the bigger picture: a guide to injury prevention
You’re at the peak of your physical fitness. You’re running faster, lifting more, jumping higher and looking the best you’ve ever looked. An unfortunately timed injury, even a minor one, can derail your progress and get in the way of achieving your goals. It’s tempting to want to work through an injury. But more often than not, ignoring an injury ultimately makes it harder to achieve your big picture goals, whether it’s smashing your personal records, winning competitions or following a healthy and functional lifestyle.
I am someone who is very injury prone. I am also someone who is incredibly stubborn and, as a Division 1 track and field athlete, always wanted to run faster, jump higher, lift more and win competitions. Despite the advice of my coaches, I wanted to train through and ignore small nagging injuries in order to be the best athlete I could be. At the end of the day, I was far from it, because I was constantly injured and rarely got the opportunity to compete while totally healthy.
Injuries happen to everyone. However, with the right plan, you can reduce how many injuries you get and the impact each injury has on your fitness and wellness.
Everyone knows that warming up before an intense workout is key to preventing injuries. But what constitutes an appropriate warmup? Your specific warm-up will ultimately depend on the type of workout that you’re doing, but the overall goals of a warmup are more or less the same. You want to raise your core body temperature, improve blood flow to your muscles, and prime your body’s neuromuscular connection (also known as the mind-body connection). An effective warmup helps improve the pattern of how your muscles fire in conjunction with one another, improving joint stability and improving strength, allowing you to increase the intensity of your workout safely.
Dynamic warmup example: 10 minutes
Jumping jacks x20
Bodyweight Squats x20
Forwards and backward arm circles x10 each direction
Hip circles x10 each direction
Those who have already had injuries that have been worked up by a physician or a physical therapist have likely participated in physical therapy. However, there have been numerous studies that have shown that pre-treating commonly injured body parts with physical therapy exercises may be effective in improving joint stability and reducing muscle imbalances. These exercises may not be traditionally incorporated in your everyday workout but may help prevent injuries before they occur.
Examples of pre-hab exercises for common muscle imbalances:
Quadricep/Hamstring Imbalances: Athletes in explosive sports often times have disproportionately strong quadriceps compared to their hamstrings.
Solution: Implement exercises that develop your hamstrings, such as deadlifts, hamstring curls, and glute bridges.
Chest/Back Imbalances: Many people over-develop their pectorals compared to their rhomboids, rear deltoids, and lats, which can lead to shoulder, chest or back injuries.
Solution: Implement exercises that help develop your back, such as pull-ups and barbell/dumbbell rows, or your rear deltoids such as rear raises and face pulls.
Rotator cuff: Similar to the above situation, many people have underdeveloped rotator cuff muscles compared to their pectorals and deltoids.
Solution: Implement exercises that work your rotator cuffs, such as internal or external rotation with cables or bands, and lateral raises.
Leg muscles: Stability of the leg is very important to prevent injury to the ligaments of the knee (such as the ACL or MCL) or ankle.
Solution: Implement exercises that emphasize knee and ankle stability, such as lunges, single-leg squats, single-leg plyometrics, and single-leg Romanian deadlifts.
These pre-hab exercises often aren’t the big lifts that give your arms the size of full-grown corgis, boulder-like shoulders or washboard abs. However, working these muscles are critical to injury prevention and will ultimately help you build your goal physique.
In addition to this, improving flexibility and mobility through stretching has been shown to help prevent injuries in a number of studies. It is important to differentiate that stretching before exercises instead of a warmup has not been shown to prevent injuries, but stretching in addition to an appropriate warmup and workout have!
Rest and Recovery
So you’ve felt a twinge or pain during your last workout. Is it safe to work through? If you continue on your plan, will you make the injury worse? Is there a way to continue training without derailing your progress?
In general, these are all very injury and person-dependent questions. The severity and acuity of the injury will often dictate how much you have to change the intensity of your workout, and you may have to adjust your training plan in order to prevent the injury from getting worse.
People have heard of the mnemonic “RICE” for minor injuries. Rest. Ice. Compression. Elevation. Resting the injury helps prevent new or worsening problems to the already injured body part. When working with sports medicine-trained physicians, they often define rest as avoiding any motion or exercises that causes pain or discomfort to the injured body part. Ice helps reduce inflammation. Compressing** (with an ACE bandage or something similar) and elevating the injured body part helps reduce swelling and edema by forcing water out of the injured site, allowing more blood flow to the injured area to help accelerate recovery. While it is not reasonable to do all of these with every injury (good luck elevating your torn abdominal muscle), it works well for many minor strains and sprains.
**It is important to note that if you are using compression, you should never wrap the bandage too tightly, as this can cut off blood flow to the body part and cause more problems. Even gentle compression can help reduce swelling!
In addition to the traditional “RICE” mnemonic, there are a few things you can do. Protecting the injured body part using the appropriate brace or splint, such as an ankle brace for a sprained ankle, can help prevent re-injury. For muscle spasms or knots, applying heat to the injury before any sort of exercise can help loosen the muscle. Medications** such as acetaminophen (Tylenol) or over the counter NSAIDs such as ibuprofen (Advil) and naproxen (Aleve) are helpful in reducing pain and inflammation.
**These medications can have side effects, and you should only use them as directed and consult your physician if you have any concerns. You should not use acetaminophen if you have liver failure and you should not use NSAIDs if you have kidney failure or peptic ulcer disease.
Seeing a Professional
When is an injury bad enough that you should see a doctor? This again is very injury and person dependent. It is near-impossible to appropriately diagnose injuries over the internet, and a doctor will be able to give you a much better answer than WebMD and strangers on Reddit, combined!
You should see a doctor if you have the following symptoms after an injury:
Severe pain that is getting worse
Inability to walk or effectively use the injured body part
Not being able to move your shoulder, straighten or bend your elbow or knee, having significant strength differences from your baseline, etc.
Point tenderness (pain at a very specific location, but not elsewhere)
Significant deformity to the injured body part
Loss of sensation or strength in the injured body part
Repeated injuries to the same body part
This is certainly not an all-inclusive list, and any injury that is sufficiently concerning or not getting better should prompt you to see either your primary care doctor or go to the emergency department for further evaluation.
Getting Back Into It
So you had an injury. Did you lose all of your progress?
The short answer: No.
The longer answer: Also no. Your progress may have been put on hold, but your body remembers more than you think it does. Studies of rugby athletes have shown that strength levels are maintained for about 3 weeks without training at all. Even if you are out for longer than this, regaining strength and muscle mass is much faster than gaining it for the first time. The important thing is that you are recovering well from your injury and you’ll be able to get right back on track.
John Li is a former Division I track and field athlete who specialized in the pole vault and a current medical student hoping to pursue a career in Emergency Medicine. He can be contacted through his Instagram at @Jawn71.
Harvard Health Publishing. “Treating Sports Injuries.” Harvard Health, Feb. 2010, www.health.harvard.edu/newsletter_article/treating-sports-injuries.
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Mcmaster, Daniel Travis, et al. “The Development, Retention and Decay Rates of Strength and Power in Elite Rugby Union, Rugby League and American Football.” Sports Medicine, vol. 43, no. 5, 2013, pp. 367–384., doi:10.1007/s40279-013-0031-3.
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