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Prevention OF Muscle Injuries

As everyone struggles with the implications of COVID-19, a lot of people’s physical activity levels have fluctuated dramatically. As people return to sporting and gym based activities, the prevalence of muscular injuries can increase. The aim of this blog will be to identify methods to help prevent muscular injuries and illustrate some fantastic home exercises that can help prevent future injuries.

Muscular Injury Risk Factors (Scroll to the end for photo guidance)

Warm Up

Whilst exercise has a long list of proven health benefits, individuals should engage in an adequate warm up procedure to reduce the risk of injuries (not just muscle injuries!). One must take into consideration what kind of activities they are about to partake in, so that they can avoid injury.  For example running based sports (soccer, football, netball) performing running drills, agility, dynamic stretching, balance, plyometric, and strength exercises prior to training/matches has been proven to dramatically decrease the risk of injuries.¹ A copy of a thoroughly researched injury prevention protocol FIFA 11+ is attached in the Appendix of this blog.

Muscle Strength

Muscular strength has been proven to be an important factor in reducing muscular injury risk. This has been seen hugely within football and soccer athletes attempting to prevent hamstring injuries ^2-7. When performing dedicated exercise programs targeted at strengthening hamstrings, over the next season the probability of injury dropped from 45-65%.^2-7

Muscle Length

Tight muscles have also been illustrated to increase the risk of muscular injury.^8-9 Tight muscles occur when the individual muscle fibres that make up a muscle become shortened and thus cannot perform optimally.  Tight muscles (i.e muscles that are too short) can be lengthened via eccentric strengthening exercises and stretching.^8-10 Eccentric strengthening exercises are exercises at which the target muscle (for example the hamstring) are being exerted whilst lengthening. 

Previous Muscle Injury

Furthermore, it has been identified that for individuals whom have suffered previous muscular injuries in the past, typically present with  reduced strength and muscular length increasing their risk of reinjury.^7,8

Recovery and Load Management

Recovery and managing your training loads are just as important as developing optimal muscular length and strength. Fast and extreme increases in your physical activity such as running can increase the likelihood of muscular, ligamentous and tendon injuries.¹¹ One must consider how much training a person has accumulated over the previous months/years versus how much training they plan on partaking in order to reduce the likelihood of future injuries.¹¹

Working From Home Exercises (Scroll to the end for photo guidance)

There are a lot of effective exercises that can be performed at home, which help target whole body muscular strength and mobility should accessing a gym be difficult!

Bridging

Should the above picture be difficult, the exercise can be performed with both feet on the ground. Should it be too easy the non elevated foot can be placed on a chair/sofa for further resistance!

Squats

Squats can be made easier via squatting up and down off a chair, and made harder by attempting single leg alterations such as single leg squats, or Bulgarian split squats as illustrated below.

Push ups

Push ups can be made easier by placing your knees on the ground, or for an additional challenge you can place your hands together and make a triangle shape with your thumb/fingers

Burpees

Burpees are a fantastic whole body exercise that’ll get your heart rate going! You can make them easier by placing hands on an elevated supporting surface like the side of the couch, as seen in the picture below

Pull ups

Pull ups are a great upper body, arm and shoulder exercise you can perform provided you have a structure that is sturdy enough to support your body weight, otherwise you can attempt bent over rows, or upright rows if you have some exercise equipment.

Renegade Rows

Should you have any exercise equipment like a band or weight, renegade rows are great at progressing your arm, back and shoulder muscles!

Bench Dips

Dips can be adjusted by the furthering the distance between your hands  (increase bias on chest muscles) or narrowing your hand distance (will bias triceps). For an added challenge can raise feet off the ground. You can use a sturdy chair or sofa if you don’t have a bench.

Forward plank

You can start on knees and progress to toes when  you are ready, aiming to have a straight line starting from your shoulders through your hips and into your ankles (or knees if choosing to do a knee plank)

Side planks

As above should planking on your toes be too difficult, you can start on knees. Again  aim to have a straight line start from your shoulders through your hips and to your toes (or knees depending on what you choose)

Russian twists

Russian twists can be quite difficult so you can place your feet on the ground to lessen the challenge, otherwise you can use some small weights as an added challenge.

Mountain climbers

Mountain climbers have a variety of alterations, to make them easier you can place your hands on a bench/chair (similar to the modified burpee). To make them harder you can increase the speed. To provide a further challenge you can try bring your knee and hand together during the repetitions.

Reference List

1. Thorborg K , Krommes KK , Esteve E , et al . Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med 2017;51:562–71.doi:10.1136/bjsports-2016-097066
2. Van Dyk N , Behan FP , Whiteley R . Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med 2019: bjsports-2018-100045 https://bjsm.bmj.com/content/53/21/1362
3. Petersen J , Thorborg K , Nielsen MB , et al . Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med 2011;39:2296–303.doi:10.1177/0363546511419277
4. van der Horst N , Smits D-W , Petersen J , et al . The preventive effect of the nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial. Am J Sports Med 2015;43:1316–23.doi:10.1177/03635465155
5. Al Attar WSA, Soomro N, Sinclair PJ, Pappas E, Sanders RH. Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis. Sports Med. 2017 May:47(5):907-916. DOI:  10.1007/s40279-016-0638-2
6. Alonso-Fernandez D, Docampo-Blanco P, Martinez-Fernandez J. Changes in muscle architecture of biceps femoris induced by eccentric strength training with nordic hamstring exercise. Scand J Med Sci Sports. 2018 Jan;28(1):88-94. doi: 10.1111/sms.12877
7. Oosterhoff JHF, Gouttebarge V, Moen M, et al. Risk factors for musculoskeletal injuries in elite junior tennis players : a systematic review. J Sports Sci. 2018; 00(00): 1-7. [DOI: 10.1080/02640414.2018.1485620]
8. Timmins R, Bourne M, Shield A, et al. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study. Br J Sports Med Published Online First: 16 Dec 2015 doi:10.1136/bjsports-2015-095362 doi:10.1136/bjsports-2015-095362
9. Bourne MN, Duhig SJ, Timmins RG, Williams MD, Opar DA, Al Najjar A, Kerr GK, Shield AJ. Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention. Br J Sports Med. 2017, Mar;51(5):469-477. doi: 10.1136/bjsports-2016-096130.
10. Kellis E. Biceps femoris fascicle length during passive stretching. J Electromyogr Kinesiol. 2018 Feb;38:119-125. doi: 10.1016/j.jelekin.2017.11.015
11. Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine 2016;50:273-280. https://bjsm.bmj.com/content/50/5/273.citation-tools

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