Injuries

Returning to sport: how to balance injury prevention and performance

Returning to sport after injury can be a daunting process. There is never a perfect time and especially after a prolonged period of time injured it can be difficult to know when you are truly ready. It is important to adapt your training regimes during a return to sport to help reduce the risk of flare-up and chronic injury before returning to your normal routine. I don’t make any claims of being an expert in this field and every person is different, but there are a few general things worth considering when returning to sport.

Injury prevention vs performance:

If you are returning to sport after a muscle/tendon/joint injury and have been attending physio, then (hopefully) you will have been gradually increasing the amount of resistance or load by exercising. Injury prevention generally focuses on slow, controlled movements possibly with low repetitions and high resistance. While this is helpful in your rehabilitation and can help you to feel strong again most sports require high speed specific movements with low resistance.

It is therefore important that when you begin to return to sport that sport-specific training forms the last part of your rehab. This could be as simple as kicking a football, having a bounce match of badminton, going to the driving range or just running. Ask your physio about any drills that you could do which will help with your injury but are also targeted at your sport.

Injury prevention plans have been shown to have some benefit particularly when tailored to individual sports such as FIFA 11+ programme for football players.

exercise

How hard is too hard?

The first stage of this is finding out what your limits are and then setting a baseline level or normal. Training sessions should be based around this and are generally advised to be at between 80-120% of normal. It is important to bear in mind when returning after an injury this is your current normal and not your pre-injury normal!

High loads or quick increases in load of 150% of normal can place you in the “danger zone” for injury and should be kept to a minimum, only used around competition times for example. Likewise exercising at too low a level such as 50% of your capability doesn’t adequately strengthen your muscles or prepare you for a normal session. Light sessions should be used for recovery sessions with a sensible balanced plan of intense work, rest and rehab work.

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How much to increase it?

Although the answer to this question would be different for every person a relatively safe rule of thumb would be to increase the amount of exercise by 10% per week. While this can make return to your previous level a laborious process and may be too slow for some people it has been shown to reduce flare-ups.

When returning to competitive sports it is also worth spending some time returning to training only before a full return. This is especially important for any team contact sports where you have to consider other people and a naturally competitive instinct which might encourage you to push harder than planned.

Make sure you are mentally and physically ready!

The psychological aspect of return to sport is often undervalued particularly if the injury happened on the field of play. Fully trusting your body to do what you will ask it can be a difficult process and Sports Psychologists are the real experts in this.

From a Physiotherapy perspective one way to help with mental readiness is to be confident in your physical ability. A rough set of targets which are specific to you are worth setting such as for a footballer to be able to:

  • Run 5-10Km
  • Sprint 20-30yards x5-10 with changes of direction
  • Hop/Jump/Land in multiple directions – (making sure that both legs are relatively equal)
  • Strike a ball full force pain-free
  • Tackle

If your targets consider, the physical demands of your sport and you know your body can meet these without any problem then hopefully you are ready to get back to normal.

 

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Injuries

Marginal gains: what are they and should I use them?

“Marginal gains” is the term made famous by the success of Team GB’s Olympic cycling team in winning multiple gold medals and by Team Sky winning the Tour de France.

They look for marginal gains by examining how they could gain 1% improvements through simple to achieve methods and have these 1% gains accumulate to make larger changes. They used a number of strategies for this including:

  • Providing each athlete with their own pillow and having a personal sleep strategy
  • Painting the floor of the mechanic area white to pick up on any dust particles which may get into the bikes
  • Analysing performance times to personalise training regimes as different people peak in the morning or afternoon. (This was linked to the sleep strategy to ensure peak performance)
  • Looking at the aerodynamics of the bikes
  • Improving infection control measures to reduce colds/infections
  • Improving diet

I personally much prefer Kevin Bridges’ marginal gains approach of losing weight: “switch from eating McCoys crisps to Quavers or have fried rather than deep-fried food”

Read more: How to treat tennis elbow

How does this apply to non-olympians?

The basic concept of marginal gains is to look for imperfections in your training/work/sport and improve them. Essentially a micro-managing of all aspects of your life. I can certainly think of a few things that I need to improve on without getting a microscope out (please feel free not to email me any suggestions!)

Where this can be useful from a physiotherapy perspective is in longer-term rehab. We regularly deal with conditions which require regular exercises over a prolonged period of time to allow a full recovery. For example, this could be after a  cruciate ligament injury to return to football; following joint replacement surgery to be able to walk around the shops or with shoulder rotator cuff injuries just to be able to put your jacket on.

Read more: What is Pilates and how can it benefit you?

Practical use of marginal gains can be just creating the time each day to work on your rehab by cutting something else out. It also applies to making sure you are physically ready to work on your exercises by finding out whether first thing in the morning or after work is a better option for you.

Diet and Sleep are key to recovery from injury and also to improving performance. We work alongside Ambition Nutrition who can advise on this more effectively than we can.

Marginal Gains for performance

At JMC Physiocures we can also offer advice on marginal gains for sports performance. This can be in the form of massage to reduce DOMS, advice on an injury prevention programme or a specific strengthening issue to help with technique. We also provide Pilates classes and work with personal trainers like Michael McCartney to help focus training on your goals.

Overall the idea of marginal gains is as simple and complicated as identifying the things you could do better and then making them better. If you are anything like me then I am sure you have a to-do-list or if you are like William then you will have 3472 post-it notes so all we have to do is pick one thing off the list at a time and make it better!