By Dr. Andrew Meyers D.O.
The temperature is rising, days are becoming longer, and the flowers are blooming. This is a signal for many of us to slowly emerge from hibernation as we transition into the spring/summer season. But as much of the 2020-21 year, this time it's different. Included in the lockdowns were closed fitness centers, numerous restrictions, and the cursed mental state of “giving up”. The covid pandemic has forced a staggering number of us, even those who maintain year-round dedication, into a sedentary life and a physical shape worse than ever imagined. As we plan to shed off our winter layers with new workout routines and the reopening of facilities, we face another enemy - injury.
When the body becomes deconditioned, changes occur on a multiorgan level. The cardiovascular system decreases cardiac output and requires elevated heart rates.1 The pulmonary system provides suboptimal oxygenation.2 The metabolic system allows for insulin resistance and overall weight gain.3 Skeletal muscles undergo atrophy, which affects size, strength, and endurance, while tendons demonstrate changes in tissue organization and structural properties.4,5
Unfortunately, the symptoms of deconditioning occur relatively suddenly, within days to weeks.6,7 So just imagine what can occur over months. As you re-enter the realm of fitness in a sedentary state, you now expose yourself to injury. Most frequently involving the lower back, followed by the knee.8,9
Injury prevention is nothing new. In fact, there are hundreds of sport and anatomically specific injury prevention programs available (11+, Runners 10, Sanford Knee Injury Prevention Program). But many of these are highly specialized and may not be a one size fits all. So why not just keep it simple with old fashion stretching? Well, the research might surprise you.
So, without further ado, here are my 4 tips for injury prevention as you get back into your routine.
1. Start with the cardiorespiratory system
A study performed by the US army found the most consistently documented risk factor for injuries was low cardiorespiratory endurance.11 Whether your routine will be yoga, plyometrics, weight-lifting, or a combination of such, spend the first few weeks dedicated to building back that cardio. Personally, I’d recommend this be completed under low impact with increasing duration to gradually re-awaken your stamina. If available, stationary bikes and ellipticals are a great option.
2. Dynamic warm-ups, not static stretching
Believe it, stretching before exercise does not reduce the risk of injury or muscle soreness.12 Instead, focus on a dynamic warm-up prior to each fitness session. research has shown that warm-ups which include light-moderate sprints, bursts of jumping jacks, activity-focused aerobics, etc, provide significant injury prevention benefits.13 Now, that doesn't mean to scrap the idea of stretching and never look back. Instead, I recommend a brief period of your warm-up to be, you guessed it, dynamic stretches.
3. Manage training load appropriately
A more recent shift in injury prevention has been made with the introduction of “training load” or “workload” management and there's a good reason. It has been demonstrated overwhelmingly in research that poorly managed training load is directly related to injury.14,15
Training load can be broken down into intrinsic and extrinsic factors. External load is the stimulus applied to the athlete. More simply, it is seen as the volume, intensity, density, etc. For example, the external load is the weight on the bar, the number of sprints performed, the grade of the hill climbed, or even the total length of the training session.
Internal load is the perceived effort of the athlete. This can easily be tracked by a session-rating of perceived exertion (sRPE) scale. Basically, on a scale of 1-10, how hard was your training session. Internal load takes into consideration how you subjectively feel, which is way more involved than being pumped its chest day. This can be affected by life stressors and emotions. Maybe you slept well, or worse, are exhausted from a night out. You could have missed lunch or had the perfect pre-workout meal. Maybe you are in joy from a recent promotion or going through a breakup. Each of these plays a role in making or breaking training.
The point of this gathered information is to keep you in the optimum range of workload, or, the center of the spectrum. Because on one end, you can be undertrained (where you likely sit after substantial time off your routine) or be at the opposite side of the spectrum, in overload. This is important because, at each of these ends, injury is prevalent. You should train enough to meet your standards, but avoid consecutive difficult days or significant changes in load.
I am only able to scratch the surface of this topic and there are many great resources on how to keep yourself in balance. I urge you to do some investigating. Read and apply this idea to your training and I promise you won't regret it.
4. Know your limits
Each human body functions on a different level. Some individuals require more time to adapt to new stress, while others can pick up not far behind where they left off. Maybe it's due to age, maybe it's due to the length of time away from activity. The trick is to listen to your body. Gut instincts may just protect you. This point brings me to a story. Several years ago, an avid gym-goer was finally able to get back into it after a moderate hiatus. After squeezing out a few reps on his final set of bench-press, his ego got the best of him. Despite recognizing fatigue, he decided on one more rep, with just a bit more weight. As the bar was lowered to the chest, his pectoralis major muscle tore straight from its attachment site, resulting in a 4-month recovery.
This story was about me - Don't be like me.
1. Martin, W. H., III, Coyle, E. F., Bloomfield, S. A., & Ehsani, A. A. (1986). Effects of physical deconditioning after Intense endurance training on left ventricular dimensions and stroke volume. Journal of the American College of Cardiology, 7(5), 982–989. https://doi.org/10.1016/s0735-1097(86)80215-7
2. Vedala, S., Paul, N., & Mane, A. (2013). Difference in pulmonary function test among the athletic and sedentary population. National Journal of Physiology, Pharmacy and Pharmacology, 3(2), 118. https://doi.org/10.5455/njppp.2013.3.109-114
3. Leiva, A. M., Martínez, M. A., Cristi-Montero, C., Salas, C., Ramírez-Campillo, R., Díaz Martínez, X., Aguilar-Farías, N., & Celis-Morales, C. (2017). El sedentarismo se asocia a un incremento de factores de riesgo cardiovascular y metabólicos independiente de los niveles de actividad física [Sedentary lifestyle is associated with metabolic and cardiovascular risk factors independent of physical activity]. Revista medica de Chile, 145(4), 458–467. https://doi.org/10.4067/S0034-98872017000400006
4.Jackman, R. W., & Kandarian, S. C. (2004). The molecular basis of skeletal muscle atrophy. American Journal of Physiology-Cell Physiology, 287(4), C834–C843. https://doi.org/10.1152/ajpcell.00579.2003
5. Frizziero, A., Salamanna, F., Della Bella, E., Vittadini, F., Gasparre, G., Nicoli Aldini, N., Masiero, S., & Fini, M. (2016). The Role of Detraining in Tendon Mechanobiology. Frontiers in aging neuroscience, 8, 43. https://doi.org/10.3389/fnagi.2016.00043
6. McMaster, D. T., Gill, N., Cronin, J., & McGuigan, M. (2013). The Development, Retention and Decay Rates of Strength and Power in Elite Rugby Union, Rugby League and American Football. Sports Medicine, 43(5), 367–384. https://doi.org/10.1007/s40279-013-0031-3
7. Coyle, E. F., Martin, W. H., 3rd, Sinacore, D. R., Joyner, M. J., Hagberg, J. M., & Holloszy, J. O. (1984). Time course of loss of adaptations after stopping prolonged intense endurance training. Journal of Applied Physiology, 57(6), 1857–1864. https://doi.org/10.1152/jappl.1922.214.171.1247
8. Feito, Y., Burrows, E. K., & Tabb, L. P. (2018). A 4-Year Analysis of the Incidence of Injuries Among CrossFit-Trained Participants. Orthopaedic Journal of Sports Medicine. https://doi.org/10.1177/2325967118803100
9. Larsen, R. T., Hessner, A. L., Ishøi, L., Langberg, H., & Christensen, J. (2020). Injuries in Novice Participants during an Eight-Week Start up CrossFit Program—A Prospective Cohort Study. Sports, 8(2), 21. https://doi.org/10.3390/sports8020021
10. Al Attar, W. S. A., Soomro, N., Pappas, E., Sinclair, P. J., & Sanders, R. H. (2015). How Effective are F-MARC Injury Prevention Programs for Soccer Players? A Systematic Review and Meta-Analysis. Sports Medicine, 46(2), 205–217. https://doi.org/10.1007/s40279-015-0404-x
11. Jones, B. H., Bovee, M. W., Harris, J. McA., III, & Cowan, D. N. (1993). Intrinsic risk factors for exercise-related injuries among male and female army trainees. The American Journal of Sports Medicine, 21(5), 705–710. https://doi.org/10.1177/036354659302100512
12. Herbert, R. D. (2002). Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. BMJ, 325(7362), 468–468. https://doi.org/10.1136/bmj.325.7362.468
13. Fradkin, A. J., Gabbe, B. J., & Cameron, P. A. (2006). Does warming up prevent injury in sport? Journal of Science and Medicine in Sport, 9(3), 214–220. https://doi.org/10.1016/j.jsams.2006.03.026
14. Eckard, T. G., Padua, D. A., Hearn, D. W., Pexa, B. S., & Frank, B. S. (2018). The Relationship Between Training Load and Injury in Athletes: A Systematic Review. Sports Medicine, 48(8), 1929–1961. https://doi.org/10.1007/s40279-018-0951-z
15. Jones, C. M., Griffiths, P. C., & Mellalieu, S. D. (2016). Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies. Sports Medicine, 47(5), 943–974. https://doi.org/10.1007/s40279-016-0619-5
Born and raised just outside of St. Louis, Missouri, Dr. Andrew Meyers received his bachelor's degree in radiologic science at the University of Missouri-Columbia. He did not travel far when he then completed his doctorate in osteopathic medicine at Kansas City University of Medicine. Now training in Ventura, California, Dr. Andrew Meyers specializes in orthopedic surgery where he is devoted to evaluating, preventing, and treating disorders of the musculoskeletal system. Health and fitness have always played a key role in his life, growing up as a multi-sport athlete. He has since been involved in competitive bodybuilding, CrossFit, and maintaining a high interest in the study of nutrition. When not found in the hospital or gym, he may be seen in the sky as a licensed pilot or hiking with his two Siberian huskies.
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