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Strategies for injury prevention

Fit to be Tried
By: Julie Young Journal Columnist
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For this first article in a series on injury prevention strategies I interviewed two rehabilitation and conditioning professionals — Laura Snow, physical therapist and co-owner at American River Rehabilitation; and Darcy Norman, a licensed physical therapist, certified athletic trainer, and certified strength and conditioning specialist with Athletes’ Performance. Before we dive in to this subject, just a quick reminder, in order to communicate we express in absolutes. The key is to take these absolute concepts and make them relative to our individual experience. That said, here we go… Injury prevention in athletics is the most effective ways to insure consistent progress and performance gains. Through my experiences as an athlete, coach and trainer, knowledge gained with continuing education and recent interviews I offer three cornerstones of injury prevention – a shift in training mentality from more is better to a balanced, integrated approach is better; fundamentally sound biomechanics; and understanding and patiently respecting the training process. Both Snow and Norman agree, injury prevention starts with a science-based, systematic progressive training plan. A solid training plan focuses on sport specific training, but also includes foundational activities that insure the athlete possesses the strength, mobility and stability to train safely and effectively. Generally speaking, endurance athletes would benefit with a mind shift in regards to training, away from a more mentality toward balanced integration. This philosophy carves time out of the sport-specific training to allow time for functional movement oriented movement prep, core stability, single leg strength, and hip stability and mobility exercises, as well as stretching and/or yoga. As we have discussed in previous articles movement prep activates the muscles and nervous system in preparation for the specific activity. An effective core stability program trains a strong pillar posture and the ability to maintain that posture through movement – essential for efficient generation and translation of power to the extremities. Single leg strength exercises improve imbalances and asymmetries, which if not corrected are culprits of injury. Hip mobility and stability insure sound biomechanical movement. Glute activation and hip stability effectively control movement, and efficiently alleviate the small stabilizer muscles, which lack endurance, from doing the work. Stretching and yoga improve asymmetries and range of motion facilitating the body’s harmonious efficient movement. Injury prevention and performance gains also rest on the endurance athlete’s willingness to take that leap of faith from a training plan that consists primarily of slowly, sloppily, slogging more and more miles to adding systematic balanced integration of quality sport specific workouts. Training for endurance events is more than covering long distances. Endurance athletes who follow a more is better plan with little structure, intensity and rest – suffer greater overuse injuries, sickness, as well as performance plateaus. To help insure injury prevention, it is valuable for athletes to follow a progressive, yet gradually developed sport-specific plan based on his/her current fitness and training, and future goals. In addition to pure endurance days, this plan includes speed and intervals, to fine tune economy of movement and train the lactate buffering, aerobic, anaerobic and nervous systems. Rest and recovery days and weeks take equal priority and demand as much diligent respect as workouts. The emphasis on the quality versus quantity approach appears to be a trend amongst the elite endurance athletes who have experienced fewer body break-downs and improved performance gains. I asked Snow, what is the number one pattern she sees that leads to injury in endurance athletes, she replied, “Easy answer, too much of a good thing… high volume, lack of recovery time, sudden increase in volume and intensity.” Norman echoed the sentiment, “We always overdo. We ask ourselves, how much more can I do rather than what is the least I can do to receive the maximum benefit.” Another valuable training plan ingredient for injury prevention is out-of-season and in-season supplemental training. For example, it is advantageous for a runner to supplement cycling on one of the week’s scheduled endurance days, which will contribute to the overall endurance base, while affording the benefits of mental and physical variety, and joint and muscular strength. Supplemental training is also effective for active recovery – I like to incorporate an evening low intensity, technique-focused swim following a morning intensity run session. In order to possess sound fundamental biomechanical movement, the second cornerstone of injury prevention, we must first possess a foundation of strength, stability and mobility. This relies on efficiently functioning hardware and software systems – musculature, bone, tendon, ligament strength and the nervous system, respectively. Norman says, “There is a trend that endurance athletes, especially runners, expect to be hurt at some point or several points in their careers. But if you have a sound program and mechanics, injury is 100 percent preventable. Running is not an impact sport – things and people are not purposefully hitting you, you can prepare for the impact. Everyone talks about biomechanics and economy of movement, but first and foremost you must develop a foundation of strength, stability and mobility. Once the foundation is established, movement prep with emphasis on glute activation and drills, reinforced and trained via intervals will develop efficient, sound mechanics.” Professionals advise to stick with science-based biomechanical information and then make that information individually relative. They also remind us a little knowledge is dangerous – it leads to thinking in absolutes and taking concepts to the extreme, with expectation of immediate transformation and results. This all or nothing approach in runners has, according to physical therapists, led to increased injuries. Therapists have seen an injury trend with runners taking the “new” running styles and minimalist movement to the immediate extreme attempting to reinvent their gait overnight. There is certainly validity to these techniques and they can be safely and effectively trained, but it is beneficial to employ a network of professionals, possessing a broad base of knowledge to assist in sound, safe biomechanical re-training. The final cornerstone of injury prevention is to understand, appreciate and enjoy the training process. An athlete who takes responsibility and understands the “why” of the plan profits with clear purposeful training. Training is an investment that demands patience and respect of the process, driven by a love of it. Athletic achievement is not an overnight proposition, it is daily dedication. If we change our perspective of our endurance training to a daily opportunity for mental and physical empowerment, we remove the sense of urgency that tempts us in to the cram-session, cut-corners, cart-before-the-donkey approach leading us down the path to injury. I may have strayed off subject or stumbled upon the realization that injury prevention strategies offer a metaphor for life – balance, variety, back to basics, and remaining present to appreciate the journey. Subsequent articles will focus on the benefits of pilates, yoga, nutrition and massage as injury prevention strategies for endurance athletes.