A Guide to Injury Reduction and Management

It is hard to imagine an athlete going through a career and never experiencing some sort of pain.  After all, pain is a normal human sensation just like hunger or thirst.  

When injury strikes, it is completely natural to have questions.  

Why do injuries happen?  How can we reduce our risk?  How can we best manage existing injuries?  What follows will help navigate the murky waters of pain and injury.  

Let’s dive in!

Principles vs. Techniques

As Jim Collins puts it, “In a world of change, disruption, chaos, and relentless uncertainty, people crave an anchor point, a set of constructs to give them guidance in the face of turbulence.”¹ 

When it comes to pain and injury, it is critical that we focus on timeless principles rather than current techniques.  

Stephen Covey notes that, “Our problems and pain are universal and increasing, and the solutions to the problems are and always will be based upon universal, timeless, self-evident principles common to every enduring, prospering society throughout history.”¹ 

The point is that principles are ever present and deep-rooted in all that we do, whether we choose to acknowledge them or not.  

To better understand the difference between principles and techniques, let’s use the example of hanging a picture frame.  An example of a principle at play when hanging a picture frame is that the screw goes in when turned to the right and comes out when turned to the left.  

We are free to choose from countless techniques to carry out the task, but we must remember that no matter what we do, the screw will go in when turned to the right and come out when turned to the left.  Whether we choose to use the biggest, toughest, and most expensive 5-speed power drill on the market or simply use Dad’s old rusty screwdriver, the principles remain universal and ever-present. 

What Are Injuries? Why Do They Happen? How Do We Avoid Them?

What is an injury?  How do we define it?  Is it the presence of pain?  Is it the presence of tissue damage?  Is it pain and tissue damage together?  Is it time off from training?  How much time off?  Is it time off from practice?  Time off from game play?  Is it only an injury if the individual seeks medical attention?  

If we cannot define what an injury is, how can we possibly begin to tease out how to prevent it?  

It is important to remember that injuries, like pain, are multifactorial, poorly defined in the scientific literature, extremely variable from activity to activity, and rarely are simply due to a single traumatic tissue-damaging event.  Not understanding the nuances behind injuries can result in confusion and poor outcomes at best, and injury at worst.  

Obviously we all want to avoid injury, but how do we do it?  

It is important to keep in mind that we cannot prevent injuries, but we can reduce our risk.  

Risk factors for injury include but are not limited to previous injury, fear of injury, spike in workload, sleep quality, age, stress level, nutrition, hydration, bodyweight, training age, daily activity level, and emotional resilience. 

One of the most impactful ways to reduce injury lies in our ability to manage the balance between load and capacity…and that is where a qualified healthcare practitioner, like a physical therapist, can help.  

Workload management is the management of the load we expose ourselves to and our bodies’ capacity to recover from it (see below). 

In order to gain a better understanding of how to properly monitor workload, let’s quickly define load and capacity.  

Load includes physical stress such as miles ran, weight lifted, daily step count, duration of a sporting bout, and gardening/yard work.  

Capacity is impacted by things like sleep quality/duration, mental stress, anxiety, depression, prior beliefs, expectations, past experiences, illness, training age, muscle strength, endurance, bone density, tendon resilience, skill, coordination, comorbidities that impact recovery such as diabetes, preparedness for a specific activity, and mental resilience.  

For the most part, the goal should be to increase load in a strategic way that allows capacity to adapt and increase in a similar fashion.  Injuries tend to occur when load spikes at a rate that does not allow our tissues to adapt.  

For example, if I tear my biceps after rapidly reaching backward to stop a baby stroller from rolling down a hill, we can say that the load on my biceps tendon exceeded my body’s ability to adapt to it.  Progressively increasing load is a good thing, so long as we respect the time it takes for our capacity to adapt.  Over time, our load and capacity should increase side by side. 

An oversimplified explanation of the dynamic between load and capacity is that a spike in load or a decrease in capacity puts us in the red zone, while a drop in load and an increase in capacity puts us in recovery mode.  

Keep in mind that capacity will likely adaptively decrease in response to a drop in load, such as that experienced due to time off from training, which is why I rarely recommend taking time completely off, but we’ll get into this later.  

If you are forced to take time off, such as during a worldwide pandemic, fear not!  Be sure to check out my YouTube series on the topic right here.

Managing Injuries

Now that we have a basic understanding of what injuries are and why they happen, the approach to managing injuries will be much clearer.  

Like we said above, pain is multifactorial and is rarely due to only a mechanical “dysfunction.”  After ruling out red flags, we approach pain and injury by gradually exposing the body to the edge of discomfort to desensitize the system to the desired movements while maintaining a training effect.  

The goal is to find a pain-sensitizing variable such as load, volume, RPE, range of motion, exercise selection, sleep quality, stress management, hydration, recovery, etc., then offer modifications to keep the athlete training as close to the desired level as possible.  Once we load and train the system with the modifications in place, we’ll slowly progress back to where we want to be, in a stepwise fashion. The initial plan is not always the best plan, but that’s ok!  Modifying week by week is to be expected.  There are many other options, depending on the athlete’s response. 

Once we load and train the system with the modifications in place, we’ll slowly progress back to where we want to be, in a stepwise fashion.  

The painful area is similar to an over-sensitive alarm system.  Basically we want to desensitize the system through graded exposure by repeatedly bringing the body to the edge of discomfort until the alarm system is desensitized.  

Think of the boy who cried wolf.  The boy’s cries are like a painful movement pattern and the villagers’ fear response is like the sensation of pain.  As the villagers were repeatedly exposed to their edge of discomfort from the boy crying wolf, their response lessened.   

“Great!  So basically we just crank into pain and eventually we will become desensitized to it!  Thanks Dr. Nick!”  To quote the late great Patches O’Houlihan, “Whoa, whoa, whoa not so fast there sport.” If we overshoot the edge of discomfort, it is possible to reinforce the alarm system and make it more sensitive.  

Let’s say I am terrified of spiders and would like to improve my tolerance to being in their presence.  If I were to be thrown against my will into a pool of tarantulas, I would likely be scarred for life and probably have more fear toward spiders, and possibly all insects, for the rest of my life.  That’s similar to us pushing it too much.  If we continuously provoke the pain past the edge of discomfort, the system will continue to be on high alert and will become more and more sensitive.  

A better approach to the spider analogy would be to start with one small spider placed 20 feet away and over the course of a few weeks, slowly move closer and closer.  My heart would likely race at each stage, but over time that response would decrease.  

I VERY RARELY recommend that athletes take time completely off from training because it tends to cause a decrease in capacity and makes it difficult to gauge where to start upon returning.  I prefer to take a stepwise approach, which makes it easy to regress when needed and progress when appropriate.  Oftentimes this is the exact opposite of what is typically recommended by healthcare practitioners.  

Let’s use the example of back pain during a barbell back squat.  Rather than starting one step down from the desired activity (in this case, a barbell back squat) with something like a box squat, it is often recommended to start at the lowest possible step with things like pelvic tilts, planks, bird dogs, and clamshells.  

While those things may have their place with some athletes who simply cannot tolerate any other variation of the desired movement, we most certainly should not be starting there.  They should be a last resort.  

A bird dog has much less carry over to a barbell back squat than a box squat at 50% 1RM.  We want to train as specifically to the desired task as possible because the more specific you can be, the more specific the capacity you’ll build for the load you’ll be exposed to.

Closing Thoughts

So while this is not a step-by-step approach to injury prevention (I would suggest using some sort of magic, perhaps from a Hogwarts strength and conditioning class, if that’s what you’re looking for), it is a North Star principle-based approach that can be applied to the vast majority of situations in which physique and strength sport athletes find themselves.  

The main takeaway is that we cannot prevent injuries due to their multifactorial nature, but we can reduce injury risk and one of our most powerful tools in injury reduction is workload management: balancing load and capacity.  When managing an existing injury, remember to take a graded approach under the guidance of a qualified healthcare practitioner. 

As you know, 3D Muscle Journey embodies a holistic and sustainable approach to strength and physique sport.  Even when structured appropriately, long-term consistent training can have its hiccups and bumps in the road.  I find it hard to imagine an athlete who has not experienced some sort of ache or pain along his/her journey.  

It is my hope that by having a better understanding of the universal, timeless, and self-evident principles of injuries, as well as why they happen and how they can be managed/prevented, you will become more resilient, confident, and independent moving forward.  

Please reach out with any questions at all.  I’d be happy to help!

 

References

¹Covey, S. (1989). The seven habits of highly effective people. New York: Simon and Schuster.