New Years Resolutions, Injury Prevention - a Chiropractors perspective
Well, it is that time of the year again and the excesses of Christmas and New Years may already seem a thing of the distant past. A new year often brings with it New Years Resolutions, many of which involve some form of fitness activity. The motivation for launching into a new fitness activity may vary, but losing weight gained over the festive season is a common reason, as is starting a new healthier lifestyle. It is hard to refute the mountain of evidence indicating the far-reaching benefits of exercise and movement in general. However, the reason for writing this article is because as a Chiropractor, Soft-Tissue therapist and runner, I always see an influx of new patients shortly after the festive season. Unfortunately, many of those new patients have taken up fitness activities as a new years resolution and then taken an injury. Injuries can then often lead to people then giving up their newfound fitness activities. This article aims to try and educate people about their bodies, explain some of the variables involved in injury mechanisms, prevent some of the occurrences and help people stay active for longer.
Important injury concepts
Adaption (tissues and bones adapt to applied forces, as is tolerable and up to a breaking point) - see adaption article.
Biotensegrity (tensional and compressive forces throughout the body) - see biotensegrity article.
Trauma or wounding (involves forces being applied to tissues and structures resulting in injury).
Healing (tissue repair creates adaptations and affects biotensegrity) - see healing article.
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.
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. 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 joints 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). A less obvious way of misusing the body would include unresolved trauma, though equally "lack of use" could also lead to a misuse injury. All of these ways of misusing the body involve adaptive tissues 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 then become apparent as the tissues start getting used during say a "couch to 5k" and might manifest as plantar, Achilles, shin, knee, hip or even back pain. Misuse type injuries can also lead to overuse injuries.
An overuse activity does not necessarily have to originate from physical activity and could easily result from a misuse activity. Quite often, a misuse activity can lead to overuse of joints structures, soft-tissues or a combination thereof. Overuse, injuries tend to arise from doing too much of something, too soon and without enough recovery time between activity. Such injuries could relate to a sport, social activity or habitual behaviour etc. Tissues and joints structures need time to adapt to the demands placed on them (as is tolerable). Hence, why top-level athletes go through a carefully planned training process, which develops throughout the training schedule. Runners, who suddenly decide to start barefoot running tend to encounter plantar fascia 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 and become slightly shorter, often due to a lifetime of wearing shoes with a raised heel. Taking the heel away means that Achilles Tendon now has the additional demands of having to stretch slightly further "normal" combined with running. Hence, the tissues need the opportunity to adapt as is tolerable to the demand changes. Over-stretching can be another common reason for injury and relate to misuse or overuse.
In some cases, there could be elements of misuse and overuse with some "abuse" type injuries. Generally, one could view any form of physical trauma (wounding) unintentional or otherwise as "abuse" type injuries. Equally, consciously doing something likely to cause injury would certainly fit within this category. Some sports and pastimes have developed protective clothing to help reduce the chances of injury while participating in such sports or activity. 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 adaptions when the involved tissues get more use, used differently or when tissue 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 then knows when something is not quite right and can get it addressed before it becomes more problematic.
There are many things that people can do to help avoid injuries and stay active.
- 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 (Chiropractor, Osteopath, Physiotherapist, Podiatrist, Running shop, Sports Medicine Doctor etc.).
- Warm-up - before exercise.
- Pace Yourself - avoid doing too much too soon, pace yourself 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 activities). Many runners fail to stretch both main calf muscles (gastrocnemius and soleus). These muscles have different attachments and require separate stretches.
- 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 Foam roller and Trigger-Point-Therapy articles)
- Diet - ensure you are meeting the additional nutritional requirements of increased activity.
- Adaption - Allow sufficient time for tissues to adapt and moderate training accordingly:-
- Type of training
- Frequency of training
- Rest and Recovery periods
- 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.
- 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, Osteopath, Physiotherapist, Sports Therapist) and get it looked at early on. Many musculoskeletal issues are easier to resolve in the early stages, as fewer adaptions have occurred. Better still get things checked before you start a new fitness regime.
- Most importantly, enjoy the short and long-term benefits of a newfound active life.
The article was written by Dr Terry Davis MChiro, DC, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
About the Chiropractor Author
The author possesses an unusual mixed background for a Chiropractor (McTimoney). His education, training and practical experience span over two decades and relate to both physical and mental aspects of health. He has also needed to push his own 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. His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. Terry also has extensive experience in security, work, health and safety and holds relevant certifications. He has also taught at 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’s combination of knowledge through, education, training, his elite military experience and personal injury history have paid dividends for the patients he sees and has treated. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.