Injury prevention principles

Shin splints. Knee pain.  There are many forum threads posted by cc'ers who are starting to get into shape, and getting injured in the process. 

This post includes tips for avoiding overuse injuries as you get into shape.  Please bear in mind that I'm not a medical or fitness professional. Just someone who is vulnerable to overuse injuries and has learned to how to avoid them through trial, error, and learning.

I was a runner in high school and college, and was constantly getting overuse injuries.  I get overuse and joint injuries from all kinds of physical activity -- running, cycling, swimming, weights, yoga. You name it, I get injured doing it. Shin splints, shoulders, knees, ankles, hips, whenever I try a new activity, I feel it in the joints or get some other overuse strain. (This may be genetic, there are relatives on both sides of the family who have had hip replacements or hip surgery.)  It wasn't until my early 30s that I learned how to exercise without chronic pain.

Here are the principles that I've learned: 

Build up slowly.

Many people getting into shape try to exercise intensely, as much and as soon as they can. This is a mistake, and often leads to injuries that set them back.

* Start with short duration, low intensity activity.  Walk or go easy on an elliptical trainer. 
* Build slowly. When you build up, don't increase your mileage by more than 10% per week.
* Build endurance before intensity. You should feel comfortable with at least 30 minutes of your chosen activity before adding intervals.

Get good gear.

If you are running or using an elliptical trainer, make sure you have good shoes.  Go to a specialized store, if you can, not a large chain superstore or mall outlet -- a place where people know how to fit shoes. 

If you are cycling, make sure your bike is a good fit for you, and is adjusted for your body. Go to a good bike shop where people know how to fit bikes. It is definitely worth the money you will spend to not have to take weeks off and require medical care. If you are cycling, you do *not* need an ultra-fancy bike to get into good shape, but you do need a bike that is a good fit for you.

Don't work through pain.

If you have joint pain, or acute muscle pain, then stop.  Either do activities that don't aggravate your injury (if you have a hurt wrist, walking is ok but tennis is not). Or take the day off.   Rest until the injury is better. Don't try and work through the pain.  Many people who are eager to get into shape are fearful of taking time off and being set back. The setback will be worse if you get more seriously injured.  If it hurts a lot, or hurts for more than a few days and doesn't get better, go see a doctor. 

Body alignment is critical.


If you are doing the same physical motions over and over again, it is critically important to have good body alignment and form, or you will get injured again and again.  Yoga with a good teacher is excellent body alignment training.  Other good resources include the Egoscue method (see link below), and Pilates (I can't speak about Pilates from personal experience.)  In addition to general body alignment training, get specialized coaching in your sport or gear (cycling, running, swimming, etc.). If you are a gym member, ask for an instructor to review your form. 

Rest.


You may want to start with 3 days of exercise per week, and build up to 4-6. After an intense workout, take the day off, or exercise very lightly. 

Summary.

By following these principles, you are less likely to get injured. And if you do get injured, you will be more likely to quickly recover and pick up your exercise routine.

Following these principles is *not* the most efficient way to burn fat and calories right off the bat.  If you are already basically fit, have good body alignment, and good gear, then dive right in, and start to do interval training and lift heavy weights. 

But if you are getting back into shape after being sedentary, then following these principles can keep you from a serious setback that makes your progress much slower overall.

Resources:

Runners World 10 Laws of Injury Prevention
http://www.runnersworld.com/article/0,7120,s6-241-285--7638-0,00.ht ml

Egoscue Method:
http://www.amazon.com/Egoscue-Method-Health-T hrough-Motion/dp/0060924306/ref=pd_bbs_sr_1?i e=UTF8&s=books&qid=1200890719&sr= 8-1

 

Original Post by melkor:

 Do not under any circumstance ever static stretch before strength training. Static stretching reduces muscle strength by about 25-30% for 3-4 hours, so static stretching of a muscle prior to exercise is a good way to reduce the training effect and possibly injure yourself.

 Dynamic flexibility/mobility drills are okay, but no static stretching before working out, ever. Save it for after.

 How about doing a run before you stretch to get the blood flowing, and then do static stretches, like while waiting for the machine or weight?

Nope, won't work - the muscles are up to 17% weaker for up to 90 minutes in most cases, in extreme cases 30% weaker for up to 4 hours in the studies I've seen, and your tendons and ligaments are also weakened by static stretching prior to strength training.

 Do Dynamic mobility drills like these, these or these before any training, static stretching only afterwards. You'll have loads better results, with far less injury risk.

This is for you runners out there with shin splints and knee problems.  I have always been in the same boat, to the point where my shins and knees ached after every run.  I stopped running until I met someone who told me about the POSE method for running.  I did a lot of research on this and FOR ME, I made one single adjustment and it made the world of difference.  The adjustment I made was in the landing of my feet.  As the POSE Method teaches, I taught myself to land on the BALL OF THE FOOT (BOF) and kept my stride to where the foward landing was never ahead of my body.  There is an article on the Posetech website:

http://www.posetech.com/training/archives/000 414.html ;

That describes this in great detail.  Making the cange felt awkward at first and the calves were sore for the first week or so.  Hope this helps...
 

Type-O in the URL, it is:

http://www.posetech.com/training/archives/000 414.html

Sorry, something is up with the copy/pasting of the URL.  That is ANNOYING!!!  There should be NO SPACES ".../000414.html"

Does anyone know how I can get over knee pain after exercise?

I know, rest until the pain goes away, then start exercising more gently. Problem is, it doesn't seem to work. I wait a week or two, the pain seems to be gone, and then when I exercise it comes back anyway.

I have fairly weak joints, but did careful research into what kinds of exercise were safe for me. So I never had any injuries, until I wanted to learn some new lifts and had a session with a trainer. She had me doing hundreds of lunges (normally I just did a few weighted ones and moved on) and since then my knees hurt after cycling, rowing, running, the works. I tried cutting out weights, but it didn't seem to help.

The only thing that doesn't cause any knee pain is swimming. But my chiro shouted at me because she said it made my back muscles spasm. Am I destined to be a couch potato?

Augh, hundreds of lunges? Oww, what the #"#¤"#¤#¤ was she thinking? The lunge is a good exercise when done correctly but any exercise where you're doing hundreds of reps can't be done correctly as a strength exercise; neural fatigue if nothing else will wreck your chances of doing it right.

 Hit up the chiro again, and look into glucosamine/chondroitin for your joints - it's one of the very few supplements that have legitimate science backing it (for a limited subset of the population with weak joints and arthritic joint pain, and joint issues in general)

 Avoid lower body movements until your chiro can have a look at you, and think about suing your trainer for malpractice and gross negligence 'cause cripes, hundreds of lunges for someone with joint issues in the first place?

 Do all ranges of motion hurt, or is the pain confined to specific joint angles?

Thanks! We don't really sue people here like in the States, unless we actually lose an arm or something. But I'll ask the chiro about it, and look out for that supplement. I think it's confined to specific (acute/crouching) joint angles during exercise, and flares up a bit randomly afterwards.

Hmm, pain at specific angles sounds like it could be something to do with the cartilage or tendons, if it was a muscle injury you'd be a bit more likely to experience a generalized pain. But my crystal ball's on the fritz again so you'd really want to show that knee to a medical professional and your chiro for an assessment.

 It's possible that you'd benefit from investing in some sort of compression bandage or support until then, but I think you'd want to see the doctor as soon as possible.

 Until then, RICE the injury as much as possible ;)

Thanks again:)

Hey everyone! I just read all three pages of this and I find it extremely helpful and positive. But I have a few questions about myself :) I am exercise fanatic! I love my gym, playing basketball/soccer/volleyball. You name it, I'll try it and most likely love it! You all may have remembered that a while back I had very bad knee issues in both knees (Chondromalacia, Osgood Schlaters(sp?), and some tendonitis) I had previously been a big runner, for 4-6 miles. I went to the orthopedist and I loved it there. I now have specific orthopedics, been to physical therapist, and for around a month or two I was "back to normal." Then during a soccer game I got hit HARD with a soccer ball on the right side of my right knee. (I was not IN the game, but at half time we went out to play) Ever since, I have had pain from my butt down through my hamstring, all the way through my calves and sometimes to the foot. I do not think the soccer ball caused it or not, but I do not know...I have done hours of research and it might be my sciatic nerve, or something else. I have also been growing lately and have been extra hungry and tired. Many people have commented on my growth and how I appear taller. Therefore it might be just that I am growing and need to rest. I have read all the suggestions by the OP and I have done most of that stuff. I really want to try yoga and my gym offers yoga classes as well as Body FLOW classes. They are like Pilates/yoga mixed. Okay, I need to stop talking :P But, what should I do??? Thanks in advance!

<3 jess

Thanks for your post!  We need more info about this stuff for us newbies.

One thing I would like to add is that warmups before, and especially stretches afterwards, have really helped me.  I have had mild osteoarthritis for about 20 years, but it has actually improved with walking several times a week.  Also, I have noticed that doing plies several times during my walks helps reduce the slight discomfort in the weak muscles and ligaments on the insides and outsides of my knees.  They used to give me a lot of pain, but now hardly any. 

Under the kneecap, however, I am now experiencing some new pains, rarely, and I think these are from my new videos that have a bunch of lunges in them. 

The slow stretchy lunge, without bending the back leg, is fine.  It's the normal lunge with lowering the knee to the floor that I just can't handle.  I stretch my quadriceps on the floor instead.  

I still have concerns about doing interval/cardio dvd's two days in a row.  I really got sore from that--and the soreness seems to be causing some nerve reactions in my left arm, too.  Tight muscles pinch nerves?  Just certain movements cause shooting 'jolts' like when you hit the funny bone.

So I am resting up from all those bicep curls and stuff today.  Anyone else experience any kind of nerve reactions from toning exercises?

I don't know about nerve reactions. But in general, it's a good idea to not do intervals two days in a row, even for people without medical issues. With weight lifting and intervals, the body needs to recover after intense exercise.  Improvements in strength/speed/condition happen while the body is recovering.  The day after doing intervals or an intense video, it would be better do have a more gentle workout such as walking and stretching.

That is definitely sciatica.  I read a book for old people (50+) on what to do.  Lie on the floor, knees bent, arms stretched out to sides.  Lift knees up to the 'table-top' position, with your calves parallel to the floor.  Now cross your legs, so the leg that is on the side of the painful hip is on top.  Breathe in and let the knees together drop to the opposite side of your body, keeping shoulders on the floor.  Exhale and hold about thirty seconds.  Then pull back to center.  Do this about 6 or 8 times, each side, alternating the crossed legs.  I have found this helped when I had a cramped periformis muscle--located underneath your glutes and around the sciatic nerve.  About the pain on the sides of the knees:  I have found 'plies' seem to help those ligaments.  But if there is a tear in the ligament, I think that requires surgery, so see your doctor if the plies cause pain.   

The latest in a long line of injured knee people...

I screwed my cartilage and tendons in a crazy horse injury (if the horse is falling too, Let Go) and now I have discovered something weird. If my normal quad lift per leg is about 20lbs, when the weather changes my right knee drops to about 5. Thankfully, I don't wear shoes over 5 lbs I guess.

Does this sound like a ride it out problem, or should I try to bring it back to 20 sonner rather then later?

I injured my back years back for napfa test. Now i can no longer do sit up.

agh. I've strained a muscle in my neck and it really hurts, especially at night. I can't think of any weight lifting exercises that would be safe to do, and I can't ride my bike on the road because I can't look over my shoulder. Apparently it can take 4-6 weeks to heal, is that right??

How I wish I would have seen this sooner!  I now have a "stress fracture" in my left foot and am wearing an aircast for the next 4 weeks (already have had it on for 2 weeks).  I am supposed to be wearing it 24/7.  It's very cumbersome to walk in and I was issued a temporary disabled placard by the DMV.  Hobbling around.... The stress fracture was apparently caused by repeated overuse.  I started walking for exercise and after many months and a 77 pound weight loss, I started incorporating some jogging into my walks.  I guess that is how it happened.  I think I've had it for 1-2 months and tried to "work through" the pain, thought it would get better.  Finally realized it wasn't going to get any better and went to the doctor to find out it is fractured.  Now I can't do my daily power walks til it heals, probably another month from now.  I have been told I can do other types of exercise, and I belong to a gym so I don't have any excuses, but power walking is my "thing" and I'm missing it terribly! When I do finally heal, I am not going to jog anymore, I think it's too hard on my old (54) body and 200 pounds.  I want to lose another 50 and I am determined, but not being able to really walk is a real set back.  I always felt good about myself when I completed my daily walk.  Now I've gained 5 pounds and feel like a total slug.  I never did any warming up or stretching, just got out there and "went".  Now I see the error of my ways.

Take care of yourselves.... having an injury is a real set-back.  Best to be careful from the get-go.  Take it from one who made this sad mistake.

 

 

 

chasingjames, if you don't want to accept permanent limitations, you probably don't need to. If you did want to get back to jogging, after you heal, you could probably succeed by building up much more slowly.

I think I needed to see this thread today, just as a reminder. I had sore achilles tendons last year and shin splints from 'too much too fast'. I did 2 sprint Tri's and a half marathon, and didn't really take time off for inuries, just gimped thru. I've laid off the running for a couple of months and am starting a program tomorrow. I have *lots* of stretching in mind. I just this evening blocked out 23 weeks on my calendar up to a June 8 marathon. I have good shoes and good intentions- wish me luck!