A Physical Therapist's Take on the Latest Fitness Trend
We need to talk about weighted vests – they're everywhere right now, and while the benefits sound amazing, I'm seeing some concerning trends in my practice. As a private in-home physical therapist with 15 years of experience, I recently worked with an active 36 year old woman in Columbus, Ohio who developed serious shoulder and neck issues after progressing her loads too fast while rucking. We could all learn from her experience and I share injury prevention tips below.
Rucking vs. Weighted Vests: What's the Difference?
Before we dive into the case study, let's clarify what we're talking about:
Rucking uses a backpack with weight plates, distributing load primarily on your hips and core when properly fitted. The pack should sit close to your back with most weight transferred through a padded hip belt.
Weighted vests distribute weight across your shoulders and torso, putting more stress on your neck, shoulders, and upper back. While popular, they can be problematic for people with existing posture issues.
The reason I’m highlighting this patient is because she committed to a fitness routine of carrying weight on her back and shoulders for a year. I find her story to directly relate to what I’m concerned I will start seeing a year after the start of the weighted vest trend. Injury prevention is a major part of my practice and passion so I’m here to give you good educational tips!
A Real Patient's Story: When Rucking Goes Wrong
Bethany is an active 36 year old woman. She started rucking in April 2024 as a joint-friendly alternative to running and a way to build community in Columbus, Ohio. She did weekly 3-mile sessions and initially saw fantastic results – better posture, improved lung capacity, and increased hiking strength.
Her progression seemed reasonable:
10 pounds for five months
15 pounds for one month
20 pounds in October 2024
The warning signs she ignored: Almost immediately after jumping to 20 pounds, Bethany felt shoulder strain and numbness in her left arm. Since symptoms didn't occur during rucking, she blamed her sleep position. This is exactly what I see patients do – dismiss early warning signs.
When things got serious: By March 2025, Bethany developed sharp, burning rib pain and thoracic spine tingling. At its worst, even turning her head triggered pain. She couldn't tolerate any weight on her back.
What went wrong:
Poor pack fit – She bought on clearance, not based on her frame size, forcing her to lean forward unnaturally
Ignoring body signals – Shoulder strain, tingling, and postural changes were red flags
Inconsistent progression – Jumping weight increments and varying distances without building up gradually
After months of pain, rest, and rehab with Balanced by Katie’s in-home physical therapy treatment, Bethany is finally recovering – but she's had to take a long break from weighted activities.
Your Action Plan: How to Start Safely
Before You Begin:
• Assess your posture – Address rounded shoulders or forward head posture with a physical therapist first
• Get properly fitted equipment – Invest in gear that fits your frame, not what's on sale
• Start light – Begin with 5-10 pounds maximum, regardless of fitness level
• Plan progression – Increase weight by 2.5-5 pounds every 4-6 weeks
Red Flag Warning Signs:
• Numbness or tingling anywhere during or after activity
• Persistent shoulder/neck strain
• Constantly adjusting straps or feeling unstable
• New aches that weren't there before
When to Stop:
• Persistent pain that doesn't resolve with rest
• Any neurological symptoms (numbness, tingling, weakness)
• Sleep disruption due to discomfort
• Inability to maintain proper form
The Bottom Line
Weighted training can be excellent for building strength and endurance – but only when done correctly. Bethany's story isn't meant to scare you away, but to help you approach it intelligently.
Remember: fitness trends come and go, but your spine needs to last a lifetime. Take the time to do this right from the start, and you'll enjoy the benefits for years to come.
If you're experiencing pain or have questions about weighted training, book a Free Movement Discovery Call with Dr. Katie. She treats patients privately in-home in Columbus, OH and virtually for patients in Ohio and California.