Overuse Injuries

overuse injuries sport injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

There are 2 types of injuries : Acute injuries and overuse injuries. Acute injuries are usually caused by a single traumatic event. Here are some examples :

  • Wrist fractures

  • Ankle sprains

  • Shoulder dislocations

Acute injuries are less common in sport than overuse injuries. Overuse injuries are usually subtle and appear over time, making them difficult to diagnose and treat. Here is some example :

  • Tennis elbows

  • Swimmer’s shoulder

  • Pitcher’s elbow

  • Runner’s knee

  • Achilles tendinitis

  • Shin splints

Why

Human body is extraordinary to adapt to physical stress. We’re used of thinking that « stress » is bad for our emotional well-being, but physical stress is simply doing an exercise or activity. This is beneficial for our muscles, tendons, ligaments and bones. This physical stress causes an internal process called remodeling. Remodeling process involves both the breakdown and the build up of tissue. It’s necessary to have a good balance between 2, if breakdown occurs more rapidly than buildup, an overuse injury occurs.

Causes

overuse injuries sport injury gym fail

Usually, it’s training errors that cause overuse injuries. These errors are too fast acceleration of intensity or duration or activity frequency. These injuries can also happen to people who return to the sport/activity after an injury. They try to make up for lost time as quickly as possible to reach the level they had before the injury. Doing an exercise with a good technique is important to avoid overuse injuries. When the exercise’s technique is bad, it creates overuse injuries. It’s for this reason that coaches, athletic trainers and teachers can play a preventive role so that athletes avoid overuse injures.

There are people who more easily have overuse injuries. An unbalance between strength and flexibility around certain joints predisposes some people to have this type of injury. Body alignment, such as knock-knees, bowlegs, unequal leg lengths and flat or high arched feet, also impact overuse injuries. There are also people who have weak links because of old wounds, incomplete rehabilitation of wounds or others anatomy factors.

Other factors must also be taken into account as equipment such as the type of running shoe or ballet shoe and terrain (hard versus soft surface in aerobic dance or running).

Diagnosis

Generally the diagnosis is based on the athlete’s history and physical examination. It’s recommended to make a diagnosis with a sports medicine specialist with a specific interest and knowledge of your sport. In some situations X-rays, bone scan and MRI may be necessary.

Treatment

overuse injuries sport injury ice

Here are some recommendations for treating an overuse injuries :

  • Cutting back the intensity, duration and frequency of an activity

  • Adopting a hard/easy workout schedule and crosstraining with other activities to maintain fitness levels

  • Learning about proper training and technique from a coach or athletic trainer

  • Performing proper warm-up activities before and cool down after

  • Using ice after an activity for minor aches and pain

  • Using anti-inflammatory medications as necessary

If symptoms persist, a sport medicine specialist may create a more detailed treatment plan for your specific condition. This may involve an exam of your training program and an evaluation of predisposing factors.

Prevention

Majority of overuse injuries can be avoided with a proper training program, common sense and learning to listen your own body. The quote : « No pain, no gain » doesn’t apply here. The 10% rule helps a lot to get things to the next level.

In general, you should increase the training’s intensity to a maximum of 10% per week. This allows your body to have enough time for recovery and response. This rule should be used to increase pace or milestone for walkers or runners. Or for the weights amount to increase for strength training programs. In strength training, add flexibility exercises and core stability exercises help tremendously to minimize overuse injuries.

It’s recommended to seek advice from sports medicine specialist or athletic trainer to prevent chronic or recurring problems. Your training program can also be modified to maintain fitness levels safety while you recover from your injuries. You must return to the sport only if an authorization is granted by a health professional.

Remember, it’s very important to warm-up before training and cool down after training.

Stats

3.5 millions of children are treated for overuse injures every year.

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food. Click here .

Anterior Cruciate Ligament Injuries

anterior cruciate ligament injury tear

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Knee is the largest and most complex joint of the body. There are 4 primary ligaments (with their muscles and tendons) and secondary ligaments for the knee to function properly. Here are the ligaments of the knee : there are 2 ligaments on the side the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) and two crossed ligaments in the center of the knee, the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL).

Anterior cruciate ligament connects the front top part of the shine bone to the back bottom part of the thigh bone and keeps the shin bone from sliding forward.

anterior cruciate ligament

Injury

anterior cruciate ligament injury tear

There are several ways to have an injury to the anterior cruciate ligament :

  • The injury can be done because of a direct hit on the knee, which often happens in team sport.

  • The injury can be done without contact with an object in a situation where the knee forced to be in a abnormal position, which causes a tear in one or more ligaments of the knee. Or when an athlete in the race change direction. Or when an athlete make a hyperextend of the knee when landing a jump, which often happends in agility sports.

Diagnostic

In the majority of cases, the doctor is able to identify what is the injured ligament. But the knee can also be injured at the joint on the surface and in this situation, it’s more difficult to diagnose because of knee swelling. To make an accurate diagnosis, it will be necessary to use a MRI scan or arthroscopy.

Prevent

There are several fast, powerful movements that lengthen (eccentric phase) and shorten (concentric phase) a muscle. These prevention programs are for injuries without contact. These exercises are to improve the nerves/muscle control of the knee. These prevention programs use plymetrics, balance and strength/stability exercises.

Plymetrics

It’s a fast, powerful movement that lengthens (eccentric phase) and shortens (concentric phase) a muscle. The concentric phase increases the muscle power. Here is an example, an athlete who jumps from a box and immediately jumps into the air after touching the floor.

Balance

Balance exercices are done with the wobble or balance board. It’s also possible to perfom exercices by throwing a ball with a partner while balancing on one leg.

Strength/stability

To improve single-leg core strength and stability, there are excellent exercices such as jumping and landing on one leg with the knee flexed and momentarily maintaining this position.

Surgical treatment

In the past, there was a technique that consisted of stitching the ligament together but it was rarely successful. Currently, the technique involves reconstructing the anterior cruciate ligament by building a new ligament from tissue taken from one of the other tendons around the knee or from on organ donation. This tissue passed through drill holes in the thigh bone and the shin bone, and then ancored in place to create a new anterior cruciate ligament. Over time, this transplant becomes mature and becomes a new living ligament in your knee.

Recovery

recovery

Rheabilitation of the knee after the reconstruction of the anterior cruciate ligament requires time and work. To have a complete function, this can last between 6 weeks and 6 months depending on the severity and level of activity. Rehabilitation rate may take time depending on the specific requirements of the sport/physical activity of the individual.

The overall success rate of the anterior cruciate ligament surgery is very good. A lot of study show that more than 90% of patients are able to return to sport without symptoms of knee instability. It’s true that some patients complain of stiffness and pain after surgery, that is why it’s necessary to make an aggressive rehabilitation until the new surgical technique to reduce these problems.

Statistics

  • One of the most commonly injured ligament in the knee

  • Female athletes participating in basketball and soccer are 2-8 times more likely to suffer anterior cruciate ligament injury.

  • Athlete who suffer anterior cruciate ligament injury at increased risk of arthritis development later in life.

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-Steph

Incline Bench Sit-Ups

incline bench sit ups

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Sitting on the bench with your feet under the pads and your hands behind your neck. Inhale and tilt your torso without ever exceeding 20° :

  • Move your torso back up by slightly rounding your back to better target the effort on recuts abdominis

 

  • Exhale at the end of the movement.

This exercise work the entire rectus abdominis muscles and iliopsoas, rectus femoris and tensor fasciae latae (these last 3 muscles help pelvis anteversion). This movement is to do with high sets.

Variant

incline bench sit ups

When you back up, you can do a rotation of your torso to transfer a part of the effort to the obliques.

Example

A rotation to the left work more intensely right abdominal external oblique, left abdominal internal oblique and rectus abdominis on the right. Twists can be done alternately or unilaterally. The goal is to focus on the muscular sensation and it’s unnecessary to incline the bench too much.

Diagram showing the senses of action of abdomen muscle and the system of viscera’s compression

action abdomen muscle system viscera compression

 

  1. Rectus abdominis

  2. Abdominal external oblique

  3. Abdominal internal oblique

  4. Transverse abdominal

With quadrupeds, the entire rectus abdominis muscles passively support the viscera (like a hammock ) and help a little in locomotion.

With human being in bipedal mode, the entire rectus abdominis muscles have hugely strengthened so that the torso and pelvis is upright and prevent the pelvis from tipping excessively during walking or running. They became powerful muscles of contention and they built a strong core to maintain viscera in an active way.

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-Steph

Lunges

lunges barbell

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Standing with your legs slightly apart with the barbell behind your neck on trapezius muscles :

  • Inhale and take a big step forward by keeping your core as straight as possible. During exercise, the thigh of the leg that is moving forward must stabilize horizontally or slightly below.

  • Back to the starting position and exhale.

This exercise works mainly gluteals. This movement can be done in 2 ways :

  1. With a simple step forward (quadriceps will work a lot)

  2. With a big step forward (hamstrings and gluteals will be work a lot and rectus femoris with iliopsoas of the back leg will be stretched).

lunges barbell

Note

As all the weight transferred to the leg that moves forward and the movement requires balance, it’s advisable to use lightweight to begin with.

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-Steph

How To Do Hack Squat

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Your legs are strained with your back against the backrest. Your shoulders are wedged under the pads with your feet averagely apart :

  • Inhale, unblock security and bend legs.

  • Back to the start position and exhale at the end of the movement.

This exercise works quadriceps :

  • More your feet placed forward and more your glutes work.

  • More your feet are spread and more your adductors work.

Attention : To protect your back, it’s necessary to squeeze your abs to avoid lateral movements of the pelvis and spine.

Adaptation to bipedalism

human being chimpanzee bipedalism glutes

Chimpanzee (who is our close relative) has a large torso size and poorly developed glutes. Because of this, chimpanzee has difficulty in straightening the core and difficulty walking in biped mode.

Human being is the only primate to be adapted to a totally bipedal movement.

The human being developed the gluteus maximus muscles to adapt to bipedalism. It’s for this reason that the torso’s size decreased to facilitate to put the core in the upright position. The human being has something more that the gorilla and the chimpanzee can’t do. The human being can block the knee joint in extension to stay upright with less energy.

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-Steph

Squat Correctly (Part 3)

squat

Classical errors

I read a Nerd Fitness article  and I learned good stuff.

Click here to read Part 1 and Part 2 

Squat is a movement that we make since baby, it’s a basic movement. But when I started to do squat with weight, I make mistakes and I’m going to talk about the classical mistakes we make when we’re newbies.

Put all the weight on your toes

You need to have your heels glued to the floor throughout squat. This is important for spreading your bodyweight and weights on the barbell.

You also distribute part of the weight on the balls of your feet but it’s not the total weight. You should be able to move your toes in all directions during the squat.

The total weight (your bodyweight + weight on the barbell) is divided between the ball of your fee and your heels.

Don’t squat down too low

Your squat should go down at least until your hips joint are below your knee (parallel).

Maybe you have a special training that asks you to make a lower squat, it’s up to you to see. But making a parallel squat is enough to work your muscles well.

When you do a partial squat , so you have a squat above the parallel, you’ll work more your quadriceps than your hamstrings, in addition you put a lot of stress on your knees. The more you squat down, the less pressure you put on your knee.

Very, very often, people make a connection between squat and knee problems. Unfortunately, it’s a negative myth, a lie that makes people afraid of squat. For exemple, a gym member saw me with my knee wrap and said : « Be careful when you squat, you’re going to hurt yourself ! ». But does he know that my knee wrap increase my squat’s performance by 5-10 % ? I don’t think so. Here are some interesting articles here  and there .

The more you squat down, the more you work your glutes. But when we squat down, we have to go back up. And more we go down and more it’s harder to go up (strength and flexibility). The squat in parallel (your hips joints below your knee), it’s enough.

If you have trouble to squat down at the parallel, it could have several causes : little mobility to your ankles, to your hip flexor or your hamstrings ; weak glutes ; poor pelvic alignment (among many other things).

Knee position

squat knee position

To do a good squat, you must have your knees aligned with your toes. As the body of every human being is unique, the position is slightly different from one person to another but your knees shouldn’t be too much outside or too much inside. Your knees are more or less in the center.

Back position

squat back position

During the whole squat, you need to have your torso up and your shoulders back. This position allows you to have your spine in a « neutral » position. This avoids having your back in hyper extend and not having your shoulders rounded forward.

Head position

squat head position

There are people (even personal trainers) who will tell you to look up or down. Let’s test it right away with an anatomical version.

When you look at the ceiling, your cervical spine is in an unsecured position and when you add weight, it becomes dangerous. Look at the ground is not better.

You need to have your head in a « neutral » position. To be able to do this, look straight in front of you. Focus on a point in front of you so that you’re able to hold a tennis ball between your chin and your torso.

Too much weight on heels and inside/outside of the feet

Often, when we’re beginners, we are so focused on putting the weight on the heels and having a good position with the knees we forget to keep the ball on the floor. You need to divide some of the total weight on the ball of the feet because it’s very difficult to keep the balance when all the weight is on your heels.

It’s the same for the inside or outside of your feet. As you put the total weight on your heels, you try to keep balance with the inside and outside of your feet. Keep the ball of your feet on the floor to distribute part of the total weight and it will be easier to keep the balance.

Complex

complex

Don’t worry, I also had difficulties to do a squat with a good technique. I’ll explain to you something I used to learn the technique. Using a box or a bench is also useful for people who have knee problems and can no longer do bodyweight squat.

Using a box/bench is great for learning to squat down by distributing well the total weight between the ball of your feet and your heels rather than on your knees and toes.

Find a box/bench that allows you to be in parallel with your squat when you’re sitting on it.

The lower the box/bench is, the more it will help you to have stronger hips. If the box/bench is exactly parallel, it will help you to have stronger quadriceps. If you’re a squat beginner, don’t worry, a box/ bench at the right height for you to be in parallel or a little below when you squat down is perfect.

Let’s go to do bodyweigth squat. Put the box/bench behind you and do one step forward.

Inspire, throw your butt back, keeping your knees aligned with your toes and squat down until your sit completely on the box/bench. Keep your body contracted and control movement.

When you seated, don’t move and study your position. Is your back and core contracted ? Is the total weight distributed between the ball of your feet and heels ? Is your head in a neutral position ? Once you answered these questions, you can get up by using you hips up. Don’t shift the weight forwards on your toes to help you get up. Use your heels, keep your shoulders back with your chest up and keep your knees aligned with your toes.

After some sets, you’ll understand how to better use your body and you’ll be able to make the movement in a fluid way.

You’ll know when you’re doing a good squat. This is when you’re in the low position of squat and when you get up, you don’t swing forward but you put the weight on your heels.

Long life to squat

Squat is cool

Ok, the majority of people say that squat is bad for knees but the truth is that it’s the safest movement and one of the best to improve your knees health (when the squat is done with a good technique). This help to strengthen your knees, improve your stability and reduce the risk of injury. This is valid for people over 60 years old.

If you already have a knee problem or have pain with squat and think your do squat with a good technique, you need to see a doctor or a physical therapist to check your knees.

What are your difficulties when you try squat ?

Share this article if you think it can help someone you know. Thank you.

-Steph

Squat Correctly (Part 2)

sqaut

I read a Nerd Fitness article  and I learned good stuff.

Click here to read the Part 1 

Barbell Squat

I know 3 types of squat and this is the best known : the high bar back (also named « Olympic Squat » or « Oly Squat »), the low bar back squat and the front squat. Maybe there are others but I’ll talk about the best known.

The difference is how you place the barbell.

Depending on how you place the barbell on your body, this will modify the squat’s mechanism and geometry. Which means that you will use your muscles slightly differently depending on how you place the barbell.

  • The Low Bar Back is a posterior chain dominant squat

    posterior chain muscle

  • The High Bar Back and Front Squat are a quad dominant squat.

Here a diagram form the book « Starting Strength » to better visualize the barbell’s placement.

diagram barbell placement squat strating strenght

Don’t worry, these 3 squat’s type work the same basic muscles. As you know each exercise has its variants. Now, you know the 3 variants of squat.

Go, find in your gym a squat rack,  a power cage or a squat stand  and place the barbell at the height of your clavicle. If you can’t do this and the height is too low or too high, choose the too low. I have never seen anyone lift on toe and with heavyweight, the accident is guaranteed.

power rack squat rack squat stands

As you read in my articles « Know how much weight to lift (Part 1 et Part 2) » [url link], it’s important to do a warm up with the barbell without weight. I don’t want to know how much you want to lift, do some sets with the barbell without weight to prepare your muscles and joints.

Low bar back squat

It’s the most popular squat’s type for beginners, general lifters and powerlifters. It’s also the squat’s type taught in the book « Starting Strength », one of the best book for beginners.

Once you have adjusted the barbell’s height, be in front of the barbell. Take a step to be under the barbell and grab it with your hands. For this squat’s type, you’ll use a thumbless grip so that your wrists aligned with your forearms.

Usually the grip’s width is near of the shoulders to create a meaty shelf to place the barbell on the muscles in our upper back (deltoid posterior). If you aren’t comfortable, you can have a wider grip. And with time, when you have more flexibility, you can have a grip near of your shoulders.

Here is the difference between a « wrapped grip » (left) and « thumbless grip » (right) : 

barbell wrapped grip thumbless grip

Once the barbell is on your back, stand up, contract your core (squeeze butt and abs) and step back. Normally, if you followed instructions well, you can only step backward. If you can take a step forward, you’re in the wrong direction.

This squat’s type is a posterior chain dominant squat and you’ll be able to lift heavier that the 2 others squat’s type.

High bar back squat

For this type of squat, you’ll start the same way but you’ll put your thumble around the barbell. This isn’t a thumbless grip.

The grip’s width is near of the shoulders to create a meaty shelf to place the barbell on the muscles in our upper back (deltoid posterior) like for the low bar back squat.

If you lack of flexibility to have a narrow grip, you can place the barbell 5cm (2inches) higher on your trapezius instead on your posterior deltoid. Which means that the barbell is placed almost on your shoulders.

Look the difference between a high bar back squat (left) and a low bar back squat (right) :

high bar back squat low bar back squat

Attention : the barbell placed almost on your shoulders and not on your spine. If you feel the barbell touching your spine, it’s too high and this can cause serious damage.

Place the barbell on your back and take a step back. Stabilize and tighten your core and squat down.

To do this squat version well, you need to keep your torso more upright. If you had difficulties to keep your torso upright with the bodyweight squat, it will be a little be more difficult here.

You can try, there is no problem but lift lightweight until you do it well to correct yourself. It would be a pity if your torso collapses and the barbell rolls on your neck (avoid this pain, really).

Front squat

For this squat’s type, you need to place the barbell in front of your shoulders. This squat’s type is quad dominant so you have to be able to keep your torso even higher than the high bar back squat.

Instead of stepping under the barbell, you place the barbell in font of you on your shoulder. To grip the barbell, it’s a little bit more complicated because you need to have mobility and flexibility in your wrists.

Front squat is done with a full grip around the barbell like the other 2 squat types but most people let the barbell roll on their fingertips (a three finger grip is enough). If you like’re me, you don’t manage to have 3 finders around the barbell, there are 2 variants :

Keep your hands to hold the barbell (if not the 3 fingertips is enough) and keep your shoulders high so that your upper arms are parallel to the floor. And squat down.

It’s important that you keep your shoulder as high as possible during the front squat. When you’re gonna squat down, you’re gonna feel the weight on your arms and it will probably correct your position, drop the weight otherwise you will hurt yourself.

What squat do ?

This is an excellent question. You’ll meet 2 clans that clash in the gyms : high bar back squat VS low bar back squat. Both clans have good arguments but that doesn’t help you make a choice.

The truth, test the 3 types and look with which you feel most comfortable, which you have the best technique and with which you can squat down the lowest (your hips joints lower than your knees). Once you have well studied and tested the 3 types of squat, you’ll find your type of squat.

Share this article if you think it can help someone you know. Thank you.

-Steph