Why do we get injured?

It seems to be the all-mighty question that defines physical therapist's job security and it is our hope that this gives you some insight. Whether the injury was trauma induced or ever-present “it just started and won’t go away”, we have to take into account the events that preceded the injury to adapt our ways of training or preparation. We inevitably swear by differing thought processes to avoid injury, but one thing that rings true among all training methodologies is movement diversity. We preach the avoidance of specialization in sports to our youth and it makes such sense to continue that thought process throughout life. Too much strength and power focus and we may lack mobility OR too much focus on endurance within one sport and we lose sight of potential weakness and asymmetry of movement that could prevent injury. In a much of a scientific, evidence based approach as needed, please tune-in, ask questions, and challenge your thoughts with how we can better avoid injuries in the future. 

Injury prevention begins with soft tissue adaptation, that is to ask, what forces are our muscles, tendons, ligaments, nerves, reaction time, and fascia trained to resist and under what volume of time and intensity? If our body is only trained to sustain 5 minutes of constant activation, force absorption, and within a small amount of mobility, then there is nothing saying that at 6 or 7 or 10 minutes of that given activity our body will remain pain-free or resistant to the forces placed on our tissues. For simplicity's sake, the example we will use in this situation is a runner (no hard feelings to all of our runner friends) and build a template of what injury prevention looks like from a tissue adaptation point of view. 

By and large, our ability to prevent injury begins with the understanding of what our movement, competition, or fitness goals are. Back to the runner example, let’s say they want to run a half marathon in 5 months and have fair experience with running in the past. It should not be a competition to see how many miles we can run each week, rather it is a tactical build up of a combination of strength training, mobility, interval training, and most importantly use of long duration, low intensity volume of running and strength (also known to some as foundation). In a study by Cook and Docking (2015), they discussed the proper progression from moment of injury to return to sport with the figure shown below. The consensus among studies performed in this realm is that frequency of workouts and consistency to build foundational strength is necessary to avoid injury when loading the tissues (bones, muscles, and ligaments). In order to do so we must reframe our mindset to incremental strength that, for our runner example, is single leg biased and focus on the ability to absorb and produce force. This starts with conversational-intensity running, cardio, or endurance (high repetition, low % of 1 rep maximum) strength training in conjunction with learning how to move well. Injury prevention in all aspects of life rely on increasing the ability to absorb and produce force, maintaining proper posture and mechanics during dynamic standing postures, improving efficiency, and reducing muscle imbalances.

Strength training is largely construed as a grueling, 60-90 minute ordeal that finishes in feeling absolutely gassed - and while there are components are meant to be exhausting and require effort, the goal is not to put you out for days on end and leave you questioning if you can still get your miles in. In the end, 2 days per week in 30-45 minutes per session is all our runner should need to compliments their goals to both reduce injury and recover or train more efficiently. That means we must strive to identify our weaknesses, asymmetries of movement, and ways we can incrementally build new habits across all aspects of movement and not just a single specific sport. 

From our look at injury prevention in both the runner's example and that of an general recreational exerciser, here are the key take-aways:

• See a PT or movement specialist that can screen your movement for asymmetries, compensations, or current/past injuries
• Create a well-rounded goal with according process-based steps to completion
• Incorportate more base strength at the beginning of your phases
• No early-life specialization --> no later-life specialization
• Mobility then stability then strength and power then sport specific training

Citations:

Cook J, Docking S. “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ‘tissue capacity’: a core concept for clinicians. British Journal of Sports Medicine 2015;49:1484-1485.

Seiler, Stephen. (2016). Seiler's Hierarchy of Endurance Training Needs.. 10.13140/RG.2.2.16667.05924. 

Teng HL, Powers CM. Hip-Extensor Strength, Trunk Posture, and Use of the Knee-Extensor Muscles During Running. J Athl Train. 2016 Jul;51(7):519-24. doi: 10.4085/1062-6050-51.8.05. Epub 2016 Aug 11. PMID: 27513169; PMCID: PMC5317187.