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 By Carl Petersen BPE, BSc (PT)
As a physiotherapist and fitness consultant I spend many hours each day dealing with injuries. The good news is that these injuries are often preventable and with early intervention and proper treatment and exercise and practice progressions their incidence and severity may be decreased. Recognizing the signs and symptoms of injuries and learning what to do about them will help you reduce your recovery time.
Two basic types of injuries can occur in training for sports, those due to trauma and those from overuse. Trauma is easy to identify, it's either from a fall or being hit by someone or something. Overuse injuries result from numerous micro-traumas to the tissues when doing " too much, too hard, too fast, too soon " and can occur anywhere in the musculoskeletal system.
For example during running the foot strikes the ground between 800-1200 times per mile with a force of 2-4 x body weight. The repetitive nature of this type of stress can be the starting point for any number of overuse injuries. Exercise causes a certain amount of damage to the tissues which respond when given adequate rest by getting stronger.
If the tissues receive too much stress too soon, they cannot adapt and breakdown. When the body's ability to adapt is overwhelmed, overuse injuries can be the result. The first symptom of overuse is usually pain, which can be followed by swelling and inflammation. Rarely is an injury an isolated event, biomechanics, flexibility, strength, poor equipment and training or judgment errors can all compound the problem.
Pre-season preparation for squash and other sports should include all of the 5'S-P components of physical training. That means working on Suppleness, Stamina, Strength, Speed, Skill and Power. As well attention should be given to proper biomechanics, appropriate footwear and equipment.
Competitive level athletes must use some form of periodization in the yearly training plan to ensure proper exercise progressions and sequencing of energy system training. Periodizing training is smart training and allows for the anatomical adaptations to occur in the soft tissues and bone so that the possibility of overuse injuries are decreased.
Without a doubt, one of the most important aspects of injury treatment is promptness. Do something about it right away. If identified early, some injuries respond well to self-treatment. Understanding is the key to prevention and allows safe pain-free activity.
The first line treatment for any "overuse" type of injury should follow the same basic principles.
P - Protection
From further injury or aggravation. This may range from more stable shoes or orthotic devices to correct foot alignment to protective taping and bracing of the injured body part.
R - Rest (Modified)
Rest from the aggravating activity. If it causes pain and swelling don’t do it. Changing to a non-weight bearing activity like cycling, elliptical trainer, swimming or water running can help reduce discomfort and keep you active.
Changing your practice routine to accommodate an injury makes sense. For instance if you have a sore shoulder when you serve, work on footwork and foot speed on court to allow your shoulder to rest while maintaining some sport specific fitness.
I - Ice
Applying ice or cold packs minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use a gel pack, crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Do not apply ice directly to the skin since doing so can cause frostbite.
N - NSAID
Non-steroidal anti-inflammatory medication taken under a physician's supervision can be effective in decreasing inflammation and pain and thus speed the healing process. Other over the counter remedies can also be helpful. Speak to your Physician to see if medication is appropriate for your condition.
C - Compression
External compression helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold.
E - Elevation
Raising the injured area above the heart helps prevent swelling and aids in draining the swelling into large blood vessels.
No article can replace a proper diagnosis or treatment plan and all persistent injuries should be evaluated by a competent health professional. A Physical Therapist or Sport Physician can give you precautions, advise you on return to participation and help adjust training techniques and exercise progressions based on your age and fitness level.
Carl Petersen is a Partner and Director of High Performance Training at City Sports & Physiotherapy Clinic’s in Vancouver, British Columbia, Canada. He works with athletes ranging from club level to those on the WTA / ATP tennis and World Cup ski tour. He travelled fulltime with the Canadian Alpine Ski Team for 15 years. His physiotherapy and fitness coaching roles have given him the opportunity to work with, coach and design training programs for Olympic Gold, World Championship Gold and World Cup medallists. Petersen has worked and lectured to physicians, therapists and coaches on 5 continents most recently in Australia, England, Ireland, Paraguay, Argentina, Turkey, Switzerland and the USA. He has published over 200 articles in a variety of publications for both the Scientific and lay community which have been translated into 6 languages. He has also written or co-authored 3 books including Fit to Play Tennis-High Performance Training Tips and has produced a series of core stability training DVD’s entitled Fit to Play™ & Perform. More information available at www.citysportsphysio.com
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