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 tend to be 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 of people is due to people starting new fitness-related activities and a New Years 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 new 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 end up with 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 such injuries are avoidable. Understanding why sports injuries can 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. There are also some basic injury prevention strategies to help reduce the risk of injuries.
Four typical injury mechanisms
Many types of musculoskeletal injury arise for one of four reasons, though there are some notable exceptions. The Osteopath (Leon Chaitow), frequently spoke of, lack of use, misuse, overuse and abuse. However, there are notable exceptions including specific diseases and congenital (birth-related) conditions and these equally 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.
Lack of use injuries
There is a great deal to be said about the phrase "use it or lose it". 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 type 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 a squeezing action via movement. There is also evidence that cerebrospinal fluid pumped around the body through respiratory action (breathing), and so this could equally be affected by movement. The movement of these fluids has relevance to the maintenance of 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 and as one would expect from starting a fitness regime.
There are multiple ways to misuse joint structures and the soft tissues of the musculoskeletal system. Some of the more obvious means of misusing our body might include poor exercise technique and habitual behaviours (laying on the sofa watching television, sitting in a slumped position for hours on end, 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 use and manifest in many ways. Somebody starting a running activity may notice plantar foot pain, Achilles tendon, shin, knee, hip pain (see specific sports-related injury articles). Misuse type injuries can also lead to overuse injuries due to biomechanical changes.
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 go through 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 change in demands placed on them. In essence, the runners Achilles Tendon will have adapted to wearing the shoes and become slightly shorter. This process will have happened over time and is generally not a problem. Taking the heel away means that 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 and relate to misuse or overuse.
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 certainly 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. It is also essential to understand that trauma (wounding) typically involves forces. Hence, tissues structures far beyond the apparent trauma site are frequently affected, and the body adapts accordingly to enable us to function. Most people only tend to notice such adaptations when the involved tissues get more use, are used differently or when tissues experience increased load. Having a good level of "self-body awareness" can certainly help prevent many types of misuse and overuse injuries. In essence, one knows when something is not quite right and can get it addressed 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 how one can use such tools (technique) 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 how one can use such tools (technique) in a self-treatment context. Equally, no one tool can do everything, which is why 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 not quite right. It is then possible to resolve the tell tail signs before it impacts performance or becomes an injury. 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:-
- 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
- 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
Adaptation (tissues and bones adapt to applied forces, as is tolerable and up to a breaking point) - see Soft Tissue Adaptation to activity and injury article.
Biotensegrity (tensional and compressive forces throughout the body) - see Biotensegrity and how everything is connected article.
Trauma or wounding (involves forces being applied to tissues and structures resulting in injury).
Healing (tissue repair creates adaptations and affects biotensegrity) - see Soft tissue repair, healing and scar tissue article.
The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
The Morningside clinic occasionally runs promotional treatment rates for new and existing patients, which are available via the online booking calendar. If you liked this article or found it interesting, feel free to share the content with others. There are lots more articles available via the TotalMSK main Health, Wellness and Sports Injury blog page, which has a brief description of all the articles to date.
About the Author
As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy techniques and advanced myofascial release methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.
The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.