Overuse Injuries? Think Again

July 17, 2019

The Role of Training Errors in Sports Injuries: A Focus on Running


Sports injuries and the factors that increase the risk of sports injury can be very complication. However, one thing that has been consistently identified in scientific study is that training errors directly increase the risk of injury. 


While this post will mostly focus on running injuries, the training principles it discusses are relevant to any athlete, coach or clinician such as a physical therapist who works with athletes.


Sports injuries can be divided into two main types:  traumatic injuries and so-called overuse injuries.  Traumatic injuries are the result of tissue failure after a single application of force, such as a sprain, strain or fracture; while overuse injuries are the result of repetitive force placed on tissues over time without allowing for recovery 


Unfortunately, it is a commonly believed (especially by physical therapists and trainers) that abnormal posture may lead to running injuries, particularly “overuse injuries”. Although this may seem like common sense, body anatomy varies greatly between people and there is actually no evidence that abnormal posture leads to overuse injuries, even among elite athletes. In addition, other factors such as the use of orthotics in the shoes, decreased range of motion, warm-up exercises, muscular imbalances, skill level and running frequency have not been found to have a direct correlation with injuries. 


The Importance of Training Errors in Injury Prevention


In the running world, about 70% of all injuries have been shown to be associated with training error.  The training error most closely tied to overuse injuries is underestimating the principle of recovery and adaptation. If in fact all overuse injuries were correctly classified as such, then all runners (and all athletes more generally) would be injured at the same point in training. Therefore, the assessment and treatment of athletes for “overuse injuries” must be re-examined. It is necessary to understand both the training program and the mechanical factors that led to the injury, as well as the biomechanics that contributed. This way sports performance professionals can help athletes rehabilitate well and return to sports safely. 


Physiologically, a stimulus applied to tissues (such as a muscle, tendon, etc.) will initiate a response at the cellular level, resulting over time (with sufficient recovery) in an adaptation.The adaptation will lead to an increase in tissue strength and response. Here is a simple example: if a basketball player jumps 20 times on Monday, applying mechanical loading  to the calf muscles, in an effort to return from an ankle sprain, and then rests for two days (adaptation and recovery), by Thursday the basketball player will be able to jump more than 20 times, as his/her calf musculature will have adapted to the stimulus received on Monday. 



As these types of under-recovery injuries are caused by stimulus during training, training is also their solution. But it must be training that takes into account balance between stimulus and adaptation (and recovery). This balance must be determined wisely (depending on the sport) to promote healing and increase the demands of the sport. Ignoring this balance will result in injury, as the stimulus will exceed the rate of adaptation. 

In summary, the tissues in the human body are able to respond to stresses placed on them in sports by recovering and adapting amazingly well.


August 12, 2024
Cupping therapy is an ancient technique that has been integrated into modern physical therapy to help alleviate pain, reduce inflammation, and enhance overall recovery. In my practice, I use cupping as part of a holistic approach to treat muscle tightness, improve blood flow, and accelerate the healing process. How Cupping Works: Cupping involves placing specialized cups on the skin to create suction. This suction helps to lift the skin and underlying tissues, promoting increased circulation to the affected area. The improved blood flow aids in reducing muscle tension, breaking up scar tissue, and encouraging the body’s natural healing processes. Benefits of Cupping Therapy: – Pain Relief: Cupping can help reduce muscle soreness and pain by releasing tightness and promoting relaxation. – Enhanced Recovery: By improving blood circulation, cupping accelerates the removal of metabolic waste from tissues, leading to quicker recovery times. – Flexibility and Mobility: Regular cupping sessions can improve joint and muscle flexibility, making it an excellent addition to your rehabilitation or performance enhancement program. What to Expect: During a cupping session, you may feel a pulling or stretching sensation as the cups create suction. It’s normal to experience some mild bruising or redness at the treatment sites, which typically fades within a few days. I ensure that each session is tailored to your specific needs, targeting areas that will most benefit from the therapy.
August 10, 2024
Blood Flow Restriction Training (BFRT) is a rehabilitation technique used to enhance muscle strength and growth by applying a cuff to partially restrict blood flow to a muscle during exercise. This method allows patients to gain the benefits of muscle hypertrophy and strength gains using low-intensity exercises. In physical therapy BFRT is particularly advantageous in settings where patients are recovering from injuries or surgeries, as it reduces the mechanical load on joints and tissues, minimizing the risk of re-injury.  The benefits and advantages of BFRT include: Muscle Strength and Growth : BFRT promotes muscle hypertrophy and strength gains even with low-intensity exercise, which is crucial for patients who cannot engage in high-intensity workouts. Accelerated Recovery : By enabling effective training at lower intensities, BFRT helps maintain muscle mass and strength during periods of limited mobility, aiding faster recovery. Reduced Joint and Tissue Stress : BFRT allows for significant muscle engagement without the high loads that could strain joints and soft tissues, making it suitable for patients with orthopedic issues or those recovering from surgeries. Versatility : BFRT can be applied to various body parts and adapted to different exercise modalities, making it a flexible tool in a therapist’s toolkit. Enhanced Safety : The low-intensity nature of exercises performed with BFRT reduces the risk of overtraining and injury, providing a safer rehabilitation option for patients at different fitness levels.
August 10, 2024
Force plates are a valuable tool in physical therapy, offering a range of benefits that enhance the quality of care and outcomes for patients. Here’s a detailed explanation of their advantages: – Objective Data Collection Force plates provide objective, quantitative data on ground reaction forces, which are essential for understanding how a patient’s body interacts with the ground during various activities. This data is critical for accurately assessing biomechanical performance and movement patterns, such as gait, balance, and jump dynamics. Unlike subjective assessments, force plates offer precise measurements, which lead to more accurate diagnoses and treatment plans. – Enhanced Assessment and Diagnosis With the detailed information force plates provide, physical therapists can identify subtle imbalances and asymmetries that might not be visible to the naked eye. For example, discrepancies in how much force each leg produces can indicate underlying issues, such as muscle weakness, joint instability, or improper technique. Early detection of these issues allows for timely intervention, potentially preventing more severe injuries. – Personalized Treatment Planning The data from force plates enables the creation of highly individualized rehabilitation and training programs. By understanding a patient’s specific movement deficiencies, therapists can tailor exercises and interventions to target these areas. This personalized approach increases the effectiveness of therapy, as interventions are specifically designed to address the patient’s unique biomechanical profile. – Progress Tracking and Outcome Measurement Force plates facilitate the objective tracking of a patient’s progress over time. By regularly assessing changes in force production, symmetry, and other key metrics, therapists can evaluate the effectiveness of treatment interventions. This ability to measure outcomes quantitatively helps in refining treatment plans and ensures that patients are making measurable improvements. – Injury Mitigation and Performance Enhancement For athletes and active individuals, force plates are particularly valuable for optimizing performance and preventing injuries. By analyzing the forces involved in specific sports movements, therapists can identify risky movement patterns that may predispose an athlete to injury. Interventions can then be designed to correct these patterns, enhance performance, and reduce the risk of future injuries. – Comprehensive Documentation and Communication The data collected from force plates can be documented and shared with other healthcare providers, coaches, or trainers, fostering a collaborative approach to patient care. This comprehensive documentation supports a continuum of care, ensuring that all parties involved have a clear understanding of the patient’s condition and progress. – Patient Education and Engagement Visual and numerical data from force plates can be a powerful tool in educating patients about their condition. When patients see the objective data, such as force distribution and asymmetries, they often gain a better understanding of their issues and the rationale behind their treatment plan. This understanding can enhance patient compliance and engagement in their rehabilitation process. Incorporating force plates into physical therapy practice elevates the standard of care by providing precise, objective data that enhances assessment accuracy, personalizes treatment plans, and tracks progress. This technology not only aids in injury prevention and performance enhancement but also fosters better communication and education, ultimately leading to improved patient outcomes.