Sports Injuries - Mostly Avoidable

Ok people. This post has been long in the pipeline as many people have been asking about injuries. I have to declare right at the beginning, that I am a sports chiropractor and treat injuries all day everyday. Also, and more importantly, I try and coach people to injuryproof themselves - my mission is to stop injuries from happening again. I have a few potentially unorthodox ideas about this, something not everyone agrees with, I'm sure, but I am personally a walking, talking testimony of my own approach. Zero injuries for 5 years now. Hope I didn't jinx it now...

  

On a Philosophical Note

An injury is not a permanent set back. It is transient. It is a wake-up call. In a way an injury is a positive thing. Let me explain. Pain and injuries are the brains way of telling you that something is wrong. Something you have been doing for the past xx number of days/weeks/months/years has been incorrect, and it is unviable. Thus an injury, and the resulting 'time out' becomes an opportunity like no other. You can assess what is was that caused an injury and then alter your habits to change the outcome in the future. If this assessment and application of new ways is done properly it will result in a body that by far superior to the old one. This, of course, results in improved athletic performance and reduced likelihood of future injuries. 

Sports Injuries - An overview.

The purpose of this post is not to analyse any specific sports injuries. It is more about learning to understand why injuries occur and what we can learn from them, and most importantly - how to stop them from happening again.

Generally injuries can be divided into two camps. 1) Acute, sudden onset of pain and dysfunction. 2) Chronic, repetitive strain type, gradually worsening pain and dysfunction. Most injuries fall into category two. Yes, shocking, isn't it? I would argue that 99% of injuries are of the chronic variety. Category one is a small fraction of the total, and simply consists of the scenario of "one minute everything is fine - incident - immediate pain and inability to continue". Getting hit by a car when cycling fits this criteria nicely. In a way we can look at it from a different angle as well. Cat 1 have external causes, Cat 2 have internal causes. To clear it up a bit - Cat 1: something happens to you, Cat 2: you have brought it on yourself over many weeks/months/years of faulty technique. Thus the typical triathlon injuries from swimming (swimmers' shoulder), cycling (Low back pain, knee issues, shoulder problems) and running (Runners' knee, Iliotibial band issues, foot/ankle problems) all fall under Cat 2.

Example: Bob is a 40 year old runner. He has Plantar Fasciitis and Iliotibial band pain on the right leg. It started suddenly four weeks ago when he upped his weekly mileage to train for the local marathon. He has made no changes to his routine over the past few years. He has no other health concerns and enjoys running very much. He is very upset and disappointed, because he read on the internet that this will now ruin his chances for a decent time on the marathon and he may have trouble with it forever.

Why?

Since Cat 1 injuries are external and occur independently from the athlete we will ignore those for the time being. The causes tend to be varied and trying to stop them from happening completely is futile.

Cat 2 injuries can usually be traced back to old injuries and old traumas and  the resulting asymmetrical functioning and compensations in functioning and technique. Even if the onset of pain may have been rather sudden, with a bit of careful examination it is possible to higlight the causes as to what predisposed the athlete to a particular injury in the first place. Usually it is due to inadequate athletic ability. This does not refer to your times in swim/bike/run. Athletic ability is the way the athlete is able to utilise his whole body to perform any task in as efficient and effective manner possible without bringing on undue stress to any given body part. Thus lacking athletic ability means that the body is able to perform very well on a single plane or in one direction only and is injury prone with any variation from the normal. Such as making a tennis player take of speed skating, or even making a road runner hit the trails instead of tarmac.

Triathletes tend to get injured due to a combination of excessive repetition and poor technique. Especially long course triathletes tend to go for the maximal mileage approach and often times at the same intensity. They also tend to shrug off minor niggles as mere nuisances and continue on their path. They tend to underemphasise recovery, which is essential in terms of healing and absorbing the the training load i.e. improvement.

 Let's check back on Bob now: On questioning and examination it turns out that he has had a niggle in the leg and low back for many years that 'comes and goes'. He also suffered from recurrent ankle sprains when playing football years ago. His hip joints are very stiff from sitting in the office 40 hours per week and commuting two hours per day. 

The quick ones among you have spotted the "upped mileage" and immediately thought that was the problem. It merely highlighted the problem, which was present for many a year previously. His nervous system could not handle the increased mileage due to the various compensations it had to deal with. The compensatory (dys-)function arises from the altered ankle mechanics and resulting muscle firing patters, as well as the stiffnes around hip joints, that alter the normal, fluid movement of the legs. This is all relatively easy to spot on video or even with a naked eye. 

Treatment

This is where it gets a bit tricky. When an injury occurs you need to find someone to help you. Someone who knows their onions. Generally it means going private. And paying for the privilege. I don't care if you choose to see a chiropractor, osteopath, acupuncturist, physio, masseur, sport doctor or even your GP.  What dictates the outcome of any treatment protocol is the follow through by the patient. Each and every time. You will need to assess carefully and to completely understand the factors that brought on the injury in the first place. You need to then let the professionals do their job (provided they know their onions) - short term relief. Then you need to change the factors that led to the injury while you go through your rehab programme - medium term improvement. Finally you must increase your athletic ability to gain the boost in performance and to become injury proof - long term cure.

Coming back to our friend Bob again. Bob thinks he needs new trainers and a massage. That's what worked for his buddy Jim. Bob does that and continues to run. Nothing improves - the problem persists and he is now getting a bit down about the whole thing and dreads his runs. Then he reads a running magazine and decides to take up stretching and foam rolling. It helps a little, especially as he also took a week off running. As he gets back to it the pain comes on again. Bob has not learned a thing - don't be like Bob.

Since Bobs problem is a chronic problem brought on by his own actions, external interventions will not produce any lasting benefit. That is why simply slipping into motion control shoes does not solve the problem. That is why any treatment alone will not solve the problem. Bob has to first get the injury treated (short term), then he has to address the technique during his rehab (medium term) and he has to improve his overall functioning to gain freedom from the injuries (long term).

Treating Triathletes tends to be a bit easier than our friend Bob. They tend to be more open to suggestions and more willing to try new things out. Maybe it is due to Triathlon being a relatively young sport - the bullheaded adherance to dogma has not yet set in. :)

Injury Proofing - Creating Athletes out of Sportmen.

 What is an "athlete"? An athlete is different from a sportsman in two crucial ways. Sportsmen get injured. Sportsmen are good at one sport, maximum two. Athletes however, possess the ability to be good at virtually any sport and perform to relatively high standard even with minimal specialised training. Athletes don't get injured.

There is one thing that comes up when talking to real athletes. They enjoy a great variety of sport/training/exercise on a weekly basis. The emphasis is on the word 'enjoy'. They have fun. They might be serious about their specific training for the next race or match, but they thrive on the variety of challenges that other activities present them with. This makes them 'anti-fragile'. It allows the brain and the body to continuously learn and to develop, it prevents the frustrating plateaus and the 'time outs' due to minor injuries. Not only do they do different things, they also do them at different intensities. There is the competition intensity which is reserved for when it truly matters, races and a few race simulation training sessions. Some times training can be done at higher, sometimes at lower intensities. Even varying the days of training sessions, times of day, weather, surface, route, and company will make a difference. Allow for a broad spectrum again. You will develop and recover much better.

Let's visit our friend. Bob has been very good at running at five minutes per kilometre, or 8 minutes per mile. He has only one speed. He only ever runs on flat roads. He is the definition of a one-trick pony. He is very fragile. His adaptive range (or tolerance) is very narrow, and his body reflects that. Bob is a "runner". He only runs - he doesn't like other sports, nor have time for them. He cannot run on uneven surfaces because it makes him sore and stiff. His heart rate shoots up if he tries to go faster or up a hill and he suffers greatly. So he avoids anything that deviates from normal. He really is making it worse for himself. I think we will now forget about Bob - he is just too stubborn for his own good.

What ever you do - Avoid the Gym!

The only people who need to go to the gym are power lifters. Their sport specific needs can only be met in there. But the rest of us better get out of the gym. All cardio work should be done outdoors. It is much more stimulating. Most people can do their strength work in the parks or woods very easily - again it allows your body to move in a much more natural way than the weights machines that force you to a certain movement pattern. Cross training can be extremely beneficial in widening your adaptive range or tolerance. The world is full of sports and activities. Martial arts, gymnastics, yoga, ball games, skiing, skating, climbing, mountaineering, racquet sports, you name it. It's all accessible and yes, none of it relies in any way on setting a foot in the gym. Use your imagination and get moving.

Personal note:

I have been able to steer away from injuries for a few years now, and I have seen my performance improve dramatically. I came across 'movement culture' a while ago which really set the cogs turning in my brain. I use principles from Barefoot Running, Animal Flow, Parkour, Gymnastics, Yoga, Calisthenics, and Plyometrics to keep me enjoying my training time. I like doing my 'monkey workouts' in the local nature park (St. Anne's park in Chertsey, Surrey) where I run on muddy trails (either barefoot or in minimalist shoes), crawl under bushes and branches, leap and vault over deadfalls and I climb trees. I jump over and off things, I pick up logs and carry them or simply throw them about. I scramble up steep and slippery hill sides and hot step down without losing my balance. I use my imagination and no workout is ever exactly the same. I come home covered in mud and with a collection of little scrapes, but I always have a big grin on my face. It's unconventional and I love it. It brings out the kid in me and allows me to get away from the clinical swim/bike/run grind. Dedicating a bit of time to this kind of activity will not in anyway reduce your commitment to your chosen sport, if anything it will make you better at it. Having fun is very good for your health!

Links:

www.idoportal.com - Great interviews and videos for your inspiration

www.movnat.org - inspirational and definitely an alternative take on fitness

www.animalflow.co.uk - super fun!

www.gymnasticbodies.com - great resource for body weight strenth exercise

and our favorite: www.youtube.com - where you can type any of the key words from above.

I welcome feedback and questions on the above topics. Please get in touch. If you wish to become a patient you can get in touch with me at the clinic by calling 01932 429584 or by email  This email address is being protected from spambots. You need JavaScript enabled to view it.

Yours in Health,

Mika