Prevention of Exercise and Sports-Related Injury, part 2
From Frank S. Chen, M.D.While it is not possible to prevent all injuries that occur during exercise and athletics, research has shown that injury rates may be lowered by as much as 25% if proper precautions are taken. There are numerous factors that potentially predispose the athlete to injury, and while there are many sports-specific variables that are beyond the scope of this article, the following are some helpful tips in preventing injuries for sports activities in general.
- Condition Properly
- Warm-up and Stretch Properly
- Avoid Overtraining and Training Errors
- Know and Follow Rules and Regulations
- Avoid Playing When Extremely Tired or in Pain
- Maintain Proper Hydration and Wear Appropriate Clothing
- Wear Appropriate Footwear
As detailed in Part I (To Your Health, Winter 2004), proper aerobic and cardiovascular conditioning is extremely important in preventing injury, but sports-specific training is also imperative. Weekend warriors have high rates of injuries, as they are usually not well-conditioned and may not be proficient in the sport they are playing, thus predisposing themselves to injury.
Expecting to "play yourself into shape" is a mistake. Targeted muscle strengthening programs should be incorporated depending on the nature of your sport (e.g., rotator cuff strengthening for those participating in overhead athletics; quadriceps and patellofemoral strengthening exercises for cyclists and runners; ankle strengthening and stabilizing exercises for those playing basketball, soccer and other sports that involve quick change of direction, etc.). Sports-specific drills will also help you become more proficient at your sport.
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Warm-up and Stretch Properly
Warm muscles are less susceptible to injury and proper warm-up is essential for injury prevention. Appropriate warm-up activities will differ for each sport and activity, and should be adjusted accordingly. Simply walking or jogging in place may be adequate, while in other instances such as with cycling, starting the sport or activity at a slow pace may also be appropriate. Stretching should follow the warm-up period. Performing even a few simple stretches specific to your sport or activity to maintain overall flexibility can not only reduce your risk of injury but also improve overall exercise performance.
Stretching after exercise while the muscles are warm and flexible will help any microtears that may have occurred to heal better. Lastly, if you have a history of previous injury to certain muscles or joints, warming up and stretching these areas is important in order to prevent repeat injury.
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Avoid Overtraining and Training Errors
Exercise does not need to hurt to be good for you. In fact, if it does hurt you are probably doing something wrong. Athletes with high consecutive days of training have more injuries, and many of them have a misconception of "more pain, more gain." Some soreness is common after exercising, but if it continues, you are pushing too hard. Soreness is caused by inflammation and microtears in the muscle fibers.
If you are sore after every workout, you are not giving your body time to recover. Allow at least 24-48 hours for muscles to recover after a strenuous workout. Then resume the same exercises or activity but at a lower intensity. When it comes to exercise, you need an appropriate balance of training and rest. Injuries can occur when the volume or intensity of training is excessive, causing damage to tissues that cannot be adequately repaired during a training cycle.
The proper amount of rest will differ among different individuals. Some general guidelines to consider include: larger muscles heal slower than smaller muscles; fast or explosive movements such as sprinting, skiing, tennis and weight-training require more recovery time than slow movements such as biking, swimming, jogging, cross country skiing.
Women generally require more recovery time than men, as do older individuals compared to younger ones. Heavier, more strenuous activities require longer recovery periods for the involved muscles. If you are noticing decreases in training capacity, persistent muscle aches and pains, changes in mood or sleep patterns, or an increased incidence of injuries, then you have definitely overtrained. In this situation, in order to allow your body to properly recover, you need more prolonged rest that may vary from 3-5 days to up to 4-5 weeks or even longer depending on the extent of underlying injury. This undesirable situation can be avoided with proper modifications in your training regimen to prevent overtraining.
Training errors can also predispose you to injury. Avoid progressing too much too soon. Increases in the volume and intensity of your workout should be made in a gradual, progressive manner. Know how to properly use equipment in the gym, whether it be the cardio machines or the numerous weight-training machines currently available. Hill training, either with running or cycling, should also be approached cautiously and progressively to avoid knee problems.
When cycling, techniques that decrease pressure on the kneecap should be emphasized initially, such as spinning, using low rather than high gears, and determining the correct bicycle and equipment settings (e.g., saddle height, cleat position, cleat and shoe type). Proper strengthening of the muscles of the thigh, especially the quadriceps, is an important part of the training regimen to prevent kneecap problems.
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Know and Follow Rules and Regulations
While it may seem like common sense, knowing the rules of each sport is very important, as is familiarizing yourself with any equipment you may be using either in the gym or on the field. The specific rules of each sport and in each facility are designed, in part, to maintain safety. This is extremely important for anyone participating in contact sports. Rules of conduct, including illegal blocks and tackles, are enforced to keep athletes healthy. In addition, appropriate protective gear and equipment should be worn at all times, especially in contact sports. Protective pads, mouth guards, helmets, gloves and other equipment are designed for your safety.
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Avoid Playing When Extremely Tired or in Pain
Do not try to push through pain or continue exercising or playing when exhausted. Pain usually indicates a problem or potential underlying injury. You need to pay attention to the warning signs that your body provides. Fatigue has been shown to be a significant risk factor in athletic injuries. For example, studies have shown that ski injuries peak in mid- to late afternoon when skiers are more tired. It is important to curtail your activity when tired to prevent fatigue-related injuries.
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Maintain Proper Hydration and Wear Appropriate Clothing
While exercising, you can lose between 6-12 ounces of fluid for every 20 minutes of activity. It is important to replenish these losses. A good general rule of thumb is to drink 10-15 ounces of fluid 10-15 minutes prior to starting your activity, and every 20-30 minutes during the activity. Weighing yourself before and after the activity is also helpful; for every pound lost you should drink one pint of fluid afterwards.
It is also important to dress appropriately during exercise, especially in extremes of weather. Porous clothing is recommended in hot weather, and adequate hydration in these conditions is extremely important. In general, thick, heavy clothing can lead to excessive sweating, which causes the body to lose heat more rapidly and may increase the risk of hypothermia. In colder weather, dressing in layers is recommended.
The inner layer should be made from a material such as polypropylene, thermax or a similar fabric that takes perspiration away from the skin. A middle layer of cotton or a similar fabric should be added for insulation and to absorb moisture. Lastly, if necessary, an outer layer such as nylon may be worn to protect against wind, moisture and other weather elements.
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Wear Appropriate Footwear
As shock absorbers, your feet are subjected to nearly one million pounds of pressure during one hour of strenuous exercise. Proper footwear is important to cushion these loads. Different sports have different requirements for footwear, and it is beneficial to wear sports-specific shoes. For example, a running shoe has more cushioning for shock absorption than a basketball shoe, which provides more lateral ankle support for sudden stops and starts on the court. In any case, wearing the proper shoes is important in preventing injury to your feet, and shoes need to be tailored to each individual's anatomy.
For example, if you have stiff and rigid feet you may tend to underpronate and thus need more heel and forefoot cushioning that is provided by a slip-lasted shoe. If your feet are flat and hypermobile, then you need more stability and motion control, as you would tend to overpronate. A board-lasted shoe with a stiffer heel and medial heel counter would be more appropriate in this instance.
Combination-lasted shoes provide differing amounts of cushioning and stability and are appropriate for feet that are not overly stiff or hypermobile. In addition, footwear alone may not be enough in providing the necessary support to your feet, and orthotics are often an useful addition. Consult a professional to inquire about custom-made orthotics or if you have questions concerning the anatomy of your feet or choosing an appropriate shoe.
When purchasing shoes, make sure to have both your feet measured, as your feet may be different sizes. Your feet expand during weight-bearing, so make sure you are standing when they are measured. In addition, your feet tend to swell and be at their largest at the end of the workday or after a workout, so you should try on shoes during these times. Wear athletic socks similar to those you will be wearing during your activity, and try on both shoes to check the fit.
Make sure your heel fits snugly in each shoe and does not slip as you walk. Wiggle your toes; if you do not have a half-inch between your longest toe and the end of the shoe-approximately the width of your thumb-try a larger size. Lastly, test for comfort by walking or jogging a few steps as this will give you an idea of the shoes' comfort during activity.
It takes time to break in a pair of new shoes and the process can be strenuous on your muscles. To make the transition easier, alternate wearing your new and old exercise shoes. Start by wearing your new shoes one quarter of the time and your old shoes three quarters of the time; then gradually phase out your old shoes. Sixty percent of a shoe's shock absorption is lost after 250-500 miles of use, so people who run up to 10 miles per week should consider replacing their shoes every 9 to 12 months.
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As more and more people recognize the health benefits of exercise and become active, it is important to understand how to participate in sports activities safely. While sports-related injuries are not entirely preventable, taking necessary precautions can help to decrease them significantly.
A proper training regimen targeting cardiovascular conditioning as well as sports-specific muscle strengthening is extremely important in injury prevention, and should be tailored to each individual. Workouts should increase in duration and intensity only gradually. Symptoms of soreness or pain should not be ignored but rather addressed through modifications in the training program to allow the body time to properly recover. Careful monitoring of your body and training regimen helps not only to prevent injury, but also to make the activities more enjoyable. If you have any questions about your personal health, consult your medical doctor prior to embarking on an exercise program. Otherwise, have fun working out and remember to play it safe!
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