In this post we look at the reasons why you keep getting injured and explain how to stop the frustrating cycle for good.
We’ve all been there. You’re feeling great, your training is going to plan and you’re looking forward to a good performance in your big event. Then seemingly out of nowhere another damn injury.
You curse your luck and think about what might have been and eventually face the reality of another slow and painful course of rehab.
The question you’re no doubt asking yourself is why do I keep getting injured?
Is this just an inevitable part of training, or is there something else going on?
I expect you’ve followed the advice of every well meaning health care professional you’ve spoken to.
You’ve been diligently stretching, foam rolling and sticking spiky balls where the sun doesn’t shine, but here you are again, injured.
So why do you keep getting injured?
Musculoskeletal (MSK) injuries are notoriously difficult to predict. The one thing the research seems to agree on however is that having suffered one, you dramatically increase your risk of suffering another one.
In fact in some cases you are twice as likely to suffer an injury in the future if you’ve had one before.
Yeah thanks I hear you say, but that doesn’t help me now!
But wait a minute, what that suggests is those previous injuries may be an important part of the puzzle.
The effect of previous injuries
Let’s take a look at a real life example to illustrate this effect.
If you want to see the impact previous injuries can have, rugby players are an excellent place to start.
Take Dominic, a former under 21 rugby international with a long list of injuries, as is common in this sport.
He originally came to see me for help with a knee injury that was proving difficult to rehab. His goal was to be able to run again pain free.
What became clear is that the lingering effects of two old injuries; a severe ankle sprain on the same side as his problematic knee, and an ACL rupture on the opposite knee, had likely scuppered every attempt to rehab his knee thus far.
Both had left the respective joints with significant restrictions that Dominic was having to work around every time he ran.
How injury impacts the muscular system
The immediate effect of injury is inhibition of the local muscles. Think how you instantly move differently when injury strikes.
Your central nervous system effectively turns off muscles to avoid further damage.
Researchers have found injecting just 20ml of saline into the knee joint is enough to cause reflexive inhibition of the quadriceps.
It’s an incredible phenomenon that occurs in fractions of a second, all with the goal of keeping you safe.
Paradoxically, this inhibitory effect also seems to be the biggest confounder in injury rehab outcomes.
Muscles that have been inhibited don’t seem to magically start working again once the injury has healed. Even after significant periods of rehab in some cases.
The tell tale signs of these deficits are restrictions in range of motion.
Not ‘my hamstrings feel tight’ type restrictions. But measurable and specific differences between how far a joint moves on one side of your body compared to the other.
It’s these specific limitations that leave you vulnerable to future injury if they’re not addressed directly.
You have around 650 muscles so your brain has options to compensate around muscle weakness, to a point.
The issues usually arise when you start to run out of compensations. That’s why if you’ve had more injuries, you tend to have more issues. You become what is commonly known as injury prone.
It’s not that you were destined for this fate as the label suggests. It’s more the impact those injuries have had on your muscular system have not been fully resolved.
Read more about muscle compensation and its impact on injury rehab.
Why running injuries are so common
If you’re a runner you’ll be more familiar with this cycle of injury than most.
This is due to the forces you’re asking your body to tolerate every time your foot hits the ground. These are upwards of two to three times your body weight with every stride.
Your body has an ingenious way of cushioning that force which is called pronation. It’s your built in suspension system.
It’s usually a breakdown somewhere in this series of motions that causes problems as you can’t effectively attenuate the forces involved.
Joint motions associated with pronation
Subtalar joint eversion.
Tibial internal rotation.
Hip internal rotation.
Trunk rotation to the same side.
Trunk side bend to the same side.
As your body is an integrated system, restrictions in any one of these motions will naturally impact the others.
A lack of subtalar joint eversion for example, which is common in runners who have suffered ankle sprains, will impact every other joint in this chain of events.
That’s how an ankle sprain may eventually lead to knee, hip or back pain.
Learn how to assess your ability to pronate and improve it with this post.
Strengths, weaknesses and training errors
I read a great analogy on the Noigroup site that likened our growth and development to that of trees. Never the same left and right and always adapting to the weather and seasons.
Your body is the product of the forces it has been subjected to over the years.
I used to play a lot of racquet sports for example. To this day if you put a racquet in my hand and ask me to get a ball, I’ll always lunge with my right leg forward.
It’s no surprise that even now I can usually split squat with a few extra pounds on my right side.
This is fine and normal unless… I took up an activity that required me to lunge off my left leg. I would need to be a little careful how I began to do that.
Of course none of us are. Not even me. Especially when there’s a ball to chase or a game to win.
This doesn’t just apply to a new activity. Even subtle changes to how you participate in your current one can cause issues.
A change in volume, intensity, bike position, running shoes, or even racquet grip size, can overload muscles that have been accustomed to working in a particular way.
Trees adapt slowly and so do we, so don’t change anything too fast.
Sleep, stress and general health status
To muddy the water further, there’s also the potential impact of your general health to consider.
If you’re working 60 hours a week, under stress, not sleeping well and making poor food choices, is your training the problem?
One of the most important parts of the training / injury equation is what you’re doing when you’re not exercising.
Exercise is a stressor. You apply it to stimulate an adaptation which means the magic occurs after the event.
The conditions have to be right for this adaptation to occur. Without adequate rest and nutrition, training just becomes another form of stress that your body may be struggling to cope with.
How to reduce your risk of getting injured again
Injuries are not random events with no discernible cause. Although the events that lead to them may not always be immediately obvious, a reason can usually be found.
I always go through the following process with my clients to ensure their last injury is in fact their final one. You can too.
• Check for and begin to address range of motion deficits
What can’t you do on one side of your body that you can on the other? Comparing the motions involved in pronation is a great place to start, especially if you’re a runner.
• Incorporate strength training into your programme
Start strength training. If you do it sensibly and with control, you’ll see improvements. This study found strength training reduced sports injuries to less than 1/3 and overuse injuries by almost 50%.
• Monitor the effect a return to training has on your muscular system
Look for restrictions in range of motion, particularly when you return to your activity. If you feel more muscle tightness than usual, that’s a sign to back off your training.
• Track sleep as an indicator of appropriate rest and recovery
7-9 hours is ideal for most people. Use an Oura ring to gain more information if you think you would benefit.
• Use blood tests to assess general health and nutritional status
We use Thriva to assess for common vitamin deficiencies and general health markers.
“I got to a stage in my early 40s of becoming tired of on/off injuries and niggles from Triathlon training. Normal physio work was just not resolving the key triggers and not looking deeper into things. Triathlon training takes its toll on the body and due to a lack of strength training suited for my body and sport meant it just kept breaking down.After working with Paul closely for over 6 months I’m the strongest I’ve ever been. Imbalances have been worked on which has meant getting back to triathlon has been easier and I’d say I’m performing better with less training but more strength work. I’d definitely recommend Paul. He’s the first person I’ve seen who’s got to the root of my injuries.”