DR SARA FORSYTH
Load Management to Decrease Injury Risk
Karly Foster MTP, BKIN
Dealing with injuries as an athlete is a common and often frustrating experience. As a Physical Therapist, my job is to help athletes deal with these injuries when they occur, identifying potential contributing factors and determining appropriate treatment and management of the issue.
Injuries can happen for many reasons. There are the acute, traumatic injuries from unfortunate circumstances such as ligament tears, dislocations, broken bones, etc. where the cause and management are relatively straight forward. The vast majority of injuries I see however, are typically the result of over-use or overtraining. When we train, the goal is to provide a stress to our body, pushing it past the point of its current fitness level to elicit further adaptations and enhance performance. To do this effectively and not cause injury, caution must be used to not push too fast or too hard and to ensure that other things are in place, such as good nutrition, recovery days and sleep. This allows for adaptation to happen and prevent too much cumulative stress that may lead to injury.
Load Management and Injury Prevention:
There are many widely held beliefs on how to train effectively for various sports and a great deal of research has been done on managing training load to optimize performance and reduce risk of injury. Despite all of this, injury can and often does still occur. The ability to tolerate and adapt to increasing training load can vary significantly from athlete to athlete and can even vary throughout the year or season for the same athlete. Many factors can influence this tolerance, including:
- Current fitness levels
- Injury status
- Training environment
- Training structure – including frequency, duration and intensity of training
- Adequate rest/recovery days/weeks and even longer periods of intentional unloading.
- Sleep amount and quality
- Adequate nutrition and hydration
- The presence of other life stressors related to work, family/personal life.
All of the factors listed above should be considered when developing a training plan for an athlete in the first place. When an athlete comes to me with an injury related to their training, these are all things that I seek information about when trying to determine what may have contributed to the injury, and also to determine what the athletes current capacity might be for recovering from their injury and returning to training.
Load Management and Injury Management:
When dealing with an injury related to training, the first step after diagnosing the issue, is determining what level of load might be able to be maintained to facilitate recovery. While most injuries related to overload will require some degree of rest to resolve, not all injuries require complete rest.
The most common injuries related to training and overload that I see are tendon related injuries and bone stress injuries. Both of these reflect an inability of the tissues, for various reasons, to tolerate the training load being placed on them. Treating both these types of injuries requires a great deal of attention to load management but often in different ways.
In the case of bone stress injuries, depending on the location and severity, a period of unloading will be required to ensure healing. In some cases, this might be complete unloading or could require the use of crutches or a walking boot. Typically, there are still forms of exercise that can still be done, especially in areas away from the site of injury, to try and maintain some fitness and strength. Working with a Physical Therapist/Athletic trainer and/or a Sports Medicine Doctor to determine what is safe to do it is very important. Once an initial rest period has been observed and healing has occurred, a gradual progression of loading must occur to facilitate further healing, improve bone strength and ultimately allow an eventual return to normal training. Again, this process is often best done under the guidance of a Sports Medicine Doctor and/or Physical Therapist.
When looking at tendon injuries related to training, compared to bone stress injuries, it is often possible to maintain a higher level of training or loading, while managing the injury. Modifications will usually need to be made to reduce the load on the area for a period of time, often altering frequency, duration, intensity or even type of training to stay within the tolerance of the tendon and avoid flaring symptoms, and then working to closely monitor this load and progress it overtime as the tendon adapts. Specific exercises for the area are also typically prescribed by a Physical Therapist or other health care providers to directly load the tendon in a specific way, helping to strengthen it as well as the surrounding musculature. These exercises also need to be progressed over time to facilitate healing but doing this is largely dependent on the severity and irritability of the symptoms and can often require some trial and error. Working on potential biomechanical contributions through the recovery process can also be helpful in shifting loads away from the affected area and improving the overall tolerance to training load.
Tips for Load Management to prevent and manage Injury
Training load management can be tricky and often difficult to do oneself. Most athletes are high performers who often find it easier to do more or go harder than to dial things back or take the necessary time to recover. Seeking out the assistance of a Physical Therapist, Coach, or Trainer to help develop appropriate training plans can go a long way in working to prevent injury from occurring. These professionals can also be useful in helping you figure out how to manage an injury and determining the level of training that can possibly be maintained.
Aside from this, a few other key things to consider around load management:
i) Track your training. There are lots of ways to monitor our training load through various apps and the use of smart watches. This can be useful to monitor frequency, intensity, duration of training as well as frequency of rest periods. It can also be useful in providing information to any health care practitioner when injury occurs around what training looks like and clues may be able to be identified around potential contributing factors to the injury.
ii) Seek out the help of a sports nutritionist to ensure your nutrition and hydration are matching your training. Adequate hydration and nutrition are crucial to help facilitate adaptation and performance but also prevent injury.
iii) Seek out the assistance of a sports psychologist or counsellor to help with strategies around stress management.
iv) Be patient and be flexible. Adaptations to training come about over time and can’t be rushed. Just like this, recovering from injury often takes time. Being patient and allowing the process to happen is important. Accepting that some weeks, months or years will bring additional challenges that can impact training, being willing and able to modify training around higher stress periods in life can help ensure that things stay in balance and work to reduce your risk of injury.
Whether you are an athlete who is looking to prevent injury, manage an injury or return to training following time off from an injury, being knowledgeable and mindful about managing your training load is essential and not something you have to or should necessarily do on your own. Seeking out the help and guidance from specific health care providers or coaches is a great way to ensure that you are managing all aspects of your training appropriately.
Karly Foster MTP, BKIN
Registered Physical Therapist
Twin Bridges Physical Therapy & Wellness