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In this article we'll review a range of exercise-induced injuries including the signs, symptoms and methods of rehabilitation.
“I spent more years as a professional athlete, fighting injury, refusing to give in until I had achieved my dream of winning Olympic gold. It has been a long, hard struggle with moments from which I thought I’d never recover.”
Kelly Holmes, 2 x Olympic gold medallist
Injury
One of the most – the most – frustrating eventualities an athlete, trainer, or sports enthusiast, can ever experience is succumbing to injury. Depending on the severity of the injury and how it is treated, determines the duration factor: recover from a severe injury can be reasonably swift if the rehabilitation process is well managed. But what initially started as a minor injury, maybe mild soreness in the base of the calf for example, can develop into something much more sinister and sustained if it is ignored.
Of course, prevention is better than the cure but, as any trainer will know, complete prevention is not possible. The best we can hope for is to reduce the risk. Quality nutrition, warm-ups, cool downs and implementing a regular stretching regime can certainly help to minimise that risk. But there is much more we can and should be doing.
Below I have outlined some of the most common ways injuries arise. By understanding their root causes, and sharpening our sensitivity to the early warning signs, we are better able to take evasive action thus mitigating the severity of the injury or, better still, stopping it before it develops into such.
Overuse injuries
The most frequent form of injury occurrence is caused through overuse syndrome. 'These injuries are becoming increasingly common as both participation in sport in general and the intensity and duration of training increases,' (Peterson 2001).
The overuse, or repetitive strain, injury occurs when we repeatedly over-exercise the body and don’t allow time for adequate rest, recovery and repair. When we lift weights, go jogging or stretch we cause microscopic tears within the muscle fibre (see video below). What makes us stronger, fitter and more flexible is when the body heals these tears and lays down additional fibres. If the trainer does not allow adequate time for this healing process to take place, muscles, tendons and ligaments (even bone) will become weaker which increases injury susceptibility.
Resting the body after exercise and sport is a crucial part of the fitness whole. Without adequate rest recovery is either impeded or prevented. One way we can speed-up post training recovery is by ‘rolling’ – otherwise known as myofascial release. The foam roller aids recovery by decompressing and relaxing the muscle whilst also increasing the blood flow. For the benefits conferred and how inexpensive they are the foam roller is an excellent piece of equipment and a must have for anyone who regularly exercises.
Minor injuries
When an injury occurs the damaged tissues are weakened and their tensile strength is immediately reduced (the tensile strength is the tissue's capacity to stretch and withstand exertion). Throughout this phase the body 'lays down' collagen tissue to bridge the tear. This area is more susceptible to re-tearing, which is why you should not stretch or foam roll recently damaged tissue.
For a minor injury at least one week should be given before you start to stretch that area. If the injury is more severe seek advice from a physio regarding rest/recovery time scales. Remember: stretching after an injury must be performed with great care and the recovery process must never be rushed.
Severe injuries
More severe injuries, such as ligament and tendon sprains, are often the result of sudden and explosive movements - for example the moment of raising the intensity from that of a jog to a sprint. Unlike overuse induced minor injuries, the cause of which can sometimes be quite the conundrum to pinpoint, the cause of a traumatic injury is obvious as the trainer will experience rapid onset of pain (Peterson 2001).
The immediate action drill after suffering a severe injury is always to stop any and all activity. To help reduce inflammation and the inevitable pain ice should be applied to the area.
If in the event of incurring a sports or training related injury, it is preferable to seek advice from a professional physiotherapist as soon as possible. Because they specialise in injury diagnosis and rehabilitation, a physio can examine the area with a high degree of accuracy whilst assessing the nature and extent of the injury. From there they will be able to provide sound advice on how to aid the recovery process.
However, it is important to bear in mind that, because ligaments and tendons, unlike muscles, have a constricted supply of blood – they actually feed off the muscles – the healing process is significantly protracted. Also, the re-injury rate tends to be higher for that reason - viz. the trainer not giving the injury enough time to fully repair.
Snaps, twangs and breaks
If you experience any of the above my heart goes out to you. Truly, for the person who loves exercise and all things physical, there is nothing worse than being laid-up with a long term injury.
After suffering a severe injury it is imperative to seek professional medical advice and support. But it’s not enough just to seek the advice, we must heed it. This is a common mistake made by the exercise enthusiast: ignoring the physio's (and/or doctor's) orders and rushing back into training too early.
You must maintain discipline and resist the temptation to rush the recovery process. Take your time and follow the physio’s advice. By doing this you stand a much better chance at reclaiming (or even surpassing) your previous performance.
Don’t be fooled
Quite often, after recovering from an injury, we feel good, there is no pain in and around the previously injured area and we feel fit, energetic and raring to go. This can be a false sense of security, a facade brought about by all the additional resting after the injury.
An inexperienced trainer may jump straight back into training where they left off and as a consequence, re-injure themselves. It seems the body can play tricks on us and when all appears well, we discover through more needless suffering, that this is not the case.
It is for this reason why, even after a minor injury, it is so important to take your time when re-introducing the body back into physical exercise.
Peace of mind
A good sports masseur/therapist is literally worth their weight in gold and if you are a training/sports enthusiast, I strongly advise that you try and seek out reputable one in your local area. The job of the sports therapist is to relieve muscle tension, break-down and smooth-out knots and encourage blood flow. Depending on your training volume you should have at least one sports massage every month – at the very minimum.
Kick (or curb) the obsession
Exercise obsession is perhaps more common than people realise. Though there are undoubtedly worse things to form an obsession to, excessive exercise is detrimental to health. By over-working the body and not allowing it sufficient time to rest and recover the trainer increases their injury susceptibility.
Yet often the obsessed trainer believes that they can continue to abuse their body without consequence. I understand this mentality all too well because I was once obsessed.
I used to train for four to five hours a day, six times per week. On average, totalled over a one week period, I would train for 25hrs. I maintained this work ethic for three years. Throughout this time I was plagued with overuse injuries, but I was stubborn, obsessed and I did not know what I was doing.
Now I have learnt my lesson, and I went about arriving at what now seems such an obvious conclusion the hard way. As a result of reducing my training output I feel fitter, my body looks better, I am much more enthusiastic about exercising because I am not always fighting fatigue, and what’s more, I do not suffer a tenth of the injuries.
Overtraining
When Bruce Lee was asked during a TV talk show if he thought he was over-training, Bruce replied ‘I’d rather be over-strained than under-trained’. To some degree I completely agree with him. However, although seemingly quite harmless, over-training is dangerous and can cause the trainer serious health problems.
Severe aches and pains, injury, chronic fatigue and brittle bone are just some of the potential negative side-effects of excessive exercise. What we must do as physical fitness enthusiasts is find that middle ground where our training intensity and duration effectively meets our perceived goals yet doesn't cause harm.
Because over-training can easily disguise itself – or because the obsessive trainer has mastered the art of self-deception – I have compiled a list of signs and symptoms which can be directly related to over-training. Singularly they should not necessarily arouse too much concern, although two or three must be taken seriously. Have a read through the list and see how many you can identify and relate to.
Signs and symptoms of over-training
Decrease in performance – when training for an event, such as a marathon, there should be a slow and steady improvement up until the race. It is common to have those ‘off days’ during the preparation stage and there is nothing to worry about if you are running set distances slightly slower than normal. What should cause concern is the frequency of these off-days increases or your performance begins to deteriorate. If you are or ever experience something similar then consider resting for a couple of days, reducing your overall training hours for a week or changing your training method.
Diminished enthusiasm – the thought of a training session should be a happy one that stirs our ambition to improve ourselves. However, when the thought of the gym or physical activity elicits prangs of loathing then this could be your body telling you it needs some rest. The diminished desire for physical training is a good indicator that you are currently doing too much.
Frequent minor injuries – constantly recurring niggles is a sign that the body needs more rest to repair damaged tissue. Persisting to train when the body has reached this state is dangerous and more serious – long-term – injuries could be just around the corner. Do your body a favour, if this sounds familiar, and give it a rest, maybe even treat it to a sports massage, you will feel great afterwards.
Lowered immune system – endurance athletes will experience diminished immune function because of the increase in inflammation. Lowered immunity makes us more susceptible to colds, infections and allergic reactions and it can slow the rate of recovery from any of these conditions.
Muscle mass reduction – there is a simple balance between rest and exercise, when the balance is maintained the athlete will enjoy augmented physicality and improvements in performance. But if the balance is upset and the volume of training exceeds that of the time it takes to recover, the athlete will then experience more breakdown (catabolism) of muscle tissue than build up (anabolism). Thus physical decline will ensue unless action is taken.
Loss of sex drive – it is well known that moderate to high intensity exercise increases libido. But what is not so well known is that over-training can deteriorate sexual appetite leading to loss of libido.
Disturbed sleeping patterns – over-training or training too late at night can affect sleeping patterns. Sleep is a crucial time for the body to start the recovery and repair process. Interrupting this process can slow the repair of muscle tissues which may hinder performance. If you are struggling to sleep at night take a close look at your exercise output and at what time you exercise. (Want to learn more about the importance of sleep?)
Points to take into consideration in the event of an injury
As soon as you experience a twinge, twang or snap STOP immediately.
The first thing on your mind should be damage limitation, so do not put any more weight on or move the injured area.
Ice the area ASAP and continue applying the ice treatment for at least three days. When icing an injury apply the cold compression for 20 seconds then remove for a minute. Maintain this regime as often as you can for three days. The reason behind this method of icing is to avoid triggering a biological defence mechanism which tries to stop tissue from becoming damaged by the cold. It does this by sending warm blood to the area which causes it to heat and swell up, which is exactly the opposite of what we want.
If the injury is in the arm or leg elevate whilst you ice.
Seek advice from a physiotherapist.
Rest, rest and rest. Make sure you give the injury plenty of time to repair.
When you start back training, or participating in your sport, take your time. DO NOT think you can start at the same level as where you left off.
If you feel pain in the area after recovery STOP immediately. Go back to rehabilitating the injured area.
An injury to the head, neck or back will require immediate medical attention. If you feel as though you have an injury within one of these areas DO NOT WAIT, go to a doctor or physiotherapist immediately.
Look after your body so that you can keep training
Prevent, Rest, Ice, Compression, Elevate
The acronym PRICE should be applied to all minor injuries – muscle pulls, sprains and bruises. PRICE can, of course, be applied to more severe injuries. However, I would only recommend this after you have spoken with a medical professional.
Prevention = When an injury first occurs Prevention/Protection should be the first thing on your mind. Prevention is about making sure you do not damage the injury further, as this can prolong the healing process. Protection of the injured area is essential because not only do you want to experience any more pain, but you do not want to make matters worse.
Rest = We all know that injury requires rest to allow healing to take place. If we do not rest we will prolong the recovery time and in some instances the injury could be made worse. Be sensible and REST.
Ice = Ice helps to reduce the swelling around the injured area, which aids in speeding recovery. The ice should be applied to the injured area for 10 minutes on 2 hours off for at least three days. It is advisable to ensure that there is a thin insulating layer under the ice pack, or you could burn the skin. Do not apply ice to an already numb area, or near the heart.
Compression = A compression bandage can reduce swelling within and around the afflicted area. When applying the bandage it is advisable to ensure not to wrap it over the injured area, it should go above and beyond the injured site.
Elevation = If an injury occurs within the arm or leg you should elevate the limb. By elevating the limb gravity works by drawing the swelling from the site of injury. When elevating a limb make sure that it is higher than the heart.
Conclusion
It is almost a certainty that a physically active person will experience an injury at some point. Few are fortunate enough to escape this eventuality. When we suffer an injury there are really only two options available to us.
Option 1: We can wallow in self-pity and fall into despair as we watch others keep fit and enjoy sports whilst we don’t.
Option 2: We can exercise our boundless capacity to accept misfortune and, in this state of equanimity, we can begin the process of recovery.
Ultimately the choice is yours.
For more on injury and prevention see our other article: Injury - Prevention is Better than the Cure.
(As we are very interested in user feedback at Hungry4Fitness, I would be very grateful if you could take a few seconds out of your day to leave a comment. Thanks in advance!)
Blog Author
Adam Priest is a former Royal Marines Commando, professional personal trainer, lecturer, boxing and Thai boxing enthusiast.
References
Peterson. L, Renström. P (2001) Sports Injurues: Their Preventon and Treatment; 3rd Edition. Taylor & Francis Publication. United Kingdom.
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