With a team full of keen runners, we know how frustrating injuries can be, especially when you have an upcoming race!

With just over 6 weeks until the New Forest running festival, many of you will be entering a key phase of your training which will likely involve an increase in your total weekly mileage. This is an essential part of the training process which will allow your body to adapt to the demands of longer time on your feet. However, this is also a phase in which a lot of injuries can be caused by pushing too much too soon!

The team at South Coast Rx Physiotherapy have written this blog to outline exactly what causes an injury and how best to avoid them during this key phase of your training.

WHAT IS AN INJURY?

In order to understand how to prevent injury, we think it is really important to understand what an injury is in the first instance. In its simplest of forms, an injury can be defined as when load exceeds tissue capacity. This basically means when a force is applied to your body (muscle, tendon, ligament, bone or even nerve) and is greater than what your body has adapted to tolerate, there is the potential that something has to give!

Broadly speaking, there are two main forms of injury which are likely to be encountered by runners:

Traumatic: These are often the result of a contact injury in sport or a high impact accident. Typically, an external, high energy, high velocity force is applied to the body. Let’s take for example a rolled ankle when tripping on an uneven piece of pavement. This has the potential to apply a force, greater than what the individual’s ankle ligaments can tolerate. In this instance, level of strength, conditioning and athlete skill can not necessarily prevent the injury from occurring. This is an inherent risk of sport. Traumatic injuries are therefore difficult to prevent as they are dependent on external factors outside of our control. Sure, having a strong and stable ankle will help to prevent rolled ankles in general, but those one off accidents which result in excessively high levels of loading are very difficult to account for!

Non-Traumatic: This is the most common form on injury sustained by runners and one which typically occurs as a result of training error. Put simply, this is generally as a result of doing too much too soon! It is our personal bias here at SCRX that these injuries can be avoided. Examples of this type of injury are commonly seen in individuals who over-train in the context of their current levels of tolerance. This can be as simple as running a distance which you haven’t completed in a long time or having a big spike in training intensity eg. suddenly adding multiple hill sprint sessions to your programme. Although training hard certainly has its merits, if you do not systematically allow your body to rest, recover and essentially grow back stronger, you risk an injury.

At this point, it is important to note that the human body is incredibly strong, resilient and adaptable. These are the underlying biomechanical principles of what happens during an injury but in reality, the underlying cause of injury is very complex and multifactorial. Your diet, amount of sleep, psychological status, beliefs and expectations all have a large part to play in injury causation and recovery. However, if we train and build things up slowly there is no limit to what you can achieve. This is evident first hand, when you look at athletes such as Ross Edgely and David Goggins, who keep breaking unbelievable records and showing us what we are truly capable of achieving.

PREVENTION PROGRAMMING 

So now the important bit - How do you build injury prevention strategies into your programming?

Injury = Load > Tissue capacity

Training can be thought of as a balancing act between load and tissue capacity. You can use a variety of strategies to manipulate both load and tissue capacity in order to optimise your training and reduce the risk of injury. First up, let’s look at load.

The foundation underlying all effective programming has to be in its periodisation. Every training block needs to contain sufficient levels of progressive overload and rest, giving the body sufficient stimulus to drive adaptation to training with enough rest to recover from this.

In managing your training load it is helpful to have a framework to help you think about how much stress you are subjecting your body to.

One of the best ways to do this is with the Training Load Factor framework (TLF). 

It breaks training down into three components: 

FREQUENCY

The number of training sessions within a period e.g. 1 week.

VOLUME

 The amount of time during each training session e.g. 1 hour. 

INTENSITY

 The intensity of each training session (measured using rate of perceived exertion (RPE) on a 0-10 scale).  

 TRAINING LOAD FACTOR = FREQUENCY X VOLUME X INTENSITY 

 A good way to think about this model is that you can choose two components to emphasise and one to take it easy on. Hitting all three maximally could soon lead to overtraining, overloading your current tissue capacity and ultimately causing injury. On the contrary, take all three too easy and the stimulus of training may not be enough to drive adaptation and could lead to detraining. It sounds tricky, but through a little experimentation you will soon find the right mix for you, based on your training experience and goals. Remember to listen to your body and understand that everyone is one of us is different. As your experience increases, your body will adapt and you can start to increase your TLF safely.

If you want to train 6-7 days per week or even x2 per day (as many competitive athletes do), you need to reduce either the volume or intensity of each session. This could be through adding supplemental strength and conditioning work or including recovery low load sessions in your week such as cycling/ swimming/mobility work. 

On the other hand, some athletes prefer training at a lower frequency e.g. 3x week. Here, as long as you have given your body time to adapt, you can hit each session harder as you have time between sessions to recover. 

WE ADVISE PEOPLE TO TRAIN SMART AND BE PATIENT IN THEIR TRAINING. BUILD THE INTENSITY, FREQUENCY AND VOLUME UP SLOWLY AND LISTEN TO YOUR BODY.

DEVELOPING CAPACITY

Runners love to run and as a result we often find that a lot of runners don’t spend much time supplementing their training programme with strength and conditioning work.

In addition to running, this is a fantastic way to improve tissue capacity to tolerate greater loads and therefore contribute to reduced risk of injury. Supplemental training which focuses on developing the strength of the entire kinetic chain as well as improving tendon stiffness through plyometric loading can not only contribute to reducing risk of injury but also improving performance. A strength and plyometric circuit completed 2-3 x per week in addition to your usual running training can be a fantastic way of developing tissue capacity.

Keep an eye out on our social media accounts over the coming weeks where we will be releasing a strength and plyometric loading programme for runners, outlining how to recover from an acute injury as well as releasing some top tips from our affiliated elite athletes.  

We hope you found our blog helpful and if you have any questions or would like to know more about any of the topics discussed or would like any help with an injury, please send us a message via our contact us tab.

Good luck with training and we will see you soon!

 9/8/21

SCRX Team

Last week Cam and I were invited guests on the famous Legion Report. An epic podcast hosted by Ray Pharoah and Danny Hayter. We talked about injury prevention in not only sport, but how this can also be applied to everyday life. I think we could have gone on for hours on the topic (we all know how much Cam likes to talk), and it certainly brought up some really interesting points! It also highlighted to me how much we can all learn from each other. Ray brought up some interesting perspectives from a coach, and how adherence to injury prevention interventions can be difficult to ‘sell’ to members. Danny’s reflections as a patient himself, were also really interesting and how with experience, he has learned to listen to his body.  

This blog is intended to summarise those key discussions and to give some practical tips on injury prevention, as well as a useful resource to refer too alongside the podcast. 

What is an injury?

In its simplest of forms, an injury can be defined as when load exceeds tissue capacity. This basically means when a force is applied to your body (muscle, tendon, ligament, bone or even nerve) and is greater than what your body has adapted to tolerate, there is the potential that something has to give. Cam described this using a Christmas cracker analogy. You can pull on the cracker at both ends and the cracker will tolerate a certain degree of force. However, once you pull beyond the cracker’s tensile threshold, it will break, and you’ll get that paperclip and tissue paper Christmas hat you’ve always wanted. 

At this point, it is important to note that the body is a lot stronger, more robust and resilient than a cracker. We are simply trying to illustrate the point that if you apply a force greater than what you can tolerate you risk an injury. In reality there are a number of factors which come into play in an injury and this biomechanical illustration is just one. Psychology in the form of beliefs, perceived threat of the injury and past experiences all come into play. 

Equally we would like to add here that the human body has an incredible ability to heal itself. Take for example a high impact trauma resulting in a fractured bone. Here the bodies healing process actually forms a callus around the fracture and heals back stronger than before. The body is adaptable and truly incredible. If we train and build things up slowly there is no limit. This is evident first hand, when you look at athletes such as Ross Edgely and David Goggins, who keep breaking unbelievable records and showing us what we are truly capable of achieving.

Can an injury truly be prevented?

This is a really good question and there is no simple answer. I think it helps first to break injuries down into the two most common types.

Traumatic: These are often the result of a contact injury in sport or a high impact accident. Typically, an external, high energy, high velocity force is applied to the body. Let’s take for example a rugby tackle to the knee. This has the potential to apply a force, greater than what the individual’s knee ligaments can tolerate. In this instance, level of strength, conditioning and athlete skill can not necessarily prevent the injury from occurring. This is an inherent risk of sport. Traumatic injuries are therefore difficult to prevent as they are dependent on external factors outside of our control.  

Non-Traumatic: In contrast to above are 100% in our control and they are actually the more common type of injury. They typically occur as a result of training error and our personal bias here at SCRX is that these injuries can be avoided. Examples of this type of injury are commonly seen in individuals who overtrain. e.g. maxing out every session with very little rest days. These guys love being in the red zone, they hit sessions at a 10/10 intensity level, and we can all think of one or two in our gym. Although training hard certainly has its merits, if you do not systematically allow your body to rest, recover and essentially grow back stronger you risk an injury. This sounds so obvious but is very often overlooked. On reflection personally, it seems to me that often it’s the simple things, often least attractive, which make the biggest difference in life. This is one such example. 

At the other end of the spectrum, we often see the novice who starts a new sport and is super keen to train 5-6x week. Although this motivation is great, very often the rate of the bodies adaptation is not as fast, and we must be mindful of this. We have to patiently allow our bodies to adapt and develop the motor patterning and strength required for the demands asked of it. Ray made a great point which emphasised how often the most consistent, patient athletes make the biggest gain in the long term. We have to be mindful of the end goal and patiently chip away at it. Big spikes ‘boom – bust’ scenarios are not as effective and risk injury. 

We advise people to train smart and be patient in their training. Build the intensity, frequency and volume up slowly and Listen to your body.

Functional Movement Screening

 Functional movement screening (FMS) is a systematic screening tool which looks at seven objective measures of unilateral muscle strength, dynamic control and mobility. Such a screening method allows you to have a tailored pre-habilitation programme to work on, designed by your physiotherapist. This proactive approach is a great way to reduce your risk of injury. 

Let’s take CF for example. An FMS performed on an individual picks up reduced unilateral shoulder mobility on the right side compared to the left. If the individual is not aware and this impairment is not addressed, it has the potential to predispose the athlete to overhead injuries. 

More specifically, a limitation to overhead shoulder mobility may negatively affect their ability to efficiently lock out on the jerk in Olympic weightlifting. This may put a greater strain on certain structures of the shoulder as the barbell is likely to be caught anterior to the centre of mass (due to the reduced shoulder range on one side). This has the potential to exceed the tissues capacity (especially if repeated over time and over multiple high load repetitions). Not only this, but this inefficiency in technique will also mean the athlete is less effective in their lift and as their overhead lock out is limited, this will also affect their performance. 

Another example we discussed on the podcast was a squat. So many people are unaware that they favour one side and lead the lift with more weight either towards the right or left. This may be due to weakness in one leg or even down to reduced ankle mobility on one side. The cause can often be complex, but the FMS is really great at breaking this down. 

At South Coast Rx we personally believe the FMS is great tool to aid in injury prevention and helps make people aware of their weaknesses. However, it must be tailored to the individual and their sport. It is also important to emphasise that this will not necessarily prevent traumatic injuries as we discussed, but does have the potential to reduce the risk of injuries through training error through identifying areas of weakness.

Prevention Programming 

So now the important bit. How do we put all of the injury prevention strategies into your programming? This again is a tricky question and no single answer.

 The foundation underlying all effective programming has to be in its periodisation. This is something which Southern Legion does really well. Every training block is incremental following the principles of progressive overload, which gives the body time to adapt to the training stimulus. In addition, members at the Legion will note how at the end of each block their will be a de-load week before the next cycle. This is great programming as it gives the athlete’s body time to adapt and recover before the next cycle. 

Alongside our coach we as individuals also have a personal responsibility to be the judge of our training load and how intense we train. 

To do so it helps to have a framework to think about how much stress you are subjecting your body to. 

One of the best ways to do this is with the Training Load Factor framework (TLF). 

It breaks training down into three components: 

Frequency

The number of training sessions within a period e.g. 1 week.

Volume

 The amount of time during each training session e.g. 1 hour. 

Intensity

 The intensity of each training session (measured using rate of perceived exertion (RPE) on a 0-10 scale).  

 Training Load Factor = Frequency x volume x Intensity 

 A good way to think about this model is that you can choose two components to emphasise and one to take it easy on. Hitting all three maximally could soon lead to overtraining and injury. On the contrary, take all three too easy and the stimulus of training may not be enough to stimulate adaptation and could lead to detraining. It sounds tricky, but through a little experimentation you will soon find the right mix for you, based on your training experience and goals. Remember to listen to your body and everyone is one of us is different. As your experience increases, your body will adapt and you can start to increase your TLF safely.

If you want to train 6-7 days per week or even x2 per day (as many competitive athletes do), you need to reduce either the volume or intensity of each session. This could be through adding skill components which are performed at a lower intensity to strength training and metcons. Also including recovery low load sessions in your week such as cycling/ swimming or mobility is key. 

On the other hand, some athletes prefer training at a lower frequency e.g. 3x week. Here as long as you have given your body time to adapt you can hit each session harder as you have time between sessions to recover. 

As discussed above you must also make time for unilateral strength and mobility exercises. Ideally these should form part of your weekly programme. They could even be incorporated as part of your recovery, or weekly deload session, as these sessions will be lower in intensity. One stat which I found really interesting was that when compared to numerous different sports, body builders had one of the lowest rates of injuries. This I believe is in part due to their focus on unilateral strengthening which is targeted at individual muscle groups in comparison to a large compound movement. Compared to an average cross fitter, I would argue that body builders will be a lot more symmetrical in their unilateral strength and in this regards we can learn a lot from the Armies of the world. Maybe it’s time to bring back the bicep curls! 

Another benefit of incorporating some unilateral strength or functional body building type exercises into your programming is that the speed of contraction is slower and more controlled than the explosive CF movements. The slow control of unilateral exercises is great for improving body awareness and overall strengthening of the muscles, tendons and ligaments. Furthermore, if you can make your mobility and unilateral accessory training programme specific to your individual weaknesses and goals then this is even better! A tool such as the FMS will help you become more aware of such impairments and benefits of these interventions should not be overlooked!

We hope you found our podcast and this blog useful. As always if you have any questions on the content or want to know more about the FMS, please send us a message via our contact us tab.

 19/3/21

SCRX Team

Get Stronger. Optimise performance. prevent injuries.

As a musculoskeletal physiotherapist I would have to say shoulder injuries are one of the most common injuries I see. Whether the injury was sustained doing home DIY, at work, or in sport, in many circumstances these can be avoided.

Load management and the volume of work you are asking your body to do, must be something we consider before we take on hours of painting, throwing, or (in the case of cross fitters), high volume sets of kipping pull ups.

Take for example a marathon runner, you would not suddenly expect a person to be able to run a marathon if they have not taken time to strengthen their calves and patiently built up their mileage, allowing their body to adapt to the impact and stress imposed on their legs.

This same principle of progressive overload and adaptation applies specifically to shoulders. However, in my experience it is surprising how often this is overlooked. Now the specific diagnosis of any injury is always unique to the individual, and history of previous injury and psychology certainly come into play. However the principle of injury is in fact very simple and applies to us all.

An injury occurs when you have overloaded the muscle beyond what it can tolerate

So how can you avoid shoulder injuries?

1. Think of yourself as a professional athlete

Whatever your task is, ask yourself; have I trained my body up for this? If the answer is no, then consider breaking down the task into smaller amounts. For example, instead of painting the ceiling of every room in your house in one day, spread this out over several weekends. This will give your shoulders and body time to rest and recover from the new stimulus and help prevent overload. This of course sounds obvious, but I cannot emphasise how many people do not consider this when doing physical work or exercise. Another example is when performing high volume shoulder to overhead in the gym. You must ensure you have developed the necessary strength in the strict form, before you introduce high rep/ volume work under fatigue!

The famous fable of the tortoise and the hare can not be more true. If you take time to patiently build up your strength, you will win the race in the long term!!

Breaking up the amount you do, will mean your shoulders have time to recover and you can avoid a boom bust scenario. Like many things in life, this proactive approach is slower for sure, but in the long term it is more sustainable and will reduce the likelihood of you having to take time off work and sport through avoiding a potential injury.

2.      ‘LIFT, PRESS, PUSH, PULL, CARRY, HOLD, THROW’

 Functional strengthening of your shoulders and upper body will mean you can tolerate a greater load and volume of work, do more, and are less likely to get injured. This does not mean you have to exercise every day. Incorporating some simple and comprehensively targeted upper body exercises 2-3x a week can make all the difference.

The stronger you are, the more capacity your muscles have and the less likely your are to get injured

Below is a list of my personal Top 6 shoulder strengthening exercises. By no means is this list exclusive, but I like them because they focus on comprehensive capacity and work the shoulder as a whole. This type of training will better translate to all functional tasks and will also prepare you with a solid foundation to take on a range of sports.

As a guide, we recommend doing 2-3 sets of each exercise, working for 8-12 reps. Ensure you maintain good form and control throughout each movement. For the thoracic/shoulder mobility exercise at the end, we recommend holding this for 20 seconds.

Top 6 shoulder strengthening exercises

 

Rotator cuff

Exercise Description: Using a light weight, rest your elbow on your knee and rotate your shoulder upwards and back down. Make sure you take this nice and steady and don't rush the exercise. Key focus: Go through the full range of motion.

  Scapular Prone Dart

Exercise Description: Holding a light weight, bring arms back, squeeze shoulder blades together and hold for 2 seconds each rep. Key focus: Squeeze shoulder blades together at the top.

 

Unilateral Ring row

Exercise Description: Using the rings/ TRX, perform single arm pulls. The more horizontal to the ground you go the harder this exercise becomes. Key focus: Try to keep your hips & core parallel.

 

Reverse KB Overhead press

Exercise Description: Hold a KB upside down then press over your head. Key focus: Maintain stability as you press the KB overhead.

 

Tempo Closed chain stability press-ups

Exercise Description: Take 3 seconds to control the press up down to the floor, then hold this position for 3 seconds. Push back up at a normal speed. Repeat as prescribed. For a scaled version you can perform the tempo press ups on your knees. Key focus: Tempo means slow. Break these up as needed.

 

Thoracic/shoulder Mobility

Exercise Description: Stand with your palms against the wall – hinge backwards and feel the stretch in your upper back and shoulders.

Hold this position for 20 seconds. Key focus: Aim to push your shoulders back past your ears.

 We hope you have found this blog useful. Please note we do recommend seeing a physiotherapist first, if you have a specific injury, If this is the case you will require a specialist assessment and some of these exercise may not be appropriate for you. This resource is designed for people want to develop their shoulder strength and adaptability and in turn reduce their risk of injury. We also hope the importance of load modification in injury prevention has been emphasised, as this is such a key factor.

If you are after a more comprehensive shoulder strengthening & injury prevention programme, we do have a progressive accessory & mobility 4 week programme for sale £20.00.

Send us a message via our contact us page and we will be able to give you more info on how to access this resource.

Prevent. Revover. Sustain.

21/01/21

SCRX Team