Article Text

Download PDFPDF

Injury resilience – let's control what can be controlled!
  1. Kelvin B Giles
  1. Correspondence to Kelvin B Giles, Movement Dynamics, Langford, Biggleswade, Bedfordshire SG18 9PS, UK; kbgiles{at}gmail.com

Statistics from Altmetric.com

Historically, resilience was used in child psychology to describe success against the odds, to describe an individual resource of resistance and latterly has been used even in monetary policy as the adaptive ability of an economic system to absorb or cushion against loss. Let us though consider the term in a sports medical setting.

‘Injury’ is feared as much by recreational participants as the high-performance athletes, as they negotiate the trials in daily life. In this editorial, I focus on two forms – controllable and uncontrollable injuries.

An injury can be defined as any physical state that impairs movement. These situations can occur in an instant through some accident or contact with something or trip or fall and none of us can truly create a physical activity environment that is completely safe from these occurrences. These injuries, in a sense, can be classed as ‘uncontrollable’. Injury can also occur after a journey of mishaps and accrued errors in movement and training and these we class as ‘controllable’. This article focuses on controllable injuries and the illustrations are primarily taken from the world of sport and physical activity although the execution of life's daily tasks at home and in the workplace also forms an arena where controllable injury can take place.

In sport, we often observe and measure activity in terms of the speed, endurance or power that underpin the sport-specific movements on view. The 21st century provides us with extensive technology to measure just about everything, and we now see an army of practitioners surrounding the athlete as they journey towards the holy grail of repeatable excellence. As advantageous as all this measurement is, especially when we can measure the speed of movement, the distance covered, the forces received and delivered, the patterns of ground coverage, the passes and tackles achieved and the technical skills and errors accumulated, the more it can shield us from the real issues that surround the controllable injury cycle.

Mechanical efficiency

The body is designed to move in a certain way, a series of interconnected levers, stabilised and moved by muscles and fascia. Certain body structures are designed for certain tasks – sequences of muscle actions have the ability to produce, reduce and stabilise force in a complex environment that react to all the senses the human body has at its disposal – a never-ending cycle of neuromuscular activity that links the brain to the body and the body to the brain automatically and reactively. This is the world of mechanical efficiency where each constituent part plays its role in a well-ordered, sequential, sympathetic operation that maximises the role of each individual part in a complex system of connection.

What has this mechanical efficiency got to do with controllable injuries? Plenty. In simple terms, the body creates movement in a pattern whereby each part plays the role that it was designed for. As one part stabilises, another might move, as one part flexes another may extend, as one part rotates another may bend – all in an efficient and coordinated sequence that maximises each part of the pattern.

The start of inefficiency: no short cuts

What happens if this efficiency or coordination suffers some interference or unwanted external influence? Sedentary living leads to a deterioration in the energy systems of the body; postural changes through sitting and slouching for hours at a time as we read all the numbers, see all the pictures and listen to all the tunes from all the modern technology are the sources of many of the contributory factors to the controllable injury.

Within a ‘fast-tracking’, ‘quick-fixing’ sporting world where immediacy of results has taken the place of patience and long-term planning, the errors keep on stacking up. Mechanical efficiency – the cornerstone of human movement – has been relegated to insignificance in the quest for skill, speed, stamina and strength. We now see a career structure in sport where we see ‘speed-specialists’, endurance-specialists', ‘power-specialists’, ‘skill acquisition-specialists’, et al – each one seemingly oblivious to the fact that everything they try to do must grow from an effective and efficient base of mechanical efficiency.

Why do we train poor movement?

Take a moment to consider what happens when a required movement pattern is unsound and is then exposed to the full measure of our modern day sports specialist who operates in a narrow band of expertise and only has this one experience a thousand times. For example, with triple-flexion and triple-extension of the ankle, knee and hip complex forming the basis of all gait/locomotion (think sprinting, running, hurdling, acceleration, deceleration, stopping, starting, agility, evasion, jumping, landing), it seems obvious that the neuromuscular pattern that coordinates this fundamental movement will not react kindly to any errors. What we must understand is that any error in this movement pattern does not shut the system down, like a blown fuse might stop your kettle from boiling. The body is an incredible self-righting mechanism and in the face of a movement pattern error (whether conceived through poor lifestyle and posture or an inappropriate bit of teaching or coaching), it will keep going. The body will recruit a series of compromises to continue the work being asked of it. It will ask certain muscles to change their role and do the job that another should have done. It will ask a muscle group to stabilise when it really should be moving just as it will ask a muscle to move when it should be stable. It will alter the joint sequences and re-route neural signals just to survive the implications of the poor movement sequence that originated through some short-term or long-term error.

If this is the only implication of a poor movement or posture, then perhaps it is not too serious a condition for us to be concerned about. Wrong again. Remember the specialist? The person appointed to get an improved result in performance? The training process now adds to the problem by continually exposing this poor movement pattern (now mechanical inefficiency) to a load. Repetitions and sets of exercises designed to improve performance now become the enemy as they create microtrauma in those body parts that are doing things they were not designed to do. Little may be seen by the coach as this process continues. The body keeps on adapting and compromising to carry out the tasks and to the untrained eye all appears to be fine. Continue the training load and the microtrauma continues its journey to macrotrauma and unfortunately can continue until catastrophic tissue failure occurs.

The usual response is that the injury or ‘accident’ came out of the blue, was a surprise, everything was going well. A quick fix by the sports medical team, a bit of rest, a few drills and back to the training process is the usual order of the day. Discerning practitioners, however, see things a little differently and have a different approach to the performance environment. They do not assume that everything is well, they question the assumption that just because the person is carrying out the physical tasks that all is well. They look deeper into the area of mechanical efficiency by assessing the aforementioned movement patterns. They guarantee movement efficiency; in fact they must guarantee repeatable movement efficiency, before considering the training frequency, density and intensity.

From this position of movement, efficiency can grow the process of creating injury resilience by the progressive adaptation to the appropriate load. The body will have to compromise less, find less inappropriate solutions to movement puzzles, and work and move more efficiently, quite a number of qualities to consider in the whole scheme of things.

View Abstract

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.