10th July, 2012

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Training advances to reduce overuse injuries

Training programs set for professional athletes have changed over time as physiotherapists and the sports medicine profession improve their knowledge about how the body responds to exercise. Not so long ago ideas dreamt up by coaches were tested on their elite athletes, and the effectiveness of these programs was measured by the athlete’s performance. These days, coaches and fitness staff already know how the human body responds to particular training programs as each form of training has been extensively studied before it is applied. As the professionalism of sport changes around the world, there has been a greater drive from clubs to protect their most valuable asset, the player. The increased sponsorship and improving financial positions of these organisations allows for bigger medical budgets, thus allowing more time for accurate planning and implementation of training strategies. The result of this is more accurate ways to both improve performance, and reduce overall load on players bodies, minimising injury rates.

A prime example of this training modification with time is here in Victoria where particular AFL clubs limit their players to a defined number of kicks per training session. On the surface, this may seem like an excess measure engineered by over controlling fitness staff, but understanding the reasons behind it gives the idea more credibility. Part of the reason for this measure was the significant increase in overuse injuries, particularly groin issues (such as osteitis pubis) in Aussie Rules Footballers in the late 90’s, early 2000’s. To better understand the reasons for this sudden increase in debilitating issues more studies were completed and this area was a focus for many physiotherapists. AFL statistics show a significant increase in the number of games missed and rate of recurrence during this period of time.

The researchers identified two recurring factors that placed Aussie Rules footballers at risk. These were: large training loads and reduced control around the pelvis. The injured players when assessed demonstrated poor control around the pelvis region, and had often been subjected to large training loads around the time of injury. The logical response of physiotherapists and medical staff was to be extra careful with training loads, and increase the number of compulsory stability style training sessions (ie. Clinical Pilates and Yoga). Part of controlling training load was to limit the number of kicks each player is allowed during training.

Another aspect of athletic training that has become highly structured is the frequency of high intensity sessions. There is a particular type of high intensity exercise that has been shown to increase the speed and/or force of a muscle contraction called plyometric exercise. Its impressive capacity to improve performance has made it a popular form of training, particularly at the elite level. Plyometic exercise involves loading (stretching) the muscle, followed by a rapid contraction. This stresses the tendon tissue (tenocyte), producing an increase in fast twitch muscle fibres, however this also loads the tendon tissue close to its failure load and at risk of damage. Current recommendations suggest that these high intensity sessions need suitable recovery time and should be undertaken at most once every 3 days.

It will be through talking to your physiotherapist that you can identify any areas of your training that may be increasing your risk of injury. Injury screening is also a way whereby you can identify the onset of these signs before they turn into an injury that ruins your season.

Written by Mark Fotheringham – physiotherapist at Malvern Physiotherapy Clinic