ATLETA Fitness

Sports Injury Occurrence and Management – ATLETA Fitness

Running is one of the most popular health and fitness pursuits across Australia, and with such a vast array of associated physical and mental benefits it’s easy to see why. As with all exercise, however, there is an element of risk through participation: risk of injury.

Running is not exempt from this, with many runners suffering a variety of injuries across lower and upper limb joints. In this three part blog series, we first investigate the basics of injury management, injury classification and the stages of injury repair. Part two and three will look deeper at a handful of the most common running injuries, and how you can utilise gym based training to minimise the risk of injury, or rehabilitate any injury that may have been sustained. Firstly, let’s take a look at the basics of soft tissue injury…

INJURY CLASSIFICATION

Optimized-AFl Hammie InjuryInjuries can be classified as either an acute or chronic issue, depending on the mechanism of injury. Acute injuries are often contact (extrinsic) injuries, or sudden onset soft tissue injuries (eg a hamstring tear while running). Chronic injuries, however, develop over time and develop from muscle imbalances, poor technique or minor body-related discrepancies (eg longer leg on Left side), as well as overuse of an area. An example of a chronic issue would be plantar fasciitis, or a sudden hamstring tear resulting from long-term poor technique. Injuries are also classified as soft tissue or hard tissue, depending on the type of tissue affected (hard tissue – bone; soft tissue – ligaments, tendons, muscles, cartilage). If we understand the mechanism and location of an injury, how do we then classify the severity of an injury?

INJURY SEVERITY (GRADING)

blood cell types

Degrees of Sprain and Strain Severity, with their associated level of soft tissue damage

Soft tissue injuries also have grades, and each grade represents a differing severity of injury. Grade I strains (muscle or tendon injury) and sprains (ligament injury) result in only a small, partial tear of the structure. Grade I injuries can be easily repaired, with full function retorted in a matter of weeks. A grade II rupture is more serious, and can sometimes result in the need for surgery, depending on the soft tissue structure involved. Grade II ruptures result in a severe rupture of the soft tissue; however, there is no complete tear and the structure still remains attached across the joint or muscle. Grade III tears are the most severe soft tissue injuries, and more often than not require surgery to repair. In a grade III rupture, the majority or the entirety of fibres in the soft tissue structure rupture, resulting in a complete separation. Obviously the location, classification and grade of an injury will impact on the ability to rehabilitate the injured site quickly and effectively. When we start to consider the degree of injury variation, including location, severity and Individual physical characteristics, it makes sense that every injury is a completely new problem, with individual challenges and time frames.How then do we make every injury ‘fit to an equal timeline’? We need to consider the three separate phases of soft tissue injury repair. Each phase lasts for varying amounts of time (depending on the factors explored above), but all are equally important in achieving a full recovery.

Acute Injury Management

The first 72 hours post-injury occurrence are the most important when considering long-term structure and function repair to the injured site. This period is known as the inflammatory phase, and is the first of the three injury repair phases.

INFLAMMATORY PHASE

The first phase is the inflammatory phase. This occurs immediately post injury, and continues for 48-72 hours post injury. During this phase, there is a large inflammatory response in the injured tissue, as lymphocytes and other various inflammation markers accumulate around the injury site. This is where the swelling of an injury site comes from. Following the incidence of an injury, the RICER method can be applied to minimise damage and swelling, and to simultaneously improve long term repair.

benefits of RICERR: Rest

Ensure you rest the injured site, and avoid any moderate to heavy loading for the first 72 hours post injury. This will help to decrease further stress on the injured site, and improve the chances of a fast recovery

I- Ice

Apply ice to the injured site, 20 minutes every two hours during the day is ideal. The application of ice cools the area, and subsequently decreases blood flow to the injured site. Deceased blood flow means there is a smaller accumulation of fluid around the site, and hence less swelling. This also means that the tissue is able to better align itself correctly, and reduces the long term effects of poor scar-tissue alignment

C- Compression

Applying a compression bandage to the affected area applies pressure to the site, and helps with the removal of excess interstitial fluid accumulating in response to inflammation. Basically, compression (similarly to ice) decreases swelling, and improves realignment of the repairing tissue

E- Elevation

By elevating the injured site above the rest of the limb, we can use gravity to decrease blood flow, and hence swelling, to the affected site.

R- Referral

It is always important to get a referral to a sports injury professional. They offer the highest level of care and knowledge on specific site injuries, and can help to return you to exercise in the shortest time frame possible

Avoid HARM (Heat, alcohol, running and massage) as all of these activities stimulate increased blood flow, and will therefore increase the swelling of the site. Increased swelling will slow down the repair and recovery process, and hinder long-term recovery.

Man injured while running on country road

REPARATIVE PHASE

The reparative phase is the second phase of injury recovery, in which scar tissue and functional fibre is laid down to bridge the gap across the ruptured site. This phase takes place from around 72 hours post injury for 1-4 weeks, depending on the grade and severity of the injury. This is the major phase of actual injury repair, so it is best to remain rested and to continue the de-loading of the injured site, so as to ensure the best recovery long-term.

REMODELLING PHASE

Likely the most important phase of injury repair and rehabilitation, the remodelling phase takes place anywhere from 1-4 weeks post injury until 6 weeks to 6 months plus, post injury. This phase is all about returning function to the injured site, and getting range of motion (flexibility) and strength back to the same, or even an improved level, as compared to pre-injury capability. Similarly, we are aiming to remove any still-visible swelling in the injured site and to minimise or remove non-functional scar tissue that may have been laid down in the period post injury.

injjury rehabIn part two and three of this article, we will look in greater detail at how the remodelling phase applies to some running specific injuries. This will include information on how to restore flexibility, joint range of motion (ROM), strength and proprioception to the injured site, and get you back to full function as quick as possible.

Employing the help of a qualified exercise professional in guiding you through this remodelling stage can ensure the best quality and fastest recovery, with the best long-term outcomes for you. Get in contact today to book in with one of our experienced trainers. All trainers are degree qualified, and offer the highest level of service in injury management and rehabilitation. With a wealth of prior experience and great depth of knowledge, it’s hard to beat the level of service we offer here at ATLETA. Don’t forget to sign up for our annual City 2 Surf Classes, starting Tuesday Week (June 2nd). Our specially crafted training program ensures you reach maximum strength and physiological capability pre-race, and minimise your risk of injury while maximising your potential for success!

Written by Johann Ruys

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