During these unprecedented times, most people’s habits and routines have changed drastically. This has led to an increase or change in activity, bringing with it a range of different types of injures. We can broadly divide people at high risk of injuries into 3 main groups based on their physical activity level. The first group includes usually active people, who were not able to train as usual and had to suddenly change their training regime to suit the new situation. The second includes usually active people, who become inactive. The third group includes usually inactive people, who suddenly become very active.
One of most common approaches to injury prevention in sport includes some sort of load monitoring and management system. Load is usually expressed using different types of metrics depending on the activity. These include weekly mileage for runners or cyclist, training duration x rate of perceived exertion (RPE), high speed running distance and many other metrics for footballers, weights x reps x sets for weightlifters. More broadly, any metric could be used to monitor load if it is relevant for the sport/activity and reliably measured. For example, let us hypothesise that you started doing a lot of gardening during the lockdown, because suddenly you had a lot of free time and you enjoy gardening. You could measure your ‘gardening load’, by simply using duration. Alternatively, if you wanted to include some type of intensity measure of your gardening in your calculation, you could rate your RPE on a scale from 1-10 after every session. In other words, how hard did you find the gardening session. You can then multiply the RPE of the session with its duration and come up with a reliable ‘session load’ metric. This is a widely used concept in professional sport, which can be adapted to any activity. We then know from the evidence that weekly load and acute to chronic workload ratio (ACWR) is particularly important for preventing injuries. More specifically, there seem to be a ‘sweet spot’ in the ratio between 0.8 and 1.3 for optimal load. Acute load is defined as the load of the last week. Chronic load is generally defined as the average load of the previous 4 weeks. In other words, both too much and too little compared to usual is significantly increasing your injury risk. And we are mainly talking about overuse injuries in this case. These include Achilles tendinopathy, plantar fascia pain, anterior knee pain, stress fractures and bone stress responses, tennis elbow, shoulder tendinopathy and many others.
But let’s go back to our three lockdown groups. Clearly the last 2 groups have done too much or too little compared to what they are used to. But, what about the first group, usually active people who suddenly changed their training regime? Clearly, by changing the way they train, they may not have done too much or too little, but simply too different. The reality is that load capacity is activity specific. In other words, if a swimmer/cyclist suddenly changes his training to become a triathlete and incorporates a lot of running, his usual swimming/cycling load does not ‘protect him’ with running. However, because of his cardiovascular fitness, he may find that running is ‘not as hard’ for his lungs. This may push him to build-up his running weekly mileage too quickly for what his muscles, bones and tendon can tolerate. Almost invariably, this will lead to an overuse injury.
We see these injuries in the clinic all the time. However, there now seem to be a trend for people who suddenly started doing a lot of plyometric training or barefoot training or hand-stand training or running training, which simply is too different from what they usually do and they did not build-up gradually enough. The good news is overuse injuries can generally be dealt with very successfully with a hands-off approach, which make them particularly suitable to be managed through virtual consultations. This is not to say that there is never a place for a hands-on approach in overuse injuries and that we never use any form of manual therapy when dealing with these injuries. However, we can say that in those cases when we use manual therapy, this is considered more of an adjunct in our treatment regime and it is never used in isolation. Every injury is unique, and our approach varies according to it, so it is difficult to make generalisations. It should also be noted that at times what may originally look like an overuse injury, turns out to be something else, and is very responsive to a hands-on approach. Therefore, an accurate diagnosis is key. When assessing these types of injuries, we often try to answer the question is this a true overuse injury? We then administer a mini treatment in the form of manual therapy to confute/verify our diagnostic hypothesis. This is not something that can be done with a remote consultation, so it is obviously one of its limitations. However, it is not always needed to achieve an accurate diagnosis.
We are preparing to partly re-open the practice to the public, but it will not be business as normal. Face to face consultations will be offered to those patients for which we feel that the intended benefit outweighs the risk. We have designed a thorough policy for face to face consultations, which we plan to review on a regular basis according to the most relevant guidelines and scientific research. See our dedicated Covid-19 section on the website to stay up to date on our face to face consultations policy and see how we will be keeping our patients and staff safe.
We feel that a new chapter is starting for us, for our clinic and for our country. We feel the need to support our community during this difficult time and as such we have decided to launch on offer. For the month of July all our initial assessments will include one free follow-up (either virtual or face to face). It’s time to get better!
The Physiokinetic Team