‘Injury Prevention’
Last week Cam and I were invited guests on the famous Legion Report. An epic podcast hosted by Ray Pharoah and Danny Hayter. We talked about injury prevention in not only sport, but how this can also be applied to everyday life. I think we could have gone on for hours on the topic (we all know how much Cam likes to talk), and it certainly brought up some really interesting points! It also highlighted to me how much we can all learn from each other. Ray brought up some interesting perspectives from a coach, and how adherence to injury prevention interventions can be difficult to ‘sell’ to members. Danny’s reflections as a patient himself, were also really interesting and how with experience, he has learned to listen to his body.
This blog is intended to summarise those key discussions and to give some practical tips on injury prevention, as well as a useful resource to refer too alongside the podcast.
What is an injury?
In its simplest of forms, an injury can be defined as when load exceeds tissue capacity. This basically means when a force is applied to your body (muscle, tendon, ligament, bone or even nerve) and is greater than what your body has adapted to tolerate, there is the potential that something has to give. Cam described this using a Christmas cracker analogy. You can pull on the cracker at both ends and the cracker will tolerate a certain degree of force. However, once you pull beyond the cracker’s tensile threshold, it will break, and you’ll get that paperclip and tissue paper Christmas hat you’ve always wanted.
At this point, it is important to note that the body is a lot stronger, more robust and resilient than a cracker. We are simply trying to illustrate the point that if you apply a force greater than what you can tolerate you risk an injury. In reality there are a number of factors which come into play in an injury and this biomechanical illustration is just one. Psychology in the form of beliefs, perceived threat of the injury and past experiences all come into play.
Equally we would like to add here that the human body has an incredible ability to heal itself. Take for example a high impact trauma resulting in a fractured bone. Here the bodies healing process actually forms a callus around the fracture and heals back stronger than before. The body is adaptable and truly incredible. If we train and build things up slowly there is no limit. This is evident first hand, when you look at athletes such as Ross Edgely and David Goggins, who keep breaking unbelievable records and showing us what we are truly capable of achieving.
Can an injury truly be prevented?
This is a really good question and there is no simple answer. I think it helps first to break injuries down into the two most common types.
Traumatic: These are often the result of a contact injury in sport or a high impact accident. Typically, an external, high energy, high velocity force is applied to the body. Let’s take for example a rugby tackle to the knee. This has the potential to apply a force, greater than what the individual’s knee ligaments can tolerate. In this instance, level of strength, conditioning and athlete skill can not necessarily prevent the injury from occurring. This is an inherent risk of sport. Traumatic injuries are therefore difficult to prevent as they are dependent on external factors outside of our control.
Non-Traumatic: In contrast to above are 100% in our control and they are actually the more common type of injury. They typically occur as a result of training error and our personal bias here at SCRX is that these injuries can be avoided. Examples of this type of injury are commonly seen in individuals who overtrain. e.g. maxing out every session with very little rest days. These guys love being in the red zone, they hit sessions at a 10/10 intensity level, and we can all think of one or two in our gym. Although training hard certainly has its merits, if you do not systematically allow your body to rest, recover and essentially grow back stronger you risk an injury. This sounds so obvious but is very often overlooked. On reflection personally, it seems to me that often it’s the simple things, often least attractive, which make the biggest difference in life. This is one such example.
At the other end of the spectrum, we often see the novice who starts a new sport and is super keen to train 5-6x week. Although this motivation is great, very often the rate of the bodies adaptation is not as fast, and we must be mindful of this. We have to patiently allow our bodies to adapt and develop the motor patterning and strength required for the demands asked of it. Ray made a great point which emphasised how often the most consistent, patient athletes make the biggest gain in the long term. We have to be mindful of the end goal and patiently chip away at it. Big spikes ‘boom – bust’ scenarios are not as effective and risk injury.
We advise people to train smart and be patient in their training. Build the intensity, frequency and volume up slowly and Listen to your body.
Functional Movement Screening
Functional movement screening (FMS) is a systematic screening tool which looks at seven objective measures of unilateral muscle strength, dynamic control and mobility. Such a screening method allows you to have a tailored pre-habilitation programme to work on, designed by your physiotherapist. This proactive approach is a great way to reduce your risk of injury.
Let’s take CF for example. An FMS performed on an individual picks up reduced unilateral shoulder mobility on the right side compared to the left. If the individual is not aware and this impairment is not addressed, it has the potential to predispose the athlete to overhead injuries.
More specifically, a limitation to overhead shoulder mobility may negatively affect their ability to efficiently lock out on the jerk in Olympic weightlifting. This may put a greater strain on certain structures of the shoulder as the barbell is likely to be caught anterior to the centre of mass (due to the reduced shoulder range on one side). This has the potential to exceed the tissues capacity (especially if repeated over time and over multiple high load repetitions). Not only this, but this inefficiency in technique will also mean the athlete is less effective in their lift and as their overhead lock out is limited, this will also affect their performance.
Another example we discussed on the podcast was a squat. So many people are unaware that they favour one side and lead the lift with more weight either towards the right or left. This may be due to weakness in one leg or even down to reduced ankle mobility on one side. The cause can often be complex, but the FMS is really great at breaking this down.
At South Coast Rx we personally believe the FMS is great tool to aid in injury prevention and helps make people aware of their weaknesses. However, it must be tailored to the individual and their sport. It is also important to emphasise that this will not necessarily prevent traumatic injuries as we discussed, but does have the potential to reduce the risk of injuries through training error through identifying areas of weakness.
Prevention Programming
So now the important bit. How do we put all of the injury prevention strategies into your programming? This again is a tricky question and no single answer.
The foundation underlying all effective programming has to be in its periodisation. This is something which Southern Legion does really well. Every training block is incremental following the principles of progressive overload, which gives the body time to adapt to the training stimulus. In addition, members at the Legion will note how at the end of each block their will be a de-load week before the next cycle. This is great programming as it gives the athlete’s body time to adapt and recover before the next cycle.
Alongside our coach we as individuals also have a personal responsibility to be the judge of our training load and how intense we train.
To do so it helps to have a framework to think about how much stress you are subjecting your body to.
One of the best ways to do this is with the Training Load Factor framework (TLF).
It breaks training down into three components:
Frequency
The number of training sessions within a period e.g. 1 week.
Volume
The amount of time during each training session e.g. 1 hour.
Intensity
The intensity of each training session (measured using rate of perceived exertion (RPE) on a 0-10 scale).
Training Load Factor = Frequency x volume x Intensity
A good way to think about this model is that you can choose two components to emphasise and one to take it easy on. Hitting all three maximally could soon lead to overtraining and injury. On the contrary, take all three too easy and the stimulus of training may not be enough to stimulate adaptation and could lead to detraining. It sounds tricky, but through a little experimentation you will soon find the right mix for you, based on your training experience and goals. Remember to listen to your body and everyone is one of us is different. As your experience increases, your body will adapt and you can start to increase your TLF safely.
If you want to train 6-7 days per week or even x2 per day (as many competitive athletes do), you need to reduce either the volume or intensity of each session. This could be through adding skill components which are performed at a lower intensity to strength training and metcons. Also including recovery low load sessions in your week such as cycling/ swimming or mobility is key.
On the other hand, some athletes prefer training at a lower frequency e.g. 3x week. Here as long as you have given your body time to adapt you can hit each session harder as you have time between sessions to recover.
As discussed above you must also make time for unilateral strength and mobility exercises. Ideally these should form part of your weekly programme. They could even be incorporated as part of your recovery, or weekly deload session, as these sessions will be lower in intensity. One stat which I found really interesting was that when compared to numerous different sports, body builders had one of the lowest rates of injuries. This I believe is in part due to their focus on unilateral strengthening which is targeted at individual muscle groups in comparison to a large compound movement. Compared to an average cross fitter, I would argue that body builders will be a lot more symmetrical in their unilateral strength and in this regards we can learn a lot from the Armies of the world. Maybe it’s time to bring back the bicep curls!
Another benefit of incorporating some unilateral strength or functional body building type exercises into your programming is that the speed of contraction is slower and more controlled than the explosive CF movements. The slow control of unilateral exercises is great for improving body awareness and overall strengthening of the muscles, tendons and ligaments. Furthermore, if you can make your mobility and unilateral accessory training programme specific to your individual weaknesses and goals then this is even better! A tool such as the FMS will help you become more aware of such impairments and benefits of these interventions should not be overlooked!
We hope you found our podcast and this blog useful. As always if you have any questions on the content or want to know more about the FMS, please send us a message via our contact us tab.
19/3/21
SCRX Team