Nerang Physiotherapy

The difference is obvious

A common misconception with a lot of sports injuries is that the problem/injury began when the initial pain was felt. What this does is lead to treatment or investigation of the injured area, and no assessment of other possible involved areas. Sports injuries are generally simple to treat, however, it becomes complex when the focus is on the site of injury and not on the whole bio-mechanics of the body.

What this is saying is that something like a hamstring strain might not be a hamstring fault, merely the end result of a series of changes that have been taking place in the body to compensate for overuse or incorrect exercises. Let's look at such a sequence. If a sports person trains regularly, without sufficient rest periods, then there will be a time when the body cannot manage the amount of load put on it. As I have mentioned before, the Autonomic nervous system (ANS), which controls the amount of blood reaching the muscles, will become fatigued from over-demand. This results in poor blood flow rate to the relevant muscles, causing stiffness and weakness. In the case of the hamstrings, the initial muscles affected will be the hip muscles. They support the leg and allow the leg muscles to operate comfortably due to a strong base set up by stable hip muscles.

If, due to poor blood flow rate, the hip muscles become weak, this forces other surrounding muscles to compensate to maintain some form of balance and function. These muscles include the back muscles and the thigh muscles (quadriceps and hamstrings). This compensation results in the hamstrings working too hard and the harder they work the tighter their fascial sheath (the 'skin' of a muscle which allows it to function strongly) becomes. The tighter the hamstring sheath gets, the weaker the hamstring gets, and it is then an injury waiting to happen. So, even normal activity done regularly can result in a tear of the hamstring or a strain of the sheath. But as you can see from above, it is not directly a hamstring fault, the hamstring has become the victim of overuse and higher muscle imbalance.

Treatment of the hamstring and not the ANS and hip muscle imbalance will result in incomplete recovery, despite the hamstring feeling better. A lot of sports persons often complain of not feeling 100% after they have been discharged from Physiotherapy or Doctor/Specialist, and it is mostly because the true cause of the problem has not been assessed or treated. This can lead to recurring injuries in the same area, or even injuries in other areas that are compensating for the same original imbalance.

It is always a bit hilarious in my business to hear of sports injuries being treated with exercises, as often the cause of the injury in the first place is exercise! I understand the concept, however, if you observe any other animal that has been injured, you will NOT see them exercising, running around, until they sense and feel the injury has recovered enough to be able to slowly test it and get moving again. They rest, sometimes rarely eat, but drink to stay hydrated, and allow the body to focus as much energy on the healing process and less on other forms of activity, including digestion. Most sports injuries are either caused by changes in the soft tissues or affects the soft tissues,and if this system is not treated, recovery will not be full.

It is my belief that similar sports injuries will recover at different times in different sports persons mainly because of the history behind the injury. If the body had been compensating for a long time before the injury occurred, then the time of recovery will be slower. It is common that treatment is not only treating the injury but also the history prior to it. However, most treatment tends to revolve around the injured site, including specialist investigation. These often pick up small tears in the site of the injury, but this is quite obvious, as the area has been under excessive load compensating for an imbalance somewhere else. I believe surgery should be the last resort not the first in many injuries (obviously serious tears will require repair surgically), but so many are treated in this way unnecessarily in my opinion. And to add to that it still does not solve the problem of the original imbalance as seen above with the hamstring example!

So what can be done to prevent injury? Well there are a few things that are good for prevention, and this includes the following:

• Ensure sufficient recovery phase. I read a great comment from a sports scientist at Loughborough University in the UK who said, "You don't get fit through exercising, you get fit through recovering from exercise". This means the rest in between exercise sessions is more important than the exercise itself. It has been shown muscles and soft tissues will get damaged in activities of a physical nature and require time to recover, but also the immune system is stressed, and has been shown to drop below normal levels for 48 hours post-exercise. This means your health is in jeopardy for this period of time. The more you train without rest, the weaker your immune system will become. Try and allow a 48 hour period between exercise sessions to allow full recovery, which will also ensure you start off on a good foundation the next time and you do not waste energy exercising while recovering.

• Stretch! This is an understated preventative measure. So often I see sports persons 'warming up' before stretching, or just getting straight into the sport without any stretch. The concept of stretch is that we are stretching muscles, and thus it is advised we warm up first. However, this concept is different when we talk of the soft tissues that surround the muscles and allow muscles to function, i.e.fascia. Stretching lengthens this mainly inelastic sheath/tissue inside which the muscle is passively stretched, thus the limit of the stretch is not set by the muscles but by their sheathings. So overstretching is quite common if we believe we are stretching muscles, as the soft tissue will become irritated and respond by tightening up, possibly painfully. With my work in fascia over many years I have come up with a method of stretch as follows: Relax the area being stretched, stretch the area till the point you feel teh 'stretch sensation' or the first sign of resistance, STOP there, hold that position and wait till you feel the 'stretch sensation'/resistance ease. This is the soft tissue telling you it has let go. Counting does not come into it, feeling the release does. Do this once per area necessary. Now you are ready to warm up, as your muscles can now receive better blood flow, have more space in which to work and are less likely to become damaged.

• Do not over-exercise. One of the reasons the top sports persons do not have a lengthy career in their chosen sports in my opinion, is because they train too much! I believe a rugby player, for example, would be able to play almost every weekend of the year, but only if they train less during the week. Training twice a day, four days a week during weekend games cannot be sustained for any lengthy period of time by anyone. I have seen too many people exercise too much and one day everything just goes south. Despite trying to increase the training, they still are unable to increase performance, and pain and injuries start to increase. And yet, it is surprising how they still feel they should be exercising more! I have advised runners training for marathons to train no more than twice a week, and they have improved their times and been injury-free! Hopefully we will soon come to our senses and understand the way the body prefers it, i.e.less is more. Try reducing your time spent exercising and increase your time recovering, and you will be pleasantly surprised at your ability to increase your workload quicker, prevent injury and perform better.

• Stay hydrated. One of the most common causes of injury is dehydration, and one of the most common causes of this is the energy drinks available. Water is what our body is made of, NOT sugar! All the talk of 'scientific' research is a cover-up for selling a product to you that does nothing more than give you a quick fix in your sugar levels, but does little for your water loss. Anytime you mix something with water it becomes a 'food', which means it takes six times longer to get the water in your system as it would if you had plain water.The reason is the body has to digest the drink, separating the 'chemicals' from the water. This takes time and the substance is in your stomach longer than it should be, while water moves very quickly through the stomach and into the blood stream. So, where possible, avoid energy drinks, drink more water and keep your muscles and brain functioning at top levels.

Other areas to look into include eating well, taking supplements to assist recovery, e.g. glucosamine, chondroitin, MSM, multivitamins, etc. Look after your general health and please don't think that exercise will make you lose weight if you don't alter your food intake at the same time. You don't put on weight because you don't exercise, you put on weight because you eat too many carbohydrates! (see here for more details)

Sports injuries can be prevented, but if they occur, they can be treated, mostly through correct assessment and an understanding of the sequences of injury. Enjoy your sport!