Royal Osteoporosis Society says that “A restricted calorie diet may reduce bone strength.” It adds that “If you lose weight rapidly, up to a third of the weight you lose will be lean mass.”

Lean mass is largely muscle. So along with the fat we’re so keen to lose, rapid weight loss can strip away our much-needed metabolic engine: our muscle.

A meta-analysis of diet trials found that diet-induced weight loss reduced hip bone density over 6 to 24 months, although the spine wasn’t significantly affected (Zibellini et al., 2015). The authors called the loss small compared with the metabolic benefits for people with obesity.

The arrival of GLP-1 weight-loss injections muddies the waters further. I’m not against them, but the weight loss they bring can be very fast.

A 2024 trial of people on a weight-loss injection found that those who exercised alongside the drug did better for bone than those on the drug alone (Jensen et al., 2024). That means anyone using them should combine their treatment with exercise, particularly strength training, to protect muscle and bone.

The message here is not “Don’t lose weight.” It’s “if you need to lose weight, do it while protecting your bones and muscles”.

Strong, not small

So what does protect our muscles and bones? The answer is given through this whole series: strength training.

In one trial, older adults with obesity lost around 9% of their body weight over six months. Those who did only cardio lost 2.6% of their hip bone density. Those who lifted weights lost just 0.7% (Armamento-Villareal et al., 2020). Same weight loss, but very different result for their bones.

For women, timing matters too. Bone loss speeds up from about a year before the final menstrual period which marks menopause, at roughly 2% a year for about three years (Greendale et al., 2012). Crash dieting in midlife piles more loss on top, at the worst possible time.

So if you’re losing weight, or thinking about it:

• Do total body strength training two to three times a week.

• Aim for slow, steady loss rather than rapid drops.

• Eat enough, with 20-30g of protein at every meal.

• Keep walking for your heart and mood, but don’t rely on it for your bones.

• On weight-loss injections? Ask your doctor about your bone health.

• For anything specific about how much to eat, supplements or medication, speak to your doctor or a registered dietitian.

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Quick healthy weight check:

1. Check your BMI

Use the NHS BMI calculator. Remember that it’s a rough guide, because it can’t tell muscle from fat, but it can tell you if you’re underweight (a BMI under 18.5).

2. Check your waist

Use the NHS waist-to-height calculator. Aim to keep your waist to less than half your height. This tells you if you’re carrying too much fat around your middle, which BMI can miss.

3. Why you need both

The NHS doesn’t indicate what a waist that would be too small is, the waist-to-height guidance only tells you when your waist is too big. So a small waist on its own doesn’t prove you’re healthy, and a “healthy” BMI doesn’t rule out excess fat around your middle.

Use BMI to check you’re not underweight, and your waist to check you’re not carrying too much around your middle.

Putting the two together:

The NHS tools aren’t suitable for everyone, so check the guidance on each page first. For example, the waist calculator isn’t for use if you’re pregnant, have a BMI over 35, or have, or think you may have, an eating disorder.

If any of these sound familiar, or food and weight have been a struggle for you, your GP is a good first step.

Want to become unbreakable?

Exciting news!

Coming in early 2027 is my 8 week course, Become Unbreakable: Future-proofing Your Body for Women After 40. No obligation to be on the course by joining the early bird waitlist, but if you decide it’s for you when the time comes, you’ll be eligible for my early bird offers and bonuses!

JOIN THE EARLY BIRDS

References

Armamento-Villareal R, Aguirre L, Waters DL, et al. Effect of aerobic or resistance exercise, or both, on bone mineral density and bone metabolism in obese older adults while dieting: a randomized controlled trial. Journal of Bone and Mineral Research. 2020;35(3):430-439. doi:10.1002/jbmr.3905

Compston JE, Watts NB, Chapurlat R, et al. Obesity is not protective against fracture in postmenopausal women: GLOW. American Journal of Medicine. 2011;124(11):1043-1050. doi:10.1016/j.amjmed.2011.06.013

De Laet C, Kanis JA, Odén A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporosis International. 2005;16(11):1330-1338. doi:10.1007/s00198-005-1863-y

Greendale GA, Sowers M, Han W, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women’s Health Across the Nation (SWAN). Journal of Bone and Mineral Research. 2012;27(1):111-118.

Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Medical Clinics of North America. 2018;102(1):183-197. doi:10.1016/j.mcna.2017.08.012

Harvey NC, Johansson H, McCloskey EV, et al. Body mass index and subsequent fracture risk: a meta-analysis to update FRAX. Journal of Bone and Mineral Research. 2025;40(10):1144-1155. doi:10.1093/jbmr/zjaf091

Jensen SBK, Sørensen V, Sandsdal RM, et al. Bone health after exercise alone, GLP-1 receptor agonist treatment, or combination treatment: a secondary analysis of a randomized clinical trial. JAMA Network Open. 2024;7(6):e2416775. doi:10.1001/jamanetworkopen.2024.16775

National Institute for Health and Care Excellence (NICE). Guidance on waist-to-height ratio for adults with a BMI under 35. nice.org.uk

Royal Osteoporosis Society. Risk factors for osteoporosis that you can change. theros.org.uk

Srikanthan P, Horwich TB, Calfon Press M, Gornbein J, Watson KE. Sex differences in the association of body composition and cardiovascular mortality. Journal of the American Heart Association. 2021;10:e017511. doi:10.1161/JAHA.120.017511

Zibellini J, Seimon RV, Lee CM, et al. Does diet-induced weight loss lead to bone loss in overweight or obese adults? A systematic review and meta-analysis of clinical trials. Journal of Bone and Mineral Research. 2015;30(12):2168-2178. doi:10.1002/jbmr.2564

Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

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This is Part 2 of The Myths That Are Working Against You. Last week, I looked at the fear of getting bulky in relation to women’s training, and how that myth has a cost. This week, it’s about a habit that is viewed as a commonplace solution for an achy back: stretching.

You wake up in the morning with a stiff back. What’s your first thought? Do some stretching? Perhaps the knees-to-chest stretch? Or lean over and touch your toes?

But here’s something you may not have expected. In a 1998 trial, people with chronic low back pain who simply avoided bending their spine forward in the first hour or so after waking reduced their pain days by 23%. A comparison group given a dummy routine improved by just 2%.

Three years later, those who had kept it up had cut their pain days by around half again. There is a nuance to this. Overnight, the spinal discs soak up fluid, which makes them stiffer and less able to cope with bending first thing (Adams et al., 1987).

But the point remains: for many people, the first response to an achy low back is a few morning stretches, especially touching their toes.

Before I put any backs up (excuse the pun), I want to make clear that I am not against stretching as a form of movement that can offer both benefit and enjoyment.

What I want to demonstrate is that passive stretching alone is rarely a solution to low back pain.

To stretch or strengthen, that is the question…

It’s not that simple. The bigger picture is that exercise does help low back pain, but there is no clear winner among the different approaches.

A 2025 umbrella review of 88 systematic reviews (Viderman et al., 2025) found that strengthening was the most studied type of exercise for low back pain. Meanwhile, a large 2021 network meta-analysis of 217 trials (Hayden et al., 2021) found that Pilates, McKenzie therapy and functional restoration were the most effective types of exercise for reducing pain. Flexibility exercises, which include stretching, helped people’s day-to-day function, but the review did not find a clinically important benefit for pain.

Yet stretching is what most people reach for first. So there is a disparity: the go-to approach is not one of the types of exercise with the clearest benefit for pain.

In my experience as a personal trainer, qualified to help people manage low back pain through exercise, several people have told me that stretching was their main way of dealing with back pain.

Lo and behold, they weren’t getting anywhere with it. But once they started doing targeted core and strengthening work under my guidance, their back pain finally began improving.

The extensive work of Professor Stuart McGill, one of the world’s leading low back pain experts, who ran a spine biomechanics lab for decades, argues that people should focus on building trunk stability first (e.g. McGill & Karpowicz, 2009).

As I covered in my article on prolonged sitting and low back pain, one common factor behind the pain is that, for whatever reason, the supporting tissues have weakened.

Stretching on its own is therefore unlikely to resolve the pain. Much of the work has to come from making those supporting tissues strong again.

Yes, but stretching feels good at the time?

Stretching can often provide temporary relief. This is a big reason why people struggle to realise that they may not be dealing with the underlying problem, and in some cases may even be making it worse.

It also feels safe and gentle, and when a sore back is causing tension and “tightness”, it seems like the right response.

People go to general classes where instructors may say, “Oh, some stretching might help your back,” or they hear from Auntie Edith down the street that her sciatica was “cured” with some stretching.

Many people, including non-specialist instructors, don’t always understand the mechanisms behind low back pain, either for an individual or more broadly.

But “tightness” isn’t always a shortened muscle. With long-lasting back pain, we often start moving more cautiously, a pattern physiotherapists call “guarding” (Williams et al., 2024). It reflects worry about movement, rather than a muscle that needs lengthening.

What sort of movement counts, then?

It is not simply that “strengthening wins”. And we need to define what we mean by “strengthening” in this context, because I’m not referring to a deconditioned person squatting 80kg with a barbell. Absolutely not.

I’m talking about functional movement that might be done along with core and conditioning exercises. Movements that build trunk stability, hip strength and mobility, as well as the posterior chain (lower back, glutes, back of legs).

For example, the exercises known as McGill’s “Big Three” (McGill & Karpowicz, 2009), the modified curl-up, bird dog and side bridge, could be taken as a safe, sensible starting point for core stability.

I teach them myself in my back care classes, but alongside other exercises that help to support the back and core. While the Big Three are a good base to work from, an early review that has not yet been peer reviewed (Laurin et al., 2022) says there is limited evidence for their effectiveness when used on their own.

For an overall programme to improve low back pain effectively, it’s best to include variety. This might be drawn from different sources, such as Pilates, yoga, resistance training, the McKenzie method and other specific, functional training.

These approaches generally overlap in the types of movement patterns they use. In my back care instruction, many of the exercises I teach look similar to ones you might find in Pilates, functional classes, and even yoga.

Having said this, it’s worth highlighting that structure, consistency and intention are what count. Sherman et al. (2011) found that 12 weeks of weekly 75-minute classes of either yoga or structured stretching both reduced pain and improved function more than a self-care book, with benefits lasting at least six months.

Another trial found that stretching performed just as well as motor control (stability) exercise for chronic non-specific low back pain over 26 weeks (Turci et al., 2023). However, the stretching in this study followed a branded programme called Global Active Stretching. It was supervised weekly by a physiotherapist, with six structured postures performed each session. The method requires you to you hold posture by working the opposite muscles, so it’s more active than most stretching.

The difference is that these stretching programmes were structured and progressive. People weren’t randomly doing cat-cow and downward dog a few mornings a week and hoping for the best.

The key is that the movement is targeted and purposeful.

Midlife movement needs to do several things

Mostly, as we can see, the evidence says that passive stretching, done as a stand-alone fix, tends to underperform.

However, stretching combined with strengthening, or used for mobility rather than as the whole treatment, can make a difference.

Chronic low back pain can strike at any age, but as we reach midlife, when we are weathering physical wear and tear and/or hormonal changes, it may well rear its ugly head.

This is especially so if we have spent many years either being inactive, or not being active in the right ways. Our bodies can tolerate a lot, but eventually they cry for help.

We need to do more for our bodies in midlife, compared to when we were younger and could get away with less. This means making sure that the time spent in any kind of intentional movement is as effective as possible, and covers several bases.

Where strengthening exercise wins over stretching is that some of it, resistance training especially, is also bone loading, and helps to maintain or even build bone. Exercise like core conditioning, yoga and Pilates does a huge amount for the stabilising muscles, which help with balance and falls prevention.

Stretching does none of this. So if you only have 30 minutes twice a week to spend on exercise that can help your back pain, why not make it exercise that also ticks several other boxes to make you fitter in midlife?

One important point, though. Where stretching absolutely has a place in midlife movement is in the cool-down. Some exercise physiologists, such as Dr Stacy Sims, say that stretching to finish a session becomes more important as we get older (Sims, 2022). You could also include some foam rolling, if you find it helps.

The crux of it

If all this talk about stretching and strengthening has baffled you, let me summarise. In tackling chronic non-specific low back pain through exercise, here are the bullet points:

• Some movement is almost always better than none, with one exception: forward-bending stretches in the first hour after waking may make things worse.

• Of the exercise approaches studied, stretching on its own did not show a clinically important benefit for pain, yet it’s often the first thing people try.

• Structured, intentional, programmed stretching has been shown in a small number of studies to reduce low back pain about as much as stability exercises.

• Stretching does not offer additional benefits of other approaches though, like bone loading or stability training, important in midlife.

And to add a little more of my experience as a personal trainer and low back pain coach, what I have found with the people I teach is that their symptoms start to improve when they adopt a rounded approach.

In my back care class, they do core and conditioning types of exercise along with some light bodyweight training. A lot of the movements we do look similar to those you may see in Pilates or conditioning programmes. I always encourage them to do more walking (an excellent activity for backs!), and if they can, to follow a strength training programme.

It’s not rocket science, but the people who have a mix of activities fare better than those who don’t, especially those who had only tried stretching before.

Want a little routine to help with low back pain? Try these.

Remember, it’s doing them consistently over time that will help. They are not an instant quick fix.

Do these any time except the first hour after you get up. Aim for two or three times a week.

Safety first: Some mild effort is fine, but if your pain increases, spreads down a leg, or stays worse the next day, stop and get it checked. See your doctor first if you have numbness, changes in bladder or bowel control, or pain after a fall.

Glute bridge

Lie on your back, knees bent, heels close to your bum and feet hip-width apart. Squeeze your bum and lift your hips until your body forms a straight line from knees to shoulders, without arching your lower back. Keep squeezing the glutes while you hold at the top for 2 to 4 seconds, then relax and lower. 10 reps, 2 sets.

If this is easy for you, add some load by resting a weight across your hips as you move into the bridge.

Why it helps: It strengthens the glutes, which help support your lower back. Weaker glutes are commonly linked with low back pain.

Wall hinge

Stand with your back to a wall, a few inches away, feet hip-width apart and a soft bend in the knees. Cross your arms at your chest and hinge forward from the hips, keeping your back flat, until you feel your glutes lightly tap the wall behind you. Squeeze your glutes to return to standing. 10 reps, 2 sets.

If this is easy for you, try a bodyweight “good morning” instead, doing the hinge away from the wall with your hands lightly behind your head.

Why it helps: It teaches your hips to take the load of your body, so that your back doesn’t have to. It also teaches your hips and pelvis to move while your back stays steady.

Bird dog

Start on your hands and knees on a mat, in a “table top” position with a flat back. Raise one arm while raising the opposite leg (e.g. right arm, left leg). Keep both limbs straight and don’t let them go higher than your back. Keep your hips level; don’t let them tip or twist. Briefly hold, then swap sides. 6 each side, 2 sets.

If this is easy for you, hold each one for longer, up to 10 seconds, or do extra reps.

Why it helps: It builds deep core stability while keeping the load on your lower back low.

To finish as a cool-down: knees-to-chest stretch (optional)

Lie on your back and gently draw one knee, then both, towards your chest, holding behind the thighs. Breathe slowly and hold for 20 to 30 seconds, then release. Keep this one for later in the day, not first thing.

Why it helps: It’s a gentle way to wind down after the work is done. It’s a cool-down, not the main event.

Next in the series: Part 3, on why ‘thin’ doesn't necessarily mean healthy, especially for bones.

Want to become unbreakable?

Exciting news!

Coming in early 2027 is my 8 week course, Become Unbreakable: Future-proofing Your Body for Women After 40. No obligation to be on the course by joining the early bird waitlist, but if you decide it’s for you when the time comes, you’ll be eligible for my early bird offers and bonuses!

JOIN THE EARLY BIRDS

References

1. Snook SH, Webster BS, McGorry RW, Fogleman MT, McCann KB. The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion: a randomized controlled trial. Spine. 1998;23(23):2601-2607.

2. Snook SH, Webster BS, McGorry RW. The reduction of chronic, nonspecific low back pain through the control of early morning lumbar flexion: 3-year follow-up. Journal of Occupational Rehabilitation. 2002;12(1):13-19. doi:10.1023/A:1013542119063

3. Adams MA, Dolan P, Hutton WC. Diurnal variations in the stresses on the lumbar spine. Spine. 1987;12(2):130-137.

4. Viderman D, Kalikanov S, Myrkhiyeva Z, Alisherov S, Dossov M, Seitenov S, Abdildin Y. Impact of exercise therapy on outcomes in patients with low back pain: an umbrella review of systematic reviews. Journal of Clinical Medicine. 2025;14(17):5942. doi:10.3390/jcm14175942

5. Hayden JA, Ellis J, Ogilvie R, Stewart SA, Bagg MK, Stanojevic S, Yamato TP, Saragiotto BT. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. Journal of Physiotherapy. 2021;67(4):252-262. doi:10.1016/j.jphys.2021.09.004

6. McGill SM, Karpowicz A. Exercises for spine stabilization: motion/motor patterns, stability progressions, and clinical technique. Archives of Physical Medicine and Rehabilitation. 2009;90(1):118-126. doi:10.1016/j.apmr.2008.06.026

7. Williams ACC, Buono R, Gold N, Olugbade T, Bianchi-Berthouze N. Guarding and flow in the movements of people with chronic pain: a qualitative study of physiotherapists’ observations. European Journal of Pain. 2024;28(3):454-463. DOI

8. Laurin E, Minerbi A, Besemann M, Courchesne I, Gupta G. The McGill approach to core stabilization in the treatment of chronic low back pain: a review. medRxiv (preprint). 2022. doi:10.1101/2022.01.21.22269311

9. Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, Delaney K, Deyo RA. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Archives of Internal Medicine. 2011;171(22):2019-2026. doi:10.1001/archinternmed.2011.524

10. Turci AM, Nogueira CG, Carrer HCN, Chaves TC. Self-administered stretching exercises are as effective as motor control exercises for people with chronic non-specific low back pain: a randomised trial. Journal of Physiotherapy. 2023;69(2):93-99. doi:10.1016/j.jphys.2023.02.016

11. Sims ST, Yeager S. Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond. New York: Rodale Books; 2022. ISBN 9780593233153.

Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

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I have something to admit. Decades ago, I used to say, “Urgh, I don’t think women should look muscly. It’s not feminine.”

What an idiot I was.

I didn’t know then what I know now: muscle is medicine. It gives us strength, but it is also essential to our wellbeing and to a longer life.

I found that out when I qualified as a personal trainer, and I became the person challenging the misconceptions.

Several female clients have said to me, “I want to get strong, but I’m scared of getting bulky.”

I gently explained that a couple of all-round training sessions with me each week were not going to turn them into Arnold Schwarzenegger.

For too many years, the fear of “getting bulky” has put women off strength training. That idea needs to change.

Convinced to become our own enemies

Social conditioning and body image pressure have convinced women to avoid the very thing that best supports our health: building muscle. And we fell for it. How bonkers is that?

It's well documented, too. A 2025 review traces how cultural norms and stereotypes have discouraged women from resistance training for decades, including the fear of becoming "too bulky".

Long-standing patriarchal ideas of “feminine beauty” (staying small, staying thin, looking waif-like) do not line up with what is healthy for women. Even fitness magazines go along with it, publishing articles on “sculpting” and “toning” (bleugh, pass me the sick bucket).

There is no such thing as “toning”. Or “sculpting”. The definition people are after is muscle, visible because there is less body fat covering it. Those magazines are simply afraid to name it: building muscle.

To actively avoid building muscle is to actively work against our own health.

Why muscle matters so much

A 2025 review titled “Evolution of resistance training in women: History and mechanisms for health and performance” (Kraemer, Fragala and Ratamess) explains that women’s adaptations to resistance training are mediated largely by the neuroendocrine and immune systems.

In plain English: building muscle isn’t just about moving heavy objects. It is tied into how our hormones and immune systems respond and adapt.

Strength is also tied to how long we live. In a UK Biobank study of around 71,000 adults, those with the highest grip strength had roughly a fifth lower risk of dying from any cause than those with the lowest. The best results came from having both high cardio fitness and high strength: roughly half the risk of those who had low measures of both. This is an association, rather than proof of cause and effect, but the pattern is consistent.

For women specifically, a US study of more than 412,000 adults found that regular muscle-strengthening activity was linked to a 19% lower risk of dying from any cause compared with inactivity, a bigger benefit than the 11% seen in men. Yet only about one in five women reports doing any regular muscle-strengthening exercise at all, according to the Kraemer review.

So no, I’m not anti-cardio (it’s important!). But I’m anti ‘cardio instead of strength’. We need both.

Muscle also protects us from injury. It doesn’t just move our limbs; muscles work together to stabilise and balance the body.

One of the big concerns as we age without strength training is sarcopenia. This is a diagnosed muscle disease, identified when muscle strength and quantity fall below set clinical thresholds (European consensus). We all lose some muscle as we age; that’s normal. Sarcopenia is something more, and it is linked to a higher risk of falls, losing independence, hospital stays and earlier death. Not everyone gets it, but the risk rises with age, and inactivity makes it more likely.

The good news is that neither ordinary age-related loss nor sarcopenia is a one-way street. Resistance training can improve strength and function, and to a degree muscle mass, even in people in their 80s and 90s. In one controlled trial of nursing home residents with an average age of 87, ten weeks of resistance training more than doubled muscle strength. It is never too late to start, but the sooner we do, the more there is to build on.

Muscle matters for our bones too. When a strong muscle contracts, it pulls on the bone it’s attached to, and that mechanical load is a signal for the bone to adapt and strengthen.

Osteosarcopenia is where osteoporosis and sarcopenia exist together, and it is linked to falls, fractures and poorer health outcomes, including a higher risk of death. Resistance training is one of the best-evidenced things we can do to support both bone and muscle. A 2025 meta-analysis of 17 trials in postmenopausal women found that it beneficially influenced bone density at the spine, femoral neck and hip.

It isn’t just “nice to fit in if time allows”. It’s a priority.

Muscle as the metabolic engine

Muscle is metabolically active tissue, though let’s keep this in proportion. Dr Andy Galpin says we burn an extra 6 to 10 calories per pound of muscle per day. Useful, but not magic, whatever the gym bros say.

The bigger story is what muscle does with the fuel we eat. Skeletal muscle accounts for roughly 80% of the glucose uptake that insulin drives after a meal (DeFronzo and Tripathy, 2009), which is why keeping it matters so much for blood sugar control. Lose muscle, and the body finds it harder to manage that fuel, whatever the scales say.

It’s ironic that, in a culture which treats “burning calories” as the number one goal of exercise (not a view I share, as you’ll probably guess), women are being sold the wrong goal. The right one is being strong; metabolically healthy and hard to break.

And this is where endless, exhausting cardio works against us. When we cut calories and lean on cardio alone, we tend to lose muscle along with fat.

In a 2025 study of 304 men and women on a calorie-restricted diet, resistance training was the only approach that increased lean mass while fat came off. The people who did no exercise lost nearly 3 kg of lean tissue, and the cardio group lost a little too. Less muscle means less strength, poorer blood sugar control and weaker bones.

Then there’s the fuel. Researchers have linked a lowered metabolic rate to what’s called low energy availability, where exercising women aren’t eating enough for what they do.

Dr Stacy Sims, who specialises in female physiology, argues this isn’t confined to elite athletes. Many of us grew up on “calories in, calories out”. She says that under-eating makes the body hold on to fat rather than release it.

Cut the calories, add the cardio, skip the weights, and we risk working against our own bodies.

You won’t become Arnie by getting strong

There are many women who love looking muscular, and women who love bodybuilding. Yes, they look “bulky”, because they train for it, with a dedication most of us will never match.

The same is true of male bodybuilders. Yet plenty of regular gym-going men don’t look bulky either, and because women have at least 15 to 20 times less testosterone than men (Kraemer et al., 2025), we put on less muscle size from the same training.

The average woman fitting in two or three resistance sessions a week, with strength as her goal, will see many benefits. She will not be auditioning for a remake of Terminator any time soon.

Most general health training also relies on compound movements that work several muscle groups at once, like a kettlebell swing (legs, hips, arms, shoulders), rather than isolated movements like a bicep curl, which targets just the biceps. Bodybuilders, by contrast, add plenty of isolation work aimed at growing specific muscles.

Heavier weights for fewer reps is the classic recipe for strength, and a lot of the early gain comes from your nervous system getting better at using the muscle you already have, not from adding size.

Building visible size is a different project altogether: lots of training volume, sets taken close to failure, plenty of food to fuel it, and years of consistency.

Let’s kick some ass!

I often think about this. When I’m old, my worst case scenario is someone else wiping my bum, helping me do simple chores and giving me a bed wash.

Instead, I want to be able to cook for myself, get in and out of the bath, carry my shopping home, and even lift my cabin bag onto the rack above my head on the plane.

I want to be a badass granny.

Strength training doesn’t guarantee any of that; nothing does. But it stacks the odds in my favour, and it’s a decision all of us can make now.

Perceptions of strength training for women are, thankfully, changing, but there is still work to do, and all of us have a part in it.

When I see strong women now, women with visible definition because they train for strength, I think: “Yessss! You go, girl. You’re an amazing role model, and I hope other women follow your lead.”

Because other women need to. We also need to big up the women who are doing it, the ones challenging the wispy waif stereotypes.

Saying “women shouldn’t have muscle” is literally no different from saying “women shouldn’t have nutritious food.”

Five myths and facts about ‘getting bulky’:

Some homework:

Next time you’re at the gym, pick up something slightly heavier than you’d normally reach for. Lift with intention, and really aim to feel the movement as you perform it. That’s all I want you to start doing.

Next in the series: Part 2, on why stretching alone isn’t the answer for your back.

Want to become unbreakable?

Exciting news!

Coming in early 2027 is my 8 week course, Become Unbreakable: Future-proofing Your Body for Women After 40. No obligation to be on the course by joining the early bird waitlist, but if you decide it’s for you when the time comes, you’ll be eligible for my early bird offers and bonuses!

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Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

Hi everyone,

Whether this is your very first programme here with me or you’ve already been using my previous workouts, you’ll see that I offer a different programme each month, beginner-friendly, intermediate, and advanced.

Every person who joins is at a different starting point, therefore I’ve designed my membership so you always have a plan to suit you.

Because you can access the full back-library as a member, you will always be able to pick a programme right for you.

There will sometimes be progression between months, and I'll mention this where it happens (for example, "beginners should try [a particular plan] before trying this one"), but be assured, you will always find something that fits.

More advanced people can find options within the other levels too, since each level in itself also has an easier entry point (Foundation) as well as the more challenging option (Building).

Every single level of every move below is new this month. If you’re brand new, this is still exactly the right place for you to start.

This month, all four exercises are based on important functional patterns that are worth spending time to learn. Once you feel comfortable at that level, you can progress as per the instructions, or go for the ‘Want more?’ suggestion, too.

Read more

Monday has arrived and you promised yourself you would start at the gym today. You’ve packed your bag. Trainers and water bottle at the ready. You are definitely going today.

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It’s now bedtime on Monday. Your bag is still there, waiting at the door. You found every reason in the world not to go.

Work was too hectic. The kids were too rowdy. TV was too compelling. Dog was too barky.

You’re down on yourself. You’d feel great now if you’d just gone.

You’ve started to notice the joint niggles from being unused. You’re getting out of breath quicker doing everything. Damn. Why didn’t you just go?

Okay. It’ll be tomorrow then. You’ll start tomorrow.

Guess what? You don’t. Is this a familiar story?

Well, it is to me. I’ve been there and done that, several times over. Being a personal trainer does not exempt me from being a normal human being.

Often, I think the rest of the world imagines that personal trainers have some superpower that swings them to the gym even when they’re sweating from flu and their goldfish has just died.

And with a smile on their face.

Okay, I think there are a few like that. They love being in the gym more than they love Netflix or eating out or seeing friends or pretty much anything else. Training several hours a day is their bag.

But most of us are not like that.

The point is that people often compare their beginning with somebody else’s extreme end point, and conclude that fitness isn’t for them.

It’s a perception that is holding a lot of people back.

The barriers we face:

Before I got started in fitness, it took me years to get started in fitness.

I didn’t identify myself as someone who loved exercise. I had a pretty shoddy time during my PE years at school. Always the last picked for any team. I never felt like I achieved anything in sport.

These old experiences have a habit of staying with you.

But for all of us - and you’re likely reading this because somewhere, for the sake of your health, you feel you have to do something about your fitness - there comes a time when we know we have to change things.

If only we could get motivated.

But part of the problem is that we’re relying on ‘motivation’ to do the trick.

Let’s first look at some of the barriers that can get in the way, then come back to why motivation isn’t necessarily what we should be relying on.

A meta-review by Vasudevan and Ford (2021), looking at barriers to strength training in women, found that some of the most common included gender-related stigma and fear of negative comments based on gender.

Another commonly cited barrier is a lack of knowledge around strength training.

People simply don’t know where to start, which is exactly why I’ve built structured plans and a beginner programme into what I offer here.

Certainly, from what I have seen in comments on my feed, this seems to be the case.

I used to be in that same position. When I was a journalist, I spent hours a day at my desk and relied on gel wrist supports, soft cushions and ibuprofen to see me through the day with a gnawing back and RSI (repetitive strain injury).

I actually didn’t know at that point that there was another way.

I was very unfit. I only really walked my dog for exercise, and did some weekend dancing - accompanied by copious wine.

The belief I held that “I don’t do exercise” also underpinned my inability to see exercise as a possible solution to my problems.

My self-belief was a barrier.

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People also might be concerned about risk factors around exercise. A 2017 study by Burton et al found that older people are worried they could be at risk of a heart attack or stroke, rather than viewing exercise as something that will reduce the risk.

Likewise, in comments from my readers, injuries or conditions that cause pain, or previously caused pain, may be a barrier. This might be a real concern, or a perceived concern.

One reader said: “I have permanent injuries from a car accident and have only felt comfortable using small weights, my own weight, and resistance bands. The fear of further injury and triggering pain...is the major reason for taking 5 years to even begin strength training again.”

When people have genuine pain or an existing condition, exercise needs to be approached carefully and progressively. In some cases, it may get worse before it gets better, like with sciatica, for example, which I wrote about recently.

That’s one reason I’m so keen on people getting appropriate guidance rather than simply throwing themselves into a programme.

Confidence - wherever it results from - is often a major obstacle, too.

I was actually petrified of going into the weights room at the gym when I first started. And that was even after I first qualified as a PT, which is when I started strength training.

So. I absolutely get it.

If me, a newbie PT, felt nervous about entering the sweaty domain of the bodybuilder, how on earth is someone who has no training and is unsure about what they are doing supposed to feel?

The tricky thing about confidence is that you only gain it after you start doing the thing that will grow your confidence.

What you need to become confident is courage.

Strength training in midlife is very important for us to create the best conditions for ongoing wellness and longevity, so whatever the barriers you face, how can you make it happen?

Say goodbye to the motivation mantra:

I know everyone loves a good motivational quote, but when it comes to fitness, waiting for motivation to strike is not the answer.

The issue is, your brain does a cost-benefit analysis of every action, and you can be equally motivated not to exercise, as Dr Ian Taylor from Loughborough University explains perfectly.

For example, you can be motivated to stay on the comfortable sofa.

You also may never feel ‘ready’.

And while you’re waiting, your body is hoping for some help. It needs you to take a different approach, and throw it a bone (excuse the pun, seeing as I often talk about bone health here).

The answer is to create a new habit, and then become disciplined about making it a regular thing. It takes time and effort. But it’s completely doable.

Honestly. For pretty much every excuse or barrier that exists - whether real or perceived - I have been there at some time.

Sometimes I still am, but I have a long-term habit now.

I also know and feel the benefits of exercise, and they encourage me to stay on track. In my experience, I don’t think I’d have been able to reverse my osteopenia without strength training.

So yes. Let’s forget about ‘motivation’, and instead, build a system.

Excellent recommended reading on systematic habit forming is Atomic Habits by James Clear - an absolute belter of a book which rewrites what we think we know about habit creation, and gives excellent practical tips to create new ones.

A very powerful tip from James is associating cues with a new habit.

For example, for most people, when we go to bed, we brush our teeth. The action of going to bed is the cue to signal it’s time to brush our teeth.

This habit is so ingrained that we barely think about it. This is where we need to eventually get to with exercise and strength training.

For example: “It’s Sunday morning. I have coffee, then I do a 30-minute strength workout.”

It takes time to practise, but as you start to do the habit more often than you don’t, it will start to feel weird when you don’t.

Reframe the barriers:

You first have to get over those pesky barriers though, don’t you?

I’ve run the gamut of excuses. I’m not a machine.

And I’ve heard them all with my clients, too. I used to ask them to find ways around them - because deep down, we both knew they wanted to change their health.

We know that you do, too, otherwise you wouldn’t be reading this.

You have to be brave, because only you can do it for you.

Have a little look at the table below. Which do you own?

Save this article so you can come back to this table and refer to it when that little voice strikes.

Set yourself up for success:

Once you have worked on reframing your barriers, you need to have a plan to start, and it needs to be one which gives you the highest chance of success.

If you absolutely know that starting the gym on a Monday is a tough call because work is so busy and you have to take the kids swimming and you need to clean the house and so on - then don’t set yourself up for failure by trying to squeeze in some training, too.

Interestingly, one study from Dai et al (2014) said that people are more likely to adhere to an exercise programme at the start of a new week.

For me, my weekends tend to be quieter.

But I also see training as something that is my leisure time - not a chore. I see it as ‘me time’, and Sunday for me is generally a great day to fit a session in.

For some people, going to the gym on the way home from work is best. If they go home first, they will flop in front of the TV instead.

Here’s a few more tips on how to set yourself up for success:

• Find a day and time to start when you know you have a definite slot. Tuesday 6pm straight after work, for example.

• Get your kit ready several hours earlier or the day before - this stops rushing from being your reason not to go.

• Be the designated driver more often. Experience shows that hangovers are a key reason in not adhering to fitness goals (obviously talking about my PT clients, not myself, hah!).

• Keep telling yourself “I’m doing something good for me”. It is not punishment, it’s physical nourishment.

• Start SMALL. I can’t stress this enough. Plan for even 10 or 15 minutes of bodyweight exercises at home once or twice a week to begin, if that is what feels doable.

Remember that strong isn’t something you are, it’s something you deliberately become. You don’t get there overnight, and that is perfectly okay.

But the sooner you begin, the sooner you will start feeling the benefits.

Here’s your challenge: don’t wait for Monday;

Pick one 10-minute session you can realistically do this week. Put it in your calendar. Put your clothes out beforehand.

And when the time comes, don’t ask yourself whether you feel motivated.

Just begin.

Before you go:

Whether you are an individual or an organisation, if health and wellness is important to you, then please subscribe here for free. Expect a weekly, informative article along my themes of strong backs, strong bones, strong muscles:

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Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

The squat is one of the most well-known movement patterns that exists. Go to the gym, watch a fitness YouTube video, or pick up an exercise magazine. You’ll see squats galore.

What’s all the fuss about?

The squat can tell us many things. And not just how bootylicious you are, or whether you have it in you to be a breakdancer.

It tells us about not just strength, but how the body is working together in its different parts, as well as range of motion, and level of mobility and flexibility.

Personal trainers love to see their clients do a squat in an initial assessment. We can read so much about how their body is functioning from it.

Of course, when I did this with my clients, I never told them they were getting a once-over on their squat, but I was noticing how their body moved.

What is a deconditioned squat telling us?

A very weak squat can look wobbly. Knees caving, back bending, perhaps the legs looking like they can’t lift the body back up to standing.

Two former clients spring to mind. The first was a younger woman, early 30s, called Sian. Sian was happy to be featured on my Instagram, so you can get a good look at her squat - before and after.

Upon starting, as Sian moved into the bottom of the squat, her back would round out, taking on an almost wave-like pattern, ending with her lower spine in a ‘C’ shape, curving down. Her legs would appear to buckle under the motion.

This told me a few crucial things. The main thing was that her whole posterior chain (lower back, glutes and hips) was not functioning together to support her weight as she squatted.

The ‘C’ shape of her lumbar spine in the bottom of the exercise was classic ‘butt wink’ (posterior pelvic tilt), where the pelvis tucks under because her hips and ankles were not flexible enough to support the depth.

It also suggested that the deep core stabilisers were not strong enough yet to keep the spine stable.

(NB: Less commonly, ‘butt wink’ can just be about anatomical structure, as well).

As you can see from the Instagram post, Sian had substantially strengthened her squat once she was a few weeks into her programme.

Her body looked decidedly different when attempting the same move.

The other client was a woman in her 50s, let’s call her Alice. I’ve got a short video of Alice’s early squat for you.

As she lowered into the squat, Alice’s legs were visibly unstable. Her knees would cave inward. Pushing back up from the base of the squat was a struggle for her.

Alice could only manage a few reps before she was feeling intense muscle burn - the feeling that so many hate when it comes to exercise.

What Alice’s movement patterns told me though, was that her glutes were weak, and not activating properly to support the legs. Her knees were caving because of this.

In fact, Alice's thighs were doing all the work, but they also weren’t strong enough, hence the very unstable appearance of her legs.

Again - after Alice had been consistently attending sessions and following her programme with me, there was a massive improvement in her squat.

A healthy squat form and why it’s important:

So why should we work on our squat?

Well, let me first make clear that it’s not about getting a ‘perfect squat’. That’s not the goal.

The point is that achieving a healthy squat shows us that our bodies are becoming conditioned and working better.

A healthy squat says that we have good muscle strength in some of the most important muscle groups, such as the glutes, quadriceps and hamstrings.

It says that we have mobility in joints that are key for movement and support - such as the ankles, hips and knees - especially as we age.

It also says that we have strong, supportive stabiliser muscles around the spine, hips and core.

This is all very well, but what does a healthy squat look like?

I gave you an examples of stronger squats with the ‘after’ videos above.

Here’s another example, from me - I mean, I have to show you mine, don’t I?

I want to stress again, this is not about striving for perfection. Bodies are created differently, and may be injured, or may have compensatory patterns that are deeply ingrained.

For example, I have some slight natural lordosis in my spine, making it bend inwards towards the base.

A person may never be able to illustrate ‘perfectly’ for some functional movements, but what matters is that their body is strong and working in reasonably good balance overall.

The point I am trying to make is that strength, mobility and stability can all be seen in how the movement pattern of a squat occurs.

As the squat improves, the visible signs of a strong body in alignment can be noticed.

And when we have a body in alignment, we have fewer problems - joint niggles, knee pain, back ache, hip pain, sore ankles - you get the picture.

A strong bodyweight squat underpins almost everything else you do in the gym:

You cannot put a barbell on your back until you have your bodyweight squat sorted. This is just asking for trouble.

Kettlebell swings, deadlift movements, and many loaded exercises all rely on a strong lower body to perform them safely and effectively.

Building bone mass in the spine, crucial to prevent osteoporosis and spine fractures, is fairly reliant on axial loading through the spine (that is, exercises like loaded back squats - where a weight is placed across the top of the back or at the shoulders before squatting).

This is impossible to do if the spine can’t handle the load, and can lead to injury.

As a PT, I would never let clients progress to loaded squats until I saw that their bodyweight squat could support it. We would then progress slowly and steadily, moving to goblet squats first.

When their body was comfortable with that, we would progress to dumbbell loaded squats - weights held at the shoulders. From here, the next move was with a short bar, before an unloaded barbell, and finally, a weighted barbell.

This type of safe progression should apply to you, too.

The recipe for an injury is to go into a gym with a relatively deconditioned body and put a barbell on your back, then try to squat with it.

This is why my beginner 4 Week Bone Foundations Programme starts with the basics.

It’s not only suitable for people interested in improving bone health, but provides a good starting point for anyone who wants a grounded introduction to bodyweight strengthening, before progressing onwards.

Assess your squat:

Video yourself now doing a squat. In order to do a squat properly:

• Stand with feet hip-width apart.

• Engage your core (this is essential).

• Bend the knees and move downwards into a ‘sit’ position

• Allow hips to move back naturally while keeping the upper body from leaning over the knees

• If it helps, grab a chair and aim for the edge of the chair with your bum.

• Keep your knees in line with your feet.

• Aim to get your thighs parallel with the floor, or as deep as your mobility allows.

• Return to standing position.

Take a proper look at your video. Did you find sticking to some of the cues hard? Were your knees caving, despite trying to keep them in line with your feet? Did your heels rise up as you moved lower?

Compare your squat to the videos I linked of Sian and Alice. Is your squat looking similar to their ‘befores’, or their afters? What is your body telling you?

• Heels rising up as you come into the lower position can indicate a lack of ankle mobility.

• Knees caving as you either lower or push up from the squat can indicate weakness in the glute medius and hip stabilisers.

• Legs wobbling and struggling to hold the squat can indicate several things - an under-developed posterior chain (that is, how the muscles in the back lower body are linking together) or general lack of strength in some or all of the muscles supporting the squat.

• Lack of a deep squat can show tightness or weakness in the hips, or lack of mobility in joints.

(A small note on the knee caving, which is also known as ‘valgus knee’: current biomechanics thinking is that this isn’t always a structural issue. In trained lifters under heavy load, it can be a movement strategy rather than dysfunction. If this is happening in an untrained person with no load, though, we can generally assume there’s a problem to address).

Ways to correct your squat while you practise it:

If you find any of these problematic squat patterns are arising, I have a few tips on how you can improve your form while your body starts to gain strength.

To train your squat, take a kitchen chair and aim to touch your bum gently on the edge as you squat. This will help the pattern of movement while you begin practising.

For caving knees, take a resistance band and loop it around your thighs, just above the knee. Squat with the band in place. When you push back up, squeeze your bum. It will help your knees come into line with the feet.

For heels rising as you lower in the squat, place a couple of same size books under your heels, or weight plates if you’re in a gym. This will allow you to go deeper into the squat until you strengthen the ankles.

How can I progress my squat?

I have written a guide on fixing your squat which includes specific exercises to help with mobility and strength in the other joints and muscles that will support it. It gives a detailed run-down of progressing all the way through to a barbell back squat.

It’s available for a mere £10, complete with 4 videos for instruction.

However, my paid subscribers can get this for FREE! Once you upgrade your subscription, the guide wil be sent out to you in your welcome email.

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Before you go:

If you found this article useful, then no doubt others will too - so please do share, I much appreciate it.

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Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

I used to hammer cardio. I remember going to gym classes and would hear instructors vaguely shout “remember to engage your core” before we squatted, and mostly, no actual instruction would follow.

That was the best of it. The worst of it would be when they told you to suck your tummy in. No, no, no. But at the time, I knew no better.

It took me to become a PT before I actually knew what it meant. And to be honest, more from the additional learning I did outside of my qualification to really drill it down. Dr Kelly Starrett is the best teacher on this (his book ‘Becoming A Supple Leopard’ gives a beautiful explanation).

The fact that I never knew how to do it properly all those years was probably one reason why my form was consistently shoddy - especially when it came to squats and the like.

“Engage your core.” “Find a neutral spine.” “Brace before you lift.” They are all great instructions, but meaningless if you don’t know what to do. I’ve even heard people being told “imagine that you’re trying to stop weeing.”

Just. Not. Good. Enough.

My guess is that most of those times being told this or whatever other ineffective cue you were given, it never got explained to you in a way that you could actually apply it.

This is a major bug bear of mine. And I will tell you why.

Being able to properly ‘engage your core’ isn’t just a little bit of icing on the cake. It’s not just about making your workouts a little bit fancier, or showing off at the gym because you know your shizzle.

It is actually crucial in protecting your spine. It is essential to ensuring your form. It is key to making your exercise effective.

Many people can get away with not doing it for years if they are not doing serious exercise, but try to do a deadlift or a loaded back squat without proper core engagement, and you can be looking at a serious injury.

Within my monthly exercise plans which are part of my paid subscription, I want my members doing this when they practise their movements.

But even if you don’t subscribe to my paid membership, I want you to be going out to the gym and approaching your routine in a way which keeps you safe, and also which makes your technique more effective.

What bracing and ‘finding a neutral spine’ mean:

Let’s ditch the jargon and the fancy words. It’s much simpler than it sounds.

While all spines are a little different, and some can be a bit hunched at the top (kyphosis) or curved inward at the bottom (lordosis), most people have a spine that has a natural, slightly curved shape. This is neutral.

‘Bracing’ is tightening the muscles around your trunk, front, back, and sides, so that your body and spine stays supported and stable while you move, rather than collapsing, rounding, or over-arching under load.

Those muscles in those places are effectively your ‘core’, and they compress around your spine to protect it when you ‘engage’ it.

You’re not sucking your tummy in, nor are you holding your breath.

What we are aiming for with this action is to form a tension throughout the ‘core’ that protects your spine while you do something with your body.

This applies whether you are lifting a weight, standing up from a chair, picking up a child, or squatting down to look in a cupboard.

The cue I prefer to use:

Like Dr Kelly Starrett, whose coaching on this has influenced a lot of how I teach it, I ask clients to engage their core in a specific order. It’s done in this order so every step sets up the next, and so clients learn a process that helps them remember.

• First, contract your buttocks. Squeeze them properly. The immediate effect of this is to bring your pelvis into alignment under your spine, rather than tilted forward or back, which is the position everything else needs to be built on.

• Then, tighten your tummy as if someone were about to punch you in it. Not sucked in. Not held. Braced, hard, the way you’d instinctively tense if you actually expected impact. You are creating functional core tension here.

• Then, walk a few paces holding that position. Once you’ve fully mastered core engagement, you don’t need to keep doing the walking bit before exercising or doing a lift - but while you’re learning, it helps to build the habit. I get my back class to do this every week. Bracing while standing still is one thing, but you need to practice the skill of bracing while walking, too. As you become accustomed to holding your body in this way, you will start to use the technique more naturally in everything you do, not just during exercise.

Remember, your spine needs protection in your day-to-day activities like bending, lifting and even walking. Posture when walking can make a difference to feeling low back pain or not.

When I talk about “engaging your core” or “finding a neutral spine” in class, this is exactly what I mean.

[Watch my video: How to engage your core]

Common mistakes I see:

Holding your breath instead of bracing. Holding your breath is not a substitute for finding actual core tension, and is a completely different mechanism. If anything, it adds unnecessary strain and cuts off just as soon as you exhale, right when you might still need the support.

“Sucking in” mistaken for bracing. Pulling your stomach in flat actually weakens your ability to brace properly, since it disengages the muscles that create the all-around pressure that is actually needed. Bracing should feel like your whole midsection has firmed up, more of a tense, than a suck. As I said earlier, imagine someone was going to punch you in the tummy. You want it hard, not sucked in.

Over-arching, or under-bracing entirely. Some people compensate for a weak brace by arching their lower back and flaring their ribs instead, which puts unwanted pressure through the spine rather than protecting it.

Why this matters beyond the gym:

As I have said above, this isn’t just a training cue for when you are in the gym or following my exercise plans.

You need to get into the habit of doing this when you go about your day. For example, before you pick up a shopping bag, lift up a box that the courier left dumped on your doorstep, or are putting the grandkids into the bath.

You can even use it when you have a bad cough - believe it or not, many people with weakened tissues in the back actually put their backs out when they cough! (It happened to me years ago, post child-birth, when everything was still very relaxed).

Practise this during all your training, and it will eventually stop being something you have to think about consciously. It becomes the position your body defaults to under load, which is exactly the protection you want for the decades ahead.

Hope this was useful to you? It’s the article I knew I needed to get up here. Please share far and wide because this is so essential for everyone to understand.

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Before you go:

Whether you are an individual or an organisation, if health and wellness is important to you, then please subscribe here for free. Expect a weekly, informative article along my themes of strong backs, strong bones, strong muscles - and follow me for notes with useful daily tips.

Paid subscribers benefit from a new exercise plan every month that is accompanied with videos and includes both beginner options as well as more challenging progressions, free downloads, and depending on your level, check-ins from me or live Q&A!

Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

This teaching draws on the coaching approach of Dr Kelly Starrett.

There is a lady who comes regularly to my back care class. She frequently shares her experience and progress with the other class members, and I’m always thankful that she does.

“It got worse before it got better,” she’ll tell the newbies.

She isn’t saying it to sound clever, but because it’s true, and she knows it might help. She remembers that after her own first attendance, she was close to not coming back to the class again, and she doesn’t want others to be in that same position. This is a message that is important.

When my class member first joined, she told me she had bad sciatica. It was pain that ran from her lower back, down through her hip, and into her leg. It was the type of pain that made ordinary life, doing things like driving, sitting at a desk, standing in a supermarket queue, into something to be endured instead of lived.

Like many people do, she had tried the usual things. The first being rest - which many think is the key solution. Then painkillers. And just waiting it out - to see if it will go away of its own accord. None of it had helped.

At her second class, she told me the pain had been much worse after coming the previous week. She was understandably apprehensive about continuing. Her husband had assured her that it was likely due to it being the first time. I’m glad he did. Because then I got the chance to reassure her that this was likely the case.

She came back for the third time - having noted that the pain she felt was just slightly better after her second class. From there, the improvements started to be very noticeable.

Now, she is a regular class member, and one of the champions of the class. She has seen a dramatic reduction in pain. And she wants to let others know about it.

Why sciatica gets worse before it gets better when you start exercising:

Time for some good old fashioned honesty. I think the fitness industry does a disservice to people by promising magical results too quickly. Or by showing all the ‘befores’ and ‘afters’, but skipping the gritty bits in the middle.

Regarding sciatica specifically, it happens when the sciatic nerve - which runs from the lower back right through the hip, down the back of the leg and to the foot, becomes compressed, ‘pinched,’ or inflamed.

It can happen for many reasons - commonly due to a vertebral disc problem, or degeneration in the spine (which is very common as we age, and there’s not a lot we can do about it apart from address the tissue creep, which I talked about in my article on prolonged sitting and back pain).

Osteoporosis as well can be indirectly linked to sciatica, when spinal fractures, and the vertebrae compression that results, can cause nerve impingement.

The pain can radiate from the back and the whole way down the leg, and it can be extremely severe in some cases.

Sciatic-like symptoms can even result not from the spine, but from issues like hamstring tendinopathy, as I know myself from personal experience. I get sciatica mildly when I have a hamstring tendinopathy flare. I also have osteoarthritis in my spine which is a culprit.

But due to my training, I know what I can do, and what I should be doing when it isn’t flared up.

For people new to purposeful exercise, it’s entirely usual for a deconditioned body to ‘feel it’ after spending time in new movement patterns that it isn’t used to.

When someone has been in pain for a long period, they understandably can spend a lot of time ‘guarding’ themselves against further pain. They do this by avoiding certain positions and doing less. So, when they do new movements, the nerves and tissues are often irritated and over-sensitive. Even with a selection of carefully chosen, appropriate movements.

This doesn’t mean the movement is wrong or shouldn’t be attempted. It is just worth understanding that this is a recognised pattern of how sciatica responds. Especially as it can make all the difference as to whether a person continues or not with the exercise. Exercise that in time, will make the problem and the pain better, not worse.

How sciatica responds to movement:

Movement of course helps to increase blood flow to the muscles and the nerve itself. This is why so many people who attend my back class (bearing in mind they don’t just attend because of sciatic pain) often report that they feel better straight after the class - because blood flow has helped reduce pain.

Over time, the movement and the impacts from it help to relieve the inflammation. Nutrients are delivered to the tissue for repair, and the tiny stresses that are placed upon the tissues as they are exercised also result in adaptations that make them stronger.

The discs in your spine, which act as shock absorbers between the vertebrae, respond to load in a similar way. Movement helps them draw in fluid and nutrients, which supports their health over time, where prolonged stillness tends to do the opposite.

In fact, prolonged stillness doesn’t just fail to help, it can actually starve those tissues of the nutrients and lubrication they need. It is part of why ‘resting’ makes the problem so much worse, the longer it goes on.

Like everything with the body, we ‘use it or lose it’. Where joints and tissues are not used, the body stops sending lubricating fluid there. Why lubricate a joint that isn’t moving?

There’s a nerve-specific component to what is going on, as well. Gentle, repeated movement helps a nerve that’s become a little “stuck” to the tissue around it to regain its ability to glide freely again. This is why targeted movement, not rest, is now the standard recommendation for most sciatica.

The bed rest that used to be advised to help sciatica and low back pain decades ago is very archaic and outdated. We need to kick that idea right into the dust.

Of course - knowing all of this isn’t going to make it any more comfortable to get through that worse-before-better week, but it does help with reframing it. It’s not that your body is telling you to stop, but that your body is trying to help you heal.

It can take courage to tread the path that works:

As you read earlier, my class member returned the week after her first, and the week after that. She only doesn’t come now if she’s on holiday.

I think this is really crucial to the story. When she made the decision to return, she didn’t have any proof it would work. I’d mentioned to the class members it might feel worse if this was the first time they were working their bodies, so she had my word. And her husband had tried to give her some positive encouragement.

But ultimately, this lady just felt she had to try something new. What she’d previously been doing - no proactive movement that was directly targeting her back problems - obviously wasn’t working for her.

Her pain point had become too great not to persist. Of course, she’s now absolutely glad that she did.

Now, she barely notices the pain. There are occasional twinges, and it depends on what she’s been up to. But overall, she frequently reports that she’s seen huge improvements in her day-to-day life.

This is priceless, really. When someone has started being pain-free more than they were in pain - what a dramatic difference to their quality of life.

If you’re feeling pain right now:

If you’re dealing with sciatica, or any longstanding low back pain, and you’ve tried moving and found it made things feel worse initially, I don’t want you to read this and think you simply didn’t try hard enough.

Nor do I want you to think that gritting your teeth through any and all discomfort is automatically what you should be doing. That’s not what this is about, and it’s very important to get proper guidance before starting.

This advice particularly stands if your pain is severe, if you have any numbness or weakness, or if it’s been going on for a long time without you ever being assessed.

Take note of this latter point especially. Whether you’re here to follow my advice, or want to attend a class locally to you, or generally just want to start moving more, if you have never had a professional assessment of the origin of your back pain or sciatica, I urge you to get an appointment booked in right now.

But if you’ve been told by your doctor or medical consultant that movement should be part of the way through for you, since the overall advice for sciatica is to stay active, then I’d like you to take this following advice, based on my class member’s experience:

• A short flare in the first week or two of appropriate movement is a known, common pattern, not automatically a red flag:

• It’s most likely that your body is responding to the activity and sensory input that it hasn’t received in a while.

• Most cases of sciatica truly do improve substantially within four to twelve weeks with the right conservative approach:

• This is an evidence-backed timeframe, not just me trying to give you hope. If you’re a week or two in, you are not yet in a position to assess whether it’s working.

The exercise needs to be the right kind:

Doing it alone, from a random video you found with no context, so often doesn’t work as well as doing it within a proper class or purposeful programme. It’s generally a mix of movement needed, rather than “one perfect exercise”, and this mixture needs to practised over time (though please see the note further down regarding ‘directional preference’).

If it’s getting worse past that initial early timeframe, or you notice new numbness or weakness, then you need to go back to your doctor and be reassessed:

Persistence isn’t the same as ignoring your body. You should not push through regardless if your symptoms get dramatically worse, or new symptoms occur.

Movements that can offer relief:

In the meantime, I can offer you a couple of temporary relief options. But remembering what I said about “one perfect exercise” not being the answer. Most sciatica cases need a more holistic approach with several exercises (for example in my case, due to hamstring tendinopathy, I have to do hamstring strengthening exercise as part of my overall routine).

Before you try these, you need to do a quick self-test. Notice what your body is already saying to you.

• Does sitting or bending forward ease the pain, or make it worse?

• Does standing or gently arching your back ease the pain, or make it worse?

Whichever direction the pain gets worse or better is going to make your decision as to which exercise to try. In physiotherapy, this is called ‘directional preference’ and is based on the McKenzie method.

Option 1: If bending forward eases the pain (flexion relief):

Knee-to-chest stretch:

>Lie on your back and gently draw one knee up toward your chest, hugging it there for 20-30 seconds, then switch sides. This opens up the space around the lower spine, which tends to help when standing or arching backwards is causing the aggravation.<

This pattern is often associated with spinal stenosis or facet joint irritation, where extension (arching back) narrows the space that the nerve passes through, and flexion (curving the back) opens it back up.

Option 2: If standing or arching back eases the pain (extension relief):

Prone press-up:

>Lie face down and place your hands under your shoulders. Gently press your upper body up, letting your hips stay on the floor, like the early phase of a yoga cobra stretch. Hold briefly, then lower down with control.<

This pattern is often associated with a disc-related cause, where prolonged sitting or bending forward increases pressure on the front of the disc, and extension can help ease pressure off the nerve.

If you’re finding this helpful, you’ll probably know someone else who also will! Please share!

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An important caveat: These options only work if you are going off what your body is telling you in the directional preference test. If trying either movement makes the pain worse, or sends it even further down your leg, stop immediately (see my note earlier about any numbness or weakness needing a proper assessment).

Going back to the lady in my class with sciatica, she is now one of the biggest advocates for the class. I often spot her speaking to new members to let them know how life has changed for her.

This is amazing, and exactly why I do what I do.

Please leave a comment:

Did you enjoy this article? Was it helpful? I really want to hear from you. Please don’t go without leaving a comment - I’d like to get to know my readers better!

Leave a comment

Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

FREE: Your 4 Week Bone Foundations Programme (worth £37):

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Hi everyone,

This is our anchor workout for September, the one to come back to again and again this month rather than chasing something new each session.

Whether you’re brand new to structured exercise or you’re already fairly active and just want a proper framework, this has been developed for you. Every movement has two levels, so wherever you’re starting from today is exactly the right place to start.

You can build on the levels if you require something more demanding, and the ‘Want more?’ suggestion will show you how.

A couple of things before you dive in. Don’t skip Foundation out of pride, nobody’s watching, and starting where your body actually is, is what makes this sustainable long-term. And don’t judge this after one go either. It’s a month-long anchor for a reason, so give it until week three before deciding how it feels.

Simple but functional

Sit-to-stands, presses, and rows aren’t glamorous, and I make no apology for that. They’re the exact movement patterns that keep you independent as you age: getting up off a chair or the floor without needing to think about it, carrying your own shopping, catching yourself if you trip rather than falling.

For bone health specifically, this matters even more than it might seem. Bone responds to load, actual, weight-bearing, “my muscles are working hard” load, not gentle movement alone. Every exercise here is a reason to keep creating more bone tissue rather than losing it. This is the unglamorous stuff that actually works, which is exactly why I keep coming back to it, for you and for me.

Read more

When I got my bone scan referral, I was fortunate. I had a student doctor the day I contacted my surgery about my risk concern.

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I was 52, and considering HRT due to menopause ‘madness’. Okay, I am being flippant - but let’s just say I felt like I was losing my brain.

(Quick note: HRT gave me my brain back, yay!)

I also had a suspected foot fracture. If you’ve read my free guide on bone health myths, you’ll know that I twisted my ankle in a STEP class, and while the movement was minor, the injury was substantial.

I was aware that HRT can stabilise bone tissue loss, and since I believed I was at risk, with osteoporosis in the family (there is a strong genetic link), I was getting in touch with my GP to look at my options.

My lucky day

As I say, I was given an appointment with a student GP. So, I brazenly requested a DEXA scan because I wanted an ‘assessment’ of my bone health, before making a HRT decision.

Based on the familial risk, he referred me. It’s a good job, because it turned out I was right to be concerned - the result came back that I had osteopenia, with a -1.3 overall T-score (although, I have since found out that the T-score doesn’t tell you everything, and there are other metrics that we can look at, as I discovered in this Substack article).

If it had been my own GP I’d have seen on that day, she would not have referred me for the scan. She actually told me that herself before looking at my records, admitting to a systemic gatekeeping issue she probably shouldn’t have been. True story.

What typically happens…

Most women - since we proportionately suffer far more from low bone density - do not get as lucky. The shoddy thing about osteoporosis is that it is usually diagnosed at a stage when medical management through prescription medicine appears to be one of the only treatment options.

Not only does it tend to be diagnosed when treatment (as well as reversal) options become limited, data from the Royal Osteoporosis Society tells us it is often when multiple fractures have already occurred.

I know from emails I’ve received from women, that once multiple fractures have occurred, life can be very difficult indeed. Severe pain, loss of independence, body and posture deformity, and loss of height are just some of the factors that make their lives miserable.

Aince I began writing and educating on bone strength and health, and launched my free guide, I have had many emails - all telling a similar sad story.

We certainly need to get assessed sooner, if any risk factors apply.

Before your next GP appointment:

If these apply to you, here are a few things worth mentioning to your doctor:

• A family history of osteoporosis or fractures

• An early menopause or surgical one

• A previous fragility fracture (a break from a fall from a minor event)

• Long-term steroid use

• A BMI that’s been persistently low

• Long term smoking or excessive alcohol use, especially if combined with any of the above

None of these mean you have osteoporosis. They’re simply worth speaking about, because a GP can only act on what they know to ask about. Remember, I got referred because I asked, not because anyone prompted me to.

Please do share this post if you’re so far finding it helpful, as others might, too.

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Menopause and bone loss is a long established fact

In the first decade after menopause, women lose bone tissue at roughly the rate of 1.5 to 2.5% a year. This is a well-documented acceleration and the health systems know about it. Yet still, by the time most women have a DEXA scan, it’s an osteoporosis diagnosis they get - not an osteopenia one.

One of the things we need to be doing is educating women to be more aware and sooner. Whether their doctor will listen is another matter (and I’m saving my thoughts about this for another article) - but any woman in her 30s or upwards should be doing something now about her bone health.

And what about the fellas?

I don’t want to leave them out. Even while men are far less likely to get osteoporosis, with around 80% of cases being women, they can still be diagnosed with it.

Because of the fact that the medical profession also assume them not to be at high risk as women, they can slip through the net even more easily.

At least half of men with osteporosis have an underlying condition which causes it, and the Royal Osteoporosis Society produce some good information on the topic to help men learn more.

One in five men over the age of 50 will break a bone due to osteoporosis, so the figure is not insignificant.

Get started on prevention, scan or no scan

Multiple recent meta-analyses (2025) confirm that resistance training measurably improves bone mineral density at the spine, hip, and femoral neck in postmenopausal women, with high-intensity training three times a week showing consistent benefit.

So what this means is, if you know yourself to be currently reasonably healthy - don’t wait for a scan, or a diagnosis, to begin a training programme that protects your bones. Honestly, you can’t afford not to.

It’s a well known statistic that one in two women over 50 will suffer a fragility fracture during their lifetime, as I talked about in my article about osteoporosis being an insidious disease - and if you have already fractured, as explained above, your options are thin on the ground.

I’m not a doctor, and I can’t comment on whether anyone’s individual treatment plan is right or not, but I am a prescriptive exercise coach - I’m qualified to train people with osteoporosis, and to have doctors refer them to me for exercise programmes.

And I urge you - please just start training. In which case, you may never need a scan - never mind a scan that comes too late.

Please leave a comment:

Did you enjoy this article? Was it helpful? I really want to hear from you. Please don’t go without leaving a comment - I’d like to get to know my readers better!

Leave a comment

Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

Update, 27 October: I’ve paused paid membership for now while the community grows. The weekly article stays free. If you’d like to be first in line when it returns, you can pledge your support. You won’t be charged anything now.

Hi everyone,

I’m so excited to share this news!

I’ve been busy, busy, busy, setting something up behind the scenes, and yes, I’m sure you guessed already what it is. I’ll tell you though, my brain has been on fire getting all the ideas in place!

You’ve probably noticed the free articles here are just that, free, and they always will be.

Every Sunday, you’ll get a in-depth piece from me. The full thing for free, not a taster with the rest locked behind a paywall halfway through.

But I have been asked by people: “what should I actually be doing, week to week to build strength?”

Reading about it is one thing. Having a working structure and a plan is another. So I’ve put one together.

What’s new?

I’m launching a paid tier for anyone who wants more than the articles - it will be an ongoing, structured way to actually build strength.

You will not only get a structured exercise plan each month, as well as a monthly ‘tune -up’ routine, you will be able to access all the plans that were published before.

So wherever you start, there will be something for you to use straight away.

How cool is that? Should you choose to upgrade to paid, here’s what you’ll get:

Paid Subscribers: £7pm, or £70per year (£5.83pm):

• A new strength anchor workout every month, built specifically for bone-loading and back-strengthening, with two levels (Foundation and Building) so it works whether you’re just starting out or are already active.

• The Monthly Tune-Up - a short plan that will offer a mobility, flexibility, or conditioning type of exercise. What I cover will depend on what comes up in comments and questions over each month.

• A monthly audio check-in from me, part pep-talk, part progress check.

• The Posture Reset Guide, complimentary for you.

• The Squat Fix Guide (usually £10), including 4 videos for instruction, complimentary for you.

This tier is for you if you want a proper plan to follow that includes different optionsdepending on where you are starting from. Choosing Annual means paying 35% less than the monthly payment - plus it will offer a longer term to actually see results.

The Unbreakable Core: £165/year

Everything above, PLUS:

• Access to The Unbreakable Vault, growing every month you’re a member!

• My full 4-Week Bone Foundations Programme yours for FREE (usually £37).

• A one-off squat assessment in your first month. Send me a video and I’ll get back to you within 14 days with what I see and where you need to focus (general movement feedback, not a substitute for an in-person assessment).

• A monthly Ask Me Anything - drop your questions in the Core chat early each month, and I’ll work through as many as I can and go through them in one recorded session that you’ll have access to.

• An automatic 10% discount on any future courses/products I launch during your membership, including any retreats I host.

This tier is for you if you want HUGE value, access to me, questions answered, and constructive feedback on your physical squat form.

Why I’m doing it this way:

I didn’t want to lock my writing behind a paywall. My weekly articles are the reason you’re here, and I think good information should stay accessible.

But I know from experience as a personal trainer that people need plans.

So what’s worth paying for though is structure - having a monthly plan you can follow which is accessible and has clear instructions.

This is alongside the extra value of an additional ‘Tune Up’ plan each month - a second session which might tackle conditioning, recover, mobility, flexibility, or even offer a solution to a common problem.

People also need to be held accountable, so my audio check in can help with that, and they need proper guidance to get things right (your monthly programme will have video instruction within it).

If you’re a founding Unbreakable Core member, you’ll be able to ask me questions via the monthly Ask Me Anything.

And there may be some little extras along the way. I can be quite a spontaneous kinda gal, because I’m also growing this organically.

If you’d like to join:

You can subscribe from today, right from the subscribe button. Your first monthly plan will lands at the beginning of each month, but you will be able to access all the previous months plans - so you will find something you can use straight away.

And if you’re happy as you are, reading the free articles every week, nothing changes for you at all. I’m just as glad you’re here either way.

Thank you, as always, for reading.

Andrea

PS. Just a quick reminder - everything you’re getting when you become a paid member - depending on which tier you opt for - will arrive with you at the beginning of the month!

Are you a gym bunny, doing classes every week? Or out in the countryside, cycling every weekend? Or in the fast lane at the pool, splashing everyone with your front crawl? Doing all this and telling yourself it's protecting your bones?

I used to think exactly the same thing. It turned out I was wrong, and the reason why really surprised me.

If you read my story, you’ll have found out that for years before I was diagnosed with osteopenia, I was pretty much a ‘cardio queen’. With full gusto, I pounded the studio floor at my local gym several times a week.

I absolutely loved my Zumba, STEP, swimming and - best of all - SPIN. I would try to get to spin a couple of times a week. Pilates as well, if I could get booked in (it was always full!).

I totally believed that I was building both strong muscles and probably, if I’d bothered to think about it, strong bones. Bearing in mind, I was also doing heaps of hill hiking.

I was so fit that when I hiked up Ben Nevis in July 2021 it actually felt really easy. The photo heading this article is me at the top of Nevis. What a day!

This was all ‘weight-bearing’ exercise, wasn’t it? Well, as I found out - nope.

When ‘weight-bearing’ isn’t ‘weight-bearing’

I might have been bearing my own weight as I hiked up mountains or held an isometric Pilates move, but it wasn’t doing the job I believed it to be doing.

There is evidence to show that exercises like brisk walking, swimming, and jogging may help to limit bone loss, but such activities do not provide the mechanical load needed to stimulate bone tissue growth enough to combat accelerated loss.

Not that I got into fitness specifically to build bone. I mostly hadn’t thought about it, to be honest. Though I would do a little smug nod to the idea that I was exercising in a ‘bone-friendly’ way, whenever something came up in conversation, or whatever.

I actually got into fitness because I had begun working as a funeral celebrant. If there’s one thing that working in the funeral industry teaches you, it is that life can certainly be short. Especially if you don’t look after yourself.

What the dead can teach the living

Getting into funerals in 2017 was a bit of a wake-up call - “this could happen to you if you don’t start looking after yourself” is the message I was receiving. Loud and clear.

I wasn’t in the best of shape at that point in my life. I was overweight, and while I did enjoy walking (I always have, especially as I’ve always had dogs), and dancing too, I was definitely not ‘fit’.

I had met the man who became my husband just a couple of years previously, and we had LOVED food, and snacking. As well as beer and wine. I put on a few ‘happy in love’ pounds.

But in my funeral work, I was being repeatedly shown that poor lifestyles can equal early death. As a fairly consistent reminder, you’d have to be made of stone, or fully head-in-the-sand, to not take note.

Putting the work in

I got disciplined. I joined a local gym and started attending classes. I’ll never forget going to my first ‘Legs, Bums and Tums’ and, shamefully, had to leave the class after ten minutes because I was unable to keep up.

Even that ten minutes left me with three days of severe DOMS (delayed onset muscle soreness), too! Hard to believe I was ever like that now, as DOMS is a very rare occurrence for me, and only happens when I’ve had a training break.

But I persisted, and ultimately, I built a very strong cardiovascular system, along with amazing endurance for distance and hill walking.

What I didn’t realise was that it should have been only a part of my overall health routine. I had no idea at the time how important strength training was.

And because I had no idea, when it came to me getting my bone scan, part of me was convinced that I’d be told that I had nothing to worry about.

I was shocked with the report. I had osteopenia. What?

What I got wrong

Here’s the thing - cardio work builds your heart and lungs. That’s why it’s called cardio. It’s absolutely essential to a healthy active life, but it’s not the only thing we need.

There’s some impact included, but the body quickly adapts to the type of low-level impact provided.

Research shows us that bone needs impact, or to be heavily pulled against by the muscle (resistance), in order to grow new bone tissue.

Not only that, the stimulus has to keep changing - and be ‘continuously novel’. The stimulus should be in the form of mechanical load providing resistance.

Since some of the foundational theory on this was published, a stack of evidence-based literature through the years continues to support this.

Like anything though, you only know it if you know it. When I started out as a fitness newbie, I didn’t really understand that strength training was a necessity. Particularly as a woman in her early 40s.

Let’s face it, the fitness messages that we women generally receive - and only more recently has it started changing - are all about “do cardio, lose weight, punish yourself for eating the cake”. Am I right, or am I right?

I mean, there’s a whole article there in itself, and I shall probably get it written at some point, but suffice to say - it took an osteopenia diagnosis to get me to understand this.

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So what did I do?

Well, if you’re new here and this is the first article you’ve read of mine, I’ll give you the good news - I turned my diagnosis around. My follow up scan 3.5 years later showed I had a significant increase in bone mineral density and that I had normal BMD again.

Because I embarked upon a dedicated strength training programme and was consistent with my new exercise routine, I had started to rebuild bone.

It was helped by changing my nutritional intake and also by lifestyle improvements, as well as HRT, but all the evidence points to it being the actual strength training that would have made the real difference.

The other aspects that I changed will certainly help to stabilise bone loss, or reduce the rate at which it is lost, but they are not alone usually enough to make a significant increase (which in my case, it was).

Some evidence shows HRT can help slow bone loss, and in some cases modestly increase density, but again, the studies show that targeted strength training is actually the thing needed to make a significant difference.

(Note: HRT is a personal decision to make with your GP or menopause specialist, not something I can advise on directly.)

Quick check: is your routine actually loading your bones?

If you can say yes to most of these, you’re likely on the right track. If not, it might be worth a rethink.

• I include some form of resistance work, weights, bands, or progressively loaded bodyweight, not just cardio.
  

• I’m working large muscle groups against actual resistance, not just holding a position or moving at a steady pace.
  

• What I lift or the resistance I use has increased over the past few months, not stayed the same.
  

• My routine changes regularly, rather than repeating the exact same pattern every session.
  

• I could point to at least one exercise in my week that has felt challenging by the last couple of reps.

  ---

So, what does ‘targeted strength training’ look like?

Well, it can depend. It’s all relative to where you’re starting, and whether your body is always used to some patterns of exercise or not.

Resistance training is the umbrella term for training that involves the muscle pulling against a form of resistance, and therefore training both the muscle and stimulating the bone. Strength training is a form of progressive weight training that falls under this umbrella.

An effective strength training programme involves several exercises that will load your muscles on a total-body basis, done in 30-45 minute sessions, two to three times a week.

The focus should be on loading the whole body, exercises that work the posterior chain (back, glutes, legs), chest, hips, shoulders and arms.

Your focus should be on progressive overload - lifting or loading weights that increasingly get heavier the stronger you become.

For beginners, this may even be starting with simple bodyweight exercises or even some isometric holds - I have a 4 Week Bone Foundations Programme which is perfect for those who are new to this.

I hope you found this article useful, and has given you some awareness of how bone-friendly your own exercise-routine currently is. Please let me know?

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Disclaimer:

This content is for educational purposes only and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

How many hours do you sit at a desk during your working day? Does your butt stay glued to the chair more than your feet ever get to tread the carpet? Or do you incorporate movement into your seated day?

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The desk job dilemma

It’s long been established that prolonged sitting is bad for backs, but a recent 2025 study among office workers found that static sitting behaviour is more strongly associated with low back pain, than sitting which incorporates movement.

In my years as a full-time freelance journalist, I sat more than I moved. I was usually so foot-to-the-pedal with work, that I didn’t get up except for tea breaks and to walk the dog. Sometimes, in very busy periods or on a deadline, I could be at my desk for 10 hours.

Combined with the stress that sometimes a freelance journalist life could bring, my lifestyle ultimately played havoc with my bio-mechanics.

No gain, lots of pain

My shoulders and neck were sore all the time. Tension knots in my upper back and around my shoulder blades were hard to undo, even by the toughest and most painful deep tissue massage.

I had repetitive strain injury in my wrists. This could be agony at times. Affecting such a small part of the body, RSI sure made a big noise. I got it in my hands, too, from using my mouse.

Then came the back pain. Gnawing across my lower back. It drove me mad as I struggled all day to reposition myself in a way that it wouldn’t hurt.

After sleep, some days I’d wake up feeling like the aches had eased. However, after a couple of hours back at my desk, the nerve twinges were pinging again, and the knots were balling tighter.

Sound familiar? Well, if it’s any consolation, I no longer have low back pain. Admittedly, I sit nowhere near as much as I used to. But my posture and body are so much stronger now. This means that the longer periods I am sitting (like when writing this) are far more tolerable.

Quite a bit changed for me - not just my working life altogether, but my whole outlook to health and to what actually is a fitness routine.

Before we go on, let me unpack a few need-to-knows about why prolonged sitting - and static sitting especially - is a big old pain in the back.

The silent creep, pelvic tilt and ‘sleepy’ glutes

Have you ever heard of tissue creep? In simple terms, it is the lengthening and stretching of tissues such as muscles, tendons, and ligaments, when they are being forced into a continual position over time.

Sitting slouched in one position for hours on end means a low-level load is placed on the tissues in the back for a long period. Over time, this causes connective tissues to weaken and misalign, leading to muscle imbalances, strain and pain.

Combine this also with the fact that the body elsewhere is in a rigid position that it is not meant to be in for hours on end. Our bodies were made to move, not to be still.

The pelvis tilts backward when we sit. Over an extended duration, there is a load on the lower spine that isn’t being supported in the same way as if we were standing or moving. This load can cause issues in the lower vertebrae and muscles around the pelvis and lower back, further contributing to the incidence of low back pain.

Then we also have the fact that our glutes (the big muscles in our bums) - being sat on instead of being strengthened, start to weaken from disuse. One of their key jobs though, is to support the spine, so we need them strong. As I tell my back class participants, of all the muscles in the body that are most important to the back, it’s probably the glutes.

Ultimately, most people with low back pain that comes from prolonged sitting will likely have a combination of these disrupted biomechanisms going on. You might not know which exact part of the internal machinery is causing the most issue, but your body will certainly tell you where the most stress is.

To put another spanner in the works - sitting for long stretches doesn’t just affect your back. There’s a growing body of research on what it does to your heart, too, and this is even for people who exercise regularly. I’ll come back to this properly in a future piece.

So, how do we fix it?

The good news is, for the majority of people, a holistic approach to spine hygiene and back strengthening generally works. The body moves together in all its amazing ways, and isolation of individual parts in a treatment plan is usually not necessary, or only for very rare cases.

Overall, I’ve generally gone for a ‘total body’ approach in most areas of my client programming - because it corrects imbalances and stops them developing, as well as the fact that every part of our body needs another part to also work properly.

However, before we delve into the physical - what about the environment we’re actually working in?

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Ergomonics matter (but not as much as movement)

Going back to my experience, in those days where I was suffering substantially. I managed my setup. Gel rest for my arms, mouse pad with a rest. I bought a specialist ergonomic chair.

I even trained myself to use my mouse left-handed as well as right-handed, so I could switch over when I needed to rest one hand. I also bought wrist splints to sleep in at night, which helped to immobilise my wrists and forearms to give them rest.

It offered some light relief, and did make a difference to my working day. Especially investing in a proper chair. Of course, now, standing desks are an option - in my old school journalist days, they were relatively unheard of. Although, I don’t have one, because it would mean a lot of reorganising of my space.

As well, new evidence shows us that it is our movement patterns that matter more - breaking from a static position frequently is more beneficial than either sitting or standing statically.

In fact, standing statically for many hours also causes load to be placed on the lower back, and can contribute to lower back pain. So standing desks are not the magical solution we imagined.

All of these ideas - ergonomic chairs, wrist splints, gel rests - are only part of a solution to a bigger problem. Like putting scaffolding up around a house that’s cracking. The scaffolding will only hold it so long, you have to get down to the foundations to fix it.

So, what movement can help?

Firstly, anyone who is already appropriately strength training two or three times a week with a total body approach is going to be in a better position. Anything we do that keeps the muscles supporting the spine healthy and activated is obviously going to help reduce our chance of low back pain.

I use the word ‘appropriately’ above, though. I’ve had clients who started the gym without knowing what they’re doing. They go and attempt a macho deadlift way beyond their capacity. Hey presto - they put their back out. Well, I could have told you that was going to happen.

However, I can’t emphasise enough that getting into an actual strength training routine that is right for your body, where it’s at, is going to help you no end. If you subscribe to my publication, you will learn how I value strengthening over stretching, always.

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I’m aware though that not everyone reading this is going to start strength training in the gym, or even at home. You want a few practical tips that will help you each day.

Become the tea runner (and other practical advice)

Maintaining a regular shift in posture is key to reducing the low back pain that comes from sitting. Active breaks take the pressure off the spine. Move for a few minutes at least every 30 minutes.

What kind of movement counts? Any that is practical! Get up, and jog or march on the spot. Run up and down stairs a few times. If you work from home or are in your own office, you have more options.

Do a few squats, star jumps and strong retractions of the arms and shoulders.

Keeping the blood pumping is also important, as noted above regarding cardiovascular health. But blood flowing into the tissues around the spine will also help reduce pain.

Find more ways to be active during the working day. Use any phone call as an opportunity to stand and walk. Become the tea runner in the office. Offer to do errands when the opportunities arise in a bid to move more.

For wrists and hands, try prayer presses. Put the hands together at the chest as if praying, and press really hard for a few seconds. Do a few reps, followed with some hand rotations at the wrist. Have a break from typing, and if you can, try a mouse hand swap.

‘Reactivate’ your glutes and release your pelvis!

Once you’ve finished your desk day - get into the habit of doing two key exercises:

1. Cossack lunge - this is my favourite for opening the hips and helping to reposition the pelvis after a long day of sitting. It strengthens the legs and works wonders for the hip flexors. It’s a variation on the cossack squat, not as deep and easier for beginners. Because it’s a more demanding one to master, I’m giving you a video demonstration to help.
   
   Do about 20 altogether (10 each side) and focus on form - you may well feel a lot of relief from the pressure of sitting after doing just a few of these, too.
   
   NOTE: This is a fairly demanding exercise for newbies. If you have limited balance or hip mobility, try holding a chair when doing it. An alternative can be alternate side lunges - stepping into a side lunge, stepping back to the middle, then stepping into a lunge on the other side. Taking your time to pause in the middle, rather than trying to move quickly from one side to the other.

   

2. Glute bridge - a number one exercise for glute strengthening. Lie down on a mat or carpet, palms positioned downwards, knees bent, heels close to the bum. Squeeze the bum while pushing the body up, so the belly button is high. Keep squeezing for a few seconds, then relax and lower. Do 5-10 reps for 2 sets.

   
   NOTE: As you get stronger, you can hold a weight at your lap to add load.

   

Make the rest of your time active

DO NOT come home from work and simply sit down again. Spend some time moving. Unless of course you want a lifelong low back pain problem to develop.

Do the above exercises. Go for a walk, go for a short run, do some cleaning, get some cooking done. Do some structured strength training.

If there’s something you want to watch on TV - either do it standing up, or sit on the floor instead of the sofa.

Dr Kelly Starrett, a very well respected physical therapist, advises we should sit on the floor for 20-30 minutes daily. It combats the rigid postures of being substantially chair-bound.

Keeping the movement patterns flexible and flowing during the working day will help immensely. However, if you have developed a lot of tissue creep and imbalances due to sitting for many years, then consider starting a back strengthening programme.

What happened to me?

Did I become a changed character and start doing all this type of exercise during my working day? Nope. I knew none of this back then.

As it turned out, the shift in the media world as print journalism moved online meant I had to adapt and reevaluate my career. It moved in new directions and I wasn’t sitting anywhere near as much as I used to.

I also got into fitness, and a more ‘on the go’ working life combined with the aerobic activity took away my back pain and RSI problems.

But now, since I have returned a little more to desk work, I do of course practise all that I preach.

Once I completed my Level 4 Low Back Pain Management Through Exercise qualification, I also now offer back care programmes for organisations, to help their workplace teams.

I would love to know if this advice has helped you. Please comment if it has?

Before you go:

Whether you are an individual or an organisation, if health and wellness is important to you, then please subscribe here for free. Expect a weekly, informative article along my themes of strong backs, strong bones, strong muscles - and follow me for notes with useful daily tips.

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Disclaimer:

This content is for educational purposes and isn’t a substitute for medical advice. Please check with your doctor before trying new exercises or taking health advice on this page; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

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Want to know how to fix your squat? I produced a squat fix guide which is linked to an article on what your squat says about you.

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For organisations (UK based):

Musculoskeletal problems are one of the leading causes of sickness absence in the UK, with back conditions accounting for a significant proportion of all work-related musculoskeletal disorder cases reported to the Health and Safety Executive.

As well as days lost to absenteeism, there’s presenteeism to consider: employees who are in work, but operating at a fraction of their capacity. It’s difficult to be productive while managing pain at their desk, in their driving seat, or on the assembly line.

Where staff are spending hours sitting or in one position doing repetitive movements, being incapacitated by a ‘bad back’ is a very real risk - and yet, it’s largely preventable.

I offer a ‘Back at Work’ programme. You can find the details and grab my one-page summary document RIGHT HERE.

My FREE Guide: Bone Health Blind Spot

It’s free, so why not grab yourself a copy? A 16-page guide giving you the low down on what exercise works and doesn’t work for strong bones.

All I need is your email. CLICK HERE.

Thank you so much for being here.

Whether you are an individual or an organisation, if health and wellness is important to you, then please subscribe here for free. I’m all about strong backs, strong bones and strong muscles.

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Welcome to Becoming Unbreakable. I’m Andrea. In a moment, I’ll tell you my story of how I became unbreakable. Before I do, if you would like to become unbreakable too, please subscribe for here and receive my free gift of a guide on how to engage your core:

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A little introduction

For around fifteen years, I was a full-time freelance journalist, substantially writing for the Guardian. I even had a 6 month column there on blogging.

I then spent many years as a funeral celebrant, and still love to do this. But my path changed dramatically after a medical diagnosis.

In September 2022, I was diagnosed with osteopenia - the precursor to osteoporosis - AKA ‘brittle bones’ (a misnomer, by the way. ‘Brittle bones’ is actually another bone disease which is very serious).

It was a baffling moment. I had been solidly into fitness for half a decade by this point. I did Zumba, STEP and SPIN each week. I went swimming. I did at least 10,000 steps a day. I hill hiked.

Frailty ain’t fitting…

I did not want to lose my independence to osteoporosis, and become fragile and fractured. But if I wasn’t already doing ‘enough’, what else did I need to do?

Note: No tangible guidance was offered by the medical professionals other than calcium supplements (which I didn’t take) and I was left to work out for myself how to change my outlook.

Upon learning that the kind of exercise I’d been doing wasn’t actually ‘weight-bearing’, I wanted to learn properly how to strength train.

Not one to do things by halves, I became a qualified personal trainer.

Gimme the low-down

I actually wanted the knowledge for myself. I was hoping that through training, I may in the least halt the progression of my condition.

Stabilising the osteopenia would have been a great result for me.

I didn’t just start strength training. I set about making some lifestyle changes - changing my diet, becoming more disciplined around sleep, and the biggie, mostly giving up alcohol.

Yup. That was a tough one! I had thoroughly rocked hedonism as a youth, and into my midife, I loved a weekend wine just like the next peri-menopausal woman relieved another week was through.

Guess what? Personal training became my career. But ‘bootylicious’ was out.

Glutes are for power, not pants

It dawned on me my real interest was in helping people with health conditions.

For me personally, I didn’t give a toss about training to look good in hot pants. I cared about making sure that my old lady body, when she arrives (not there yet!), can kick ass.

I then became even more qualified. I got all fancy obtaining a Level 3 Exercise Referral and a Level 4 low Back Pain Management Through Exercise.

I used to suffer incredibly with back pain with my butt at a desk all day in my journalist career, so I knew how valuable this knowledge-broadening would be.

Officially “unbreakable”.

In May 2026, I had a follow-up DEXA scan to see where my bones were at. I was astounded to discover that my bone density had returned to normal.

I had put in the hard work, and I won. My bones were strong again.

The training, nutrition and lifestyle programme I had designed for myself had done the job. It continues to do so, too - because this is a lifetime commitment. Ain’t never gonna give it up.

Which brings us here. Everyone should be unbreakable. And I am on a mission to teach others how to do this - whether it’s their bones or their backs. But likely - both - as if you work on one you’re usually working on the other.

Who is Becoming Unbreakable for?

My focus is both on bone health, back care, and muscle strength.

I teach back care classes in the community, and offer a back health programme for workplaces. I run commissioned sessions for local organisations, including a commissioned short course to a local council.

I offer bone strength programmes to individuals, and write guides and newsletters on osteoporosis prevention through lifestyle, exercise and nutrition.

Here on my Substack platform, I will be sharing helpful advice, education and information in these key areas - strong backs, strong bones, strong muscles.

These are the essential components to becoming unbreakable.

Subscribe for free and I’ll send you my guide on how to actually engage your core, one of the most useful things I teach every week in class.

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If you know someone else who will benefit from this publication and the wealth of information that I provide here, please do share:

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Disclaimer and safety note:

This content throughout this publication is for educational purposes only and isn’t a substitute for medical advice. I am not a clinician. Please check with your doctor before trying new exercises or taking health advice from within these pages; especially if you have osteoporosis, a diagnosed condition, or any concerns about your health.

Here’s the answer to the title in a nutshell: osteoporosis is an insidious disease because it is a silent condition. You often don’t know you have it until it’s too late.

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Osteoporosis is often known as ‘brittle bone’ disease. It occurs when we lose bone tissue. There is no pain associated with it, aside from when it’s very advanced and is causing other complications in the body, such as fracture of the spine causing pain.

You won’t notice changes in your health as a result of having low bone density.

There are no symptoms in the early stages, when it matters the most to catch it.

For most people, they know they have the disease when they have a fracture which may come about from a very minor incident. Or even worse, they will know when they break a bone.

80% of people with osteoporosis are women. The key reason being our different hormonal constitution. Menopause, when oestrogen drops, is a major time of bone density loss.

As well, women tend to have smaller, thinner bones than men to start with.

One in two women over the age of 50 will suffer a fragility fracture during their lifetime, but by the time it happens, they are already often in advanced bone disease.

This means if you are female and reading this, you absolutely must take note - because there is a strong chance that it will happen to you.

Men can have osteoporosis too, though. Since it is a lot rarer, they do tend to get missed from screening - and for that reason, it can mean they are even more at risk of going unnoticed until in very advanced stages.

According to the World Health Organisation, osteoporosis is a serious global health concern. Yet, it is a disease that in many cases, is largely preventable - even while being so prevalent.

Why is it such an issue?

Part of the problem is that people view ‘brittle bones’ as an ‘old person’s disease’, not understanding that the work to prevent it happening actually needs to be done decades before.

People find it hard enough to pay attention to their health for the things they can notice changing, never mind the things they can’t. So even if they are aware that low bone density may come to haunt them when they are older, they won’t act now to prevent it.

There are also people who think they are doing the right things but might not be quite hitting the mark. This was me before I actually got diagnosed with the stage that occurs before osteoporosis sets in - osteopenia (which is now reversed).

This is the exact reason why I created my free ebook The Bone Health Blind Spot, which explains a little more about what osteoporosis is, and when it comes to exercise, what does and doesn’t work for bones, and for prevention.

Your bones need you to be their advocate - because they only speak for themselves when it’s often too late.

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There are some things that are obvious when it comes to bone health, and others that are less obvious.

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One very powerful secret ingredient in our bone health armoury is getting consistent, quality sleep. 

I used to teach my PT clients the whys and hows of good sleep habits, because sleep impacts on so many aspects of health.

Unsurprisingly, there’s also a link between bone health and poor sleep, too.

A study on aging carried out in England found that getting less than 6 hours a night, or more than 9 hours a night, is associated with higher osteoporosis risk and lower bone mass density. The balance between bone formation and bone breakdown is disrupted by bad sleep.

Not a revelation, really. I mean, consistent poor sleep (including sleep that is influenced by alcohol or sleeping tablets - making it ‘sedation’, rather than ‘sleep’) is linked to poorer health outcomes overall.

When sleep functions are disrupted, everything is…

There are three key ways in which sleep affects our bones, and they are also the ways in which sleep affects other aspects of our health. They are via disruptions in our circadian rhythm, our hormone regulation, and our cellular repair (with cellular repair being one of the key functions of sleep overall).

A growing body of research including night shift workers as subjects, is showing us that messing with our circadian patterns also impacts upon on our bones. We know already that even mild disruptions to our ‘body clocks’, like jetlag from flying or having consistent late nights on weekends, can cause health issues.

Hormone dysregulation is also a well known result of poor sleep. It impacts our appetite, our cortisol levels, and even reproductive function. Since healthy hormone regulation is also important for healthy bone tissue - you guessed it, consistent hormone imbalance can play havoc with our bone growth and repair.

As well, it is during deep sleep that our bone tissue gets repaired - as cellular repair occurs throughout the body at this time.

With all this in mind, can you imagine what the body of a menopausal woman is going through?

She is in the middle of a hormonal whirlwind, with oestrogen tanking, and her sleep is disrupted anyway because of that. Plus, she is likely to be sleep deprived either because of the hormonal imbalance, or the stress of dealing with menopause, or with hot flashes, or all of them.

The problems are compounding, so it is no wonder that menopausal women are most at risk of having low bone density and becoming osteoporotic.

So, how do we try and get better sleep?

It can be a difficult one to tackle because many people with very disrupted sleep are so anxious about bedtime that this in itself imposes a hurdle upon getting a restful night. However, these are my suggestions as a starting point:

1. Speak with your doctor to see if you have any deficiencies that might be impacting upon sleep, or if there is another physical cause. Dr Stasha Gominek says that vitamin D deficiency can be a key cause of poor sleep (but get tested before taking any supplements willy nilly). Of course, menopausal imbalances may also be the root cause - ask your doctor about options.
   

2. Avoid sources of stress before bedtime or during the evening. This includes getting involved with social media arguments on your phone and watching anxiety-inducing documentaries. In fact, turn your phone off at least an hour before bed to avoid the ‘blue light’ impact (which will awaken your brain).
   

3. Get your circadian rhythm into check. Do this by getting out into the daylight within the first 20 minutes of waking, perhaps having your morning cuppa on the doorstep or in the garden. Get an evening walk in as dusk is falling. Keep the lights dim in the home before bed, and as above, avoid the blue light of devices before bed.
   

4. Eat regular, protein-rich meals and stop eating at least 3 hours before bed. Protein is great for bones, for satiety, and for muscle growth and repair. It will keep you full and the older you get, the more you need it. Not having a full stomach before bed means rather than your body having to digest food during your sleeping hours, it can simply do the repair job it needs to do.
   

5. Avoid alcohol at night time. I know, I know - you think a glass of wine helps you sleep. But it really doesn’t. It sedates you. Your brain doesn’t go into the deep restorative sleep it needs, and you essentially become sleep deprived while believing you’re sleeping. Alcohol also raises cortisol levels the next day, which contribute to the poor sleep pattern even further. If you want to keep booze in your life, go for a weekend lunch out and have a glass then, instead of in the evening.
   

6. If you wake during the night - DO NOT LOOK AT YOUR PHONE OR THE CLOCK! The block capitals are necessary. I can’t stress how important this is. Avoid the temptation to restimulate your brain, and avoid the temptation to check the time. Instead, try some deep breathing. Imagine a dark pool that you are sinking into, and keep breathing yourself further into the pool. See if the relaxation can help you switch back off.
   

I hope this helps. It’s my mission to help more women get their bone health in check before they discover their bone health is already impaired. Sleep is more important than we realise for our bones, so it’s worth working on.

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