Avoid the "too much too soon" mistake and take the injury prevention vaccine

Physiofit is passionate about the prevention of injuries. At this time of year, we see many injuries that are a result of doing “too much too soon”. To help reduce this happening we want to explain how the body reacts to load and a range of simple techniques that you can use to monitor the activity you are doing and strategies to reduce the chance of injury.

Spikes in activity

Both adults and children alike find that their level and intensity of exercise peaks and troughs throughout the year. The body has the most amazing capacity to adapt to any stress or load placed on it providing that it has time to do so.

The problems start when we have a sudden spike in a new activity or we do more sport at a greater intensity following a period of rest such as following the Christmas holidays. When we then resume our sport with renewed vigor in a determination to regain any lost fitness the sudden spike in activity results in tissue overload and pain. Transitions between the sporting seasons such as the end of the football season and beginning of the cricket season pose problems with double the demand on the body.

Many experts have used graphs such as Fig 1 to help us understand what is too much or too little and it varies from child to child and athlete to athlete. As you can see there is a “sweet spot” (Gabbett 2016) where performance increases but injury risk is balanced. If you have not done the appropriate training, then the body is not used to the load expected of it and rapidly reacts and can be as much an injury risk as too much.

Athletes who are accustomed to high training loads tend to have fewer injuries providing that they have time to adapt. Injuries occur because of:

• Poor training methods

• Excessive and rapid increases in training loads

• Too little rest and recovery

What can you do to avoid “too much too soon”?

1. Evaluate each session’s intensity

It is not just how much you do but also how hard the intensity of the session. A good way to evaluate intensity is to teach athletes about Rate of Perceived Effort (RPE). There are several ways of doing this, but a simple 1-10 scale works well as shown in Fig 2.

2. Keep a session diary

A training diary is an effective way of monitoring load and effort. Many athletes we work with use a wall planner or electronic spreadsheet to flag up potential bottlenecks and highlight points in the year when they want to be performing at their best.

3. Calculate chronic:acute workload

The recipe for injury prevention is based around a chronic:acute workload ratio. The chronic load is the average of the last 4 weeks eg how many miles you have run (x the intensity of each session). The acute workload is what you have done that week. The chronic:acute ratio should be no more than 1:2 and the margin for error is around 10% increase on the average of the previous 4 weeks. Research has shown that as little as a 15% increase is enough to increase your injury risk substantially.

4. Keep to the 2/4/7 rule

The important factor is giving the body time to adapt and become stronger. My so called 24/7 rule is based on the recipe adopted by the England Cricket Board which is no more than 2 consecutive days of fast bowling with no more than 4 days of play in every 7-day period. This gives the body time to recognise the stress and react and become stronger. This is a sensible approach to most sports giving the body a day to recover allowing minor stresses to be heal and repair and more tissue can be laid down in case the load recurs.

Types of injuries

In growing athletes, there are two common types of overuse injuries, those affecting the bone and those affecting the insertion of the tendon on to the bone. Excessive, repetitive and sudden loading of young bones can cause bone bruising which often causes pain. With adequate rest, this will settle but if the symptoms are ignored, the child becomes at risk of a hairline fracture in the bone known as a stress fracture. These types of injuries tend to affect cricketers, footballers, swimmers and gymnasts who repeatedly arch their lower back stressing the bones in the lower back. They also are prevalent in the shin and foot bones especially in young runners. Recent thinking is that, in addition to excessive load there may also be a link to low levels of Vitamin D and it is worth considering supplementing the diet of children who live in northern England and those involved in indoor sports such as swimming and gymnastics.

It is not only the muscles and bones in these very active children that are at risk. These children are often exhausted and susceptible to a condition called overtraining syndrome with recurrent sore throats and fatigue. Ensuring children get adequate sleep is paramount as this is when the body can repair and grow. In adults, we see many overuse injuries in tendons such as the Achilles tendon in the calf caused by a sudden spike in activities such as running and is known as a tendinopathy. However, in children the area of bone where the tendon attaches to the bone is weaker than the tendon itself and loading the tendon in the same way results in a growth plate injury to the bone. These injuries are commonly found in the heel where the Achilles' tendon attaches (Sever’s disease), the quadriceps attachment at the knee (Osgood Schlatters disease) and can occur in any area where muscles attach to young immature bones.

Our injury advice

Traditionally the advice for overload injuries was rest. With careful management compete rest may not be necessary if the athlete is given the correct early advice. Reducing the load down to a level where the symptoms become more manageable ensures that the tissues get time to adapt but that they do not become weaker. We usually advocate that a level of pain that does not exceed a 3/10 pain (10/10 is the worst pain known) and that settles by the next day is acceptable, but this is athlete dependent.

Physical literacy is as important as Math’s and English literacy

The better conditioned a young athlete becomes, the stronger level of protection against injury. Learning to move correctly is critical to a child's development and just like they must become literate in Maths and English, it is essential that they learn correct movement patterns and become physically literate. Movements such as lunging, crawling, squatting and deadlifts form the basis of many sports and should be taught at an early age but are often missing from the current physical education curriculum.

Physiofit specialises in the development of young athletes and can provide guidance on how to create strong and robust athletes who learn to monitor their workload and safely learn how to do age appropriate strength and conditioning in a 1:1 or class environment in our rehabilitation centre in Wilmslow.

If you would like to receive a handout on how to help your child succeed in sport, please do email us on info@physiofit.co.uk or take a look at our website www.physiofit.co.uk.

References

Gabbett TJ The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med Published Online First: 12 January 2016. doi: 10.1136/bjsports-2015-095788

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