The problem of overwork

AS AN athlete, you can safely say that sports-related injuries are an unfortunate part of daily life. An injury can be defined as damage to any structure of the body, whether bone, muscle or nerve, etc. When these injuries occur, they can range from minor inconveniences to being debilitating or life-threatening. Injuries can be classified in different ways, but, for the purpose of this article, the following categories will be used: traumatic injuries and overuse injuries. Traumatic injuries are those that occur suddenly, usually because of too much force being exerted on or by the body.

This article will discuss overuse injuries and their management. Overuse injury is a general term used to describe injuries that develop over time. They usually occur because of inappropriate loading of the tissue, which results in repetitive micro trauma to the various tissues of the body structures (muscle, tendon, bone). This repetitive micro trauma can subsequently overload the tissue’s ability to repair itself, leading to an injury. The symptoms of the injury are usually mild at first, and are often overlooked or ignored. These symptoms then progressively worsen over time, if the cause is not addressed.

An important aspect of injury prevention is understanding why they occur in the first place. While there is not much one can do to prevent traumatic injuries, there are factors that can be controlled to decrease the severity of these injuries, and to mitigate overuse injuries. These factors can be classified as: (1) modifiable and non-modifiable or; (2) intrinsic and extrinsic. Modifiable risk factors are those things we can manipulate, such as strength, flexibility and technique.

Non-modifiable risk factors include age, sex, and a history of previous injury. Intrinsic risk factors are directly related to the body and include muscle weakness or imbalance, flexibility, alignment, etc. Extrinsic risk factors refer to things external to the athlete’s body such as training load, shoes, environmental conditions, nutrition etc.

By nature, overuse injuries are multifactorial, with training load errors being one of the most prevalent factors. Training load errors include:

• Insufficient warm-ups/cool downs

• Inadequate recovery periods between training sessions

• Excessive volume (how many sets and repetitions) and/or intensity (how much weight/resistance)

• Increasing training volume or intensity too quickly

• Poor exercise technique.

To effectively mitigate the occurrence of overuse injuries, athletes should undergo a pre-participation evaluation and baseline fitness testing before training commences for the season. The aim of the pre-participation evaluation is to identify:

• Muscular imbalance/weakness

• Muscle tightness/poor flexibility

• Malalignment issues such as genu varum (bow legs) or valgum (knock knees), overpronated feet (flat feet), etc

• Body composition (distribution of muscle, fat, and bone).

This pre-participation evaluation should be sport-specific. This means that all tests conducted will target the main muscle groups that are used in the sport. The evaluation should contain functional tests that simulate sport actions, and a battery of special tests that screen for the most prevalent injuries in the sport.

Baseline fitness testing guides the development of the training programme for athletes. These tests should also be sport-specific. Baseline fitness tests will assess the different components of fitness, such as strength, flexibility, speed, agility, endurance, and power. There may be some overlap between fitness testing and the pre-participation evaluation. As athletes progress throughout their training season, strength and conditioning training loads should be adjusted to complement their technical training load. Principles of periodisation should be applied when making these adjustments.

At the beginning of the training programme, emphasis should be placed on technique and form. A solid foundation in exercise technique not only helps in injury prevention, but it maximises the physiological gains from training. Poor form and technique lead to both overuse and acute injuries. The start of the training season is also a good time to educate athletes regarding nutrition, recovery and equipment types and usage. Once athletes have been introduced to these concepts, there should be regular educational sessions that reinforce the knowledge and offer additional guidance, if necessary.

Lastly, athletes should have access to a sports psychologist, who will assist them in mental preparedness for training and competition.

Injury prevention requires a multi-disciplinary approach. Ideally, a management team would consist of coaches, a sports physiotherapist, a sports kinesiologist/strength and conditioning specialist, a sports psychologist, a nutritionist, and a medical doctor, even if some members are engaged as consultants. Each member has a key role to play in ensuring that injury occurrence is mitigated as best as possible, or detected early and treated appropriately.

Sport Pulse and Sport Matters are fortnightly columns highlighting advances that impact Sport. We look forward to your continued readership.

Tajay Grant is a physical therapist employed to the Mona Academy of Sport, Faculty of Sport, and can be contacted at tajay_g@yahoo.com