Injury Prevention Strategies

Musculoskeletal Injury Prevention and Strategies

There is usually an increased demand for Musculoskeletal health services at the start of any New Year. Having worked in the MSK health field for over 16 years, the author regularly sees such demand shortly after the festive season. The problems are the same each year, yet many are avoidable. Some people put off having an issue looked at until the new year. However, the main influx is due to people starting new fitness-related activities and a New Year's Resolution. The motivation for launching into a new fitness activity may vary. Losing weight gained over the festive season is a common reason. Equally, turning over a new leaf and starting a healthier lifestyle is high on the list. It is hard to refute the mountain of evidence indicating the far-reaching benefits of exercise and movement in general.

Unfortunately, many of those taking up a new fitness activity soon get a sports injury. Sadly, early injuries can lead to people giving up on their new fitness activities, goals and good intentions. The fact is that many of these injuries are avoidable. Understanding why sports injuries occur and how tissues adapt can help prevent many injuries. This article aims to educate people about their bodies and how and why things can go wrong. Some basic injury prevention strategies also help reduce the risk of injuries and are one aspect of self-care.

Four typical injury mechanisms

Many musculoskeletal injuries arise for one of four reasons, though some notable exceptions exist. The Osteopath (Leon Chaitow), frequently spoke of, lack of use, misuse, overuse and abuse injury mechanisms. However, specific diseases and congenital (birth-related) conditions can also affect the correct functioning of the musculoskeletal system and would not be related to the previous four categories. The following four injury mechanisms also mention biotensegrity, tissue adaptation, and healing. The related articles section has much more detailed explanations of these areas. Each area, along with trauma, has enormous relevance for injury prevention, training, and performance.

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Lack of use injuries

The phrase "use it or lose it" has more relevance than most may think. Many functions within the body require movement to help move fluids around the body, e.g. venous return (deoxygenated blood supply), lymphatic flow (lymphatic fluid relevant to immunity) and synovial fluid (related to cartilage). Many joints within our body and spine include cartilage, and the squeezing action of movement helps maintain this. In some respects, cartilage is a bit like a "sponge," and nutrients and waste products are transferred in and out of the material via squeezing and movement. Evidence also shows that a pumping action moves cerebrospinal fluid around the body through respiratory action (breathing). The movement of these fluids is relevant to maintaining various bodily functions and overall health in general. There is growing evidence of the benefits of activity on musculoskeletal health, immunology and other bodily systems. Evidence suggests that a lack of use of the musculoskeletal system results in earlier degenerative changes, which is highly logical. Tissues and structures will also adapt to a lack of use and affect overall biotensegrity (see related articles section). Such changes are likely to become noticeable when one places new demands on the body, which is what one would expect from starting a fitness regime.

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Misuse injuries

There are multiple ways to misuse joint structures and the soft tissues of the musculoskeletal system. Some more obvious means of misusing our body include poor exercise techniques and habitual behaviours (lying on the sofa watching television, sitting in a slumped position for hours on end, and not taking breaks). Such behaviours may easily result in neck pain (see neck pain article - Neck Pain treatment, causes, help - An MSK Therapy perspective) or other musculoskeletal related pain. A less obvious way of misusing the body would include unresolved trauma, though equally, "lack of use" could also lead to a misuse injury. These ways of misusing the body involve adaptive tissue changes, resulting in changes to biotensegrity and, thus, how everything moves. For example, an unresolved ankle inversion injury could lead to adaptive changes elsewhere in the body. Such changes may only become apparent as the tissues get more used and manifest in many ways. Somebody starting a running activity may notice plantar foot pain, Achilles tendon, shin, knee, and hip pain (see specific sports-related injury articles). Misuse-type injuries can also lead to overuse injuries due to biomechanical changes.

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Overuse injuries

An overuse activity does not necessarily have to originate from physical activity and could easily result from a misuse activity. A misuse activity can often lead to overuse of joint structures, soft tissues, or a combination thereof. Overuse, injuries tend to arise from too much of something, too soon and without enough recovery time between activities. Such injuries could relate to a sport, social activity, habitual behaviour, etc. Tissues and joint structures need time to adapt to demands or loads placed on them as tolerable. Hence, top-level athletes undergo a carefully planned training process, which develops throughout the training schedule. Runners who suddenly decide to start barefoot running can encounter plantar fasciitis and Achilles tendon issues. Such issues typically arise because the tissues do not have adequate time to adapt to the changes in demands placed on them. Essentially, the runner's Achilles tendons will have adapted to wearing the shoes and become slightly shorter. This process will have happened over time and is generally fine. Taking the heel away means that the Achilles Tendon has to adapt to a change in load instantly. Such a shift in burden with the increased demands from running can lead to injury. Over-stretching can be another common reason for injury related to misuse or overuse. Other misuse and overuse injuries can occur from simple things, including a poor working setup. Many people can spend prolonged periods on computers. A poor computer setup can affect both the upper and lower body. However, it is easy to rectify by following a simple six steps ergonomic computer setup. Even our sleeping position and correct pillow selection can result in misuse or overuse type injuries, due to a lack of support and prolonged tissue loading. Again, creating and adopting a good and supportive sleeping position is easy.

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Abuse injuries

There could be elements of misuse and overuse with some "abuse" type injuries in some cases. Generally, one could view any form of physical trauma (wounding), unintentional or otherwise, as an "abuse" type of injury. Equally, consciously doing something likely to cause injury would fit this category. Some sports and pastimes have developed protective clothing to help reduce the chances of injury while participating in such sports or activities. Understanding that trauma (wounding) typically involves forces is also essential. Hence, tissue structures far beyond the apparent trauma site are frequently affected, and the body adapts accordingly to enable us to function. Most people only notice such adaptations when the involved tissues get more use, are used differently or when tissues experience increased load. Having a good "self-body awareness" can help prevent many types of misuse and overuse injuries. In essence, one knows when something is wrong and can address it before it becomes more problematic. See the article on Finding a good, ethical Musculoskeletal health professional - An MSK Therapy perspective for some insider insight into finding a good patient-centred practitioner.

Sports Injury Prevention Strategies

There are many things that people can do to help avoid injuries and stay active. It is also worth noting that as crucial as self-maintenance activity is, there are always limits. Self-stretching, foam rolling, massage guns, etc., all have limits on what they can achieve. Limitations relate partially to using such tools (techniques) in a self-treatment context. Equally, no one tool can do everything, which is why good MSK professionals use a combination of tools/techniques.

There are many things that people can do to help avoid injuries and stay active. It is also worth noting that as crucial as self-maintenance activity is, there are always limits. Self-stretching, foam rolling, massage guns, etc., all have limits on what they can achieve. Limitations relate partially to using such tools (techniques) in a self-treatment context. Equally, only some tools can do everything, so good MSK professionals use a combination of tools/techniques. Hence, there are occasions where outside professional help is the best strategy. Trying to rely on the internet and self-treatment can often result in more extended periods away from activity or an increased frequency of injuries. Personal body awareness often comes with increased bodily use. Most elite-level athletes are very attuned to their bodies and know when something is wrong. Resolving the tell-tale signs before they impact performance or become an injury requires self-awareness. Resolution may involve a simple change in training, self-treatment or professional help, depending on the issue.

• Hydration- ensure you are adequately hydrated, pre, during and post-activity.
• Footwear - select appropriate footwear for the planned activity and seek professional advice if necessary.
• Warm-up - before exercise.
• Pace Yourself - avoid doing too much too soon, and try not to compare yourself to others.
• Warm-down - after exercise.
• Stretching - stretch muscles effectively (duration 12-20 seconds, force (discomfort, not pain), correct technique, do not overstretch, stretch muscles relevant to the fitness activities). Many runners fail to stretch both main calf muscles (gastrocnemius and soleus). These muscles have different attachments and require separate stretches.
• Avoid over-training
• Self-maintenance - Foam Rollers, Stick Rollers and Trigger Point Therapy or Massage Balls can all be useful. However, these all have limits regarding what they can treat, how effective they are, and in some cases they can actually make symptoms far worse. (see the Foam roller and Trigger-Point-Therapy articles)
• Diet - ensure you are meeting the additional nutritional requirements of increased activity.
• Adaptation - Allow sufficient time for tissues to adapt and moderate training accordingly so wherer relevant:-
  • Speed
  • Distance
  • Weight
  • Number of Repetitions if performing a specific exercise. Performing a single exercise once is a rep or repetition.
  • Number of Sets. Sets are a group of exercise repetitions e.g. 3 Set of 10 Reps=30 Reps in total and there should be a rest period between Sets. Rest periods may vary according to training goals
  • Type of training (cardio, weights, impact, low-impact etc.)
  • How muscles are exercised (concentric, eccentric, isometric)
  • Intensity of training based on Heart Rate (Aerobic, Anaerobic etc.)
  • Frequency of training
  • Rest and recovery between training, type of training and intensity
  • Terrain
• Aching - understand that things may ache and which may not have ached before, typically (24-72hrs) post activity. Tissues need time to adapt in relation to the new demands placed on them.
• Strengthening and conditioning training for specific sports-related tissues as is tolerable, can make them more resilient to injury.
• Professional exercise help - get professional advice regarding the correct technique (sports specific coach, personal trainer, exercise physiologist, etc.).
• Professional musculoskeletal help - If something is not feeling right, then seek professional advice (Chiropractor, Doctor, Myotherapist, Osteopath, Physiotherapist, Sports Therapist) and get it looked at early on. Many musculoskeletal issues are easier to resolve in the early stages, as fewer adaptations have occurred. Better still get things checked before you start a new fitness regime.
• Most importantly, enjoy the short and long-term benefits of fitness and activity.

Biotensegrity, Adaptation and Tissue Healing

Related Sports Injury articles

• Plantar Fasciitis or Plantar Fasciopathy
• Ankle Injuries (Inversion and Eversion)
• Shin Splints
• Iliotibial Band Syndrome (ITBS), Runner's Knee
• Patellofemoral Pain Syndrome, Runner's Knee, Rower's Knee