Extrinsic injury risk factors

The tissues of the body are potentially capable of withstanding considerable stress. For example, it is not uncommon for upwards of three times the body weight to go through the body even when jogging slowly. However, tissues that have not been accustomed to such forces will not have adapted to withstand them and are therefore likely to be injured when they are applied. Certain types of movement demand that the body either develops force rapidly or must control force very quickly.

Sprinting and jumping for example, require the muscles to develop big forces very quickly to ‘power’ the action and also to control the limbs and body with each foot contact or landing. Consequently, this type of training or activity must be gradually introduced as part of a training programme, preferably following a period of several weeks of general training.

This is where the help of a coach can be invaluable in planning a training programme. If your sport or activity involves impact (running, jumping, etc.) then wearing appropriate footwear and exercising on a suitable surface are extremely important of the impact force going through the body is to be kept to a minimum. The most appropriate footwear will often depend upon your gait and joint mechanics, since someone who has excessive pronation, for example, has different footwear needs to someone who does not. Furthermore, the shock absorption, stability and support characteristics required of sports footwear will differ according to sport, technique and bodyweight.

However, should you suddenly change from exercising or training on one surface, to exercising or training on another (grass to road, or road to track) you may well be inviting an injury. This is not only because of the difference in impact, but also because the feedback from muscles and joints will be different and the body often needs a couple of sessions to work out precisely how to control the difference in loading and any changes in joint position. It goes without saying that a sudden change in footwear to either a different brand or a different type may also result in injury.

The answer is to work new shoes and surfaces into your programme gradually over the course of several training sessions. Be observant even when training on a ‘safe’ surface (such as grass) since uneven surfaces can sometimes result in an ankle sprain. Training errors The usual culprits are those that result in excessive loads on the body. These include volume/distance and intensity. Many recreational sports performers often do not realise that the elite sports performers they sometimes try and emulate in training have spent many years of training consistently, gradually increasing the workload in order to do what they do.

It is an old, but true adage in sport that ‘it takes ten years to get good at anything’. All top class sports men and women will plan their training so that foundation training (cardiovascular conditioning, general strength) is followed by a period of specific strength, prior to highly demanding speed, power and competition work. Woven throughout this progressive structure will be all the elements of preventive conditioning that each performer requires in order to minimise their injury risk.

As part of this approach, sports performers will set goals, and regularly assess both their success in achieving these goals, and undertake regular (at least three a year) assessments of general and sports specific fitness (endurance, speed, etc. ). Most sports coaches and national governing bodies of sport can provide details and examples of programme planning, goal setting and assessment. As a general guide to understanding training errors that result in injury, it is important to keep a training diary. This need only include brief details of the session (what you did, e. g. mileage/volume, speed/intensity, sets/reps, etc.

) and the date and time you did the session. Should you succumb to an overuse injury, looking back through the diary can usually help you pinpoint what changed, and therefore what may have contributed to the injury itself. Technique A number of overuse injuries are clearly related to sports or exercise technique. Indeed, some injuries are even popularly named after their sport (e. g. tennis elbow). Often it is the repetition of an action with faulty technique that results in excessive load on tissues and subsequent injury. For example, tennis elbow is usually an injury to an extensor tendon of the wrist.

Sometimes it is triggered off by a change in equipment (such as racket size, grip size or even string tension). However, it is often the result of a faulty technique (backhand, or top spin forehand). This should be checked and corrected with a tennis coach. Similarly, a low elbow position in overhead activities (racket sports, swimming) can result in elbow or shoulder injury, excessive anterior tilt of the pelvis in runners can contribute to hamstring injury, and an incorrectly set cycle (handlebars) can result in wrist/nerve injury or knee injury (seat height/position).

In every case of overuse injury, it is always worth considering whether sports technique is as good as it can be. This is also true of exercise technique in the gym (whether resistance training or stretching) and advice should always be sought from a qualified instructor on how best to perform any exercise. Furthermore, it should be remembered that skill breaks down with increasing fatigue, so the last few repetitions of any exercise in the gym should be watched most carefully and should be as technically correct as the first few.

Prior to engaging in strenuous exercise, training physical activity or competition a thorough warm-up is recommended. This is because many of the body’s tissues (particularly muscle) respond better to loading when they are warm. The warming up process should include whole body exercise (jogging, cycling, the sport itself at low intensity) that increases blood flow to muscles and makes then more responsive. The length of this warm-up phase will depend upon the ambient temperature (the warmer it is, the less time needed to become warm) and what is going to be done.

All out sprinting for example, is extremely demanding, and warming up to sprint is not just a case of increasing temperature and local blood flow, but of gradually preparing the muscles and joints to generate maximum forces very quickly. Consequently, movement specific or sports specific drills will form part of the warm up phase, along with flexibility work aimed at taking muscles and joints through the range of motion that will be required during the activity or sport.

Warming up for an exercise session may take as little as ten minutes, whilst warming up for demanding sports training or competition can take 30 minutes or more. At the end of every training session, all sports performers will warm down, bringing their body back down to normal, usually through low intensity activity, followed by flexibility exercises. As with the warm up phase, the time course is similar according to what has been done.

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