Ultramarathons. What , why and how are the questions I'm most commonly asked. Hopefully you find some answers here from my own personal perspective. My other blog at www.mile27.com.au/blog is full of information on running and health and fitness in general.

Monday, 24 August 2009

Why we get injured and is rest the best treatment?



Bit of a long post today but hopefully a very informative one.

Injuries have plagued me for many years and I have suffered almost every running injury there is. I also develop rehabilitation programs for many of my clients suffering injuries, so I've got a keen interest into why the body becomes injured and what the best approach is to recover from the injury. Over the last year or so I have turned my attention to how to prevent them in the first place.

We tend not to think about injuries until we sustain one and then we restart the stretching routine we've been neglecting. This is obviously not the smartest way to approach the problem. If we could somehow prevent them before they happened we'd save a lot of time. Injury prevention to most people means warm up and cool down properly and stretch. Pretty boring really which is why we tend to skip it. Well new training techniques have been developed that not only prevent injuries they also improve performance. Read on and I'll tell you all about it.



Why injuries occur.

Injuries occur because a joint, muscle, tendon or ligament is placed under more load than it can handle. This can be a progressive load that gradually overloads the structure over time or a sudden load which damages the structure immediately. Either way the load is more than the structure can tolerate.

Injuries suffered from a progressive load are initially felt as a minor discomfort that disappears after warm up. The progressive load continues to wear down the structures and the minor discomfort increases to the point where it is present all the time and exercise is compromised.



What to do when we are injured

The goal of injury recovery should be to return the body to a condition that if it was placed under the same load that brought about the initial injury it would be able to handle that load. Unfortunately most injury recovery programs aim to return the body to it's pre-injury state , i.e. the same state that was unable to handle the training load placed on it

The first advice given when suffering an injury is rest. Unfortunately rest is often thought of as the magic cure for all injuries. If you start training again and you are still injured then you simply didn't rest for long enough. Rest is of course beneficial in many situations but what does rest actually mean? Doing no exercise at all is most peoples definition of rest and unfortunately rest alone doesn't often solve the problem.

If you have strained a muscle then rest will give your body a chance to repair damaged tissues. The body repairs muscle tissue by depositing collagen fibres in the muscle. These fibres are aligned randomly over the torn muscle fibres. Without further stretching, massage and exercise these new fibres won't align themselves to the same direction as the muscle fibres and become known as scar tissue. Scar tissue is weaker and less elastic than muscle tissue so your chances of becoming injured in the future are greatly increased. So although a period of rest is required, a period of active recovery is also required before the body is ready to resume normal exercise.

When the injury doesn't involve a torn muscle such as knee pain, tendinitis, lower back pain, shin pain etc. rest has very little affect on the injury. To understand why think of what you would do if your car is making a horrible noise and not firing on all cylinders. The approach you are least likely to take is to not drive it for a week, then try it again a week later and hope that magically the problem has been fixed. You may argue that the body unlike a car is an organic organism and therefore has the ability to repair itself. This thought is valid in the case of a torn muscle but if faulty biomechanics are the cause of pain then resting for a week isn't going to change the biomechanics and consequently the pain will be the same. The site of the injury may feel improved initially as the weeks rest has given the body a chance to reduce any inflammation present but the cause of the inflammation has not been addressed.


To truly recover from an injury the actual cause of the injury must be addressed. Often we are told the cause of an injury is a tight muscle. For example Iliotibial band syndrome is often “caused” by a tight Tensor Fasciae Latae muscle. Stretching this muscle will solve all our problems apparently. However have you ever asked yourself why that muscle is tight in the first place? Often it is because part of your Gluteal muscles are weak. Why aren't they working like they should? Identifying the root cause or causes of the problem is the key to overcoming injury. Once this has been discovered then corrective exercises can be used to stretch, strengthen, activate, stabilise and mobilise the appropriate muscles, joints, tendons, ligaments.


Once we are injury free how can we prevent any further injury?

Common advice is to make sure we increase our training mileage gradually, make sure we run in good shoes, introduce speed and hill work in small amounts and slowly build it up, take recovery weeks and recovery training sessions regularly, get regular massage and stretch before and after training sessions. This is all very good advice that should be followed by everyone, but, many of us who follow this advice still get injured. Why?


Almost all injuries happen unilaterally. We strain a muscle on one side of our body but the same muscle on the other side is fine. We blame the increase in mileage or speed work, shoes that are to old or stretching that we didn't do after the session yet we never think to consider why the other side didn't become injured as well? If increasing the mileage too quickly was the “cause” of the injury why did one side become injured whilst the other side coped ? If the extra speed session we introduced is the reason we became injured how was it that one side coped without any problems?

The truth is that particular muscles and joints on one side of the body could cope with the demand placed on it whereas the other side of the body couldn't. If both left and right joints had the same strength, flexibility, mobility and stability as each other then it makes sense that the body would have coped with the training demands placed on it. Think about all the injuries you've ever had. Have you ever been injured in both your left and right leg or arm in the same spot at the same time? No, thought not. So if we really want to prevent injuries then we need to ensure the strength ,flexibility, mobility and stability in the joints and muscles on our left side are the same as the right side.

Obviously there are some loads which no matter how balanced , strong and flexible the body is it wont be able to cope with. You will however receive plenty of warning signs from your body before this happens and if you listen to these will be able to avoid injury.

How to determine if your body is balanced, strong, flexible and mobile?

Many of us will already realise we have one muscle tighter than another. Unfortunately the solution is not as simple as stretching out the tight muscle. You need to discover why that muscle is tighter. If you stretch it you will only temporarily increase muscle length because the reason it became tight in the first place hasn't been addressed.

To fully understand your joints and muscles strengths and weaknesses relative to your activity you need to assess the movement of every joint in the body as it performs that activity. For example the demands placed on your musculoskeletal system during tennis are far different to that during long distance running.

We think of an activity like distance running as a fairly one directional activity. We run in a straight line after all so how many other directions of movement can be involved. Although we do run in a straight line all of our joints and muscles move in three different directions or planes. Take your hip for example. During running when your front leg hits the ground your hip goes through internal rotation, adduction and flexion. In plain english that means your upper thigh rotates in relative to your pelvis, moves closer to the midline of the body and your upper thigh lifts. Every joint goes through the 3 dimensional movement in varying different degrees.

The foot bone is connected to the ankle bone ....

Another factor that is often ignored is that the body works as one complete unit. What happens in one part of the body affects what happens in another part. If you've injured your foot then it affects the way your whole leg, pelvis spine and even the other leg function. No joint works in isolation. Take the knee , it's function is connected to and dependant on what happens at the foot and what happens at the hip, not to mention the spine. To truly recover from and prevent injury the whole body needs to be assessed because your knee problem might be stemming from a lack of movement in your foot or a tight muscle in your hip and have very little to do with "tight" or "weak" muscles around the knee.

An assessment that takes every joint in the body through three different planes of movement in relation to your chosen activity will very quickly highlight problem areas. Once identified these can be corrected through specific exercises. Once any deficiencies have been corrected then exercises can be progressed to develop overall strength, flexibility, stability and mobility in relation to your specific activity. This will not only improve your movement efficiency it will also allow you to withstand a greater training load and therefore improve performance.

If you would like to be assessed and are based in London I am offering free functional assessments for the first 5 people to contact me which will highlight any deficiencies in your feet, ankles, knees, hips, lumbar spine, thoracic spine and shoulder joint relative to your sport. Please contact me on andydubois@hotmail.co.uk for more information.

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