Basic Injury Prevention

Basic Sports Injury Prevention - An MSK Therapy perspective

Well, it is that time of the year again, and the first British Airways Run Gatwick Half Marathon is fast approaching, all 13.1 Miles of it and the author is running it. Hopefully, the weather will be better than for this year's (2018) Sage Reading Half Marathon, fingers crossed. The last thing that anybody wants during preparation for, or while attempting a Half, Full, or Ultra Marathon is the “stress” of a running-related injury. Many of the principles of injury prevention covered in this article equally apply to other sports and activities too.

In the case of running such, injuries can occur for a whole range of reasons including:-

• Overtraining
• Previous unresolved injuries, affecting joints, tissues and structures within the "Kinetic Chain"
• Inadequate warm up or cool down
• Failure to adequately stretch tissues
• Overstretching tissues
• Lack of hydration
• Other medical conditions
• Accidents
• Poor technique
• Illness and more…

Tissue Adaptation and Injuries

That said there are things that one can do to help prevent an injury and understanding a little about how injuries can occur can help. In simple terms, tissues and structures within the body can adapt. However, the ability to change depends on many factors, including genetics, level of fitness, loading, duration, the speed of adaptation, available nutrients, oxygen, hydration, energy, temperature and more. Tissues and structures will adapt to a point, before breaking or becoming damaged. There is a commonly known law in Musculoskeletal medicine called Wolff’s Law which relates to bone remodelling and another called Davis’s law (no relation), which refers to soft tissue structures. These law’s attempt to explain how bone and tissues respond to the application of various forces or loads. In the case of Bone, it will remodel and adapt to loads, up to a point before becoming damaged or breaking. In essence, bones become thicker, and one can often see this in larger framed individuals, especially in the lower legs. The extra bone thickness in the lower limbs is often even more pronounced with individuals who have lost a lot of excess weight. At the other end of the scale, astronauts face many issues in space. The lack of gravity means that the bones tend to adapt to the lack of loading and lose density. As a result, exercise programmes have been developed for astronauts while in space and as a means of trying to counter some of the impacts of a zero-gravity environment. As for Davis's Law, it is a little easier to observe some of the effects on muscles by looking at somebody who regular exercises and somebody who does not. There is a more in-depth and up-to-date article covering Soft Tissue Adaptation to activity and injury here.

The author has personal experience of tissues within his body adapting to the demands placed on them, both within the elite British military environment and in his own time. In his early twenties, the author walked the 275 mile Pennine Way, solo, with approximately six stone on his back and in 14 days. The weather was horrendous for around 12 days of the trek, and he lost over one stone in weight during the process. It is fair to say that his body had a great deal to adapt to, an additional six stone in weight, terrible weather, 14 - 16 hrs walking a day and challenging terrain. Equally, the adaptation process was far from painless and pretty unpleasant for the first 7-8 days. However, after eight days the body just seemed to adapt, and it was reasonably plain sailing from there onwards and not remotely painful. It did take a few days for the body to adjust back to not carrying an additional 6 stone in weight and there were a lot of comments about one bouncing around when walking. Anyway, one digresses, back to running. There is a high probability of injuries becoming chronic if one does not take active measures to prevent, treat and recovery from injury.

Training and the relevance of sports specific coaches

A good running coach will know how to manage the various factors or variables, giving the runners tissues the best chance of adapting. Failure of the tissues to adapt correctly can lead to injury and injuries can still happen even with a running coach, due to unforeseen events. Injuries then lead to tissue adaptations as per the previously mentioned adaptation article, though also involving healing (see healing article for further details). Experienced running coaches will create a running programme tailored to the individual's needs and the time available. The plan may be over two to three months for a half marathon, such as the Reading one or longer for a full marathon. Typically, the mileage and duration of the runs are likely to vary over the length of the plan, depending on individual needs. Distances are expected to gradually increase throughout the programme and then drop off in the final week before the event. Many coaches may also add speed work sessions, and specific weight training, if the individual athlete has a specific goal or time to achieve. The entire plan will also include rest days and is designed to give the tissues within the body the best chance to adapt to the increased physical loads of training. There are many well known or common running injuries, some of which can be quite problematic to resolve. The author has personally experienced many such injuries in all of the years he has been running and most during his time with the military. Virtually, all of the running type injuries have both a structural and a functional component to them, and one can affect the other and vice versa. In essence, structure relates to the "physical joints", bones, ligaments, cartilage, bursar etc. The functional aspect relates more to the soft tissue structures which affect the joint, such as muscles, tendons and fascia. That said, one could easily argue that fascia is both structural and functional (see the article on Biotensegrity and how everything is connected for a much more detailed explanation).

Basic Injury Prevention / Risk Management Strategies:

• Warm-up and Warm-down.
• Stretch muscles effectively (duration, force and technique).
• Hydration (ensure you are hydrated sufficiently pre and during activity).
• Diet (ensure you are meeting the additional bodies needs of exercise).
• Ensure you have the correct technique for your sport and seek advice if unsure.
• Allow sufficient time for tissues to adapt and moderate training accordingly:-
  • Distance
  • Speed
  • Terrain
  • New footwear and type
  • Rest / Recovery periods / Sleep
  • Vary training to complement activity
• Self-treatment
  • Foam Rollers (Article).
  • Trigger Point Therapy and Massage Ball use (Article)
• Seek Soft-Tissue maintenance/preventative treatments, as needed (Sports Massage, Chiropractic, Myotherapy, Physiotherapy, Dry Needling, IASTM etc.)See the article on Finding a good, ethical Musculoskeletal health professional, which covers what to look for and avoid.