Injury Risk Management in Performance Sport◆ ☕️ 5 min read
(Some of what I will be discussing is what Jordan Shallow preaches about daily. Make sure to check him out.)
We've all encountered injuries in some way, shape, or form. The specifics behind injury occurrences are complex, which is why we can't really speak about "injury prevention". At most, we can discuss ways of injury risk management.
By the simplest definition, injury is the outcome when applied force is greater than tissue tolerance.
Injury = Applied force > Tissue tolerance #
The common practice in regard to injury management is built around tissue tolerance, and tissue tolerance alone. Going to a rehab "specialist", they might overwhelm you with eccentric, isometric, or tempo exercises to build up the tissue after you have injured it.
That's the wrong way to look at things. The real question is why is the tissue met with so much force?
This is when we start moving away from a simplistic understanding of how our bodies manage forces and towards considering the complexity of the central nervous system.
The central nervous system is always interested in finding the path of least resistance. If something is not working properly, it will compensate elsewhere to get the job done. Just strengthening the tissue will not fix the problem long-term, because we are not challenging the learned pattern of how and why the force is applied through that specific tissue.
Our focus should be on finding ways to direct the force away from the tissues that can’t tolerate it, like ligaments and tendons, and more towards tissues that can, like muscles.
As Jordan has said, your body has no obligation to make sense to you.
We can’t simplify our bodies’ functioning to the level of “ The muscle is tight. So it must be short. So I should stretch it.” or “ The muscle is tight. So it must be weak. So I should strengthen it.”
Now, without a doubt, there is a load of evidence on how such a simplistic approach has worked in a rehab setting. But we always have to consider the context.
If you bring in Becky from down the street who has barely done any physical activity in her life, playing around with some isolatory movements to train a very specific action of a muscle might help her get rid of some of the pain she has been feeling.
This is why the traditional practice is still used to a large degree. You can strengthen the structures in untrained individuals and have some success with it, but this approach wouldn't get you too far with advanced athletes.
In sport performance, we need a lot more specificity to fix the problems. We need to think about proper execution of compound movements under load to directly impact the force distribution and change the nervous system’s path of least resistance.
It's important to be able to make a distinction between muscle action and muscle function.
Muscle action relates to how a muscle behaves when it moves from its origin point to its insertion point. It's those isolatory actions of muscles that are often targeted in rehab.
Muscle function relates to how a muscle behaves when we walk and breathe. Walking and breathing is what human function hinges on. Understanding muscle function should be our main priority.
What is required is a global understanding of the interactions between the structures in our bodies.
Anyone can google that our gluteus medius muscle, which is one of the three glute muscles, acts as an abductor of the hip among its other functions.
In case we perceive the glute med to be weak, it doesn’t take much to prescribe an intervention to target abduction specifically via a common exercise like clamshells and get the glute med stronger while the leg is actually in the air. When our foot is on the ground, however, and we go through the gait cycle, our glute med functions as a lateral stabilizer of the hip. It’s that specific function of the glute med that should be the main focus of our intervention, not the action of the muscle.
Or, you could perceive your psoas major muscle, which is a hip flexor, to be tight. The “ Oh let’s stretch it then,” approach is just too shallow to deal with the root of this issue.
We need to look further than that. We need to consider the function of the psoas. We need to realize how it is placed in the body and how it functions during gait and breathing.
Psoas is connected to the lumbar spine. Its function is to stabilize the lumbar spine during gait. Instability of the lumbopelvic complex might explain why the psoas is tight. The tightness means that we are applying too much force to the muscle, which implies that something else is not doing its job properly.
This understanding allows us to identify appropriate exercises to restore proper function of the psoas. We could prescribe walking lunges, or create internal rotation of the extended hip, or restore proper gait cycle mechanics (tip – diving deep into understanding human gait mechanics will tell you everything about muscle function), or respect and fix axial alignment (the alignment between the skull, rib cage, and pelvis). We need to challenge and alter the execution of movements to modify the nervous system’s path of least resistance and fix the problem.
This is where it is necessary to differentiate between strength and stability.
Muscle action is related to the strength of the muscle which implies its ability to exert force.
Muscle function is related to stability which implies the ability to resist force.
Stretching and strengthening do have their place, but stability has to fit somewhere in the answer. Don't overlook that. Integration of all those elements will provide you with more reliability in terms of injury risk management.
That's all I have to say on this. See you on the next one.