EXERCISE AS PART OF INJURY MANAGEMENT AND PREVENTION

  

If you’ve been injured and visited your physiotherapist, chances are you’ve been given exercises to do at some stage of your recovery.  Most people understand the link between getting muscles stronger after an injury, but exercise can actually be prescribed to manage your training, reduce future injuries, improve performance and actually reduce your pain during your treatment. However, exercise is often under-utilised and can often be an afterthought for many injuries or training plans.

At The Injury Clinic we strive to ensure you stay injury free, getting you to a level higher than pre-injury and staying active post treatment.

Read below to learn about how exercise can be used in many other ways and improve your knowledge of the role of exercise!

 

EXERCISE PRESCRIPTION

To discuss exercise as part of injury management, it’s first important to discuss exercise prescription.

Exercise is prescribed as a specific plan based on someone’s own needs or their personal activity goals, as exercise is customised for each person, it’s an important role of the physiotherapist to constantly review and modify to target these goals. Exercise prescription refers to using exercise as a treatment, or part of a plan to treat or modify a condition and must consider safety and effectiveness.

Key components to exercise prescription include:

  • Type of exercise: strength, motor control (how we move) or mobility are the common types which may be prescribed.

  • Frequency: an important factor so you know you’re doing enough/not too much, referring to how many times a day and week.

  • Specific: actually doing the exercise that will improve your condition or reduce your injury rate.

  • Intensity: very important, finding that level that’s hard enough but not too much is often an ongoing battle!

EXERCISE FOR INJURY MANAGEMENT

Exercise is an important part of treatment for musculoskeletal health conditions, for many it’s the foundation treatment. There can be a lot of complementary treatments for pain and illness but for many conditions exercise prescription is the first line treatment, and not to mention very safe and without many side effects.

 

Why exercise?

For acute injuries, deconditioning or a decrease in muscle strength occurs almost immediately after. For long standing pain or chronic conditions, this can be a gradual reduction, and may go unnoticed until you try to resume activities. In both scenarios your tissue tolerance has reduced. That is the ability for the muscles and soft tissues to withstand the load of the activity, whether it’s a 5km run or a long walk, which can result in pain or further injury.

Often people seek out injury advice to treat the pain, but a comprehensive assessment will often show a level of weakness, motor control reduction, stiffness or reduction in mobility.  For this, exercise is prescribed to treat the cause, and aid in the treatment of pain.

 

How?

Exercise can be a powerful treatment in reducing pain if it is managed well, it can improve pain levels, improve tissue healing and stimulate muscle growth which actually reduces pain.

Often during an injury pain can change the way we move, to avoid the pain or when there is fear of movement. This can often last long after the actual injury has resolved, and the affected tissues have healed. In this case restoring pain free movement, and utilising exercises to build up correct movement patterns and strength of muscles can be progressed to avoid injury reoccurring and normal pain free movement established.

 

Exercise for specific injury/conditions:

  • Low back pain: after an acute bout of low back pain, depending on the cause there is often an increase in muscular tightness/spasm and restriction of movement. For many low back pain patients, beginning to move again can be a difficult experience, but using exercise reduces muscular spasm, increases blood flow, improves strength and reduces the need for pain relief and anti-inflammatory drugs.

  • Tendon pain: After a tendon overload, often the result is pain within the tendon, which is sore to touch, which doesn’t improve with rest. Returning to sport reproduces the pain which can affect activity. Eccentric exercises as well as heavy slow controlled exercise has been shown to reduce swelling, reduce pain and help remodel the tendon structure to reduce pain in the short and long term and prevent future injuries.

  • Osteoarthritis (OA): exercise has commonly been shown to be the key treatment for many joints affected by OA. The knee joint can be the most commonly affected, and painful OA can restrict stairs, standing and walking. Strengthening exercise and mobility can be used to improve muscle strength, reduce the forces on the knee, allow longer periods walking and standing and reduce future unnecessary surgery.

EXERCISE FOR INJURY PREVENTION

If you’re training for sport or a big event, chances are you’ve spent a lot of time and energy training to improve fitness. However, strengthening as a form of injury prevention is often overlooked in these programs often due to time, fear of overdoing it or simply unaware of the benefits.

 

Why exercise for prevention:

Some injuries are unavoidable, these often include contact injuries or accidents that occur during sport. As for other injuries, such as overload-based injuries the cause may be based on decreased strength, endurance, mobility or movement control, all of which are manageable by exercise. 

If you’re injury free it can be easy to think further strengthening programs are not important for you, the introduction of strengthening has been shown to reduce injury risk by up to 68% (1). Further to this, following a specific program can improve your performance by reducing the onset of muscular fatigue, improving movement efficiency and reducing overuse patterns linked to common injuries. 

 

Preventative programs:

Preventative programs are often forgotten part of training for football, netball soccer or marathon training, yet the introduction of a program even over as little as 10 weeks can reduce injury risk. When introduced into preseason for soccer injury prevention including lower limb adductor training can reduce or even eliminate adductor based injuries during a normal season (2). However, the identification of an adductor injury in the middle of the season may mean multiple games missed.

 

Common reasons exercise is not included in injury prevention:

  • Muscle soreness: starting a new strength program may increase short term bouts of muscular soreness, as this may interrupt normal training it’s best to start as early as possible in your program/preseason with little and small increments.

  • Time: The idea of adding 2-3 more sessions to the week may not appeal many during a marathon program. Starting early in your training may mean that during heavier run weeks the exercise is maintained at lower levels, this allows maintenance of strength whilst not disrupting on sleep or recovery from main run sessions.

  • Previous experience: If you’ve played a season of football before or ran a ½ marathon in the last 6 months, you may think you have already got the strength and mobility to perform. Strength and mobility can reduce over time or after smaller injuries which can go unnoticed in your training plan, only to present when training intensity increases.

  • Importance: We often put our specific training as number one, and everything else as an after thought, but if we put as much time into preventative exercise and strengthening injury can be greatly reduced.

SUMMARY

Exercise is a form of treatment at many stages of injury, after an injury has been successfully managed with rehab and other interventions it’s important to maintain strength and aim to improve this greater than your previous level. Pain free may just be the start, improving strength, mobility and control to improve your function, ability to continue to train at 100%

 

REFERENCES

  1. Lauersen JB, Bertelsen DM, Andersen LB The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials British Journal of Sports Medicine 2014;48:871-877.

  2. Harøy J, Clarsen B, Wiger EG, et al The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial British Journal of Sports Medicine 2019;53:150-157.

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