Some thoughts on sports injuries

Annoyingly i seem to have picked up a mild wrist injury. Nothing serious but painful enough to stop me fully participating in my sport of choice - Olympic style weightlifting. There is never a good time to be injured, and it can sometimes lead one to wonder why you bother giving up so much time and training so hard for something, when the rewards are so minimal. Therfore i thought i would share some of my current thoughts on sports injuries, how they may be broadly classified and how to begin thinking about managing them. 

running injury knee

Broadly speaking, sports injuries can generally be classified as either:

  • Over-loading
  • Under capacity 
  • Biomechanical errors
  • Shit happens

Over-loading and over training is common feature of tendon and ligament injuries and stress fractures. These tissues take time to adapt to training, sometimes years. The sudden increases in exercise volume or intensity that frequently occur after Christmas, in spring or the run up to holidays can push them past their capacity and they begin to complain. The key to dealing with this type of problem is to de-load, allow the pain to settle and then gradually build up more intelligently with gradual incremental increase of load, volume and intensity. Reducing the load and conditioning the body so that it is able to tolerate exercise better is the key to managing this type of injury. Seeking the advice of a professional personal trainer or physiotherapist who specialises in sport can also be useful here.

Under capacity of the tissues overlaps with over-loading. In this instance the tendons, ligaments or what have you are just not up to the demands of the activity full stop. The common picture is the middle aged gentleman who decides to return to play 5 a side on a Sunday, hasn't sprinted in years, still thinks he is 21 (we are all still 21 in our heads) and is surprised to learn that his Achilles tendons just aren't up to the job of sprinting across a football pitch. Explosive and dynamic exercise is the culprit here, and the demands upon the tendons are massive. Treatment here consists of dealing with the immediate pain / swelling / dysfunction and developing a progressive loading program to build capacity of the tissues. Seeking the advice of a professional personal trainer or physiotherapist who specialises in sport can also be useful with these first two situations.

Management of Biochemical errors is where physiotherapists really come into their own ! If the cause of your running related knee injury is a pelvic imbalance, then no amount of relative rest or load management will provide a long term solution. We often bumble along with these problems for years, trying to increase running volume for instance but never able to get further than 12 miles because of that blasted iliotibial band pain in the knee ! These conditions need careful assessment and management and are amongst (for me at least) the most rewarding to treat.

Accidents happen. We have good days and bad days. Your running on the fells, you turn your ankle and bang its a sprain. these cant be foreseen. Shit happens. By and large, they will usually get better with the correct acute management.

Now the interesting thing about these four categories of sporting injury is that they frequently occur concurrently, often over a time scale of years. Commonly we see patients with what looks like a simple acute calf tear (file under shit happens), only to find out that have an old hip injury which has left them with residual weakness in the gluteals (biomechanical errors) but they never noticed because they have just decided they are too fat and have started running 3 miles every day (under capacity AND over loading). 

This is where the really interesting work begins.......