SPORTS INJURIES – The good and the bad stuf
Content by: Carmen Andrews, B Sc Physiotherapy UCT
Before speaking about pain as our informer of tissue damage its worth appreciating the complexity of this protective sensation. By definition, “pain is an unpleasant sensory and emotional experience that motivates us to do something to escape it”.
We asked Carmen what you need to know!
What is pain and how does it work?
Tissue damage triggers a signal to be sent via specific pain sensory nerves from the site of tissue damage to the brain. The brain then evaluates this pain information in the context of the situation and decides if we will experience that pain sensation or not.
The intensity of pain is therefore not an indication of the severity of tissue damage; it’s an indication of the brains conviction to protect an injured area. Hence the immediate danger of a situation, motivation and beliefs can affect pain.
Pain can occur in the body where there is no actual tissue damage and no pain is not an indication of no damage.
What pain do I push through and what pain do I listen to?
THE GOOD PAIN STUF
Training pain – the price we pay to improve our performance. Fatigue sensation is not a bad pain.
Pain from training – muscle pain one to 2 days after a hard downhill or different training session is known as DOMS (Delayed Onset of Muscle Soreness). This discomfort in is not due to lactic acid but to the micro trauma to the muscle and resulting inflammation.
Adequate recovery after DOMS results in stronger muscle fibres replacing the weaker ones that were damaged. The end result is stronger muscle tissue. If you train hard after a session that has caused DOMS, you will impair the healing process which will result in weaker muscle fibres.
Avoid taking anti-inflammatory medication to relieve DOMS pain and this will hinder rather than help the healing process.
THE BAD PAIN STUF
Pain and stiffness in a specific area, first thing in the morning.
Pain during your warm up that disappears or eases enough to complete your training session but return once cooled down
Pain that is forcing you to change your technique, training program or affecting your performance.
Pain that you want to take medication for.
Pain makes you change the way you move, whether you intend to or not. Your brain will select different movement patterns because it is aware of the injury site and will try to protect it.
Don’t mask pain with anti-inflammatory or analgesic medication so you can train – taking the pain sensation does not mean you’re taking the injury away. Getting into a habit of compensatory movement patterns will set you up for another failure as a different area will become overloaded.
What causes injury?
You had a momentary loss of talent and took a tumble – you know what caused the injury. Once you know the extent of the damage, you know how to protect it and how long it will take to heal.
Get a qualified medical professional to diagnose your injury. You’ll then receive the appropriate instruction on how best to manage the injury, how much rest is required and what you can safely do to keep fit while respecting the healing process. You’ll start training at the right time and know how to return to your pre-injury training program.
Insidious onset of pain. This will be caused by repetitive micro trauma – as we say “tissue overuse, misuse or abuse”. This can be due to intrinsic factors such as muscle imbalances, inflexibility or poor technique, or extrinsic factors like bike set-up, road camber or your chair at work.
Chances are this is a pain you can still train with. Sort of. You need to have the source of the pain diagnosed to know how to treat it and manage training load. It is important to identify the intrinsic and/or extrinsic factors that set you up for the injury. This will guide an effective rehabilitation and prevention strategy.
How can I prevent the BAD stuf?
KNOW YOUR BODY
Address the weak link: If you know you have ‘weak knees’ or ‘a stiff back’ seek the help of medical professional for a diagnosis and management plan. Keep the bigger picture in mind and do your homework not just for the immediate performance benefits but for your future physical health.
KNOW YOUR SPORT
Running technique, mountain biking skills, bike set up, golf swing, efficient swimming technique – fill the gaps
Program: Know your goal and train accordingly. This will maximise the effectiveness of your training efforts and minimise the risk for overtraining.
Cross train: challenge your stability and flexibility and power – it will improve your sport!
Warm-up: increase heart rate and blood flow to muscles, switch the nervous system to training mode, prepare your body for fast movement! No static stretching for the legs unless specifically indicated by your health professional.
Cool-down: now is the time to stretch the areas out of the positions they have been working in.
Recover: consider your program + life demands. If you don’t sleep enough you won’t recover enough and failure from fatigue can creep in or your immune system will lose battles.
Learn from experience – be mindful how your body responds to foods.
Health comes first – with the barrage of conflicting information out there, consult your health care professional, stick to the dietary lifestyle that works for you and monitor your blood results.
Performance comes second.
KEEP THE BALANCE
The body is an amazing structure seeking to maintain balance at all times.
Train / rest; fuel intake / energy output; core stability / strength in large muscle groups; flexibility / control of movement.
To maintain the balancing act requires the discipline of listening to your body. Whether it’s mentally or physically, you will be rewarded in the long run!
How dangerous is inconsistent training?
The body has the most amazing ability to adapt to stressors. In the process of getting fitter changes will happen in your energy chemistry, to the heart muscle, blood vessels in the muscles, the nervous system as well as structural changes to muscle, bone and tendons.
The body will continue to change in response to the demands loading places on it. Change will also happen in reverse when the accustomed loading is removed.
For the energy and cardiovascular systems, on/off training may be 3 steps forward and 1 step back. For tendons it can be 1 step forward and 3 steps back as they struggle to cope with relatively sudden change.
We stay active because of the health and social benefits it gives us and because it’s pure fun. But life happens and so does boredom. Reality is that doing something is always better than doing nothing.
Keep moving, find other fun activities and learn new skills and when you return to your sport practise mindful progression into training after a period (3 months or so) of relatively reduced load.
Love your winter training, revel in summer holiday training, find challenging and exciting goals and have a blast!
How do I keep sane while recovering from an injury?
Prof Lorimer Moseley is a clinical scientist investigating pain in humans. In 2011, Lorimer was appointed Prof of Neuroscience and Foundation Chair in Physiotherapy at the University of South Australia.
If you could tell your patients 5 things what would they be?
In all the world, the person most suited to mastering your situation is YOU.
To get where you want to go will require a journey, not a quick fix, and you will probably need to be courageous, patient and persistent.
By virtue of being human you will have very effective and pervasive protective mechanisms.
Threats hide in difficult to spot places.
By virtue of being human, your system will adapt to the demand s placed on it, as long as you keep finding the place between adaptation and protection.
Recovering from an injury is not a passive process. Be persistent and consistent with practising the correct management and be patient enough to allow your body to respond.
What factor does age contribute and what should I be aware of?
Kids are not mini adults and sustain different injuries to adults. Skeletal maturity is reached at very different ages and in some males can be as late as the early twenties.
The little ones – physical activity allows kids to learn movement skills and build strength. This solid base set them up for developing better cognitive skills, self confidence and the enjoyment of participating in sport.
Growth spurts – these are the stages in which bones grow in length. Muscles, nerves and other soft tissues take time to catch up to the rapid bone growth. The brain has to learn new skills or adapt existing movement skills to the now longer limbs – challenging stuf that results in clumsiness until all the bits have learned to work together efficiently again!
Early specialisation – this has been shown time and again to be detrimental to injury occurrence and the longevity of participation. The absolute best foundation a kid can have to enjoy sport, maybe excel at 1 sport later is a broad skill set.
Example 1: running is a skill. If a mini cricketer only plays cricket and maybe swims, they will lose out on learning how to sprint efficiently and run longer distances efficiently. Both these are such helpful foundations to enjoying sports make resuming running as an adult easier.
Example 2: Once you can ride a bike you can always ride a bike. Skills learnt as a kid playing around on your bike for hours on gravel, grass, sand, learning to jump pavements fills a massive skill gap that people who learn to mountain bike in adulthood miss out on. Serious time has to be spent on skill training to make up for these instinctive/reflex responses you would have learnt as a kid.
THE GOLDEN YEARS
Be Persistent: no matter how old, try to get an injury treated and make the necessary adaptations to resume and maintain a level of activity.
Be Consistent: a few months of inactivity won’t undo what decades of activity has achieved, but a few years might be the mountain that can be too hard to overcome again.
Keep the mindset of expecting to never have to give up: Aside from 91 year old South Africans swimming the Midmar Mile and setting 100m sprint world records, cardiac, stroke and other dreaded disease patients always do better when adhering to their physicians and physiotherapist exercise guidelines.
Brukner P, Khan K , 2014 ”Clinical Sports Medicine” 4th Edition, McGrawHill (Australia)
Tucker R, Dugas J, 2009 “Runners World: The Runners Body” Rodale (USA)
Canadian Sports Centres “Canadian Sport for Life: A Parent’s Guide to Long Term Athlete Development” http://www.sportforlifecentre.ca/uploads/ParentsGuide.pdf, 1/11/2015