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Why So Many Injuries This Season?

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The roster of the Baltimore Ravens has been completely decimated due to one of the most injury plagued seasons in recent memory. A total of twenty players have been placed on injured reserve thus far, and fans are desperately seeking answers as to why so many. Is it the fault of the trainers? The strength and conditioning staff? Could it be due to CBA practice restrictions? Or is it just plain bad luck?

Ron Chenoy-USA TODAY Sports

The roster of the Baltimore Ravens has been completely decimated due to one of the most injury plagued seasons in recent memory. A total of twenty players have been placed on injured reserve thus far, and fans are desperately seeking answers as to why so many. Is it the fault of the trainers? The strength and conditioning staff? Could it be due to CBA practice restrictions? Or is it just plain bad luck?

I do not have any direct knowledge of the training principles used by the Ravens medical/training staff. However, there's no doubt that their staff is comprised of some of the brightest minds in the field of sports medicine. It can also certainly be argued that little could have be done to prevent the majority of the team's injuries. For that reason, I do not subscribe to the viewpoint that this season's injuries are solely the fault of the trainers and doctors. But, with that said, that does not mean that there may be some areas of training that they could alter.

A DIFFERENT APPROACH TO TRAINING

Many rehabilitation and strength/conditioning programs predominantly focus on obtaining maximal strength gains while training in a single plane of motion. However functional athletic activity is multi-planar and highly complex, and therefore requires a much more integrated approach to training. Such an approach must focus on training in multiple planes of motion, challenging the entire muscle contraction spectrum, and incorporating components that address flexibility, the core, balance, plyometrics, speed/agility/quickness, resistance training, and sport-specific conditioning.

By doing so one can efficiently and effectively prepare athletes for optimal performance while also reducing risk of future injury. Several months ago I wrote an article that discussed why some athletes are more prone to getting hurt than others. This article will focus on discussing just a few of the principles that are most frequently neglected and overlooked.

MULTI-PLANAR TRAINING

There are three planes of motion (frontal, transverse, sagittal) and athletic activity occurs in each of them simultaneously.  Even though some movements may appear to be single-plane dominant, dynamic stabilization in the other planes is still required for adequate neuromuscular control during athletic performance. The frontal plane bisects the body into front and back halves and includes motions that involve lateral movements. The transverse plane divides the body into upper and lower halves and generally refers to motion that rotates or pivots. The sagittal plane bisects the body into two halves and allows for flexion, extension, and linear motions.

Of the three planes, the transverse plane poses the greatest challenges to balance and dynamic stability and, therefore, most sports injuries tend to occur during transverse plane movements. However, the majority of traditional strength and conditioning exercises occur in the sagittal plane. By training exclusively in the sagittal plane it becomes impossible to effectively prepare an athlete's muscles that are dominant in other planes of motion. This, in turn, makes the athlete at higher risk for injury and it does little to improve overall athletic performance.

ECCENTRIC STRENGTH TRAINING

Strength training is a common, and vital, component of any athlete's training regimen. Muscles are able to produce tension through a variety of means and have both concentric, isometric, and eccentric properties. Concentric contractions occur when the contractile force of the muscle is greater than the resistive force, resulting in shortening of the muscle. All explosive athletic movements (i.e. jumping, sprinting, etc) require concentric muscle strength. An isometric muscle contraction occurs when the contractile force is equal to the resistive force, resulting in no visible change in muscle length. During athletic activity these types of contractions help to dynamically stabilize the body. A common example is the role the rotator cuff plays to stabilize the shoulder joint when throwing a ball. Eccentric contractions refer to when the contractile force of the muscle is less than the resistive force, resulting in lengthening of the muscle. This occurs during the lowering phase of any resistive exercise.

With athletic movements muscles will work as much eccentrically as they do concentrically or isometrically. Yet primary emphasis is nearly always placed on concentric force production during strength training. Eccentric strength provides important decelerating properties that are found in nearly all sport-specific movements. An example can be seen in an athlete's ability to control their landing after jumping in order to minimize the amount of stress on their joints. This makes eccentric strength a critical component of athleticism. If the athlete is unable to decelerate and stabilize their body then their ability to properly accelerate during sprinting, cutting, or jumping will be inhibited as well.

IDENTIFICATION AND CORRECTION OF MUSCLE IMBALANCES

Several studies have found that muscle strength/flexibility imbalances are associated with higher risk of injury. Subtle changes in posture, pattern overload, injury, and neuromuscular alterations can all lead to these imbalances. A skilled and competent physical therapist is well suited to identify such dysfunctions and correct them in order to maximize performance and prevent future injury. Two of the most common findings are altered reciprocal inhibition and synergistic dominance.

Altered reciprocal inhibition occurs when a tight muscle causes decreased neural input to its functional antagonist (a muscle on the opposite side of the joint). For example, tightness of the iliopsoas muscle (hip flexor) often leads to decreased function of the gluteus maximus (hip extensor). Given the functional importance of the gluteal muscles, failure to correct inhibition of this muscle will lead to faulty movement patterns and, ultimately, injury.

Synergistic dominance essentially refers to when smaller muscles (synergists) try and make up for a dysfunction (inhibition or weakness) in a big muscle. This is frequently found in the relationship between the hamstrings and gluteus maximus. Each of these muscles help to extend the hip, though the gluteus maximus is much more efficient in executing this function. However, when it is weak or inhibited the hamstrings will work in overload in an attempt to "pick up the slack". This is an incredibly common finding amongst individuals who suffer from chronic hamstring strains. The muscles simply become stressed and overused, which eventually will cause them to break-down.

Injuries, themselves, are another common cause of muscle imbalances. For example: research has shown that ankle sprains result in a decrease in neural control to the gluteus medius and gluteus maximus muscles. In fact, one study determined that subjects with unilateral chronic ankle sprains have weaker hip abduction strength on their involved limbs. This alteration in recruitment leads to decreased strength and control of the lower extremities during functional activity which will ultimately put the athlete at an increased risk for injury. Therefore, when rehabilitating an athlete with an ankle sprain, merely treating the ankle is poor and insufficient care.

THE CORE

Core training is arguably the most important aspect of any sports performance/rehabilitation program. However, many athletes either train their core muscles inadequately or neglect training them altogether.

The core can loosely be defined by the structures that make up the lumbo-pelvic-hip-complex. This grouping of muscles, ligaments, and fascia work in a coordinated and intricate manner to produce force concentrically, decelerate force eccentrically, and stabilize against compressive, torsional, and shear forces isometrically. Weakness of these structures not only results in less efficient movement and poorer athletic performance, but can also make an individual more susceptible to injury.

It is well established that core weakness is a risk factor in the development of low back pain. However, research demonstrates that athletes who have suffered from ankle sprains, knee pain, and muscle strains commonly present with core dysfunction as well. One particular study examined the relationship between hip strength and patellofemoral pain amongst female athletes.

The researchers found that those who suffered from knee pain presented with significant deficits in hip abductor and hip external rotator strength. Unfortunately, poor hip strength and stability tends to be a typical finding in athletes, particularly adolescents. Nevertheless, pain, function, and even athletic performance (i.e. vertical leap, agility, and explosiveness) have all been shown to improve with adherence to a properly designed core training program.

CONCLUSION

Hopefully this article was helpful in providing a little insight into aspects of training that are frequently neglected. As always, feel free to leave any questions or comments below.

- Dr. Bobby Esbrandt, PT, DPT, PES