The injury prevention vaccine
Physiofit is passionate about the prevention of injuries. At this time of year, we see many injuries that are a result of doing "too much too soon". To help reduce this happening we want to explain how the body reacts to load and a range of simple techniques that you can use to monitor the activity you are doing and strategies to reduce the chance of injury.
Spikes in activity
Both adults and children alike find that their level and intensity of exercise peaks and troughs throughout the year. The body has the most amazing capacity to adapt to any stress or load placed on it providing that it has time to do so. The problems start when we have a sudden spike in a new activity or we do more sport at a greater intensity following a period of rest such as following the Christmas holidays. When we then resume our sport with renewed vigour in a determination to regain any lost fitness the sudden spike in activity results in tissue overload and pain. Transitions between the sporting seasons such as the end of the football season and beginning of the cricket season pose problems with double the demand on the body. Many experts have used graphs such as Fig 1 to help us understand what is too much or too little and it varies from child to child and athlete to athlete. As you can see there is a "sweet spot" (Gabbett 2016) where performance increases but injury risk is balanced. If you have not done the appropriate training, then the body is not used to the load expected of it and rapidly reacts and can be as much an injury risk as too much. Athletes who are accustomed to high training loads tend to have fewer injuries providing that they have time to adapt. Injuries occur because of:
- Poor training methods
- Excessive and rapid increases in training loads
- Too little rest and recovery
What can you do to avoid "too much too soon"?
1. Evaluate each session's intensity
It is not just how much you do but also how hard the intensity of the session. A good way to evaluate intensity is to teach athletes about Rate of Perceived Effort (RPE). There are several ways of doing this, but a simple 1-10 scale works well as shown in Fig 2.
2. Keep a session diary
A training diary is an effective way of monitoring load and effort. Many athletes we work with use a wall planner or electronic spreadsheet to flag up potential bottlenecks and highlight points in the year when they want to be performing at their best.
3. Calculate chronic:acute workload
The recipe for injury prevention is based around a chronic:acute workload ratio. The chronic load is the average of the last 4 weeks eg how many miles you have run (x the intensity of each session). The acute workload is what you have done that week. The chronic:acute ratio should be no more than 1:2 and the margin for error is around 10% increase on the average of the previous 4 weeks. Research has shown that as little as a 15% increase is enough to increase your injury risk substantially.
4. Keep to the 2/4/7 rule
The important factor is giving the body time to adapt and become stronger. My so called 24/7 rule is based on the recipe adopted by the England Cricket Board which is no more than 2 consecutive days of fast bowling with no more than 4 days of play in every 7-day period. This gives the body time to recognise the stress and react and become stronger. This is a sensible approach to most sports giving the body a day to recover allowing minor stresses to be heal and repair and more tissue can be laid down in case the load recurs.
Our injury advice
Traditionally the advice for overload injuries was rest. With careful management compete rest may not be necessary if the athlete is given the correct early advice. Reducing the load down to a level where the symptoms become more manageable ensures that the tissues get time to adapt but that they do not become weaker. We usually advocate that a level of pain that does not exceed a 3/10 pain (10/10 is the worst pain known) and that settles by the next day is acceptable, but this is athlete dependent.
Physical literacy is as important as Math's and English literacy
The better conditioned a young athlete becomes, the stronger level of protection against injury. Learning to move correctly is critical to a child's development and just like they must become literate in Maths and English, it is essential that they learn correct movement patterns and become physically literate. Movements such as lunging, crawling, squatting and deadlifts form the basis of many sports and should be taught at an early age but are often missing from the current physical education curriculum.
Physiofit specialises in the development of young athletes and can provide guidance on how to create strong and robust athletes who learn to monitor their workload and safely learn how to do age appropriate strength and conditioning in a 1:1 or class environment in our rehabilitation centre in Wilmslow. We also have a new strength class for adult runners aged 14+.
Gabbett TJ The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med Published Online First: 12 January 2016. doi: 10.1136/bjsports-2015-095788
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