How to Prevent Injuries

When it comes to injury prevention, the first thing people think about is exercise technique, and this is because “good technique” refers to distributing the loads of a specific activity across different structures in a way that both maximizes performance and minimizes the risk of placing too much stress on any individual structure.

Note: The right amount of stress is “Adaptive” (positive) stress and results in progressions. Whereas too much structural stress and it becomes “Maladaptive” (negative) stress and injuries occur – we want Eustress (Eu = good), not Distress!

Although technique is very important, I consider there to be three key pillars when it comes to injury prevention: The 3 L’s

• Load Tolerance
• Load Management
• Listen to Your Body
• Technique gets an honorary mention

A key component of Load Tolerance is Mechanical Strength, which refers to the inherent capacity of the body’s structures (such as bones, muscles, ligaments, and tendons) to withstand forces without breaking or failing. It encompasses the structural integrity and resilience of these tissues. For example, strong bones can resist fracture when subjected to compressive or impact forces, and strong muscles can generate and sustain force during movements and activities.

Load tolerance extends to how the body responds to and adapts to different types and magnitudes (sizes) of loads. Load tolerance considers not only the inherent strength of tissues but also factors like neuromuscular coordination, joint stability, and the body’s ability to distribute and manage forces effectively (technique). It involves the body’s capacity to handle various loads without experiencing pain, injury, or dysfunction.

In physical training and sports, improving load tolerance often involves enhancing mechanical strength, but it also encompasses aspects like flexibility, balance, proprioception, and endurance. For example, a well-rounded training program for an athlete might include strength training to improve mechanical strength and agility drills to enhance load tolerance by improving coordination and stability.

A person’s mechanical strength is influenced by a combination of factors, including genetic predisposition, lifestyle choices, nutrition, and physical activity. Although genetics can play a role in an individual’s baseline mechanical strength, many of the factors listed below are modifiable through lifestyle choices and interventions. Regular exercise, a balanced diet, and other healthy habits will help improve and maintain mechanical strength throughout one’s life, even in the presence of genetic predispositions or aging-related changes.

1. Genetics: Genetics play a significant role in determining a person’s baseline bone density, muscle fibre composition, and the overall structural integrity of their musculoskeletal system. Some individuals may inherit genes that make them naturally more predisposed to having strong bones and muscles.
2. Physical Activity: Regular physical activity, particularly strength training and weight-bearing exercises, can significantly improve mechanical strength. Activities like resistance training and bodyweight exercises help stimulate muscle growth, increase bone density, and improve joint stability.
3. Nutrition: Proper nutrition is essential for maintaining and building mechanical strength. Adequate intake of essential nutrients, including calcium, vitamin D, protein, and other vitamins and minerals, supports bone health, muscle growth, and tissue repair.
4. Hormones: Hormones, such as testosterone and estrogen, directly impact muscle growth and bone density. Hormonal imbalances can affect an individual’s ability to develop and maintain mechanical strength.
5. Age: Mechanical strength tends to peak in early adulthood and gradually declines with age. Aging is associated with a decrease in bone density, muscle mass, and muscle strength. However, regular exercise (especially load-bearing exercises) will mitigate some of these age-related declines.
6. Gender: Gender can also influence mechanical strength. Generally, men tend to have greater muscle mass and bone density than women, which can result in differences in overall mechanical strength. However, both men and women can improve their strength through training – women can also experience a large reduction of bone mineral density (BMD) during the menopausal transition.
7. Injury History: Previous injuries or medical conditions can impact mechanical strength. Injuries to bones, muscles, or joints can lead to weakness or reduced functionality in affected areas. Proper rehabilitation and physical therapy are often essential for recovery and restoring strength.
8. Lifestyle Choices: Lifestyle factors such as smoking, excessive alcohol consumption, and poor dietary choices can negatively affect mechanical strength. These behaviours can contribute to bone loss, muscle weakness, and reduced overall physical fitness.
9. Medications and Medical Conditions: Certain medications and medical conditions can impact bone health and muscle function. For example, long-term use of corticosteroids can lead to bone loss, and conditions like osteoporosis can weaken bones.
10. Environmental Factors: Environmental factors such as exposure to high levels of pollution or toxins can have adverse effects on health, including bone and muscle health.

As we can see from the list, countless factors influence an individual’s ability to tolerate stress and the forces placed through the body when walking, running, jumping, and lifting, and many of these factors can be hard to quantify. However, one data point that gives us a lot of insight into someone’s load tolerance is their training history (Training Age) and current training state.

Training age is a concept used in sport and fitness to describe the number of years an individual has been consistently engaged in structured training or physical activity. It’s a way to measure an athlete’s or fitness enthusiast’s experience level in their chosen sport or exercise regime. Training age is a more relevant indicator of an individual’s readiness and ability to handle certain training loads and intensities compared to their chronological age.

1. Chronological Age vs. Training Age: Chronological age refers to the number of years a person has been alive. In contrast, training age focuses specifically on the number of years an individual has been actively participating in training or sports. Two people of the same chronological age can have vastly different training ages, depending on their athletic backgrounds.
2. Beginner vs. Experienced: Individuals with a low training age are typically beginners or novices in their chosen activity. They may have recently started training or have limited experience. On the other hand, individuals with a high training age have been training consistently for many years and have accumulated a wealth of experience and adaptations from their training.
3. Training Adaptations: Training age is closely related to an individual’s physical adaptations and improvements. As someone trains consistently over time, their body undergoes various physiological changes, such as increased strength (Mechanical Strength), endurance, flexibility, and skill development. These adaptations contribute to their overall training age.
4. Training Readiness: Training age is important when designing training programs. It helps coaches to gauge an individual’s readiness for more advanced training techniques and higher-intensity workouts.
5. Plateaus and Progression: Individuals often experience faster progress and adaptation in the early stages of their training age. As training age increases, progress may slow down, and individuals may encounter training plateaus. This is when more advanced programming and training strategies become crucial to continue improving.
6. Injury Risk: Individuals with a low training age are generally at a higher risk of injuries when exposed to intense or advanced training protocols prematurely. Training age should be considered when assessing an individual’s injury risk and designing injury prevention strategies.
7. Sport-Specific Training: In sports, training age can be used to identify athletes who have spent considerable time developing their skills and fitness for a particular sport. This can be a factor in talent identification and athlete selection.
8. Individual Variation: It’s important to recognize that individuals may progress at different rates, even with the same training age. Genetics, dedication, training quality, and other factors can lead to substantial variation in training outcomes.

Why Technique is Important:

Now we have established what mechanical strength and load tolerance are; it is easy to explain why technique is important. Ultimately, the aim of technique is to distribute the work across multiple structures in a way that facilitates the best performance while not overworking a single structure. Of course, if that structure has the load tolerance to pick up the slack, then it will likely be fine, but if someone who can lift 200kg spreading the load across almost every structure in the body suddenly tries to do it with far more emphasis on the back, the back may not be able to tolerate the additional load and therefore, the said structure might sustain an injury.

To create a program that is suitable for an athlete, it is key to understand their training history and training age, as well as their current training state, which relates more to the present conditions.

An athlete’s training state refers to their current physical condition, including their fitness level, readiness for competition, and overall preparedness to perform at their best. This term encompasses a wide range of factors that coaches and athletes consider when planning and assessing training programs. An athlete’s training state can be dynamic and can change over time as a result of training, recovery, and other lifestyle factors.

Key elements of an athlete’s training state include:

1. Fitness Level: This is a measure of an athlete’s physical capabilities, including strength, endurance, speed, agility, and flexibility. It reflects the training they have undergone and the adaptations their body has made in response to that training.
2. Fatigue Level: Athletes experience varying degrees of fatigue as a result of training and competition. Monitoring fatigue is important to prevent overtraining and to ensure that athletes are adequately rested and recovered before important events.
3. Injury Status: The presence of injuries or niggling issues can significantly affect an athlete’s training state. Coaches and medical professionals need to consider an athlete’s injury status when planning training programs and competition schedules.
4. Nutrition and Hydration: Proper nutrition and hydration are essential for maintaining energy levels, supporting muscle recovery, and overall performance. An athlete’s diet and hydration status can impact their training state.
5. Mental Preparedness: An athlete’s mental state is critical to their performance. Factors such as confidence, focus, and motivation can all influence an athlete’s training state. Mental skills training and psychological support may be used to enhance mental preparedness.
6. Recovery: Adequate rest and recovery are crucial for maintaining an optimal training state. This includes factors like sleep quality and duration, active recovery techniques, and the management of stress.
7. Training Progress: Coaches and athletes monitor an athlete’s progress over time to assess their training state. This involves tracking improvements in performance, such as strength, speed and aerobic fitness.
8. Competition Schedule: An athlete’s training state must align with their competition schedule. They need to peak at the right time to perform at their best during important events.
9. Periodization: Training programs are often organized into periods or phases, with varying intensity and volume. The athlete’s training state should align with the specific phase of training they are in.
10. Environmental Factors: Environmental conditions, such as climate and altitude, can also affect an athlete’s training state and performance.

Once we have established an athlete’s training history and their current training state, it is all about managing the loads that we place on the athlete.

Of course, we can’t eradicate all injuries because accidents happen. Sometimes things just don’t go to plan, and there isn’t always a clear reason for that. However, we can take an educated approach to managing the frequency, volume, and intensity of training to ensure we create a training program that minimizes the risk of injuries.

Injuries and niggles are often caused by doing a little too much and overreaching a little too far in a session (a spike in training intensity) or doing a little too much of the same thing causing repetitive strain injuries (a spike in frequency/volume). Therefore, the management of these training variables is, in my opinion, by far the most important thing to consider when it comes to injury prevention.

Disclaimer: Rule 1 when it comes to injuries:Don’t risk making it worse. If you are not qualified to diagnose the issue, refer to a doctor or physical therapist (there might be exercises that are initially contraindicated), and of course, there could be other underlying issues that need to be addressed.

The final “L” is Listen to your body, and this one is absolutely key!

Ultimately, when it comes to most injuries, time is key. The human body is amazing and works to heal itself and fix little niggles and injuries all the time. In fact, most of the injuries people worry about will heal all by themselves given time, and this is especially true if the injury has not been compounded by the individual NOT listening to their body and refusing to give the specific structure time to rest and heal.

More often than not, giving a specific structure time to heal doesn’t mean a complete cessation of activity. It simply means an adaptation of some of the activities you are doing. And this brings me to my TAB Method.

The TAB Method

The TAB method is a protocol I created after years of working with general clients and athletes and mentoring numerous personal trainers and coaches. The TAB method may seem like the common sense approach and that’s because it is; it makes absolute sense. However, when people get injured, they tend to worry, and that’s normal. But it is key to understand that most of the time, the body just needs a bit of time to heal the affected area, which is often helped by a few adaptations in the exercise regime.

• Take away aggravators – initially, get rid of the things that make the injury feel worse during exercise, hours after and the next day (if you keep picking a scab, it will never heal)
• Add in exercises that feel good – load the tissues, increase circulation, and promote healing / add in mobility work to reduce excessive tension
• Build resilience to the aggravators – injury prevention 101 is build the strength to accommodate the stress. Once initial healing has taken place, we need to progressively build resilience in the tissues

Always consider what the athlete’s current load tolerance is: It is common to see individuals load a movement and complain of discomfort and pain, and from this, they conclude that the movement is bad for them. However, if the individual can perform a Romanian Deadlift (RDL) with 20kg pain-free, but when they perform it with 100kg, it hurts, then it is not an issue with the movement, but instead, their tissues cannot currently tolerate the 100kgs of load – build load tolerance progressively (Progressive Overload).

The IIR Protocol

The IIR (Isometric, Isotonic, Reactive) Protocol is one I often use when returning an injured athlete back to sport. Often, athletes will get a great diagnosis and perform the early stages of rehab well. However, they skip the Reactive Stage and return to sport (RTS) unprepared.

In short, athletes often spend weeks performing controlled movements in a gym environment, and then once they are pain-free, they jump straight back onto the field, sprinting, changing direction, and jumping maximally. They then re-injure the same muscle and wonder why – because they haven’t progressively worked back up to rapid eccentric and concentric contractions.

Stage 1: Isometric

Contractions with no change in muscle length – holding the position for 40+ seconds.

Stage 2: Isotonic

Eccentric (lengthening) and Concentric (shortening) contractions – progressively loaded.

Sub-Phases:

• Tempo: Specifically Slow Eccentrics and Pauses
• RFD (Rate of Force Development): Fast Concentrics

Stage 3: Reactive

Explosive/Elastic movements such as jumps and throws – plyometrics and ballistic training.

Contractions in response to a stretch: Stretch shortening cycle (SSC) (explained below)

• Stored Elastic Energy: Just like a rubber band, a stretched muscle wants to return to its original length due to the tough elastic properties of tendons (which attach muscle to bone). Imagine the recoil of a thick tendon such as the Achilles tendon – if genetics gift an athlete with a long Achilles tendon and subsequent training toughens the tendon, then this is going to greatly benefit their ability to jump
• The Stretch Reflex: There are receptors in the muscles and tendons (proprioceptors) that detect changes in muscle length (muscle spindles) and muscle tension (Golgi tendon organ). When there is a sudden change in muscle length, the muscle spindles send a signal to the spinal cord and a signal is sent back to contract the muscle. The Golgi tendon organ, on the other hand, can inhibit muscle contraction as a result of excessive tension that could result in injury. With progressive plyometric training, we can learn to capitalize on the stretch reflex (muscle spindles) and reduce the sensitivity of the Golgi tendon organ to maximize our ability to contract forcefully

Exercises are commonly described as Slow-SSC >250 milliseconds (0.25 seconds) or Fast-SSC <250 milliseconds. A vertical countermovement jump is considered slow-SSC as the duration of the SSC is approximately 500 milliseconds, whereas sprinting is classed as fast-SSC as the duration of the SSC is approximately 80-90 milliseconds.

Author

Coach Jason Curtis