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The causes of injury and methods of reducing the risk
For the exercise enthusiast nothing is more frustrating than an injury. Whether it’s a niggle, pull, pop, strain or tear being put out of action makes us miserable. Depending on the severity of the injury any and all forms of activity could be off the menu for the foreseeable future or, if we’re not so unlucky, the range of activities merely constricted.
One thing’s for sure, if you regularly participate in some form of physical exercise or sport you probably will at some point suffer an injury. Unfortunately this is like some irritating axiom or universal law. We simply cannot escape it.
Thinking back over all the years of training, I can’t remember a year when I completely avoided some form of injury. And of the hundreds of people I’ve trained with over that span of time, I couldn’t recall one who didn’t get injured at least once.
Amongst the active injury is prevalent. I couldn’t tell you what the injury percentage rate is across that growing body of people who engage in exercise and sport, but I’d be surprised if it was much less than 95%.
My go-to guys on injury – Peterson and Renström (co-authors of the brilliant book Sports Injury) – offer no clue as to the accuracy of my lazy supposition. But what they do say is that the frequency of injury is predicated on a number of factors. Those factor include:
1: The type of activity you engage in
2: The intensity of the activity
3: The frequency
4: Adherence to rest and recovery procedures
In brief I will discuss each factor. Following on from this I shall share with you a number of ways we can reduce injury susceptibility through self-rehabilitation.
Factor 1: The type of activity we engage in
It stands to reason that a rugby player is likely to suffer more injuries than a footballer (broken nails and smudged makeup doesn’t count), a gymnast more than a shot putter, a CrossFit competitor more than a gym junky. The evidence points to the glaringly obvious fact that high impact/intensity activities place greater strain on the physiological systems thus increasing the likelihood of injury occurring. The takeaway here is: assess your sport/exercise discipline and if it falls into factor 1 you should be taking extra precautionary measures to reduce injury susceptibility.
Factor 2: The intensity of the activity
High intensity training is a must if you do not want to wallow in the dismal mire of stagnation. As Bruce Lee wrote: We must not place limits on our potential but continually strive to push beyond plateaus. However, though I admire his philosophy and enthusiasm, Bruce over-stepped the line when he concluded his motivational remark with: if it kills you it kills you. After all, it’s no good being the fittest corpse in the graveyard and if we blindly pursue augmented physicality without heeding the warnings of the body we will wind up a cropper. The takeaway? Interchange high intensity with low to moderate intensity exercise sessions and ensure to supplement with plenty of R&R.
Factor 3: The frequency and overuse
My go-to guys have something to say on Factor 3. ‘Overuse injuries are generally caused by repetitive overloading, resulting in microscopic injuries to the musculoskeletal system,’ (Peterson and Renstrom 2001). They also give us an indication of the number of injuries that are caused by overuse: up to 50%! Of course, professional athletes – such as cyclists and triathletes – by necessity must overuse their bodies. I read of one world champion Ironman (actually a woman) who trained for 40 hours a week. But even the risks posed by extreme overuse can to an extent be mitigated by implementing rehabilitation interventions (more on these in a bit).
Factor 4: Adherence to rest and recovery procedures
Put your hand up if you are guilty of committing, on a regular basis, one of the following acts physical fitness folly:
1) Not conducting an adequate warm-up prior to activity
2) Rarely if ever stretching post-exercise session
3) Failing to adequately rest the body
4) Training on a pre-existing injury that has yet fully healed
5) Ignoring that mild niggle at the insertion point of X muscle
6) Infrequently engaging in myofascial release (foam rolling)
7) Infrequently or never engaging the services of a sports therapist
If you raised your hand to none of the above bravo! You are doing pretty much everything possible bar wearing a suit of cotton wool to reduce injury susceptibility. Raising your hand to 2 or less indicates that you are taking conscious steps to safeguard yourself against injury. Well done and keep it up. Also, maybe consider occasionally including those procedures that you didn’t raise your hand to. Those that raised their hands more than twice you are a ticking time bomb and though it is true that no amount of self-therapy can completely prevent injury, the less you do the greater the risk you run.
Methods of Self-rehabilitation
At this stage in the article we should be slightly wiser on two points. The first: injury is eminently a bad thing and is best avoided. The second: the factors that can cause or exacerbate injury are known to us. This last point is worth dwelling on for a sentence or two longer. By knowing the most common causes of injury are we can take active steps to steer well clear; and if, for whatever reason, we can’t avoid them we raise conscious awareness and be more proactive with our rest, recovery and rehabilitation procedures. To which we now turn.
In brief I aim to examine methods and procedures that can be used to reduce injury susceptibility. By finding time within our day where we can devote 10 or 15 minutes to recovery and rehabilitation our chances of remaining injury free increase dramatically. Really, if you love exercise and activity this is a must.
Stretching
According to the American College of Sports Medicine a mere ten minutes of daily stretching can reduce your chances of incurring an exercise-related injury by as much as 50% - which is a whopping pay-off. The types of stretching include static or developmental stretches where we hold the position for between 20 seconds and 1 minute.
When performing a stretching regime, and this is best done post exercise, it is advisable to include the major muscle groups whilst also paying additional attention to those muscles predominantly worked during the session. So even if your main sessions consisted of, say, a five mile run, you should still stretch the muscles of the upper body but ensure to focus extra time on the quads, hammys and calves.
Stretching (flexibility) is a crucial and extremely important component of fitness yet it is probably the one that is most overlooked. Why this is the case I couldn’t quite say; maybe the vast majority of trainers are incredulous to the benefits of stretching. Whatever the reason ensure that you are not among these risk takers and implement a stretching regime. It’s easy to do and for the little time it takes the rewards could be substantial.
How to include 10 minutes of stretching into your day
Probably one of the best ways to ensure that you get your 10 a day is by bolting a stretch on to the end of you training/sports sessions. As soon as you finish pumping iron or pounding the tarmac immediately (or after the cool-down) initiate your stretching regime. Begin with the muscles of the upper body and slowly work down to those of the legs. The ACSM recommends holding each stretch for 10 to 30 seconds each.
However, I read a report recently that suggested holding post-exercise stretches for between 20 seconds to 1 minute and repeating each stretch 2 to 3 times. Basically, you perform stretches as you would a resistance exercise; the only difference being the reps are time and the intensity is much lower.
A stretch should never cause physical pain or discomfort. It should induce a mild sensation in the area being stretched.
Another way you can get more elasticated is by introducing into your life the Yogic science. This is my secret weapon against injury. Every morning, without fail, I scrape myself out of bed about 5ish, roll out the Yoga mat, and slowly work through a series of sun salutations and various floor exercises. I’ve been doing this religiously for about a year now and not only is it a beautiful way too start each day but it has noticeably increased my flexibility which has translated into fewer injuries and improved physical performance. I cannot sing more highly the praises of Yoga. (For more on the Yogic science see the suggested reading list below.)
Myofascial Release
We all know that exercise results in minor microtrauma; that is, microscopic tears to the muscle fibres. Over time, and if not adequately treated, this can result in excessive inflammation and scar tissue. One simple and highly effective way to aid recovery is though myofascial release. This is where controlled pressure is applied to the muscles breaking down knots, releasing tension, removing metabolic waste and encouraging blood flow.
One way we can enjoy the benefits of myofascial release is through foam rolling. Though by no means a substitution for a good sports therapist, the foam roller offers us an inexpensive supplementary method of reducing exercise-induced muscle dysfunctions whilst enhancing muscle relaxation and encouraging repair (Healey 2014).
Some dos and don'ts of foam rolling
Do: get in the habit of rolling regularly – not just when you feel a bit stiff
Don’t: roll sore muscles – recent studies have shown that if we roll damaged muscle tissue, or muscles in which we are experiencing nasty DOMS, we could inadvertently make matters worse
Do: apply gentle pressure evenly over the fascia – including focusing on origin and insertion points
Don’t: roll over the lumbar spine – this is quite dangerous as it places acute pressure on a segment of the vertebrae. It is fine to roll the area of the back around the thoracic region but even so I advise exercising excessive caution
Icing
Icing is a method typically associated with injury – the footballer sprains her ankle and the physio all of a panic rushes onto the pitch brandishing an ice pack; the runner feels a sharp twinge in the Achilles and on getting home breaks open a bag of frozen peas (don’t use frozen peas – instead use a Mueller ice bag). However, icing is an excellent way of encouraging and facilitating recovery post exercise. And you don’t have to be injured to ice! After a hard session an ice pack can be applied to those areas most affected. By doing this you could reduce the inflammatory response, decrease the severity of the DOMS and stimulate blood flow.
I agree that it’s not always practical or possible to pop out an ice pack and apply it to the rotator cuff for ten minutes (20 seconds on/minute off). But fret not, taking a cold shower (if you’re Spartan enough for it) is a good method of eliciting similar recovery responses as icing; this accounts for why professional rugby players after a game are encouraged to spend a few minutes in a plunge pool prior to popping corks in the communal bath. Even just a couple of minutes immersed in cold/icy water has been shown to reduce post-exercise inflammation whilst mitigated the soreness that is anathema to trainers the world over.
Let’s take a breather and summarise what we’ve covered thus far.
Whenever we exercise or take part in a sporting activity we are putting ourselves at risk of injury. This we know and accept as we do any other universal law. However, unlike a fixed constant, we can take active steps to reduce – not prevent but reduce – our susceptibility to sustaining an injury. By engaging in a daily stretching routine (or Yoga), regular myofascial release (foam rolling) and occasional icing (cold showers) we can minimise risk.
Is there anything else we can or should be doing?
Yes, as a matter of fact, there are two training principles that we absolutely must pay attention to. It is these principles that will form the focus of the following four paragraphs and will lead us nicely to the conclusion of this article.
The importance of warming up
"The combination of warming up and stretching has been shown . . . to actually reduce the incidence of injury."
Christopher M. Norris
Regardless of how many times I see someone neglect to warm-up prior to exercise it never fails to astonish me. Why, I can’t help asking, why do they so flagrantly disregard such an important component of exercise? Why are they happy to put themselves at risk? Is it ignorance? Stupidity? The absence of understanding? Or were they poorly and inadequately introduced to exercise when they first embarked on the pursuit of improved fitness? Whatever the answer be the trainer who neglects the warm-up is putting themselves at risk.
What does the warm-up do for us? In short, a lot. An appropriate warm-up can enhance physical performance and prepare the body for exercise by bringing about a number of important physiological changes. These changes include raising core and muscle temperature, facilitating neuromuscular function and preparing the trainer psychologically (Watson 1995).
But of course the most important change here is the rise in muscle temperature. When muscles are warmer they become more flexible, supple and less susceptible to injury. It is for this reason and those previously mentioned why you must absolutely spend – at a MINIMUM – ten minutes warming up before exercise or sport.
Some more benefits of warming up
1: Increase in joint mobility
2: Increase in blood flow throughout the body
3: Increase in aerobic metabolism
4: Decrease in lactic acid production
5: Increases maximum power output
6: Orientates the trainer’s psychology to exercise
(List adapted from Watson’s – Physical Fitness & Athletic Performance pp. 79/80)
Best types of warm-up activities
Rowing: because it activates the two major muscle groups
Cross-trainer: much for the same reason as the rower
Rowing interspersed with body weight and light resistance exercises
Remember: spend no less than ten minutes warming up. The intensity of the warm-up should gradually increase. Towards the end of your warm-up the intensity should peak. The warm-up should include exercise that feature in your main session; really it ought to mirror your main session.
The importance of cooling down
Much like the warm-up the cool-down phase is often overlooked, omitted and/or ignored. Though perhaps not as important as the warm-up, cooling down post exercise plays a vital role in the self-rehabilitation, injury avoidance whole. During intense activity oxidative metabolic waste builds up in and around the muscles. This unavoidable by-product is toxic and it can impede recovery. Studies have shown that a progressive cool-down, which we might also call active recovery, can speed the removal of metabolic waste thus allowing the body to begin the process of repair.
Best types of cool-down activities
Rowing: perhaps for the first half of the cool-down; for the second half you could progress on to a stationary bike or light jogging/walking
Cross-trainer interspersed with low intensity resistance activities
Remember: spend no less than 5 minutes cooling down. The cool-down can mirror the warm-up in reverse; that is: start off at an intensity close to the conclusion of your main session and then slowly deescalate the intensity and with it your pulse rate. The stretching regime should follow the cool-down and one is not a replacement for the other.
In Conclusion
Together we’ve ascended a substantial edifice of information. Truly, I hope our discussion has been of use to you. The primary aim of this article was to encourage you, the reader, to take active steps to ensure that you are limiting your risks of incurring an exercise-induced injury (if you are not already doing so of course).
I’ve attempted to shed some light on the primary causes of injury. In conjunction with the causes I have identified a number of methods we can use to keep injury at bay. Though we can never completely prevent injury we can limit the risks.
The only way to achieve this is through taking decisive steps to implementing correct training principles and regularly engaging in self-rehabilitation practices. If you love exercise and pain-free movement you’ll begin taking those steps today.
(As we are very interested in user feedback at Hungry4Fitness, I would be very grateful if you could take a few seconds out of your day to leave a comment. Thanks in advance!)
Blog Author
Adam Priest is a former Royal Marines Commando, professional personal trainer, lecturer, boxing and Thai boxing enthusiast.
Suggested Reading List (for more information on any of the books click the image)
Stretching by Christopher M. Norris
A reasonable level of flexibility is essential to the healthy functioning of joints and muscles, which in turn facilitates performance and reduces the risk of injury. Now in its 4th edition, The Complete Guide to Stretching provides an accessible overview of the scientific principles that underpin this form of training and offers more than 70 exercises designed to safely increase range of motion right across the body.
Anatomy of Hatha Yoga by H. David Coulter
This is the first complete authoritative source combining the study of hatha yoga with anatomy and physiology. David Coulter provides an in-depth physiological examination of more than 100 yoga postures and practices and their relationship to the systems of the body. It includes chapters on breathing, relaxation and meditation as well as detailed diagrams, illustrations and photos.
Sports Injury by Lars Peterson and Per Renström
This popular handbook comprehensively covers the prevention and treatment of sports injuries, and is thus essential reading for all athletes, trainers, physio-therapists and doctors. The book covers all international sports and features extensive use of action photographs.
Physical Fitness & Athletic Performance by A. W. S. Watson
Sports Science has increasingly developed both as an area of research and as a university subject. This book gives an authoritative account of the biological basis of athletic performance and training, based on an analysis of scientific and medical research in the area. The findings are presented in such a way that anyone involved in training for high-level sport will find the information accessible and of interest.
References
ACSM’s Guidelines for Exercising Testing and Prescription, Ninth Edition
Healey, Kellie C.1; Hatfield, Disa L.1; Blanpied, Peter2; Dorfman, Leah R.1; Riebe, Deborah1 The Effects of Myofascial Release With Foam Rolling on Performance, Journal of Strength and Conditioning Research: January 2014 - Volume 28 - Issue 1 - p 61-68 doi: 10.1519/JSC.0b013e3182956569
Norris. M. C (2004) Stretching. A & C Black. London.
Peterson. L, Renström. P (2001) Sports Injurues: Their Preventon and Treatment; 3rd Edition. Taylor & Francis Publication. United Kingdom.
Watson A. W. S (1995) Physical Fitness & Athletic Performance. Longman. England.