From my perspective as a physical therapist, in the past 3 months there existed two groups of people, namely those who ‘ found ‘ exercise for the first time or rediscovered it after a long absence and then those who decided it was a good time to break from their regular exercise routine and take to the couch to exercise the Netflix subscription instead!
We physio’s have been dealing with the first group in recent weeks and we are now preparing to deal with the 2nd group. A good example are club GAA players, the length and breath of the country, some of whom have done little if any training in the lockdown, but will now be returning to their clubs to train from the 29th June for championship games to start from July 31st. Many clubs have issued training plans to their squads to complete individually or in small groups between now and June 29th. The difficulty here is that it is a one size fits all type plan, for some who have done some fitness work during the lockdown it will be no problem but for those who have done nothing it could be a shock for the body and set them up for injury. Research shows where there have been long lay offs in professional sports with short time frames for return to play injury rates soar. So what might this be like for amateur club players of any code? Though GAA club players have 8 weeks to be ready for games the temptation for coaches and individuals will be to go from 0 to 100mph very quickly in order to feel ‘the work has been done’ when games finally return. This highlights the ‘golden rule’ for a safe and injury free return to full speed – it must be gradual!
Progressive Return to Training
The advice is simple: don’t overdo it and avoid doing too much too quickly. Tissue overload is needed to develop strength and fitness, but it’s a balance and too much overload results in injury. Start small and with each training session increase the load by about 5 to 10% max (so if you start by going for a 20 minute run, your first in 10 weeks, then increase it to 22 minutes the next time and so on).
Before you start a training session, be sure to warm up, specifically perform a dynamic warm up. A dynamic warm-up can be defined as a series of movement drills performed in a progressive, deliberate sequence from low to moderate intensity. The initial drills might
jogging using different movements or running drills
then gradually advancing to fast accelerations and changes of direction.
It includes movements that stretch certain muscles and joints to prepare them for the work ahead.
This measured build-up in intensity during a dynamic warm up enables the circulatory system to move blood to the working muscles for a steadily paced warm-up of the soft tissues. It also warms up the nervous system, getting the brain talking with the muscles, allowing your muscles to work more efficiently.
Training places stresses on the body. If given adequate time to recover these stresses will act as a stimulus causing the body to adapt in a positive manner, making it fitter and stronger. However, if there is inadequate time between training sessions the body
does not fully recover and minor damage to tissues can consequently develop into
an injury. To aid recovery good quality sleep is a vital element of recovery as the body’s repair team works most efficiently while we sleep. Research shows that poor quality / insufficient sleep not only impacts recovery time but also impacts performance at game time significantly and remember fatigue leads to increased risk of injury.
Hard training causes depletion of muscle’s glycogen stores. Muscle glycogen is an essential fuel during strenuous exercise, the depletion of it causes fatigue and inhibits performance. If glycogen stores are not effectively replaced, you will start the next training in a semi-depleted state, causing potential fatigue and therefore increased injury risk. The same is also true of dehydration and the need for fluid replacement after training. So make sure you are getting enough nutritious food as you resume your training and as the quantity and intensity increases
Mobility – or the ability to effectively move through a full range of motion – is key to a healthy body. Training causes scar tissue and muscle adhesions to form, which reduce your mobility and negatively impacts your stride. A large proportion of non traumatic injuries stem from muscle tightness leading to restricted biomechanics and alterations in running form.
Dynamic stretches done daily, even if you don’t run/train that day, are great for general strength, flexibility and stability. These include leg swings, lunges and squats.
Even when brushing your teeth balance on one leg to improve core strength and stability. Remember when you run, 50% of the time you have all your body weight on one leg!
Use a foam roller regularly. Prioritise those especially tight “trigger points” when rolling to stay loose and supple.
Keep moving during the day, stretch at your desk, and keep a tennis or golf ball in your drawer to roll out the soles of your feet whilst working at your desk.
Get regular massages if you can.
On the days that you are not training, make time to spend a few minutes performing gentle static stretches to the main muscle groups, ideally after you have carried out a dynamic warm up. Never perform static stretching without spending a few minutes warming up first.
Weak muscles are more prone to injury and less resilient to the impact forces experienced while training. There is a growing body of evidence supporting the use of strength training to reduce injury risk as well as leading to improved performance. So you should incorporate some strength work in to your return to training plan 2/3 times a week. You don’t need a gym to do body weight exercises that focus on the core and main muscle groups. Exercises like planks, side planks, bridges, lunges, calf raises and heel drops, Nordic hamstring curls and squats including single leg squats to name a few will all be beneficial.
One of the strongest risk factors for injury is a previous injury in the past 12 months. Ideally therefore you want to prevent the first injury! If not, then ensure your injury is fully treated, healed and rehabilitated before you start a progressive return to training to avoid a re-injury. Even if you don’t feel pain from the injury now, you may well need to continue your rehabilitation treatment for some time after the injury has healed.
Most injuries occur because the athlete/player exceeds their soft tissues capacity to tolerate load by increasing the load too quickly which is then exasperated by inadequate recovery time. Other factors that likely contribute to injury on return to exercise will be inadequate nutrition including hydration, poor flexibility, strength deficits and history of previous injury.
If you would like further help with your safe return to training and exercise or need treatment and rehabilitation for an injury, you can contact me on 0877873439. I am located at Caherclough, Lisronagh, Clonmel and also at Canada Street Waterford.
By Aidan Bradshaw
Ph. Th. BSc. M.I.A.P.T
Member of the Irish Association of Physical Therapists
Clonmel Physical Therapy Clinic