Maintaining a regular exercise regime can present a significant challenge. With our busy lifestyle, time, motivation levels, boredom and fatigue are important factors in maintaining regularity.
Being able to overcome these issues is an achievement in itself, not to mention the next common barrier to physical activity; onset of exercise induced injury. Pain arising due to exercise is an extremely common presentation to sports medicine practices Australia wide and is a familiar barrier to many exercise programs.
The most common injuries that arise due to exercise include non specific lower back/pelvic pain, knee overuse, and tendon irritations.
Non-specific lower back/pelvic pain can be associated with nearly all forms of physical activity. Pain can arise from a number of patho-anatomical structures including disc, facet joint, sacroiliac joint and gluteal trigger points. Disc related injury generally involves exercise modalities that incorporate loaded, repetitive or sustained flexion (bending forward), with cycling and weight lifting (especially dead lifts/squats) being the most prominent. Facet joint injury is most notably associated with sports/exercise that involves repetitive or sustained extension/rotation, including tennis, golf, running and cricket fast bowling. Due to the vertical orientation of the sacroiliac joints and the stabilising function of the gluteal muscles, injuries to these structures can occur with most weight bearing forms of exercise. Avoiding injuries to these structures involves ensuring adequate deep core/gluteal strength, adequate lumbopelvic control and correct technique (ie. Running stride, golf swing, tennis serve).
Typical presentations of exercise related knee injuries include patellofemoral syndrome (PFS) and iliotibial band friction syndrome (ITBFS). Both of these injuries are overuse in nature and are related to running loads. Minor changes in load can sometimes predispose to injury. These changes can seem as insignificant as adding a kilometre to your running route, wearing a different pair of trainers or doubling up with similar training modalities on consecutive days. Avoiding these injuries involves establishing good pelvic/knee/foot control in one leg stance. This may commonly include improving gluteal function and correction of foot mechanics. Overall load can be accounted for by varying training modalities on different days (ie. run, swim, resistance training).
Tendons are at the pinnacle of load sensitive tissues! The internal structure of tendons comprises cells that will react and produce pain sensitive chemicals at the slightest hint of overload. Thus it is imperative when building your training from a very low base to sit down with your sports physiotherapist devise a goal (ie. half marathon) and formulate a steady, graduated training plan, being vigilant for any reactive tendon pain. Avoiding these injuries includes a high degree of monitoring, correction of any biomechanical abnormalities, and strengthening of shock absorbing muscles (glutes, quads and calf).
Avoiding injuries can be a substantial challenge in itself. Three points to consider in injury prevention include; ensuring optimal body mechanics, monitor and control overall loading and consider training variability. Consult your sports physiotherapist to dissect each of the variables and you are giving yourself the best chance to stay in the game.
Shane O’Sullivan
Sports Physiotherapist
Prahran Sports Medicine Centre