Winston Salem Fitness

Winston Salem Fitness – Who gets injured more: hard-charging fitness buffs or plain recreation-seekers? According to research, the more enthusiastic individuals have a higher incidence of injury. These hard drivers tend to ignore the early warning signs of microtrauma and stoically continue to train through pain. A similar finding is discussed by Dr. Russell Pate in the book Physical Activity, Fitness and Health. In a small, one-year follow-up of 40 runners, he found that Type-A behavior, but not running mileage, was associated with an increase in running injuries, particularly multiple injuries.

This fact may serve as a caution for staminacs that might otherwise push themselves too hard when faced with a nagging problem. By listening to the body and making proper activity adjustments based on the symptoms, minor problems will often be addressed at an early stage and never have the chance to become an obstacle to continued training.

Injuries also can cause psychological pain, according to Dr. Michael Stuart and colleagues at the Mayo Clinic in Rochester. They noted that injured individuals who normally exercised regularly became depressed, angry, and their energy level decreased when they were unable to train. Additionally, this depression became more pronounced the longer the layoff. Their findings suggest that the chronic background noise of injury limiting exercise tends to have an adverse effect on stamina. Suggestions offered by this group include:

Think positive: you will recover – Recognize that the injury is only a temporary setback and focus on the future. View the injury in light of a lifetime of exercise and acknowledge that this is simply a minor, transient obstacle.

Your body’s instinct is to heal itself – For many injuries, the body will perform all of the work of healing, if provided with a proper environment. Follow the guidance provided by your physician or physical therapist. Recognize that by following a plan, most individuals receive a mental boost by knowing that they are helping themselves. Additionally, the implemented plan may be beneficial by accelerating the recovery process. Turner Blackburn, Director of the Berkshire Institute of Orthopedic and Sports Physical Therapy in Wyomissing, Pennsylvania, writes, “Sports medicine doesn’t wait for Mother Nature. We are always looking for a short cut to allow the patient/athlete to return as quickly and safely as possible. Sports medicine tries to pamper Mother Nature. Since the muscles have an automatic shutdown following an injury that results in atrophy, reverse the process as soon as possible. The sooner the intervention, the fewer problems there will be.”

Stay involved with your sport – To combat depression, stay involved with the activities that you enjoy. If you can’t actively participate in the activity, find a book or videotape and use this time to reflect and learn.

Turn your injury into a positive learning experience – Look back on the training and analyze why the injury occurred. Since most injuries are of the overuse variety, examine the training program and determine if any mistakes were made. If a problem can be identified, it can be avoided in the future.

Summary

In summary, a well balanced program is one that is achievable, fun, and meets the basic exercise prescription components of intensity, duration, and frequency. These guidelines to minimize injury of progression, specificity, overload, recovery, and consistency, should be built into your workout program. Exercise is a lifelong endeavor that has many physiological benefits, but ultimately it is beneficial because it makes you feel good!

Winston Salem Fitness – While these positive training principles yield suggestions to limit injury risk, they are implemented in a program over time. Day-to-day exercise issues include the role of warm-up, stretching, and a cool-down. They prepare the body psychologically and physically for your workout. Additionally, it is widely believed that properly performed, these measures help limit the risk of injury.

Warm-up: The warm-up session is preliminary exercise, which may last a half-hour or more in competitive sports. For recreation, the warm-up is normally much shorter and may practically consist of simply jogging the first mile slower than normal training pace. The purpose of the warm-up is to elevate the heart rate and increase the body temperature by several degrees. It helps a person to psychologically prepare for the exercise session. Since movement is occurring with the warm-up activity, the range of motion of the joints and the efficiency of muscle contractions are also enhanced.

The increase in muscle temperature associated with an adequate warm-up can result in increased performance. Donald Kron of the Sports Medicine Clinic in Lake Charles, Louisiana, reports that warming-up the legs results in an increased vertical jump and an increase in maximum cycling power. “We have an easier time selling athletes on stretching to enhance performance than to prevent injuries,” says Kron. “We like to design stretching programs that allow the athlete to rehearse the movements required in each sport.” The warm-up often consists of both general exercises, such as calisthenics, stationary bike cycling, or jogging, and exercises that are specifically related to the chosen activity. Examples of a specific warm-up are swinging a golf club or tennis practice, which are skill rehearsal for the activity.

Stretching: Stretching is routinely included in the warm-up outlined above, because it seems reasonable and makes sense. However, the jury is out regarding its efficacy, particularly if engaged in prior to an activity like jogging. Dr. Van Mechelen found that injured runners have stretched significantly more before running than non-injured runners, and FitNews, the publication of the American Running and Fitness Association, has referred to stretching for injury prevention as the “Myth of the Month.” FitNews summarizes the debate by noting that, “No matter how hard you look, you won’t find a single controlled research study that proves stretching reduces the frequency of injuries.”

Additionally, there does not appear to be any hard evidence that supports the contention that stretching will decrease post-exercise soreness, although continuing research is underway. However, the stretching procedure intuitively seems to be an appropriate part of the warm-up routine and may be a form of an insurance policy for some. As the Penn State Sports Medicine Newsletter suggests, “No one wants to be blamed for an injury because he or she did not use all of the warm-up tools available.”

This controversy does not mean that stretching is useless. Stretching will increase your flexibility if performed properly over time. The research cited above, however, questions why stretching needs to be done routinely, and if so, how should it be done? The answer to the first question appears to be a qualified ‘yes,’ stretching should be done routinely. The effectiveness of stretching to achieve flexibility makes it an important tool for the maintenance of joint range of motion that naturally tends to decrease over time.

Stretching for flexibility will help minimize the loss of elasticity and counteract some of the connective tissue stiffness that occurs with time. This type of stretching is part of a program that should be sustained over a period of months for sustained increases in joint motion. As investigators at The University of Illinois point out, there is no reason to expect significant flexibility decrements over time in healthy adults.

Their research has found that differences in flexibility with age are so minimal as to be of limited clinical importance. At least to 74 years, any substantial loss of joint mobility should be viewed as abnormal and not attributable to aging, and therefore, should be treated much as it would be in a younger individual.

The second question dealing with how stretching should be done is a little easier to answer. That is, it is now clear that stretching cold muscles is a bad idea. Stretching should occur only after the temperature of the muscles has increased. It should be preceded by a warm-up or performed during and/or after workouts. Research by Dr. Dean Taylor and colleagues at Duke University suggests that the optimal time to hold a stretch is approximately 12 to 18 seconds.

They note that the largest increase in flexibility occurs in the first four repetitions. In terms of how hard to push during the stretch, the guidance by Bob Anderson, author of Stretching (the best selling book on the subject) brings straightforward advice: “Good stretching is knowing your body. It has nothing to do with how far you can move any particular part. The feeling you get when you stretch is a good gauge. The right feeling is when you can perform a stretch, but it doesn’t hurt.”

Effective stretching starts slow, using a static or gentle isolated muscle stretch. Vigorous bouncing, sometimes called ballistic stretching, should be avoided at first because it loads the muscle-tendon unit too rapidly and increases the likelihood of a strain. Further, when a stretch occurs very rapidly, there is too little time for the normal connective tissue relaxation to occur, which may render the stretch ineffective.

Following an appropriate warm-up and gentle progressive stretching program, some ballistic activity may be appropriate as a prelude to a dynamic sports event. The key again is start slow and be warm and loose prior to engaging in explosive activities. Bob Anderson points out that, “There are many methods of stretching, some more complex than others, but if practiced regularly and with sensitivity, all seem to yield results.” If soreness occurs, it suggests that overstretching is occurring and the vigor of the stretches should be decreased.

Joggers can start out slowly, and functionally loosen up as they progress through the first mile or so. Pre-exercise stretching may not be as important for them, but should be emphasized following the workout to promote flexibility. With golf, however, it’s unlikely that you would want to drive with 50% effort on the first tee, especially with an audience surveying the shot. In this case, an adequate warm-up with some focused stretching exercises and activity specific repetitions should be performed before your game.

Cool-Down: The cool-down is designed to bring the body back to a pre-exercise level and minimize the effects of the workout on future flexibility. By protracting the exercise at a reduced intensity, the body can metabolize some of the soreness-producing lactic acid that has accumulated in the muscles during a vigorous workout.

Additionally, if a person simply stops an workout, there is a chance that with the relaxation of veins in the legs, blood will pool there, and the person could faint. By maintaining activity at a reduced rate, cardiovascular function slowly returns to near the normal rest state. This is also an ideal time to stretch, since the muscles are warm and tissue compliance is greatest.

Progression: Progression is perhaps the most important concept to minimize the chance of an overuse training injury. The body adapts to the things that it does regularly and allows gradual improvements in performance. For instance, the reason that new recruits, and not the drill sergeants, are usually injured in basic training is that the sergeants have been performing the activity for months or years and their bodies have adapted to it. That is, any individual who has exercised for a long time is probably going to be able to continue that activity without significant difficulty.

Individuals get into trouble when they change their program to either do more or train at a higher intensity, or are attempting to come back after a layoff. Dr. Smith, advocates a 10-percent rule for minimizing the chance of injury. Smith says, “Each week, there should be no more than a 10-percent increase in the amount of training time, amount of distance covered, and number of repetitions performed in your activity. If you increase your intensity, don’t increase your distance. Although no controlled study has as yet defined the optimum safe training progression for an athlete to follow, but adhering to the 10-percent rule makes good sense.”

This concept is tied to the familiar exercise prescription which recognizes three variables that describe virtually all activities: 1) duration, 2) intensity, and 3) frequency. The chance of an injury increases dramatically when any of these are individually increased by more than 10 percent in a given week. Additionally, the total exercise exposure, expressed by the product of duration, intensity, and frequency, should not increase by more than 10 percent for any given week.

This may actually be a liberal rule of thumb, if the advice of a legendary Oregon track coach is considered. Bill Dellinger’s solution for his elite track athletes was 10 percent a year! About Dellinger, Runner’s World correspondent Bob Wischnia states, “That may be one reason Dellinger’s greatest runners, such as Steve Prefontaine, Alberto Salazar, and Ken Martin, didn’t peak until after graduating from college. The 10 percent solution is even more applicable to midpack runners. It reduces the risk of injury and allows plenty of time to get stronger and improve.” All of these variables interact with each other and a change in one causes an impact on the body which will result in slow adaptation over time.

A second element associated with progression is “periodization,” a training cycle designed to deal with changes in intensity and duration. When intensity increases, duration decreases. Conversely, when duration increases, intensity decreases. Coaches have used periodization to enhance the performance of their track and field athletes, but it has now become a common training principle that can be adapted to most all exercise programs. Periodization increases the power of the 10 percent rule by providing additional time to recover.

While periodization programs appear in many forms, they all include a varied training stimulus and periods of planned rest. What most people associate with the 10 percent rule is that increments can be added week after week. This probably isn’t the best approach because some tissues need more time to adapt. Dr. (Col) Tom Scully, a surgeon at William Beaumont Army Medical Center, found that by backing off slightly about every third week during an increased phase of training, the incidence of stress fractures in bone decreased markedly. Meanwhile, the respite allowed recovery and bone growth to occur, which he states, “should be considered to be the skeletal goal of physical training programs.”

Specificity: Specificity deals with the type of activity included in a workout. It is clear from a decade of clinical research that every exercise is unique and there is not a great deal of crossover effect from one activity to another. It’s risky to assume that one type of exercise adapts you for all others. Therefore, from an injury prevention perspective, you should change your workout routine very gradually, if at all possible, and recognize that your limits refer to specific activities.

To illustrate, we can contrast two related (yet significantly different) activities of jogging and sprinting. Although both use the large muscles of the legs, they differ in both the specific muscle fibers used and the way these fibers are activated by the brain. Jogging is a slow, rhythmical activity, and “slow twitch” endurance fibers are called upon to perform this task. Sprinting takes big bursts of energy. It uses a specialized set of muscle fibers called “fast twitch” fibers which are specialized for strength.

Although a jogger may have trained these endurance fibers, the bigger, stronger fibers that are activated in a sprinting activity would not be receiving a significant training effect while jogging. An expert panel at Penn State cited this disparity, noting that it is fiction to think that “participation in aerobic exercise produces significant strength gains for the muscles involved. For example, the leg muscles of champion marathon runners clicking off repeated sub-five minute miles are not much stronger than age and gender-matched spectators lining their 26 mile course.”

This phenomenon explains why muscle pulls are so frequent in weekend athletes who attempt to play sports like softball or basketball. Sprinting activates a new group of muscle fibers and creates higher tension levels, which may overwhelm the muscle-tendon unit and result in a pulled muscle. To be prepared to sprint, the training program needs to be specific and include some sprinting.

Training needs to be tailored to meet the specific demands of the activity performed. Jogging is different from sprinting and these differences need to be recognized and respected. The bottom line is, be cautious when undertaking new activities, and provide the body with some time to adapt to the novel task.

Overload: Overload is the stimulus required for a positive training effect. This is most easily visualized with weight training, where an individual is pushing or pulling a given weight in an effort to make a muscle stronger. If the weight that is used is easy for the individual to move, and the muscle is not “overloaded” or tasked to work at a greater than normal level, there will not be a training effect.

For example, if an individual performs 20 push-ups a day, five days a week, at the end of the year that individual will be able to perform 20 push-ups. The outlined push-up program is adequate for maintenance, but it is insufficient for a positive training effect or improvement. In a similar fashion, with aerobic programs, when the goal is to increase the aerobic capacity or improve running speed, an overload is required to serve as the stimulus for this change. The interval training program discussed in this guide is an example of a training program that uses periods of overload mixed with the next component, recovery.

Recovery: Recovery is providing the time and environment for the body to adapt to the demands that have been placed upon it. As indicated earlier, the number one mistake is doing too much, too fast. Often, this drive is expressed in the adage “if a little is good, then more is better!” Recovery can take the form of an easy workout, or the well deserved day off.

It isn’t necessary to train every day with the same workout. For example, experts agree that the greatest benefit of aerobic exercise coincides with training just three days a week. Some small benefit exists for training up to five days a week, but beyond that, a point of diminishing or reversing returns is reached. Even world class athletes need recovery.

Bob Wischnia of Runner’s World describes a run with the one-time marathon world record holder, Rob De Castella. He writes, “I assumed everyone was running slowly out of politeness to me. Afterward, we retreated to a pub to blow the froth off a few, and I mentioned to Deek (De Castella) that he didn’t have to run quite that easy just for me. ‘I wasn’t running easy for you,’ Deek said, mildly irritated. ‘It was for me. When I run hard, I run very hard. But when I run easy, it’s extremely easy.’ Deek believed that the single greatest mistake most runners make is to run too hard on their easy days.” The lesson: build recovery into your exercise program.

Cross Training is another way to put some recovery into a training program. For a regular jogger, replacing a run with a session of swimming, cycling, stair climbing, or walking would be an example of crosstraining. The values of cross training are only beginning to be recognized, but they include keeping training interesting by adding variety, decreasing injury incidence by promoting recovery, and providing an invigorating workout while resting the muscles and joints normally stressed.

Consistency: Consistency is staying on track and insuring that the exercise activity is performed properly. When individuals become fatigued, their form will often deteriorate and stress will be placed on tissues which have not adapted to the demand. Remaining vigilant for proper exercise form will significantly assist in minimizing the risk of injury.

Winston Salem Fitness – The number one training error is overuse, or doing too much too fast. When the body is faced with a new task, it does its best to adapt to the challenge, but the adaptation takes time. Dr. Angela Smith, a Cleveland-based Orthopedic Surgeon, advises that “Training error leading to chronic injury is a major cause of downtime in sports. It takes time for the bones, tendons, and muscles of athletes to adapt to the stress of workouts. How much you train really comes down to being able to listen to your body and make adaptations in your workouts as needed.”

Overuse injury occurs because most people are totally unaware of the biomechanical stresses involved in simple exercise and ignore the toll on their body. It’s not surprising that 30 to 75 percent of all sports injuries are attributed to overuse. The team physician for the University of Washington, Dr. Stanley Herring, illustrates the problem by pointing out that “A 70-kg (154 lb.) runner at 1175 steps per mile absorbs at least 220 tons of force per mile.” That’s an incredible amount of pounding! With these types of cumulative forces, injury results from microtrauma, rather than from a single overwhelming event.

The common feature in these overuse injuries is not that the workout was inappropriate, but rather that the repetitive trauma overwhelmed the body’s ability to repair itself. Mistakes of performing too much, too fast, are extremely common with changes in season, activity, or changes in terrain. Common sense needs to be employed during training to provide an adequate mix of overload and recovery. When sound, positive, training techniques are employed, the vast majority of overuse problems can be avoided.

Training, properly structured, may be an example of “less is more.” Dr. Smith notes that while exercising, “Pains in your muscles or joints indicate that you’re doing too much, too soon. Cut back on your distance and intensity until you’re pain free.” The key to training properly is to have a reasonable progression, and recognize the need for overload, recovery, and consistency.

Other predisposing factors for injury can be grouped into personal characteristics and training characteristics. Personal characteristics are factors such as age, gender, experience with sport, previous injury, body composition, and psychological make-up. Training characteristics include items like warm-up, stretching, equipment, time of day, and the training program.

Since the personal factors are either not modifiable, such as age and gender, or are difficult to modify, they will not be considered further. Positive training principles are provided to address training characteristics and optimize the chance of remaining “in the fast lane.”