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Core Sport UK: Physio, Injury Prevention and Rehab

My first blog for CoreSport UK. So I better start with some thank you’s and that is to Ranju and Jim. Firstly, for running a great business and providing us with great products and secondly for inviting me to write for their website and business which is a pleasure to do so.

So what to talk about for blog number 1?  I had loads of topics on my mind and I am excited to get them out there on this platform and also excited to learn from the readers as well as we all have something to offer in the field of the body and exercise. So, for my first piece I decided on a general introduction to physiotherapy and what this platform might offer and rather than write pages and pages on different stuff and bore you all in my first piece. So for now I will simply focus on some key points.

Injuries happen, that’s sport. It’s how we prehab and rehab that makes the difference

In the sporting world injuries happen. It is a fact of life and one we accept when we take part in any form of activity. We can however reduce the risk of injury and if the unfortunate does occur we can treat and most importantly rehab said injury. The most common injuries in the weight lifting population (and we’ll get into all of these in future articles) are shoulders, lower back, knees and upper back / neck complaints.

So, what can we do to prevent injury?

Prevention is the name of the game. If we can be preventative rather than reactive then we can reduce the risk of injury. This involves things like looking at those areas which may be weak or underdeveloped and training those (rotator cuff and posterior chain spring to mind). We won’t prevent all injuries as this is impossible, but we can reduce the risk and make sure you are in the best shape to recover quickly if injury does occur.

Key features of injury prevention

Training is the big one. Is training periodised all year round? Is there a good progressive structure to follow? And note the word ‘progressive = slow build’. Or are you taking shortcuts? In the words of my friend and former colleague Andy Sweeney who I’d like to give a nod to for his expert advice, “are you trying to emulate Arnie but don’t do it all year and take shortcuts” i.e. ramp or taper to quick or to slow. Research in other fields tells us that training error can account for 60-80% of all injuries with rapid increases in training volumes being the biggest risk (30% or more; Nielson et al, 2012).

Why not take shortcuts? 

Muscle builds quicker than soft tissue, if the muscle gets too big, too quick before the tendons, ligaments, surrounding sheaths and connective tissue can adapt to the size changes you are going to have altered mechanics and overload. If we overload a tissue beyond its capacity then it will become painful. This goes for the use of adjuncts as well, e.g. support belts. If you’re not able to lift something big, using a belt isn’t going to make your tendons able to either.

It is also important that training and hypertrophy gains are achieved through both functional and non-functional exercises to eliminate the differences between getting big versus getting strong. Naturally, we want both. If training is purely non-functional (i.e. bench press…when do we have to lift a heavy weight laying on our back?) then we may not get a good carry over to the next session or we might just get good at bench press but not strong. What you train for is what you get. This paper by Smart et al (2014) highlights the differences in transference of physical qualities into functional, game tasks. We might get big but not strong which will ultimately put technique under strain with the potential for injury.

Functional exercises can form part of the next key feature of injury prevention which is a Prehab programme. As mentioned above this includes exercising those muscles that we might not normally, or that are underdeveloped and over-powered such as the rotator cuff muscles, the muscles of our posterior chain; back, glutes etc.

And what can we do to rehab?

When we do suffer from that unfortunate injury there are a number of changes that happen to the injured or painful tissue. There will be an acute reactive stage where it is likely some rest will be needed, some pain relief and this is the stage where some of the techniques physiotherapists can use such as hands on treatment, taping and acupuncture can be effective. This should be alongside some gentle form of exercise; movement based or static / isometric contractions.

Beyond this acute, reactive and painful stage we need to return the tissue back to or beyond its original capacity (Cook and Purdam, 2015). With pain and different use of the area we get muscle wasting, imbalances and dysfunctions which can lead to the continuation of pain beyond the bodies and the tissues normal healing time. The brain is exceptionally efficient at keeping us doing stuff through compensatory mechanisms but maybe not in the most efficient way for our body. For example Knee research shows that muscle activation of the quadriceps muscle is inhibited during walking when in pain leading to maladaptive movement (Henriksen et al, 2007). And this is where rehab is so very vital, building back up the capacity of all the tissues; muscles, ligaments, tendons etc. to do what you are asking of them. And this will need a gradual approach in what we call graded exposure, which is important for any form of rehab as it allows the body to adapt back to the tasks that we ask of it without becoming overloaded (Baechle and Earle, 2008). People’s common mistakes are that once pain subsides they dive straight back in to what they were doing pre-injury without consideration to the changes to the body. We have to ask ourselves, “Has the athlete trained enough to return to play safely?” (Blanch and Gabbett, 2015) (see pic). A twitter pal of mine, Greg Lehman pens this superbly when he says we need to “calm s%&£ down, and build s%&£ back up”.

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