Month: March 2023

As the Winter sporting seasons begin to kick off, it’s imperative to continue checking in with your body  to minimise injuries during the season. The start of the season is when we tend to see an uptick in injuries as individuals ramp up their loads up without observing how their body is handling the stress.

 

Our connective tissue continuously adapts to the loads we place on it. However, like all parts of our body, our connective tissue has a certain limit. Tendons are a type of connective tissues that are significantly affected by sudden changes in load. A common tendon injury we see when presented with excessive or sudden changes in loads are termed tendinopathies (aka “unhappy tendons”). Our most up to date understanding of tendinopathies can be summarised in the model below:

We effectively want to keep our tendons happy and pain-free by incorporating interventions that address overall tendon function and capacity (Cook et al., 2016). Tissue capacity is a measure of how much load your tissue can currently handle. When we slightly exceed our tissues current capacity, we inherently challenge our bodies to adapt in order to make the activity easier the next time we perform it. However, stressing our tissues well beyond their capacity levels exponentially increases the risk of injury. 

 

Previous injuries that have not been rehabilitated completely can develop into recurrent injuries; as well as become key contributors for the cascade of compensatory factors that place abnormal forces through otherwise healthy body tissues (Hylin et al., 2017). A good proxy for avoiding this spiraling effect is to be aware of niggles throughout your training or sporting season. It is always better and easier to manage niggles or aches immediately, rather than down the track after they have blossomed into chronic injuries. In fact, niggles and previous injuries are the primary predictors for the development of future injuries (Whalan, Lovell & Samson, 2020).

 

The tricky part is determining when you should continue to push your training versus deloading and recovering. Although there are recommended guidelines around this, it should be individiualised based on current tissue capacity, previous injury history and possibly associated compensatory factors (i.e., biomechanics/movement patterns).

 

If you are unsure where your current tissue capacities lie, want to screen previous injuries or assess your biomechanics, seeing a physiotherapist or exercise physiologist can be quite useful in determining the best plan around injury prevention, as prevention really is the best cure. Click here to book an appointment today!

 

By Veeral Patel | Senior Physiotherapist

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References

1. M. Whalan , R. Lovell & J. A. Sampson, (2020). Do Niggles Matter? – Increased injury risk following physical complaints in football (soccer), Science and Medicine in Football, 4(3), 216-224, DOI: 10.1080/24733938.2019.1705996
2. Cook JL, Rio E, Purdam CR, et al. (2016). Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? British Journal of Sports Medicine, 50, 1187-1191.

3. Hylin, M. J., Kerr, A. L., & Holden, R. (2017). Understanding the Mechanisms of Recovery and/or Compensation following Injury. Neural plasticity, 7125057. https://doi.org/10.1155/2017/7125057

If you’re serious about getting into running (or any exercise for that matter) and it’s been a while since you’ve thrown on the runners, there’s a few things to consider and tick off the checklist before heading out the door. 

The list below contains some important factors for injury prevention that people often forget when starting a running program.

Correct Loading Mechanics:

The load placed on your body when running is huge – depending on your speed and gait patterns, you place anywhere between 3-8x your body weight with every step! A 5km run will average a little over 6000 steps, so loading your joints correctly (particularly your hips and knees) is important for the longevity of your joints. 

Hip strength and stability should be at an adequate level to support movement and loading patterns pertaining to running. These include (but are not limited to) hip extension and thoracic rotation.

Difference in Limb Strength:

Strength discrepancies between your left and right leg are normal and common. However, exceeding a 10% difference in strength for a given muscle group (in comparison to its counterpart) can lead to joints experiencing loads they were not biomechanically designed to withstand. The negative impact on the joint is only exacerbated by the increased impact from walking to running.

Before we clear someone to start running or continue after an injury or time-off, it is important for us to run some tests. We use AxIT technology to record and measure the strength between the muscles of their right and left legs. 

For example:

• A normal Hamstring to Quadricep ratio less than 0.66 has been shown to negatively affect lower limb performance (2)

• Hip abduction/adduction ratios of less than 80% have been shown to influence physical performance. (1)

Correct Loading & Preparation for Tendons and Ligaments 

Creating programs which strengthen and prepare muscles is straight forward. However, progressive loading of the tendons and ligaments is often less considered when returning to running – leading to overuse injuries. Tendons and ligaments are incredibly smart.  Like muscles, they adapt in their size and/or material properties according to mechanical load. Developing stiffer tendons by increasing collagen synthesis will assist with the way that both the muscle and tendon together – are able to withstand load. 

Initially, a walking program should be followed to introduce a gradual increase in load to the tendons and progression of volume (e.g., kilometers). When both strength levels are adequate and a progressive walking program has been completed, a running program can be initiated.

As a general guideline, increases should be around 10% per week. However, this is not a concrete rule and should only be used as a guideline for tendon adaptation whilst taking other injuries into consideration. 

Like muscles, tendon and ligament fibers break down slightly during training and during the recovery period – build up stronger in adaptation. The difference is that muscles yield a higher blood supply, therefore their recovery is much faster (up to 24 hours)!

Green line: – acute increase in collagen & protein synthesis. Peaking around 24 hours post exercise and staying elevated up to 80 hours post exercise.  Maroon line: degradation of collagen which occurs simultaneously. Degradation occurs earlier and to a greater extent. This is a normal tendon response.  Purple line: The net balance of collagen synthesis and collagen degradation. A negative net balance occurs 18-36 hours after exercise, following with a positive balance up to 72 hours later (3)

 

Click here to learn more about our team at Exercise Lab.

By Pip Tockuss | Exercise Physiologist

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References

1. Hip Strength testing. (2020). Strength by Numbers. Retrieved March 23, 12 C.E., from https://www.strengthbynumbers.com/resources
2. Knee Strength Testing. (2020). Knee Strength Testing. Retrieved March 23, 12 C.E., from https://www.strengthbynumbers.com/resources
3. Managing patella tendinopathy in powerlifting Pt.1 – Understanding Tendinopathy. (2023). Modern Physiotherapy Aus. Retrieved March 23, 13 C.E., from https://modernphysio.com.au/managing-patella-tendinopathy-in-powerlifting-pt-1-understanding-tendinopathy/