How to Predict and Prevent Injuries

Injury Prevention is my Jam.

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In late 2015 I was watching a Free Shoot session during a University of the Fraser Valley’s Men’s Basketball Team practice. After a few minutes of observation, I texted the head athletic therapist of UFV and said “This guy is going to have knee problems” accompanied by a picture. Fast forward to early 2016, he tore his ACL. It was a non-contact injury while he was changing directions at the baseline. I wasn’t thrilled that I was right, but I did take some pride in my prediction coming true.

I tell this story to illustrate a point, not to brag about my premonition abilities (cue Twilight Zone themsong here). By no means can I see the future, otherwise I would be an investor and not a Kinesiologist. Instead, I want to use it to emphasize the importance of mechanics and default movement patterns. Most injuries are preventable, and almost all non-contact injuries are preventable. As I watched the athlete I noticed something I call a motor fault (i.e. a bad habit). Every time he took a shot his ankle and knee collapsed (i.e. his knees came in over his toes and the arch of his foot flattened out). This pattern is quite literally the mechanism for ACL injuries.

Before I move on, I need to make an important note: faulty mechanics DO NOT guarantee injuries and “perfect” mechanics DO NOT guarantee you will be injury free. Injuries are multifactorial. How strong are you? What is your activity background? What sport/activity are you in? What is your history of injury? There is no way to predict with 100% certainty whether or not you will get hurt. However, optimizing your mechanics and reinforcing solid movement archetypes is going to move the needle towards ‘robustness’ and ‘injury resilience’ while moving it away from 'injury prone' and 'made of glass.'

How I made my prediction: 

If only it were so simple....

If only it were so simple....

No.... I don't have a crystal ball that predicts injuries. Wouldn't that be sweet tho? Instead... I look for patterns.

Let’s talk about the movement pattern I saw and why I believe it predicted his injury. The nature of basketball involves a lot of practicing on hard surfaces, wearing terrible shoes and shooting hundreds of shots in a single session. It is the perfect environment for bad habits to turn into faulty patterns. Because the player was taking so many shots in succession it gave me a chance to analyze what his default motor pattern was. It wasn’t the individual repetitions that were doing damage or weakening his ACL.

If anything, the repeated stress may actually even contribute to strengthening his knee.

The problem is that he keeps hitting 'save' on a document that has a lot or obvious spelling mistakes. In other words, he was reinforcing the habit that wouldn't work when he needed to produce power through his legs at high speeds. He would automatically collapse his ankle, his knee would follow, and the force would translate back up his body and into his shot. Ankle collapse and knee valgus are actually creating stability, but instead of relying on muscle contractions it relies on passive structures, in this case the ACL. He probably could have taken 10,000 more shots with the same movement pattern with little consequence, other than maybe the occasional soreness that could be attributed to any aspect of the practice.

Imagine if the tires on your car are worn down from faulty alignment for mile after mile. As long as you are driving moderate speeds and employing reasonable driving habits you will probably be ok, even if you have to slow down suddenly or make a quite turn. Now take the same turn or try to brake while going 100mph. The kink in the system is about to become really obvious when you can’t brake in time or you miss the turn and sail right over the cliff.

 

The Result: Not pretty.

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Your body has some similarities to your car. You can buffer a bad motor pattern until you can’t. High speeds = high forces. Bye, bye, ACL.

To fix it we need to get into the laboratory: the weight room. These same motor patterns that we see in injuries almost always reveal themselves in the gym. Do you have the motor control to squat with your knees over your toes? Because if not, what do you think is going to happen in a high-speed/high-risk environment?

 

In my mind, there are 3 aspects to consider when you are trying to fix a motor pattern...

Motor Pattern = Motor Control + Mobility + Stability

None of these are more or less important than other, but some might be more important for you as an individual. Hypermobile? You probably don’t need to work on your mobility, but stability could be a hole in your game. Ultra-stiff body builder? You might need to focus on mobility. None of these factors work independently, and you might need to work on all 3.

1. Motor Control

Motor Control is the coordination part of the equation. Like everything, it is multifaceted and is going to be different for everyone.

It is usually a motor control issue when you can perform the correct movement when coached or when you have feedback. This is especially true for kids. Teaching kids to walk with their feet straight, or jumping with their legs in the proper position can be as simple as teaching them how to perform the movements correctly. For adults, especially those who have been sedentary, it could take multiple training sessions to re-write the default movement pattern and learn the new one. This is where 'Practice makes Permanent.'

 

2. Mobility

Mobility refers to your ability to achieve full range of motion at a given joint. For example, if you can raise both arms overhead without letting your rib cage pop out or arching your back excessively, then congrats! You have full shoulder ROM. Mobility and Stability usually go hand in hand. Mobility restrictions can be due to pain, tissue stiffness or mechanical issues. That being said, everyone under general anesthesia has full range of motion (barring a bony block or mechanical dysfunction). In other words, 99% of us have the ability to reach full Range of Motion, but something is keeping us from it. This is where the brain chimes in. Increased muscle tone, pain, and posture are the result of the guy/gal upstairs controlling the show.

A Note on Pain: pain is the brains’ way of telling us something is wrong. It doesn’t tell us WHAT is wrong, just that something is wrong. If the pain is chronic (lasting longer than 3 months), then the pain might not even correlate to structural damage, but instead, are paired with the motor pattern itself. A lot of the time working with a physical therapist, chiropractor or kinesiologist to ‘reprogram’ the brain is more relevant than trying to heal damage.

 

Mobility Restrictions are often the result of stability issues, but it doesn’t guarantee that you will get injured. Remember, the body is robust and more than capable of dealing with a bit of faulty mechanics. That being said, when you have severe restrictions, you are probably more likely to get injured than if you have full ROM. Be aware though that the vice versa can be true as well and hypermobility can lead to a whole different set of injuries (e.g. dislocations and subluxations).

 

3. Stability

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Stability refers to your ability to control your limbs throughout a range of motion. The term ‘instability’ can often be daunting and intimidating. Like mobility, instability doesn’t always mean you will get injured. Nor should you shoot for excessive stiffness. Your body is meant to move, some joints and segments more than others, but it is meant to move with intention and control.

That being said, hypermobility doesn’t always mean that you have unstable joints. Just because a contortionist or a gymnast can twist and bend in ways that make your back hurt just looking at them doesn’t mean that they are not in control. On the contrary, mobility restrictions are often the result of instability somewhere in the range of motion that causes the brain to restrict the ROM. When this happens we need to strengthen and cement the proper motor pattern and reclaim that range through loaded exercises and mobility work.

 

Where to start?

This can all be confusing, especially for the recreational athlete, so I want to give you somewhere to start. Before I do that, just remember, NO ONE is perfect and there is no perfection. We are all just trying to continually move towards perfect, getting better (even if it is by 1%) every week.

If you are new to training, start by learning the fundamental movement patterns. I highly recommend a coach because we have been trained to have different eyes. We can see things that a lot of people can’t, which speed up your learning process. At the very least, video yourself performing these movements, review them and then practice again. Practice doesn’t make perfect, it makes permanent, so take the time to learn the technique.

Fundamental Movement Patterns:

  1. Squat
  2. Lunge
  3. Hinge
  4. Push
  5. Pull
  6. Twist
  7. Locomote (walk/run)

Below are a few simple guidelines to get you started. Your pattern doesn’t need to be perfect before you start training, but making sure you are as technically sound as possible is going to go a long way and speed up your training process.

1. Squat

  • Can you squat ATG? (Can you squat Ass to Grass?)
  • Can you squat to parallel with your back flat, your knees over your toes and your feet pointed forward?

2. Lunge

  • Can you lunge to 90/90 with both of your knees?
  • Can you keep your back flat?
  • Can you keep your knees over your toes?
  • Do both of your sides look the same?

3. Hinge

  • Can you hinge to 90 degrees with your knees soft, your back flat, and your feet pointing forward?
  • Do you recognize when your back is rounding?

4. Push

  • Can you push/press with your forearms perpendicular to the weight?
  • Are your wrists neutral (not bent forward or backward)?
  • Is your shoulder in a neutral position, i.e. is your shoulder rounding forward or elevating?
  • Can you press without your back arching?

5. Pull

  • Can you pull with your forearms perpendicular to the weight?
  • Can you pull in a neutral position, without your shoulders elevating or rounding forward?

6. Twist

  • How far can you turn your upper body/shoulders while seated in a chair?
  • Are both your sides even?
  • Does your twist come from your upper back (as it should be) or your lower back?
  • Are you able to resist outside forces that try and make you twist?

7. Locomotion

  • Can you run barefoot?
  • Can you run with your feet underneath you and a smooth/soft foot strike?
  • Can you keep your core stiff/in control while running?

All of the above guidelines are basic for athletes and coaches, but might be new to you. The catch is that if you are reading this you are a human with a human body, which means they are also fundamental for moving efficiently. If you can perform all of these movements with great form, then you are well on your way to both injury prevention and improved performance (did I mention that mobility optimization and athleticism go hand-in-hand?).

Take the time to step back and improve your mechanics. This doesn’t need to take 6hrs a week. Incorporating technique work into your warmup and between sets will often be all that it takes. As little as 5 minutes, a day can make a significant impact. Don’t be afraid to load a pattern, even if it isn’t perfect, and don’t get stuck on ‘Paralysis by Analysis’. It is still more important to get into the gym and do SOMETHING, than what you actually do when you get there. Having a solid workout incorporating each of the fundamental movement patterns is going to keep you balanced and moving towards your goals.

-Mark

B.Kin, Chiropractic Student

Want to learn more about Mark? Learn more about me and my background.

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Author: Mark Murdoch, Kinesiologist, Chiropractic Student. Have questions? Email me. I want to help! mark@leofitness.ca