How To Recover From Any Injury

Image credit: Marcus Needham

Pain is a complex, emergent experience.

Tissue injuries are not.

Tissue injuries occur when the loading on the tissue exceeds its capacity.

This can be an acute issue – think of a sprinter suddenly straining their hamstring mid race – or a chronic issue – think of a builder developing elbow pain over time.

In both circumstances, the principle is the same.

The formula for managing an injury is fairly simple on a macro level:

  1. Decrease the volume, intensity and/or frequency of aggravating activities to manageable levels
  2. Improve biomechanical efficiency
  3. Increase capacity with progressive overload


What is challenging is how to achieve these objectives in living, breathing humans who have needs, wants and annoying things like emotions that make us behave irrationally.

This is where a clinician needs to have excellent listening and communication skills, be a master of persuasion and thoroughly understand the physiological and biomechanical aspects of movement, stress and adaptation.

This post is going to outline a few of the methods I use to achieve the above outcomes.

Decrease Volume/Intensity/Frequency of Load

The most obvious thing to do when we are injured is often the hardest.

Why?

  • Necessity. We all need to continue working, caring for family or performing our activities of daily living (ADL). It can be hard to offload your injured body part when there is a baby crying or a load of laundry that needs doing. Let alone when you have a work deadline to meet.
  • Desire. This is an emotional issue. Many of us desire to continue doing something as it brings us pleasure, status, or allays a negative emotion like guilt or fear. For example, it is common for people to want to continue to push themselves exercising whilst they are injured because of body image issues.

However, in most cases, an all or nothing approach is not required.

You don’t have to stop something completely to reduce the loading effect.

Here are two examples from a patient who has lateral hip pain that I’ve diagnosed as a gluteal tendinopathy. In these cases we are reducing the volume of the load primarily:

  • Use the fitness tracker in her phone to estimate her daily activity level. Work out at what activity level her symptoms flare up. Stay below that activity level while gradually building up during recovery.
  • Track her walks accurately (pace/duration) and work out at what level her symptoms flare up. Stay below that activity level while gradually building up during recovery.

Here is another example of how I reduced the intensity of the load in a builder with elbow pain. He couldn’t stop working, and a lot of what he did (using tools) aggravated his injury.

  • Use tennis grip tape to wrap around the handle of his hammer. This increases the circumference of the handle, which reduces the mechanical leverage of the forearm muscles, taking the load off the tendons at the elbow.

In most cases, there are ways to continue doing what you need or want to do, with some modifications. And in most cases, this is actually better than complete rest.

Improve Movement Efficiency

Everybody knows Roger Federer. You don’t have to be a tennis fan to appreciate his skill and technique. He makes things look easy.

As we improve our skill at a task, we become more efficient as well. It takes less effort and as a result we tend to load our body less.

Roger Federer demonstrates this – his supreme technique has helped him accumulate very few injuries in his career, despite a demanding schedule and advancing age.

However, we don’t need to look to elite sport for examples of movement efficiency.

Think of your local pizza parlour. If it has been around for a while, watching the chefs put a pizza together is a picture of movement beauty (okay, I really love pizza). Every time I try and replicate this at home I just end up tired with a very messy kitchen bench.

Or let’s keep it closer to home. When I was younger, I didn’t know how to iron a shirt well. My mum could iron all of my dad’s and my brothers’ shirts in the time it took me to do one. All that effort, all that time under load. It’s easy to see how my inferior ironing skills could lead to more load on my body. Even though my mum was doing more total work, her body was adapted to it, and she did it in a way that was smooth and effortless. Contrast that to me, not adapted to ironing (still not) and very tense and inefficient.

When it comes to rehab for an injury, it’s not just the capacity of the tissue that we have to worry about, but the efficiency of movement, which affects the loading on that tissue for each movement/activity.

Improving movement efficiency is a topic in and of itself.

My approach is based on the following formula: 

The input is related to sensory information from the nervous system. The better the quality of sensory information, the better the output. This is why rehab should begin on the sensory side. Sensory input can be improved with manual therapy, which is likely one of it’s biggest roles in modern practice.

Processing is based on cues and context. We can change both, but we have no idea how it will affect the processing. I’m not a big fan of the word processing, as it sounds to much like a computer, and we are not a computer or machine.

I discuss this in more detail here, and also here.

Increase Capacity

Remember at the start of this post when I said:

Tissue injuries occur when the loading on the tissue exceeds its capacity.

Well it makes sense that as well as reducing the load on the affected tissue(s), we increase the capacity as well. This has two benefits. No, actually, it has three benefits:

  1. Loading tissues helps with repair.
  2. Loading tissues that are painful helps (re)build confidence in the injured tissue.
  3. Increasing tissue capacity protects against future injury.

I like to use a two pronged approach here:

  • A targeted exercise approach
  • A graded return to activity approach

This isn’t revolutionary. It doesn’t have to be. It just has to be done well.

In the targeted exercise approach, I use a simple progression. I like someone to be able to (where possible) perceive the tissues properly (sensory awareness) before we work on the following:

  • Isometric to dynamic
  • More stable to less stable
  • Simple to complex
  • Less task specific to more task specific

There is some evidence to suggest local loading, particularly with isometrics has a pain relieving effect, which is why I start there.

More stable positions allow people to focus on the movement or activation required, without the extra motor and sensory demands of stabilising their body in space.

Starting simple allows more mental energy to be directed to recruitment patterns, while progressing to complex reinforces these patterns in different contexts.

Finally, starting less specific to the task allows for the load to gradually be progressed as tissue capacity increases.

Graded Return to Activity

This is an expansion of the first topic, reducing the load.

Put simply, we simply reverse the process, gradually increasing the load until the tasks can be performed normally again.

A good rule of thumb is to progress no more than 10% per week, to allow the person and the tissues to adapt. You cannot go too slowly, but you can absolutely go too quickly.

Conclusions

This is my current approach to treating tissue injuries.

You have to remember that not all tissue injuries present with pain, and not all painful presentations are related to tissue injuries.

When pain is the primary problem, we can use a similar approach if localised tissue sensitivity is deemed to be the main contributing factor.

Finally, we know that past injury is a big predictor of future injury. So while the pain from an injury subsides as the tissue heals (the tissue will heal if you give it a chance, regardless if you rehabilitate function or not), if you want to minimise your chance of re-injury in the future, it pays to be thorough.

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

Achilles Tendinopathy? Treat The Whole For Better Results

Statue of the Achilles, wounded by an arrow through his heel – Achillion Palace, Corfu island, Greece

The Achilles tendon is one of the coolest tendons in the body.

While many body parts are named in Latin or Ancient Greek, the Achilles tendon draws its name directly from Greek mythology.

For those who don’t know the story:

Achilles was a hero in Greek mythology and one of the main characters that participated in the Trojan War. He was also the protagonist of Homer’s epic, the Iliad. 

When Achilles was born, his mother wanted to make him immortal and thus, dipped him in the river Styx. However, she did not realise that his heel, by which she held him, was not touched by the waters, and so that was the only part of his body that remained mortal. (1)

Achilles was then struck down in battle by an arrow through his heel, or more accurately, his tendon, hence we name it the Achilles tendon.

The Achilles Tendon Is Strong

The job of a tendon is to transmit the force developed by a muscle to the bone to which it attaches. The Achilles tendon is one of the thickest and strongest in the body, and allows us to walk, run and jump efficiently. It’s almost like having our own springs in our legs. In fact, when we run, the Achilles tendon deals with forces up to 12.5 times our body weight – for me, currently weighing around 87 kg, that is 1087.5 kg!

But It Still Gets Injured

One of the most common forms of injury to the Achilles tendon is to develop an “overuse tendinopathy”.

An overuse tendinopathy, or more accurately, an overload tendinopathy, occurs when the loading on the tendon causes an increased rate of tissue breakdown, beyond which the body can keep up with. This results in inflammation, swelling and pain localised to the tendon.

Side note: all tissues in the body are in a constant state of breakdown and building, it’s when the rate of breakdown is increased beyond the body’s repair capacity, or the body’s repair capacity is impaired, that we see problems.

We Don’t Know Exactly Why

Researchers haven’t been able to isolate a single variable that causes Achilles tendinopathy (surprising eh?), but the following are implicated:

  • Running (recreationally and competitively)
  • Participation in other sports like track and field, racquet sports, volleyball and soccer
  • Use of certain antibiotics (fluoriquines)
  • Biomechanical issues at the feet
  • Age, gender, height and weight
  • Injury history, like previous ankle sprains

What we don’t know, is exactly what happens that makes the tendon painful.

We Don’t Even Know Why They Get Better

With Achilles tendinopathy, we will often see symptoms that correlate with structural changes early on in the clinical history, but as the condition progresses and goes on for longer, this correlation becomes weaker and weaker.

In fact, in many cases, it has been shown that diminished or even absent pain is accompanied by little to no structural change to the tendon!

We Do Know What NOT To Do

You’d think that simple rest would therefore be best for an Achilles tendinopathy, however, that’s not the case. Too much rest and we lose conditioning of the tissues, and thus our capacity is reduced, leading to recurrence, only this time it takes less and less loading to aggravate.

We also know that taking anti-inflammatory drugs is not the best approach either. Firstly, there isn’t strong evidence to suggest inflammation is the primary cause of pain. Secondly, anti-inflammatory drugs have side effects. Thirdly, anti-inflammatory drugs can impair healing.

Stretching tendons also gets a bad rap, though I’m not sure why this is a blanket no. Some tendon injuries respond to being stretched (it’s simply a form of load), while others do not. You’ll see why below.

We Also Know What Works

In the physiotherapy world, where much of the research on tendinopathies is done, load management strategies combined with targeted exercises are currently the treatment with the best supporting evidence.

The actual type and dosing of the exercises has not been fully established, though we do know that you can push the loading higher than you would expect, even if it is painful.

You can use different types of exercises:

  • Eccentric where you load the lengthening portion of movement
  • Isometric: where you load the tendon without lengthening or shortening it
  • Concentric/Eccentric: where you load the tendon in a full range of motion (lengthening and shortening)

To my knowledge, the best approach has not been established in research, and in my experience, different people respond better to different approaches.

This might have something to do with some recent research that suggests there are different types of tendinopathy: compressive, shear and friction, and tensile.

As the names suggest, these imply that the tendinopathy occurs as a result of different types of tendon loading, which makes sense to me. It also makes sense that if there are different aggravating loads, the exercises which have the most benefit will also differ.

The evidence suggests avoid those loading mechanisms which are aggravating (load management), whilst stimulating the tendon with loads that don’t aggravate it.

For most people, isometrics are a good, neutral, place to start.

You can do these in a variety of ways, but one of the most accessible is to sit with your thighs under a table and feet on a block, then press your thighs into the table by raising your heels. You want to be about 70% of your maximum contraction, at least to begin with. Hold that contraction for up to 45 seconds (though I will often break it down to 3×15 second holds per set). Over time you can increase the intensity of the contraction and then progress to dynamic loading.

Sometimes exercises will hurt while you do them. That’s okay. As long as your pain doesn’t spike, or get really bad afterwards, you are stressing the tissues in a positive way.

Hands On Treatment?

This is something I learnt from my colleague, osteopath Cameron Kealy who runs Recharge Osteopathy in Melbourne, along with teaching at Victoria University.

There aren’t any studies (to my knowledge on this), just clinical observations.

Cameron will treat Achilles tendinopathy with a localised technique. He will grasp the tendon and find a position where tension is relieved and hold it – often for 5-10 mins – waiting for a tissue texture change. He will then check and treat the pelvis and upper neck. Another osteopath, Walter McKone, has also suggested the key to relieving Achilles tendinopathy is optimising blood flow by treating the pelvis.

Success leaves clues, even when there aren’t studies.

Now, we know that manual therapy doesn’t change the structure of tissues.

What is happening is likely an effect of working with the sensory nerves around the tendon.

But if a person’s pain decreases, allowing them to load again and return to activity, I’m all for it.

This Makes It Work Even Better!


At the moment, one thing that all this focus on localised exercise for tendinopathy is doing, is forgetting that the injured and painful tendon is part of the body, which is considered a whole.

After all, the blood that supplies our tendons also supplies everything else.

The nervous system that perceives the tendon also perceives everything else.

The nutrients delivered to the tendon are, you guessed it, also the nutrients delivered to everything else.

Once we have labelled the tendinopathy, the more important thing to do is to look at the health of the person.

In fact, this is the premise of osteopathy: find the health within the person, and remove the barriers to that health being expressed.

After all, it isn’t lack of exercises that cause a tendinopathy, it is lack of capacity. Exercise can increase physical capacity, no doubt about it.

However, lack of capacity can be cause by sub-optimal physiological function, and not just poor load tolerance. For example, impaired blood flow.

And, as I have discussed before, it is often easier and more efficient to “remove the handbrakes” to performance/health, than it is trying to force adaptations.

Enter The ANS

The autonomic nervous system (ANS) regulates physiological function in our bodies.

It is controlled by lower brain centres – that means we don’t have direct conscious control over it. This is a good thing, as regulating all the systems in our body is a lot of work.

Having a balanced ANS is important for health. When the ANS is over or understimulated, so that it skews towards one state too much, health is affected.

This is where it gets really interesting.

The School Of Physiotherapy at The University of Otago has been doing some interesting research (and research that should be done by osteopathic schools, but that’s another issue altogether) on the effects of manual therapy and the ANS.

Recently, one of their PhD students looked at whether spinal manipulation, delivered to the thoracic spine (which is where many important ANS centres are located) would have any effect on recovery from Achilles tendinopathy.

First, they did a review on the effects of manipulation and the ANS. That is, they looked at all the research on the topic to see if manipulation affected ANS function in any way. They found a positive relationship.

Then, to look at whether this would affect recovery from Achilles tendinopathy, the researchers created two groups: a control, which received usual care for Achilles tendinopathy (read: exercises) and the intervention group, which received usual care plus spinal manipulation.

The group receiving the spinal manipulation made better improvements in both pain and function compared to the usual care group.

Whilst only a pilot study, this is promising. It suggests that improving whole body, or rather whole person, health and function, is the most optimal way to treat Achilles tendinopathy.

Future studies will need to look at whether this was a specific effect of spinal manipulation, or a general effect of manual therapy, however, my gut feeling is that the researchers are onto something.

Don’t Forget The One Percenters

Finally, when we are really seeking above average results, we can add the extras, which can help take things from good to great.

These extras wouldn’t be classed as treatment on their own, but they enhance what you are doing already.

In my opinion, these extras are what should define private healthcare. This is what you are paying for. Not just “usual care”, which is offered by the public health system, but exceptional care, with exceptional results to match.

Some of these “one percenters” can include:

  • A tailored, not generic exercise plan
  • Specific nutritional strategies, including supplementation advice
  • Behavioural and mindset coaching (we know that mindset is an important factor in recovery from injury)

These are not specific to Achilles tendinopathy, but they can definitely play a role in addition to the treatments mentioned above.

Conclusions

If you are suffering from Achilles tendinopathy, the two most important things you can do to manage/treat it are:

  1. Load management: avoiding/reducing aggravating movements initially
  2. Build capacity: use loading/exercise strategies to build capacity in the tissue and inhibit pain

However, while these strategies would give you the majority of benefits, if you are looking to optimise your recovery, then there are more options available.

I’ve outlined some of these options, which you give you a clue as to how you can really enhance your recovery from an Achilles tendinopathy injury.

As with everything, it comes down to you.

The two big questions any osteopath worth their salt should ask are: what do you want, and what can you do to achieve it?

Some interventions are not realistic because of cost, availability or other reasons. Whatever your situation, your treatment approach should be optimised for you.

That means treatment for Achilles tendinopathy should have a whole person focus, and not just a tendon focus.

Nick Efthimiou Osteopath

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

 

References

(1) Achilles

(2) Throw Away The Anti-Inflammatories & Start Loading Your Damaged Tendons

(3) Infographic – Tendinopathy – Thou shalt load. But how? With Dr Ebonie Rio

(4) Exploring the changes in pain, function and sympathetic activity when a thoracic spine manipulation is used as an adjunct to the treatemnt of Achilles tendinopathy

Further Reading

Why Achilles Tendon Problems Don’t Heal

Recharge Osteopathic Clinic

The Truth About “Muscle Imbalances”

Running man muscles anatomy system

With almost a decade of experience working in a gym as a personal trainer and osteopath, muscle imbalances are a familiar topic to me.

Courses abound claiming to teach trainers and therapists how to “assess” for muscle imbalances and then “correct” these imbalances with specific stretches or exercises or treatment techniques.

The notion of muscle imbalances that need to be corrected feeds into the idea of an all-knowing practitioner, who can identify the problem causing your pain and then give you the tools to resolve it. I have previously bought into such notions. I was wrong.

Luckily, mistakes are simply lessons, and now I can share my lessons with you.

In the post, I want to outline what a “muscle imbalance” is, why they occur and their relationship to pain. By understanding all of this, you will be able to know exactly what to do about any muscle imbalances you have.

What Is A “Muscle Imbalance”?

Like many questionable concepts in the training and treatment world, there is no clear consensus on what a muscle imbalance actually is. Here are a few examples from page 1 of google:

To summarise, muscular imbalance is seen when the muscles that surround a joint provide different values of tension, sometimes weaker or tighter than normal, thus limiting the joint movement. – Wikipedia

The most common abnormal muscle condition in active and inactive people alike is muscle imbalance, which occurs when two or more muscles don’t contract and relax as they should. This type of problem is referred to as neuromuscular imbalance. – Phil Maffetone, PhD

Simply put, muscle imbalances occur when one muscle is stronger than its opposing muscle. – Dailyburn

What we can deduce, is that a muscle imbalance is a difference in muscle length and or/strength between two or more muscles acting on the same joint.

Why Do Muscle Imbalances Occur?

Are muscle imbalances the problem, or a solution?

If you see muscle imbalances as a problem, in and of themselves, then you will try and correct them with interventions targeted at those muscles.

If you see muscle imbalances as a solution, as I do, then you will try and consider why these “imbalances” exist – if you argue that these imbalances are a solution the body has come up with, then they are not exactly imbalances, but rather adaptations.

So how can a muscle imbalance be a solution?

Well, if we start with the premise that the body, being a biological organism, has an innate mechanism for survival, and will strive to do so above all else, for the sake of procreation (which ensures the long term survival of the species).

We can then deduce that these imbalances are a survival mechanism, or adaptation, aka a solution to a problem.

Back in high school math, my teacher always urged the class to show our working on a problem. If we happened to stumble upon the solution accidentally, then the solution wasn’t that great. Additionally, if we made a mistake early on in the process, but continued with the correct methodology to land at an incorrect solution, then we were awarded consequential marks.

The body is like a math problem.

It’s goal is survival, and execution of tasks (the solution), it doesn’t care how it performs these tasks (working), nor does it care if these “faulty” solutions lead to issues either elsewhere in the body or in the future (consequential marking).

So, if we get back to topic – muscle imbalances are a solution to a problem, which can then be a problem in and of themselves.

What is the problem?

Usually, it boils down to a lack of stability, somewhere in the body.

Now, a lack of stability can co-exist with a lack of mobility within a joint segment – you can’t exactly stabilise/control movement if there is nothing to control, can you?

Why would you lose mobility/stability at a joint?

Adaptation.

As mentioned, the body is continually adapting in a way that best serves it, in that moment (however long the moment is), based on the overall exposures to different stimuli.

Thus, a young tradesman who works 50+ hours per week will have a different body to his twin brother who is a uni student who has 12 contact hours and spends another 20 or so reading and using a computer (assuming all other variables are equal, which is very unlikely).

So, What Should I Do Then?

Acceptance is the first step.

Accepting that muscle imbalances happen, and will continue to do so, no matter what. They are often a good thing, as they allow you to accomplish your day to day and recreational tasks more efficiently.

Imagine if you were a recreational runner. Your muscles will adapt, forming “imbalances”, related to your running pattern, in order to make running more efficient for you.

Is this bad? Not always.

Is it good? Not always.

However, if your muscle imbalances are related to another issue – pain, poor function (i.e. you can’t do what you want to do), then you need to assess your environment, your activities and lifestyle and your overall health status.

This will give you an insight to your ability to adapt and deal with said environment and lifestyle, and why such imbalances may be occurring.

Essentially we want to know:

  • What you can currently do – ie your absolute ability, in this case, as it pertains to movement. We do this by testing and assessing.
  • What you do regularly – your lifestyle and regular activities, that would contribute to your current ability. This is done by having a conversation (history taking).
  • What you aspire to do, or cannot not currently (the problem).

If there is a gap between what you aspire to do and what you can currently do, we seek to find out why.

If the problem is something the testing and assessing has revealed, then we can address those findings, within the context that the current state of the body isn’t necessarily a “problem”, but a “solution” to your current situation – sum of lifestyle, environment, your healthy status and health history.

So, that means, if a muscle is “tight” and another is “weak”, but this is because it is more efficient to be this way, we have to regress to progress.

That is, go backwards to go forwards by reducing the complexity of the movement and increasing the stability, so the movement is more easily performed without compensation.

Once mastery in a regressed position is achieved, we can progress.

In essence, you are addressing the muscle imbalance by addressing total body function, that is, the sum of our body’s mobility, stability and capacity, expressed in context.

This means, if you are having issues sitting, then we must improve your ability to demonstrate good function in sitting, but also your overall function, as your functional ability to sit is a subset of your overall function.

Simply put, improve function, and you improve the muscle imbalances.

However, the inverse is not true, if you improve the muscle imbalances, there are no guarantees you will improve function of the body.

Conclusions

Muscle imbalances are real, in that they are described consistently by different people.

They are not, as consistently described, problems that need addressing.

Muscle imbalances occur as a way for the body to adapt (poorly) to a stimulus over time.

In order to resolve a muscle imbalance, we must determine what our bodies are capable of, what we are asking of it and whether there is a gap between the two.

The size of this gap gives us insight as to how and why the body might be adapting/compensating.

We then address this gap by improving global function – that is total body mobility, stability and capacity – in a systematic way, allowing the body to “re-learn” optimal movement patterns that are stored in the brain.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

 

 

References

Sapolsky, R., Introduction to Human Behavioural Biology

Wikipedia – Muscle Imbalance 

Dailyburrn – Muscle Imbalances and Functional Movement Screen

Phil Maffetone – Muscle Imbalance, Part 1

Phil Maffetone – Muscline Imbalance, Part 2

4 Major Exercise Programming Mistakes

Woman stretching hamstrings.

He who represents himself has a fool for a client. – Abraham Lincoln

In many cases, it could be also said that the person who writes his own training program has a fool for a trainer.

The reason, in both cases, is the difficulty of being objective in deciding your own needs.

It’s only natural to gravitate towards what we like and what we are good at (often one and the same), which means when we write our own exercise programs, we often neglect what we need.

In fact, if you coach yourself, chances are you are making (or have done so in the past) at least one of the following common exercise programming mistakes.

Now, if you are experienced enough, with the accompanying knowledge, you can write yourself good programs, but I would always argue, that these will generally be inferior to a program written for you by a coach with equivalent or greater knowledge and experience than you.

The problem with programming mistakes is that they compound over time (more on that later), and the risks they pose are not insignificant.

Risks of Poor Exercise Programming

Before I go on to describe some of the most common exercise programming mistakes I see, I want to outline the risks involved with making these mistakes:

  • Injury. This is far and away the biggest risk of poor programming. In my opinion, if you exercise for health, you should never get injured as a result of your exercise program. I understand that for competitive athletes, a certain amount of risk is assumed in order to push the limits of performance, and I also understand that on any given day, shit happens, so a random injury might occur. But often, what seems random, is not, and if you look at past workouts, there were modifiable factors that contributed to the injury. The other injury consideration is joint degeneration.
  • Negative postural changes. Posture is complex – it has psychological and emotional components to complement the physical components that are commonly talked about. One of the influences on posture are the activities and tasks we expose ourselves to on a regular basis. With poor exercising programming, you can develop poor postural habits.
  • Suboptimal progress. To be honest, the risk of getting injured is enough of a reason to ensure good exercise programming. However, even if you are a throw caution to the wind type, good programming will ensure you make the best possible progress towards your goals, whatever they may be.

The Most Common Exercise Programming Mistakes People Make

These 4 mistakes are not listed in any particular order, and I would say, based on experience only, that the majority of people who have poor (or no) programming when it comes to their exercise make more than one of these mistakes, if not all!

1. Improper or lack of warm up

There’s a popular quote in trainer circles:

If you don’t have time to warm up, you don’t have time to work out.

Unfortunately, like many things, the quote is more popular than the practice.

Too many people make the mistake of not warming up properly before exercising, or, even worse, not warming up at all.

Excuses range from “it’s boring” to “I don’t have time” and god knows what else.

Like many things, there is a disconnect between what most people do and what those who are succesful do.

For example: professional sports clubs, with million dollar athletes, have staff dedicated to optimising warm ups in order to maximise training and game performance and minimise injury risk.

The bottom line is, warming up is important.

During a warm up, there are 3 main goals:

  • Psychological preparation – a transition period from what you were doing, to what you are going to do.
  • Physical preparation – increase body temperature, address physical qualities like mobility and muscle activation
  • Skill practice to prime the nervous system for the upcoming task

If you don’t warm up properly (or at all), you decrease your subsequent performance and increase your risk of injury. A lose-lose situation.

2. Lack of Flexibility Work

Time magnifies errors in training. – Ian King

Ian King has been a physical preparation coach for more than 30 years, and is often outspoken about many topics. However, his opinion is based upon experiencing of producing real world results with both athletes and coaches over many years, so his opinion counts.

One of the biggest topics he is vocal about, is flexibility training.

I like static stretching. I know, I know…current trends in sport science have found favor in other methods, like dynamic stretching. But, in my opinion, it’s all part of a circle that’s slowly turning. Static stretching was the big hit in the ’80s, and I suggest that it will be again. – Ian King

Not only does Ian promote the less popular static stretching, he also promotes stretching before a workout.

Now, I’m not going to regurgitate his reasons for doing so – you can read the article for yourself – but the biggest take home was that if you are performing activities that stiffen your connective tissue (just about everything involving muscular contraction), then you should be performing activities that decrease this stiffness as well.

To counter the points above, people will cite research that demonstrates decreases in power and force production immediately after stretching (lasting up to 15 minutes).

To paraphrase Ian again, if you did a study that measured strength immediately after a weight training workout, you would see a decrease in strength, and the researchers would conclude, based on that data, that weight training makes you weaker.

The solution lies in watching how top level athletes have prepared for many years, which is generally a variation of the following sequence:

  1. 3-5 minutes of general warm up to elevate body temperature
  2. Static stretching
  3. Dynamic/specific warm up
  4. Workout
  5. Go home

The added bonus of this: after your workout, when you are tired, you don’t have to do anything else, except maybe walk around a bit to cool down and start recovering.

3. Ignoring structural balance

Structural balance is a term I first read about in the writings of Charles Poliquin, another highly experienced strength coach.

Whilst we know that posture is poorly correlated to pain, we also know that the body will adapt to repetitive activities.

Thus, if all you do is run, then your body will adapt to running, which is both good and bad.

Good, because your performance will increase, bad, because you need to do more than run in your life.

Wealso  know from various research, that relative strength imbalances can lead to injury, so the implication is clear: balance your training to reduce injury risk.

This means:

  • Exercising a variety of physical qualities – strength, power, endurance, flexibility etc.
  • Performing a variety of activities.
  • Moving across different planes of motion and different “levels” (ground, standing, kneeling etc).
  • Balancing stresses across joints as best as possible.
  • Allowing for periods of higher intensity/lower volume and lower intensity/high volume.

4. “Too Much”

This is not a specific claim, but rather, an observation that most people, once they cross the line from casual exerciser to exercise enthusiast simply do “too much”.

Whether it is too much strength work and not enough flexibility and endurance work, or too much exercise and not enough rest and recovery.

I’m a massive proponent of doing something everyday if possible, but that doesn’t mean smashing yourself every day.

In my experience, this simply stems from being overly emotional about the outcomes attached to exercise.

You are not your fitness.

If you have an overly emotional attachment to certain outcomes associated with your fitness, I’d suggest you do some deep contemplation to find more balance in your life.

Conclusions

It might seem that I keep repeating myself when I talk about training: warm up, manage your volume/intensity, work on all physical qualities, prioritise rest and recovery etc etc.

That’s because:

  1. This is what the vast majority of people need to do, but don’t
  2. Training isn’t as complicated as the internet makes it out to be.

What is complicated, is you as a person (we all are), and so a good coach helps you recognise where you are, what you need and what you don’t. In fact, many of the benefits of a coach are not that you have the best program (it doesn’t exist), but rather adherence, consistency and progression, regardless of the means.

To avoid making exercise programming mistakes, it’s best to enlist help. There are options to suit all needs and budgets, ranging from free programs online all the way to individualised coaching (both online and in person).

Whatever your scenario, even for a short time it’s worthwhile investing in coaching of some form, in order to learn skills that will stay with you for life.

 

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Australian Institute of Sport – The Warm Up and Cool Down

(2) Ian King Blog

(3) Ian King – The Lazy Man’s Guide to Stretching

(4) Charles Poliquin Blog

7 Effective Ways To Avoid Injury Exercising

Group Exercise @ Healthy Fit, Fitzroy North

Supervised group training at Healthy Fit – professional supervision is a great way to reduce injury risk whilst exercising.

There are numerous benefits to exercise, but what’s often not mentioned in all the pro-exercise publicity, is that there are also risks involved, chiefly the risk of injury.

Many people, despite their best intentions to get healthier and feel better, actually end up unhealthier and feeling worse after injuring themselves pursuing their fitness goals.

Recently, I polled my personal Facebook account for stories of injury whilst exercising.

It didn’t take too long for my notifications to start pinging like crazy. Here are some of the responses I got:

went for a 7-8km run then stupidly tried to do a back session whilst fatigued. deadlifting with no energy then gave me a slipped disc and a very shitty year ahead.

it still niggles. its probably at about 85%. back in the gym but i never lift at more than about 60%. also trying footy again this year but am a little worried about getting a big bump. long car trips are also a horrible experience if i dont have a rolled uo towel to place on my lower back.

I was doing weight training and now my knees are stuffed!

Sore left glute early on in hockey season. Hockey is a right handed game (seriously) and a lot of players tend to develop niggles on the left side.

Buggered knee from years of over exertion bad form and bad knees

Yes many times mainly due to my strength being far superior than my mobility and flexibility at the particular time.

High volume squats. Poor form with my wrist. – sprain which eventually led to avascular necrosis of the lunate.
Heavy tb deadlift pb. Not enough food tat day and lifted too heavy given a lack of conditioning (hadn’t lifted heavy in 3 months) back injury – 6 months.

Back is fully recovered, wrist is permanently injured.

 

Not all injuries are created equally, however, and there were many stories involving accidents and trauma which I haven’t shared. Whilst little can be done to eliminate accidents, setting yourself up to exercise as safely as possible can greatly reduce your risk of injuries like the ones described above.

In my years of practice, and especially now being an osteopath based in a gym, along with almost a decade of personal training experience , I’ve learnt a few things about why people get injured exercising. A lot of the time, there is the perfect storm of preventable factors that combine to result in injury.

With that in mind, I’ve listed 7 ways to prevent injuries whilst exercising:

 

1. Make sure you want to exercise in the first place

Most people don’t think things through properly before they start.

When it comes to exercise, before you start, you have to know why.

Without a good reason to exercise, you won’t put in the effort to do things properly, which is a sure-fire route to getting injured, or you will, but the effort will be such a stress that it negatively impacts other aspects of your life.

Deciding to exercise will either have a positive or negative motivation behind it.

Positive: I want to be healthy and feel strong so that I can live a full life.

Negative: I don’t want to end up weak and frail and isolated in a nursing home.

Neither is right or wrong, but from experience, negative motivation only lasts so long. If it gets you going, great, but be aware that those that stick to exercise for life tend to have positive motivations for doing so. Don’t worry though, chances are you’re reasons for starting will be different to your reasons for sicking to it.

Exercise is fantastic, most people should be engaging in some form, but it is not essential to exercise to be healthy.

So if you chose to do so, know your reasons.

 

2. Learn to move well

This was almost going to be number 1, because, even if you don’t “exercise”, chances are you move.

Learning to move well is both simple and complex at the same time.

The knowledge behind the process is actually quite complex, but what you have to do is relatively simple. The key is to seek out an expert who has the complex knowledge but can provide you with simple, actionable steps to get you to move well.

Whether it’s an osteopath, a personal trainer or both, the initial investment in learning to move well will pay you dividends for life.

 

3. Know your weaknesses (and address them)

We all have strengths and weaknesses. Naturally, we gravitate towards our strengths.

Big strong people tend to like to lift heavy things. Tall and lean people tend to like to run, row or ride.

Of course, these are just generalisations, but the point is, if we only ever focus on our strengths, chances are we will limit our potential achievements and increase our risk of injury, as our bodies become ever more efficient at compensating until they can no longer.

Identifying your weaknesses is a tough thing to do. Most of us a terrible at looking at ourselves objectively. This is where it pays to hire a professional to tell you what you need to work on.

Not only will address your weaknesses make you more resilient, but your biggest fitness gains will come from improving your limiting factors.

 

4. Progress intelligently

One of the biggest predictors of injury is the ratio of acute to chronic training volume.

What the heck does that mean?

It means when you see a big increase in the amount of work done in the short term, relative to the amount of work done in the long term, then injury is more likely.

Put another way, you have to build up your tolerance to large training loads.

That means starting well within your capabilities and progressing gradually.

The 10% rule – not increasing total training volume by more than 10% per week – is a good general guideline to go by.

Start with an assessment to work out your current abilities, and then progress gradually, using different means of progression. Intensity, volume, frequency, rest, density and even activity/exercise selection are all variables that can be manipulated to provide progressions.

You should have certain indicators that help you identify when you are ready to progress – whether they are qualitative (rating of perceived exertion (RPE) scales) or quantitative (biofeedback like heart rate or power output). (1)

This will prevent your ego getting in the way and causing you to make to big of a jump too soon, which is a massive cause of injury.

 

5. Prioritise recovery

Everyone loves to train hard, not many people like to put in the effort to recover well. However, your ability to exercise is determined by your ability to recover.

Recovering means more than time off training. It means actively taking steps to relax and regenerate both your body and mind.

That means your nutrition and sleep must be on point, but also, your workload and personal life must be taken into consideration of your exercise load.

There are a few ways you can monitor you recovery.

Old school: keep a journal, track your mood and a RPE for each session. If your RPE is going up and your mood is going down, it’s a good sign you’re not recovering enough.

New school: Heart rate variability (HRV) apps. HRV is a way to measure your autonomic nervous system activity, which is a good marker of how stressed you are. You can download various free apps which will sync up with a chest heart rate monitor, whilst at least one can use your smart phone’s camera to measure your heart rate via your finger tip.

Recommended HRV apps*: EliteHRV,  ithlete, HRV4training (iPhone only) (2)

The best approach, which is also the most effort, is to combine a journal, RPE scale and HRV data. Initially, it won’t tell you much, but over a longer period of time, you’ll gain valuable insight to your physical and mental state, which will allow you to know when to push hard and when to back off.

Even if you don’t monitor your recovery status, simply allocating time for active recovery techniques is doing better than 95% of people.

 

6. Balance your training over time

Depending on your individual goals and personal characteristics, you will train in a way which builds particular physical qualities.

However, it is important for health and longevity to build all physical qualities to some degree – flexibility, mobility, power, strength and endurance.

Even if you are a highly specialised athlete, outside of your sport, all training is general in nature, and thus you should aim to improve a range of general physical qualities to minimise injury and maximise performance. If your sport is “the game of life”, then this only adds to the need to exercise a broad range of attributes.

Balance is more than being well rounded; you want balance between periods of hard training and periods of consolidation, which goes back to prioritising recovery.

 

7. Don’t chase fatigue

Anyone can make you TIRED. It takes a skilled professional to make you BETTER.

One of the biggest mistakes people make when exercising, whatever their motivation for doing so, is “chasing fatigue”.

This is a problem, because whilst how we feel on any given day is important, it gives us no insight into whether we are actually improving.

Additionally, chasing fatigue often results in compromising your movement in order to complete a given task, which is risky business to say the least.

This occurs because people associate with certain feelings, and a common association, often perpetuated by the mainstream media is that a workout has to be hard to be effective.

Now, of course, some exercise sessions will be tiring, that’s completely okay, but fatigue should be a by product of exercise, not a goal in and of itself.

You don’t always have to improve from session to session, or even in a straight line (pro tip: neither happen in the real world anyway), but, over a long enough period of time, you should improve at what you are doing.

The best way to know this is to keep a training journal, but if that’s too tedious, having “milestones” throughout the year where you test yourself are a good way to keep track on a macro scale.

8. (BONUS) Fit the exercise to your body, not your body to the exercise

Not everyone is built to run long distances or squat heavy weights with a barbell.

This goes back to knowing your weaknesses (and strengths), but you should choose activities and techniques that suit your body type and abilities.

If you like to run, that’s fine, but maybe marathons on roads don’t agree with your body, so instead, you try shorter distances or trail running.

Likewise, if the gym is your thing, build your program around exercises that suit your body, not what some article online says is the best “butt builder”.

Final Thoughts

Injuries can still happen, despite your best intentions, but there are lots of things you can do to minimise your risk, the above list covers 7 very important elements to consider.

A lot of them have overlap – doing too much too soon and not getting enough rest – and are generally brought about by not knowing any better (forgiveable) or getting emotional/letting your ego guide your decisions (not-so forgiveable).

Exercising should be enjoyable, not a chore, and this list isn’t meant to take the fun out of exercise, but rather, help keep you injury free so that you can continue to exercise in a way that you enjoy.

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



Notes

(1) To read about a simple, easy to use RPE scale, as used by the Australian Institute of Sport, read this.

(2) I’ve only used EliteHRV, but the other two come highly recommended from other professionals I trust.