The global pandemic, lockdowns, and work-from-home directives have been proceeded by the meteoric rise of interest in exercise and sports. Weary from having to stay at home, restless from inactivity, and increasingly aware of the incredible benefits of cardiovascular and muscular exercise and sporting activities, many millions of people around the world have committed themselves to regular physical activity and have sustained their efforts. This phenomenon is not an exception where I live, and this documentary below explores it along with the rise of the fitness industry rather well.

With the rise of exercise and sports, however, comes the heightened risk for injury. Getting into a new sport or physical activity can be exhilarating, especially for people who have been sedentary for a while prior and have discovered how good the act of moving one’s body can feel. And, as the documentary above shows (@33:00), lots of people are getting overuse injuries that can take months to heal, cause unwanted pain, possibly turn chronic, prevent the person from returning to doing the things they enjoy, and lower their overall quality of life.  

As far as possible, no one wants that to happen, to themselves or others. It would be like getting a car as a gift and crashing it in the first week, losing the car and one’s legs in the process, such that one could never drive (with legs) again. There is an ocean of literature about injury prevention in exercise and sports. Professional sports invest tons of money to research injury prevention protocols, coming up with routines such as the FIFA11+ which is designed to lower the risk of injuries such as ACL tears and other injuries common among professional football players. But this information is rarely sought by new and eager exercise enthusiasts or communicated properly to them by industries that are more concerned about profiting off their subscriptions.  

The two big factors that contribute to overuse injury risk are volume (e.g., running every day for weeks or months with no rest when previously you never ran at all) and repetitive suboptimal movement (e.g., pulls ups in bad form without any variation in intensity, velocity, grip position). Anyone getting into some new sport or exercise routine would likely be doing it often, repetitively, and likely also with bad form or posture. These contribute to the statistical and anecdotal rise of sports-related injuries among people who aren’t of sports pedigree. What then can we do to prepare ourselves for our newfound sporting and exercise activities without destroying our bodies and regretting it decades later when the pain from our injuries turns chronic?  

The first thing we can do is to find out more about our sport and determine if research has been done on injury prevention best practices. Typically, people who play sports at a professional level adhere to some physical conditioning protocol, so that their bodies are strong enough to resist injury when it is being stressed by the sport. Paradoxically enough, to reduce the chances of injury, you must first have conditioned your body well enough for it to take sporting loads that are necessarily of lower intensity. For example, if you sprint when playing football, you should be able to sprint faster than that in your physical conditioning training. This will look different for every sport, but the bottom line is that you should progressively expose yourself to training loads that are greater in magnitude than sporting loads.

Getting strong takes time, but if you are consistent, the appropriate adaptations will occur. Find out what kind of conditioning routine should go with the sport you have chosen. If it is an established sport, there should be lots of literature on it.

The second thing we can do is to commit to a proper warm-up routine before engaging in our chosen sport. Warmups do several things, including but not limited to recruiting our muscle fibres so that they are ready to try hard. When warming up, muscles and tendons are heated beyond their normal resting temperature, becoming more elastic and resistant to tearing. Warmups should be more dynamic than static (not a hard and fast rule), and their intensity should be sustained at around 70 percent of the actual activity for optimal influencing of connective tissue. Anything below that is a waste of time. For example, if you are warming up for a fast run, a leisurely walk isn’t going to help. Try this instead:

Done well, warmups not only prepare you physically for the activity, they improve your performance too. People who grew up playing team sports at a competitive level probably know this well. Others don’t have that experience and may therefore feel self-conscious about warming up when no one else is warming up either. In some sporting activities, there is even a culture of making fun of people who warm up. All I can say is, if you stick with a good warm-up routine, you’ll be the one having the last laugh when you’re still able to enjoy your sport at a fulfilling level of intensity and skill at an advanced age, while others cannot.    

Dr Tyler Nelson, whose credentials can be read below,

Dr Tyler Nelson is a recent graduate of Logan University, obtaining his doctorate of chiropractic medicine in April of 2014 and his masters in exercise rehabilitation in September of that same year. He completed his masters internship at Brigham Young Universities under Brett Mortensen and is currently one of the chiropractic physicians for the BYU athletics department. He is currently dry needling certified and trained in sport’s performance rehabilitation with an emphasis on functional movement and neuromuscular re-education. He received his Certified Strength and Conditioning Specialist certificate through the NSCA in 2015 and enjoys writing strength programs for athletes in the Salt Lake valley. Currently Tyler is an adjunct faculty member at SLCC where he teaches human anatomy and physiology. His primary interest is in neurobiological pain science and furthering the protocols and guidelines created for treating chronic spinal pain.

recommends several components to be present in a good warm-up routine for sports that require whole-body movement. They are listed here:

• Strength component. The focus is force production. Increasing force production requires a slower and more controlled movement.
• Balance component. The focus is coordinating muscle groups around the core and extremities for movement efficiency. Increasing balance requires variable speeds of movement.
• Flexibility component. The focus is total available range loading, not static stretching, which reduces force output.
• Agility component. The focus here is moving in multiple directions at multiple speeds. Think about muscle lengthening (eccentric deceleration) while under control.
• Plyometric component. The focus here is full readiness for sports participation. The ability to absorb forces, produce opposing forces rapidly, and change the direction of those forces.

Injury prevention is better than cure. The greatest predictor of injury is former injury. So, not sustaining injuries is ideal. And having a strong body as well as sticking to proper warmups are some good protocols to adhere to. But what happens when you do get injured? The first thing to do is to assess the extent of the injury. If the injury is serious enough to merit immediate medical attention, e.g., you can see bone sticking out of the flesh, self-assessment isn’t necessary. The majority of sports-related injuries, however, lie somewhere between a minor tweak of a ligament to a major fracture of a bone, and those serious about physical activity will, at some point, encounter scenarios where they have to play guesswork with their injury, i.e., what kind of specialist to see, or not see a specialist at all, and how to rehab the injury in any case.      

The current understanding of tissue recovery divides it into three stages, starting with inflammation, then proliferation, and finally, remodelling. Right after an injury, whether acute or gradual onset, blood flows to the injured site, causing redness and swelling. Such inflammation may look bad and feel painful, but inflammation is a necessary part of the healing process. Back off from straining that part of the body. Depending on the severity of the injury, the acute inflammatory phase normally lasts between 1-7 days. After the swelling and pain go down, the body sends new tissue in the form of collagen fibres and other cells to replace the injured tissue. There will still be pain and irritation in this phase, which can last from 6 days to 6 weeks. Consistent rehab exercises are necessary to smoothly transit to the next phase, the remodelling phase. In the remodelling phase, the tissue is being remodelled to become as strong as it can be before the injury. This can take any time between 12 weeks to a year, depending on the tissue. Improper use of the affected area during the remodelling phase will cause reinjury. This often happens when overeager individuals, losing their minds at not being able to play their sport, reinjure themselves by going back to play again too early. At every step of the recovery process, close monitoring of pain and consistent progressive rehabilitation is vital if the injured party wishes to return to similar levels of intensity in his or her chosen sport.   

Different kinds of tissue heal at different rates. Muscles take 6-8 weeks to heal. Bone injuries, 6-8 weeks as well. Tendons have less blood supply, so they can take 8-12 weeks. Nerve injuries are highly variable, they can take several weeks or never heal at all. Joints take 4-8 weeks. Whatever part of our bodies is injured, we can use some acronyms to help with our assessment. The first is SINS: severity (pain level), irritability (what sets the pain off), nature (sharp or dull), and stability (is it getting better over time). If the pain is high, is set off by almost anything, is sharp, and does not get any better over a week, time to see a doctor. Pain serves to alert us to danger, but pain can sometimes continue long after its usefulness as a protective agent, as is the case with chronic pain. All exercise injures our tissues microscopically, and this causes pain. So, some pain (= discomfort) must always be tolerated when exercising or playing sports. If there is no pain (= discomfort), you are not exercising. You are just moving your body. Delayed onset muscle soreness (DOMS) is also normal and should go away after several days. DOMS that doesn’t go away after several weeks is a red flag. Finally, one person’s small irritation is another person’s intense suffering. The bottom line is that pain is subjective. Therefore, careful, life-long attention to pain and how it changes are probably the only ways to separate the signal (i.e., you need to do something about it) from the noise (i.e., it’s nothing to worry about).

https://www.youtube.com/watch?v=YMGM6reaMVI

The next useful acronym is POLICE: protect, optimal load, ice, compression, and elevation. The recent scientific literature on injury recovery has revealed the importance of optimal loading for successful rehabilitation. Unless a bone fracture is involved, you should start rehab exercises as soon as the inflammation phase is over, i.e., pain and swelling have decreased. These appropriate rehab exercises – for example, eccentric exercises for tendon pain – may produce some discomfort and fear, but you must get past them to successfully manage the injury. Tolerate only small amounts of pain and constantly monitor it to ensure that you are not under or overdoing your rehab work. Rehab exercises tend to be low in intensity and high in volume, meaning they are easy to perform but have to be performed something like 20 minutes three times a day every day for months.  

If you have decided to get medical attention for your injury, see a sports medicine specialist, even better if the specialist is specialised in the sport that got you injured. Doctors tend to see injuries through the lens of their discipline and may recommend interventions that they are familiar with but aren’t the most useful or meaningful option for you, like invasive surgery. Often, they have different goals from you too. They want you functioning again, but you may want much more, i.e., to be able to play your sport at the highest levels again. Only you have your best interest at heart, and so you must be the manager of your recovery. Go to your doctor prepared with research to discuss options and to clearly explain your intention to not only recover from the injury but to regain full strength and range of motion for your sport.   

Your doctor or therapist may recommend certain interventions such as painkillers, or physiotherapies such as deep transverse friction massage, ultrasound, sports massage, dry needling, trigger point therapy, heat, ice, electrical stimulation, and more. These all act directly on pain-sensing pathways in the nervous system and can therefore offer effective short-term relief. But there is little evidence that they have any positive effects on the health of the injured tissue. Such interventions may therefore be useful for professional athletes looking to get some short-term relief so that they can continue competing at the highest level. For someone looking to properly recover from their injury, however, long-term rehabilitation is the way to go.

When you return to your sport, if you don’t want to revisit the crippling effect of injury, it should also be time to reassess your form, use of equipment, movement patterns, stress levels, work-life balance, competitive environment, and more. Many of these factors likely contributed to your injury. Commit to life-long rehab. Rehab does not end when the pain ends, it is a life-long commitment requiring permanent changes to your exercise routine so that the formerly injured site remains strong and healthy for as long as you intend to use it.

To recap, here is a checklist of things to consider when starting a new exercise routine or sport:

• Learn about the common injuries related to your new sport or exercise routine
• Engage in physical conditioning activities (strength, flexibility, agility, etc.) that reduce the chances of you becoming injured
• Learn about and adhere to proper form, you may need a coach to determine this
• Warm-up properly every time before playing the sport
• Pay attention to pain and monitor how it changes within and beyond your sporting activity
• Reduce lifestyle factors that contribute to injury risk, e.g., bad sleep, bad diet, stress, and so on
• When injured, assess the injury comprehensively and commit to a rehab protocol
• Seek medical attention where possible, but go prepared with research and a clear directive about what you want out of the consult
• Be patient with recovery, commit to the rehab protocol, you can do it while watching your favourite shows
• Don’t give up