Injury prevention pt 4. Practical solutions for addressing the structure, imbalances and instabilities.

12 May

TLDR:
Posture is dynamic, being static for too long or overloading a particular movement pattern can develop structural imbalances.
Generally a good warm up or conditioning session can override these ‘imbalances’ through variation and loaded ranges of movement.
The more stable a/ the structure, the more forces it can handle before the stress becomes a strain.
Overcoming or avoiding a previous injury requires greater attention to address the imbalances.

Incorporating exercises into a daily routine is the most practical method to do this.
Eg. Single leg balance whilst the kettle boils or bread toasts.

  1. Structural integration
  2. Practical methods for restoring stability and strength
  3. Exercise suggestions  

Introduction.

The following article will do its best to outline the human structure, how we interact with gravity and the ground below us. Deliver practical methods, used by myself and my clients over the past 7 years to help develop stability, strength and balance to reduce the risk of injury.

As you can imagine, pole vaulting, can develop some pretty heavy imbalances. Lumbar disc problems, hamstring tears, shoulder impingement and damaged ligaments in my ankle.
I came off pretty lightly, however I didn’t enjoy being in pain and at the time I was studying sports injury prevention and rehabilitation.
Though many exercises prescribed to me were great and the soft tissue treatment worked great, I often, like many of clients over the years, forgot to continue doing the exercises or build up with progressions to handle more load.

Essentially this had led me down a path of aiming to understand the human structure deep, quite literally.
Many times my weight had fluctuated, aiming to compete at lower body weights, though it seemed great at the time as the immediate benefits were obvious, one point I dropped too much muscle mass, from 84kg down to 74kg. Around 77-78kg was the sweet spot, where my reactivity was high, force to body weight was high and my structural stability had yet to be affected.

Losing that much muscle mass was hard work, I wouldn’t recommend it, especially for a speed/power sport, I had lost significant upper body stability and began having shoulder impingement issues, that I had never had before.

I was on a significant calorie deficit and fasting between sessions, though it seems ridiculous and it totally is, I’d like to note again, to begin with it was working well which was reinforcing the process.


Muscle mass along with strength/ the ability to neurologically stimulate the muscles and articulate the joint through an optimal range of motion are significant factors to keeping a joint healthy.

It’s very likely that if you lack in any of the above categories, the risk of an injury is significantly greater, which is why corrective exercises and soft tissue release work great for rehabilitating an injury.

Now what about prevention?
We all know prevention is better than a cure.

Prevention can and should be directly built into the warm up, it may be extensive but my athletes have 15 exercises to complete before performing their sessions.
It’s almost a session in itself but as the intensity is relatively low it doesn’t negatively impact their session quality.

Stimulating and strengthening the muscles that assist our balance can also be done outside of training to either assist the rehab process or prevent any reoccurring injuries.

 

Structural integration

Each joint has a level of balance and optimal position to maintain throughout the structure, our first line of balance with the ground is out feet and arches, should we stand and shift our weight to one leg this can cause tension further up the chain and cause instability issues at hip and knee. See figure 1 below.

If left untreated for sometime and these imbalances further develop, the weak areas are under greater stress which can lead to injury.
The time where I lost too much muscle mass for the demands of my sport, had caused me greater exposure to injury due to less stability at that joint.

If you’ve read my previous injury prevention and rehabilitation articles, the latest research suggests, if a muscle is short and weak, these muscles are easier to injury.

Our structure does a great job at compensating in order to keep our eye level balanced, which is why you may notice some people with chronic imbalances, subconsciously contort their bodies to maintain this eye level. 


Figure 1. Does a great job at displaying these very common imbalances.

 

But as I said before, you need not worry if your warm up and training programme addresses these imbalances or have a regular routine that you follow to restore balance, eg. yoga.

Although, I always suggest to my athletes to be aware of how they sit and stand, especially if they’re required to be in those positions for a long time, eg. at work or studying.

It’s only when these issues are left unaddressed and overloaded does a problem occur.

What I have also noticed is that during or post injury the muscles that are lacking strength and control to stabilise the joint/s that are weak.
Which is why regular correct exercise works really well.


Once you become stable and strong, the imbalances are less pronounced and as I mentioned before, the risk of injury is reduced and very often, in many cases such as running and sprinting, the more stable and stiff the foot, ankle, hip and knee, the more efficient the energy transfer is on ground contact.
Initially the effects are negligible however overtime, the benefits will appear, either directly or indirectly.
Depending on the region of the injury, there will be overdeveloped (tonic) muscles, that are over working to compensate for either weakness elsewhere (phasic) muscles and the lack of range of motion nearby.


To diagnose any imbalances, I highly suggest booking in with a Sports Osteopath. Ideally one with experience in your sport/event.
My recommendation is always James Miles Christiansen who works out of Oldfield Park in Bath.
Stay tuned as our interview will be out later this week.

 

Practical suggestions for restoring stability and strength

One of the greatest battles to the working athlete, is making the time to train.

Alongside that, it’s fighting the odds against getting injured as we age.

Which is why I have found the best and most practical method for addressing any imbalance is by incorporating them into your daily life.

Setting side extra time to perform exercises is difficult, however, there are moments in our day where we are waiting.
Since the lock down, I’ve been able to focus on own training a lot more and it’s been great and as I’ve introduced new methods and all the contact injuries I’ve sustained over the past two years are feeling great.

It may also be worth considering, is your imbalance caused by a weakness or lack of muscle mass. If so, building muscle occurs through resistance training and also a calorie surplus, specifically protein.
Once I had increased my exposure to resistance training again and increased my protein and calorie intake, the problems I had in the shoulder capsule disappeared.

Here is an example of the exercises I have introduced and when I perform them. (It has helped that I’ve been stuck inside brewing more teas and coffees than I would normally drink)

AM – I am for roughly 1.5-2 mins per exercise

  1. Whilst kettle is boiling – single leg balance left knee up
  2. Whilst coffee is cooling down/ brewing – single leg balance right knee up
  3. Whilst bread is toasting – Double leg calf raise 
  4. Brushing teeth – Tibialis anterior raises against wall 

Midday – aim for 2-mins 

  1. Whilst tea or coffee is brewing – glute bridge hold 

(Alternatives could be waiting for bus and performing straight leg balance hold, which I also do when queuing to enter the super market)

PM aim for 1.5-2 mins

  1. Whilst I’m cooking I will often balance on one leg if I’m not chopping foods etc.
  2. Whilst washing up, I contract my glutes as hard as I can or balance in a calf raise.


Pre bed – 2mins

  1. Brushing teeth – either tibialis anterior raises again or single leg balance knee lifts (1 min per leg)

There are always opportunities to build in corrective exercises, the reason I choose these exercises is that the majority of my injuries have been in the lower body and they’re fairly easy to perform.

I highly recommend trying to incorporate two or three of these exercises, the acute/ immediate benefits are really good.

Picture 2. If you are curious about which joints require either stability or mobility .

Exercises that address multiple imbalances at once are far more time efficient and likely more transferable to sport.

Glute stability:
Before getting out of bed.

  1. Clamshells
  2. Glute bridges

Hips, core/ lower back:

The infamous McGill Big 3

  1. Curl up
  2. Side Plank
  3. Bird Dog

https://squatuniversity.com/2018/06/21/the-mcgill-big-3-for-core-stability/

For more questions or suggestions please don’t hesitate to contact me.

Connell.coach@gmail.com

Stay tuned for the next Q&A with the elite.

Connell