It's a shame to say that one of the single biggest risk factors for sustaining an overuse injury amongst endurance athletes is whether they have sustained the same (or similar) injury in the past. This suggests one of two things - either our athletes have some unidentified genetic predisposition to sustaining the same injury to a specific anatomical landmark, or that we in the medical and health professions are short-changing our clients by not addressing all of their clinical deficits resulting from their injury. Unfortunately, the latter appears more viable. Throughout my training as a physiotherapist, we were drilled to ensure that following any injury, a pre-requisite range-of-motion and level of strength had to be met prior to returning to their chosen sport. Whilst these guidelines are important, they do not encompass all of the specific areas that are compromised as a result of the initial injury. Consequently, it appears that we may be discharging patients too early.
One specific component of the injured athlete paradigm that is vastly gaining further exposure in the research literature is that of neuromotor coordination. Note that this is very different to 'strength.' In essence, 'strength' can be defined as the amount of force (typically measured in Newtons) that a muscle can generate by either shortening, remaining still, or lengthening. Strength is important, as it provides the foundations for two paradoxical components of fitness - both power and endurance. Both of these variables are simply derived from the equation: force over time - with the value of the denominator being far greater in the latter (endurance). Strength allows our bones and joints to move quickly, powerfully and/or for a long duration in whatever direction we desire. The muscles that are best suited for this role are those that are located more superficially (I like to call these the 'mirror' muscles, as these are the muscles that gym junkies like to spend a lot of time conditioning so that they look impressive when out on the tune); in scientific terms, these are classified as 'global' muscles. In essence, these muscles are mostly under our conscious control; hence we can chose when to activate them, along with controlling the amount of force which we choose to apply. Fundamentally, we condition these muscles by generically applying the '3 sets of 10 repetitions' principle in order to improve their force output (i.e. strength).
Conversely, 'local' muscles are situated very close to our body's joints, and hence are not as easily seen as they are covered by our global system. These differ fundamentally from global muscles in that their primary role is not that of force output, it is merely to activate in a fast and coordinated manner in order to centrate and stabilise our joints so that our global muscles have a solid platform for which they can exert their force output from. Furthermore, they differ neurophysiologicaly in that they function below the level of our conscious control - in other words, they activate automatically in a feed forward manner in that we do not need to actually devote our attention towards. I am going to state this now (prior to elaborating further on a future post regarding the arguably flawed status quo of our therapeutic/corrective exercises) - local muscles do not respond to strength training principles of '3 sets of 10 repetitions.' This is why you will never see me prescribe internal and external rotation exercises with a thereband to clients with a rotator cuff injury, or 'clamshells' in order to 'activate' someone's gluteals.
Coming back to the original question - it is well established that our neuromuscular control is altered immediately post injury. The central nervous system adopts a compensatory strategy following an injury in attempt to off-load the injured structure, providing it with the best possible environment to allow it to heal. An example of this occurs when you sprain your ankle - without realising, you will rotate your entire lower extremity of the injured side outwards in order to reduce the amount of stress that would otherwise be applied to the outer ligaments of your ankle. Whilst this provides an extremely effective short term strategy, the body does not spontaneously default back to its original posture once the pain and swelling has subsided. As a result, your body is likely to adopt this posture into all of its normal activities of daily living. Running with an out-turned foot impaires stabilisation of the entire lower extremity, allowing the knee to cave inwards during midstance - which is a biomechanical cause of a vast array of common injuries including plantar fasciitis, Achilles tendinopathy, and runner's knee to name just a few.
Nevertheless, it is important to consider that this is simply one factor that may contribute to your current running-related injury, and the relative weighting of this past history is going to differ vastly from client to client. Factors such as training errors, running technique, basic mobility and stability are all imperative variables to consider when attempting to determine the underlying causes of any running injury. As I commonly say to my patients, no two running injuries are ever the same, meaning that if I had 10 current clients with the clinical diagnosis of Achilles tendinopathy, I would have 10 very different treatment protocols based on the relative contributions of the above-mentioned variables that each client uniquely presents with.
So next time your medical practitioner asks you 'what injuries have you experienced in the past,' hopefully you will better understand the significance of such information and how it allows them to tailor their treatment plan to your own unique presentation.
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