Training

Avoiding musculoskeletal injuries during and post isolation

By Emma Williams May 11, 2020


The physical impacts of COVID19

COVID19 is presenting all sorts of challenges in many aspects of life, and for an active population like the military some of those challenges impact directly on our ability to perform our job and remain ready. As restrictions start to lift and ‘business as usual’ slowly returns, it is imperative we are conscious of the potential for injury in life after lockdown.

During this period of isolation and restrictions, many will have found it difficult to continue their current fitness regimes- whether that be due to working from home, lack of access to gyms/equipment, time or motivation. While some people will be getting creative in trying to keep fit, and others might have suitable equipment at home, many will be struggling to maintain or improve their fitness.

The Australian Defence Force (ADF) can expect an increase in certain injuries as members adjust to the evolving restrictions, and then once restrictions are lifted. We will inevitably see a spike in injuries related to changes in ‘load’ when we resume going to the gym and playing sport. Looking at data from various US professional sports, it is common to see a two-to-four-fold increase in musculoskeletal (MSK) injuries following an extended (six weeks or more) time out of sport. This data also shows a spike in MSK injuries during pre-season training as most athletes are de-conditioned from the off season.

Current screening tools (e.g. Functional Movement Screening) have been shown to have low validity in predicting an individual’s risk of acquiring an injury. While we may not be able to predict if a specific individual will sustain a particular injury, we can hypothesise the likely injury trends that will result from the current environment and how to best avoid them.

Once gyms reopen and strength and conditioning physical training (PT) sessions resume, one significant risk is members returning to where they left off without considering the significant de-conditioning that will have occurred. Common types of injuries due to overload (i.e. too much too quickly) are tendinopathies and muscle strains. Power is the first component of training that is lost with de-conditioning, followed by strength which will start to decline within weeks of a reduction in training load. Endurance is usually less susceptible to breaks in training, but will still be affected given a long enough break.

Managing load

In PT terms, ‘load’ includes variables of time, weight, distance, repetitions, sets and intensity (which can be measured with the rate of perceived exertion). A simple way to calculate how much you should be increasing your load is to increase one parameter by 10% per week. This method does not work as well for novices or elite athletes, but it is useful in the general military population. For example, if you are running 20 kms a week, and then suddenly increase to 40 kms, you are markedly increasing your risk of an overuse MSK injury.

What members often do not consider is the cumulative load of all activities when undertaking PT. If you compartmentalise your strength and conditioning sessions, your cardio sessions, weight loaded marches, battle PT etc. and do not consider the cumulative effect (including incidental activity like walking/gardening/housework) then the risk of overload is greater. Likewise, if you are not tracking your workouts there is risk of either under or over training. By writing out a simple program, and documenting your sessions you get an effective visual understanding of what your overall load is - and it also keeps you honest!

Types of injuries

Tendinopathies occur due to overload - tendons do not like holidays or sudden changes, so they will not be appreciating the current restrictions! For example, if you are recovering from an Achilles tendinopathy, rest will be your enemy.  Your pain will probably decrease, but to achieve a physiological adaptation and functional improvement to strength and/or endurance, you must load the tendon. If you suspect you have a tendinopathy or other MSK injury, please seek advice of a physiotherapist for an appropriate assessment and program.

A sudden spike in load with heavy weights in the gym after more than a month off puts you at risk of muscle strain, tendinopathies or sprain. If you have not been lifting your usual weights for more than a month, easing back into heavier weights is recommended, and will see you back to where you were pre-COVID19 sooner than if you load up too quickly and sustain a MSK injury.

Top tips for avoiding COVID19 related MSK injuries.

During restrictions:

  • Keep moving! If you are someone that normally struggles with any component of the BFA now is a perfect time to improve those scores. Get your hands on a graduated running program and plug away at it. Throw in a push up challenge and some daily planks (prone holds).
  • Mix it up. If you cannot get in the gym, then get out in the fresh air and work on your running - BUT graduate it. If you normally run 4.8km a year for your two fitness tests then do not run up Mt Ainslie/Castle Hill/Mt Enoggera in one hit! Gradient/distance/time/speed all count towards load so do not change it up all at once. If you increase distance, do not also add hills at the same time.
  • Fartlek or High Intensity Interval Training (HIIT). These methods provide great bang for your buck (time). A quick 20 minute session gets the heart rate up, and will achieve physiological changes in a short space of time.
  • Body weight. Just because you cannot maintain the same weights that are available in the gym, this does not mean you should stop completely. Body weight exercises can maintain range of motion and some baseline strength. To add some load, grab the toddler (or another, more inanimate object) for some front squats, find a heave beam or change out the bench press for push ups.
  • Alternatives. If you are someone that is missing their regular massages, acupuncture or other forms of hands on therapy– do not despair. While these types of treatments make you feel good, they are not the be all and end all. These therapies can be fantastic as an adjunct to training but they do not ‘heal’ or ‘fix’ MSK injuries. Be wary of claims that a treatment will ‘realign’ joints, ‘restore’ movement or ‘speed up’ healing. Trust that any form of movement and exercise is probably just as restorative as a massage or ‘alignment’.
Once restrictions lift:
  • Do not expect to be able to pick up where you left off if you were unable to maintain your regime. Do not go too hard straight out of the gate, else you will be taking two steps forward followed by four steps back (and into the physio department!).
  • If your PT decreased and your intake of food/beverages increased (it did not help being stuck at home over Easter), then be mindful of any extra weight you might now be carrying, and factor that into your load. A few kilos may not feel like it will affect your training, but it all counts.
In general:
  • Many non-traumatic MSK injuries are attributable to training error, meaning that they are potentially preventable by following the principles mentioned above.
  • Early presentation to physio is beneficial to avoid compounding symptoms and potential further tissue damage. It is much easier to treat milder symptoms before they escalate into a more severe or chronic problem.
  • The human body is amazingly adaptable. If you load appropriately, factor in suitable recovery sessions, and know when to seek advice and treatment; you will be optimising your performance.

Rarely do MSK injuries occur as a result of one factor. While you can have an optimally designed PT program you cannot discount the influence of diet, sleep and stress. Pain is a complex entity and often is not indicative of actual tissue damage. Common sense goes a long way, listen to your body and if in doubt reach out to your friendly PTI (if uninjured), or get those worrisome niggles checked out by the local physio department.


Portrait

Biography

Emma Williams

MAJ Emma Williams is a physiotherapist in the RAAMC. She has had postings to both the Close and General Health Battalions, JHC Health Centres, and deployed on Op Slipper with MTF-1. She has recently returned from two years in Washington DC, where she was the Defence Project Manager for the Embassy of Australia Relocation. 
Currently she is the SO2 Human Performance, Physical Dimension at the Directorate of Human Performance - Army and is passionate about injury prevention and rehabilitation.

 

The views expressed in this article are those of the author and do not necessarily reflect the position of the Australian Army, the Department of Defence or the Australian Government.



Comments

Ma’am - excellent insight into injury prevention and the importance of a sound reintegration strategy. The current situation is yet another example of why periodisation is such an important factor in the development of Human Performance. Covid-19 has allowed us to refocus on the one common element - The Human. The current lay off is very similar to a xmas leave period and/or a posting whereby acclimatisation is essential. A focused and concentrated effort to optimise performance in a periodic reintegration strategy will enhance long term performance, reduce injury and increase occupational specificity. We need to ensure that this strategy is not a COVID 19 - “fizzy today, flat tomorrow” problem. A long term approach in looking after our ONE common element - The Human, is paramount. Great article! Jimmy Wright WOPTI 1 CHB - BRISBANE

Ma'am-excellent article! So very relevant as some people start to emerge out of a state of PT hibernation. I hope the article will generate individuals to reflect and review their current and realistic physiological condition and abilities against their ambitions and the requirement for a progressive, patient return to PT to avoid injury.......

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