Pre-season training to prevent injury

Andy Chalmers

December 17, 2021

Coming into December, we now see the return of pre-season training amongst local sports, and with that, a rise in overuse injuries including muscle strains, tendinopathies and bony stress. These conditions are likely to be increasingly prevalent given the interruptions to the 2020 and 2021 seasons for most local athletes, leaving them vulnerable to load-based injuries. Below is an overview of these types of injuries that may be presented to us, what to look out for, and how to best manage them headed forward.

Muscular injury:

Muscle strains are commonly injured in ball sports such as Australian Rules Football, Soccer and Netball, including the hamstrings, adductors, quadriceps and calf muscles. On initial assessment, it is important for a thorough assessment to determine what structure is injured and the extent of strain which will assist in determining return to play and what rehabilitation is required. Diagnostic imaging may assist with getting precise diagnosis, however we try to avoid where possible.

Trying to understand events leading up to the injury is important such as how much load/ training, previous injury history and whether a ‘mechanism of injury’ was evident – typically during a deceleration (slowing down) or eccentric contraction (muscle contraction in a lengthened position), or if the pain came on gradually. Objective examination by a Physiotherapist should involve screening for bruising/swelling to the area, level of mobility, strength deficit between sides, as well as careful palpation. The importance of differentiating between the structure affected- myofascial, musculotendinous or tendinous injuries relates to the Physio being able to provide a clearer prognosis for the athlete headed forward, which may result in recovery timelines of approximately up to 3 weeks, 4-8 weeks, or 2-4 months, respectively.

Management of Muscle strains:

In respect to initial management of these injuries, ‘PEACE & LOVE’ is now supported as the most evidence-based acronym for acute injury management (Dubois & Esculier, 2020). This involves: PROTECTING the join

ELEVATING the joint

AVOIDING anti-inflammatories in the initial 72hrs

COMPRESSING the joint

EDUCATION

This is followed by:

LOADING the injury gradually

provide OPTIMISM regarding the injury

promote VASCULARISATION through cardiorespiratory exercise

EXERCISE including mobility, strength and proprioception.

Strength & conditioning principles should be considered in rehabilitation of these injuries and incorporate elements of muscular endurance, hypertrophy (building muscle), strength and power. The muscle also needs to be exposed to rapid acceleration/deceleration, change of direction and sports specific drills. As previous muscular injury is the biggest risk factor for a future muscular injury, care should then be taken with injury prevention into the future. Eccentric strengthening continues to be widely backed by research in support for injury prevention, including the Nordic hamstring curl, which was able to reduce hamstring strains by up to 50% when included in an injury prevention program. (Van Dyk et al., 2019).

Nordic Curl (Muscle and Strength, 2021).

Tendinopathies:

Tendons are load dependent and as such may have frequent injuries in local sports this season, given the stop/start nature of the 2021 season. These tendinopathies are most frequent in the Achilles, patella, hamstring, and rotator cuff tendons, amongst others. As such, a thorough subjective history that highlights changes in load may be the first indication of a tendon injury, as well as:

  • pain generally being activity related
  • being worse in the morning
  • taking time to warm-up
  • being worse after activity

Objectively, tendon pain is usually well localized, and a patient should be able to point to their pain with one finger.

Management of Tendinopathy:

To manage tendinopathies – tendon loading, kinetic chain strengthening (strengthening muscles above and below injury), load management and education are the primary strategies supported by research (Murphy et al., 2019). Isometric exercises offer a nice introduction to tendon loading and may even offer a pain relieving effect, as has been shown in the patella tendon (Rio et al., 2015). But for the tendon to improve in strength and be able to tolerate the demands of return to sport, which may take up to and should be progressed over the course of up to at least 12 weeks – heavy/slow loading, strength training, kinetic chain strengthening, plyometric, and sport specific activity all need to be incorporated into rehabilitation (Malliaris et al., 2013).

Seated calf raise for Achilles Tendinopathy

Bony stress:

Bony stress injuries are overuse injuries, which represent the failure of bone to withstand repetitive loading, leading to structural fatigue and potentially damage. Management of these injuries involves looking for a causative factor for the injury – as per the previous subjective history, controlling the pain, conditioning, axial loading, and finally return to sport.

Look out for more information on bony stress injuries in our upcoming blog.

Summary:

Careful diagnosis is required to not only determine the injured structure but to also determine the extent of injury to give a prognosis for return to sport. An individualised assessment will also form the foundation to the injured area’s management and prevention in the future. Coincidingly, athletes should be exposed to varying forms of progressive strength and loading tasks in their rehabilitation, with an aim of working towards a return to sport following a step-by-step loading continuum. If you would like assistance with setting up a pre-season training program to prevent injury or if you have been injured in your pre-season, contact Grand Slam Physio on 52772151 or book online in Geelong or Torquay to set up an individualised program.

ABOUT ANDY CHALMERS:

Andy graduated from Latrobe University and has special interests in utilising exercise based rehabilitation, acute and chronic sporting injuries, lower limb tendinopathies and loading issues. Andy works with AFL team Western Bulldogs and is the head physiotherapist for the North Geelong Warriors (NPL), and has qualifications in strength and conditioning and Clinical Pilates. He is currently studying a double Masters in High Performance and Sports Physiotherapy

References:

Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine, 43(6), 409-416.

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE.

Malliaras, P., Barton, C. J., Reeves, N. D., & Langberg, H. (2013). Achilles and patellar tendinopathy loading programmes. Sports medicine, 43(4), 267-286.

Murphy MC, Travers MJ, Chivers P, Debenham JR, Docking SI, Rio EK, Gibson W. Efficacy of heavy eccentric calf training for treating mid-portion Achilles tendinopathy: a systematic review and meta-analysis. Br J Sports Med. 2019 Sep;53(17):1070-1077. doi: 10.1136/bjsports-2018-099934. Epub 2019 Jan 13. PMID: 30636702.

Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British journal of sports medicine, 49(19), 1277-1283.

Tenforde, A. S., Kraus, E., & Fredericson, M. (2016). Bone stress injuries in runners. Physical Medicine and Rehabilitation Clinics, 27(1), 139-149.

Van Dyk, N., Behan, F. P., & Whiteley, R. (2019). Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. British journal of sports medicine, 53(21), 1362-1370.