By James Cameron BASRaT and Jenny Manners MCSP MSc
“I’m just injury prone” – A single phrase that is transferable and echoed all the way from elite sport to Sunday afternoon bike rides. It is the assumption that certain, unlucky people have a natural pre-disposition to injure easily and should therefore be accepted as a fact of life whilst enviously looking at those that train 7 days a week with no problem. No aches, no pain, no stiffness, no nothing! But is it true?
No! Fortunately for those of us who pull a muscle every time we jog, we aren’t struck by a life-long curse of injury prone-ness. Instead our injuries, unless traumatic, are biomechanical issues. Simply put this means that at some point during the movement your are performing, as part of that sport or activity, there is an issue with timing, balance, feedback, control (more about this later) or flexibility in either the joints or the muscles. The key to reducing or completely eliminating your ‘injury prone-ness’ is to identify where the biomechanical or movement can be improved, through a more structured screening procedure and then stick to the exercises you are given!
Easy eh? Biomechanical or movement screening, posture and running analysis are increasingly popular and are quite rightly, used more an more when someone presents with a niggle that wont go away. However, it’s important that you seek the advice of a professional who will screen you in the context of your sport or recreational activity as opposed to the more traditional more specific joint or soft tissue assessment. Video as a screening tool can be very effective and we use App’s that can slow you down and pause you mid flow – so to speak! It’s also useful for you to see yourself because it often makes sense of what you are physically feeling.
So back to the biomechanical issues! There are several key elements to normal (whatever that may be!) movement patterns, which minimise the risk of becoming injury-prone.
• Balance (eyes, ears, feet) – many of us understand our vision helps keeps us upright but did you know that the vestibular system (in our ears) and specialist sensory nerve cells in our feet are just as important? A loss of balance, even a slight loss, needs to be addressed because to avoid falling over the muscles can tighten to compensate and we reduce our how much we are prepared to move around (imagine trying to reach for shot an awkward shot in tennis)
• Joint feedback (proprioception) – via stretch receptors in the ligaments and capsule surrounding the joint, which constantly tell you where your arm or leg is in space and the position it’s in at any one moment. For example, in your ankle these receptors feedback to the muscles and joints in the hip/knee/foot about the type of surface you are training on to reduce the risk of a sprained ankle.
• Nervous system (feedback, instruction) – in other words your nerves. They are responsible for sending messages backwards and forwards from the body to the brain to produce movement. A lot of these movement patterns are pre-learned from an early age but they can be ‘re-learned’ – this is where a lot of the re-training occurs as our brain is very plastic – it can learn and develop new patterns with the right instruction.
• Muscular strength and endurance – this may seem obvious but endurance is often overlooked its not always about how strong we are but how long the muscles can keep performing the same movement over and over again
• Joint flexibility and available ‘controlled’ range of movement – so we understand that as a hurdler you need a great deal of hip and knee flexibility but often compensations occur, so the spine flexes and the pelvis tilts backwards to make up for a stiff hip but this may not be obvious to someone watching. Control is often confused with strength, in this context we want all the movement we need but under smooth muscular control as opposed to just being very flexible.
• Control and management of forces – can you land, jump, change direction, stop quickly, receive or strike a ball, be tackled and maintain yourself (your body’s) center of gravity or are you overbalancing? Can you keep all your joints in alignment whilst performing these activities? Often to improve these you need to work on one or more of the above first.
All of these different systems working harmoniously together, whatever the context (weather, types of ground surface, training alone or at a race or competitive event etc.), will mean you are much less likely to pick up a niggle, spend hours stretching or foam rollering after every event or training session AND will improve your overall performance (speed, distance etc). These different systems and structures are inter-dependant on each other and the interactions between them are continuous, happening in fractions of a second.
For some of us it is quite easy to pin-point why we have started to develop a problem, a new sport, increasing the distance, speed or frequency of our chosen activity, although often you either just rest for a while or just put up with it as surely its supposed to hurt when you do more? I always say yes of course you will get muscular soreness with any increase in training but it shouldn’t last for weeks on end. But what about those of us who are doing the same as we always have, why would we ‘suddenly’ develop symptoms? Our bodies are amazing and can adapt or compensate for a loss of flexibility, poor balance or less than optimal force management for weeks, months or even years. However, there is a limit to how much the tissue (muscle, joints or nerves) can tolerate this increase in stress or load and eventually, sooner or later you will receive your warning that this aren’t right! Whether its pain, more and more ‘injuries’, a loss of performance or tighter and tighter muscles.
Ok so what does all of this mean?
If we use an example of a 45 year old male weighing roughly 90kg jogging; when he lands with his right foot the ground reaction forces, ie how his foot, ankle, knee and hip respond to striking the ground needs to be as efficient as possible as his joints are supporting around 2.5 times his body weight at this point. That is a large amount of load for our joint structures however, it is totally manageable because it’s what our joints were designed to do.
Problems occur if one or more of the feedback, balance or control systems are not working together as efficiently as we need them too. For example, a common problem is the knee rolling inwards on landing his causing all of the 90kg bodyweight and muscular force to be transferred through the lateral aspect of the knee (the outside portion of the knee) rather than been evenly dispersed throughout the joint (see below). This may lead to the structures on the medial aspect of the knee (the inside aspect) to be “stretched” which can affect the structural and the joint position feedback (proprioception). This can lead to a constant battle with knee pain whether it’s ligament, cartilage (inside your knee) or muscular, you can see how he easily he could assume that he is “injury prone”.
So, can it be prevented?
Yes! Through injury prevention – not the most imaginative name.
Through biomechanical screening we can establish “injury prone” areas and provide expert advice and exercise prescription to prevent it. We take a personal history to see if you may have had other problems (could be from years ago) that you may not realise has contributed to your current situation (such as repeated ankle sprains, broken bones, surgery) and ask you to perform specific movements (which may seem unrelated at the time). We should reiterate the importance of seeking a professional’s advice who is experience at using screening as part of their assessments, scary ill-informed advice can significantly affect your confidence. Something we see very commonly in the above example is a ‘diagnosis’ of ‘over-pronation’ which is ‘corrected’ by a trainer that prevents the movement or a custom-made (often very expensive) insole (orthotic) (now we are not saying they don’t have a place!) however, this could be due to poor balance, fatigue in the leg muscles generally as he runs, poor control of the thigh/hip position from the hip muscles, not bending his hip properly when landing or a timing issue. A thorough screen looking at the whole body and each of these elements in turn will help identify where the issue is and so exercises can be directed very specifically to address it.
Throughout my time at the professional football/rugby clubs of the North West most of the players would have this initial screening done during pre-season to identify injury risks and they had a tailor made injury prevention program. This injury prevention program would then be completed every morning before training started. The better the program, the lower the injury risk.
If you are struggling with knee pain associated with running try our Top 5 Tips to help reduce your ‘injury-proneness’ for the knee:
1) What is your lunge technique like?
Have a look in the mirror:
• Does your knee roll inwards?
• Is your front foot flat?
• Are you dropping down towards the floor?
• Is your trunk relaxed & upright?
• Are your front toes & foot relaxed?
2) Squat with a ball
• Feet are hip width apart – knees in line with 2nd/3rd toes
• Sitting bones point to the floor
• Feel the thigh muscles & the bottom (glute) muscles tighten gently as you bend & then when you return to standing
• NO knee pain! – check your technique again!
• No tightening of your core / abdominal muscles required!
Did you know that poor balance directly affects how well the muscles around your hip & knee work? It’s not all about strength!
Just some ideas below – NO weight required! Try without shoes & socks
Key things to look for:
• Does your foot become stiff or the toes tighten to grip the floor?
• Are you still breathing?!
• Does the rest of your body feel relaxed?
• Is your knee locked straight? Try softening it a little
• Are your hips / pelvis facing forwards?
• Can you turn your head right/left or look up/down?
• Can you move one arm at a time up & forwards or up & out to the side?
4) The Clam
A brilliant exercise for strengthening the muscles (Glute Med) which holds the pelvis level when standing on the leg & helps to prevent the knee rolling inwards. This exercise always looks easy – it’s all in the technique.
A good test is to know if this is a good exercise for you is to see what happens when you stand on one leg:
If you look like picture B do the clam exercise below:
• Can you feel the hip on the side you are lying on?
• The movement is just the leg – no rolling backwards
• Are you holding your breath? Let it go!
• Mix up some holding the up position for 10 seconds
• Do 25 x 4 Slowly!
5) Stretches for the muscles that affect the knee
Stretches should not be painful – hold up to 30 seconds & the puling sensation should ease. If it doesn’t ease release the stretch slightly & repeat
If you have tried these or think you may need a second opinion then book one of our FREE Sports Injury Screening Assessments with either of us to find out how we could help you just call us on 0114 2749542
Chris, Nov 2015. 3 Most Common Running Injuries and Solutions. Running Performance Training. www.runningperformancetraining.com/common-running-injuries-and-solutions/
Michaud, Thomas C. July 2012. Development of the arch: Functional implications. Lower Extremity Review. www.lermagazine.com/article/deveopment-of-the-arch-functional-implications
Stach4W, August 2012. 3 ACL Injury Prevention Exercises for Women. Stack4W. www.stack.com/a/acl-exercises-women