INJURY PREVENTION + THE 5 KEY POINTS TO REMEMBER...

WITH FABIOLA AGUIRRE
(Physiotherapist at Fleur Wellbeing)
Injuries are no fun.. We can all most likely put our hand up and recall an injury that has occurred in our lifetime. For some, the injury may have lasted 2-3 days and you can no longer remember whether it was your left or right side! And for others, your injury set you back months, even years, and significantly changed your way of life. For most however, it usually leaves a lasting mark and changes the way we approach certain types of movement or exercise. And that is very normal and beneficial! It's our bodies way of protecting us.

But what if we could go that one step further and be that little bit more aware of factors that can double, sometimes triple fold our likelihood of having an injury. What if we took a few extra steps along our exercise journeys to help decrease our chances of an injury? Well let's explore the 5 key indicators that you can start asking yourself and doing from today.

1. KNOW YOUR LIFE STAGE
Sounds pretty basic, I know. But being aware of what is currently surrounding your life and what stage of life you are at will help to give you some awareness on what sort of things to prevent injury from.

TEENAGERS 
There is so much change occurring during adolescence, and in particular from a musculoskeletal point of view, the changes in hormones that occur.  At puberty and post puberty we see changes in neuromuscular control (ie. Jumping and landing technique), where boys undergo a significant neuromuscular control spurt whereas girls do not. For instance height increases (especially in leg length), strength increases (particularly in males), and ligament laxity is altered resulting in girls being more lax (loose) in joints. Many injuries occur for the first time during adolescence- and many of these can have long term implications. 
The most common adolescence injury is patellofemoral pain – AKA anterior knee pain; followed by apophysitis of the lower limb (aka ‘growing pain’), ankle injuries, instability of the shoulder, neck pain, headaches and stress fractures (especially lumbar spine in gymnast and dancers). These injuries usually occur with the load that you are putting through your body- either by the amount of training or the amount of plyometric (jumping) activity their completing. 

How to prevent an injury: Making sure you have a clear training plan that is an even mix of jumping/ strength/ stretching/ neuromuscular control (Pilates).  Not doing too much of the one type of training- especially if you are going through a growth spurt. Also using a mirror or receiving feedback from your coach/instructor on ‘perfecting’ the landing from a jump.  The aim is to land as quiet as a mouse and pretend the ground is made of soft foam and is melting your landing. 

PREGNANCY
Now the importance here is not so much in the  20-22 gestation week mark, as most ladies will usually modify their exercise routine. I am talking more of the initial 6-20 week period where it's still early and most women have very few physical signs and restrictions to their exercise. But take note of these.
If persistent vomiting is present there can be dehydration and electrolyte imbalances, and thus your body may feel not only the effects at a symptom level such as fatigue and weakness, but this also happens at a cellular level. Muscles will be more inefficient in exchanging nutrients and can lead to increase cramps and muscle strains. So simple measures such as natural or electrolyte drinks are a good alternative, but always chat to your GP or an accredited dietician if its persistent.  Postural changes begin as early as week 8 and continue to change as the pregnancy continues. One of the biggest causes of pain and ceasing of exercise is lower back and pelvic girdle pain. This happens mainly due to the way our body moves with the new changes (biomechanics) rather than hormonal. Learning the ‘new ‘ safe and best posture to exercise in, in the early stages will allow you to exercise safely and pain free well into your 3rd trimester. Seeing a Physiotherapist to give you these postural strategies in the very early stages of exercises will ensure injuries are minimised entirely.
And lastly getting yourself a heart rate monitor watch or learning how to take your carotid (neck) pulse will allow you to monitor your heart rate.

MENOPAUSE + PRE MENSTRUAL 
Exercise has a strong positive link with increasing bone density and decreasing the effects of osteoporosis in our 50-60+ age group.  There is emerging strong evidence to show that stress fractures (which are fractures caused by maximal and repetitive loading on the long bones of the body) have a link to menopause and pre hormonal changes in the body.  What does that mean from an injury prevention? If you are pre menstrual or irregular in your cycle, really focusing on good technique and not doing too much of the one exercise is important.  Ladies going through menopause, it’s a good idea to check in with your GP and find your bone density measures prior to commencing new or repetitive physical exercise -moderation is key.

2. LISTEN TO YOUR BODY
This may sound self explanatory and easy to do, but how many of us have pushed through our pain barrier to get to the last repetition?! Pain during exercise can be our single best indicator that your body is not enjoying the intensity/position/load that your body is being exposed to. Our bodies create pain as a warning flare to us that something is not right and could lead to injury.  
Now let's not confuse fatigue pain with actual pain.  Sorry everyone but that pain is good for us! Fatigue pain will almost always occur around the site of your body that you're working on and it will always settles with stopping.  
The pain signs to watch for is if it is pain localised to an area of the body you're not exercising, for instance your getting back pain but your completing a clam exercise for your glutes.  If your instructor has not told you what muscle group you should be targeting (which at Fleur Wellbeing, you always know) then ask them. Or stop...
Look for other pain signals such as sharp pain, painful clicking, pins & needles, or a burning pain moving from up to down (for instance from the bottom down to the ankle)
Sometimes stopping and changing your body positioning is the easiest way to avoid pain leading to injury. Always ask your instructor or a health professional if it keeps occurring. 

3. WARMING UP THOSE TISSUES
Warming up before exercising has many well researched benefits such as creating vasodilation (widening) of the capillaries and arteries that feed into muscle and connective tissue. It essentially ‘wakes up the body’ and kick starts the engines for many of the muscle parts used in exercise.  Another important wake up call it creates is the notion of wiring the brain to body connection. Better known as neuromuscular connectivity. This is an essential part of going into any exercise that involves plyometric, bounding, change of direction and large dynamic movements. When this doesn’t work well things like knee, foot and ankle, spinal and shoulder positioning can be put into injury provoking positions. 
How to address this for injury prevention? There are many ways we can do this but 2 of the best ways are completing small to larger upper and lower body movements and increase the either speed/complexity/ range of the movement.  So for instance to warm up before a walk we would want to warm up or ‘wake up’ our ankles, calfs, quadriceps, arms, glutes etc. And we would do that in small movements ie. A butt squeeze and release, to a large movement ie. Squat with knee lift. But if we were warming up to play a game of netball our body would need to wake up our body positioning and add some intensity and change of direction etc. Again your coach, trainer, Physiotherapist can give you a warm up routine that is specific to your sport/exercise routine. 

4. UNDERSTAND THE INJURY CYCLE
Let's say its too late and you have already suffered an injury to your body. You definitely don’t want to hurt yourself again, but when is the right time to return to exercise, and how to avoid re-injury? 
The best way to approach your injury is to understand a little about the tissue healing process and general timelines for injury recovery. Most injuries will follow this stage of healing: degeneration (actual injury), inflammation (the reaction to the injury- causing pain and swelling), repair (the magic window), and fibrosis (scar tissue formation). 
Generally, muscular injury during exercise falls under muscle strain or ‘pulled muscle’ or a contusion (bruise) and the actual stages of healing mentioned earlier take up to 4-6 weeks before you reach the last fibrosis stage. The question can you exercise in that time? Of course you can! 
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The real question is what should I do at what stage.  For most the first 24-72 hours can be quite painful and uncomfortable to do any form or exercise. So its crucial to use this window to reduce your swelling, maintain some gentle movement and loading of the muscle, and look at what factor/s may have caused the injury. If in this time the pain or swelling persists, then getting to your Physiotherapist sooner rather than later can help determine a more specific guideline for your injury. The ‘danger’ for most muscular injuries lies in that week 2-4 when your symptoms significantly reduce and sometimes go, so you return to exercise.  The site of injury and the surrounding muscles may not have the strong scar tissue that forms after injury and the surrounding muscles are not strong enough to hold, so this is where you can end up with a re-injury or worse more injury.  
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So it's important to take note of your injury date, create a rough timeline, know your ‘danger window’ and progress your exercises accordingly to your injury window.  So by the time you reach week 4-6 you want to be almost at full pre injury capacity and training. The good news is that you can and should continue training throughout your injury!
Again this is where your coach and Physio can guide you with specific exercises and tests to see where your injury and whole body is at, and help monitor your progress. 

5. COOL DOWN THOSE TISSUES + RECOVER
Injury prevention also lies in not just what we do before exercise but also what we do after.  All exercise goals will aim to create more muscle, change muscle to lean muscle, increase our fitness, flexibility etc. For this to happen, your body will actually undergo a very microscopic injury to the muscle (including our heart) and bones, in order for it to repair, change and improve. So it's important for us to understand and respect this process by way of gentle stretches, walking, foam roller, large (but slow) dynamic movements. Most of these are best done straight after your exercise but others can certainly take place at a later point in time. This is where recovery lays an important role in injury prevention.

A lot of our ‘repetitive strain’ or tendon injuries (achilles tendonitis, plantar fasciitis, in children Oschgood Schlatters) come from too much load and not enough recovery phase. Allow your muscles and joints to have a day where you complete lots of different stretches, use your trusty foam roller, massage ball or exercise ball, and where you just take the intensity right out of your exercise of choice. Maybe you might choose to do all the easy modifications on one day and that’s all it can take for your body to recover and prepare better for the next time you go hard!

Well that’s it in a nutshell on injury prevention. I hope you can all take something from this and use it in your next exercise class or sport. Happy to answer any other questions regarding the above or something else you have to add or ask too!

Written by Fabiola Aguirre
PHYSIOTHERAPIST
Fabiola is available for appointments at Fleur Wellbeing on Monday & Friday's.
To make a booking please contact Fabiola directly
​via email: fabiolapaguirre@gmail.com or phone 0423 684 052