The potentially injurious nature of the lockdown-part I
Updated: Jul 9, 2020
On the whole, this forced lockdown has been good for us, right?
I would say so. Most people have found working from home a liberation giving them more quality time to themselves and with their families. Many people have used this surplus of free-time to start an exercise program. A survey by running brand ASICS suggests that people are exercising 37% more during the lockdown. Fitness tracker apps have reported a 252% increase in global registrations and a 44% increase in monthly activities. And it’s no wonder when 67% of people agree that exercise was a stress management mechanism and 80% of people using it to maintain good mental health. Home gym equipment, running shoes and bike sales have gone through the roof over the lockdown period. I have certainly noticed more people on the streets and the trails when I’ve been out for my morning jog. Long may it continue! The country needed an overhaul of its general activity levels, and for all the anguish caused by the pandemic, one shining light will be if we can all keep up this new-found passion for exercise.
However, many injury clinics are now noticing is a surge in the numbers of people who have developed overuse injuries. So is the answer to simply exercise less? No.
Let’s take two case studies as examples of how problems could arise. This blog will focus on patient 1. Next week’s blog will focus on patient 2. Both studies demonstrate familiar similarities but with some subtle differences.
Let’s call her Anna. Anna has decided that since she has had so much time on her hands during lockdown to take up running. Her work furloughed her, so she found herself with an abundance of opportunity to lace up her old trainers and hit the roads. She wasn’t wholly foolish in her efforts; downloading a ‘couch to 5k’ app on her phone to use as a framework.
Week one started well. A walk –jog –walk – jog format, gradually building towards continuous running. There were rest days factored in too. She instantly found her wellbeing improving. She was sleeping better, with less stress during the day. Her body shape looked more favourable to her. A few weeks in, she decided that her old battered trainers had seen better days so splashed out on a new pair. All the mod-cons like the medial arch support, enhanced anti-supination, an air sole to cushion her footfall. She was quickly falling in love with running.
Fast forward another few weeks. Anna is still running. More than she ever has before. Anna decided to ditch the app because it was suggesting rest days and she just wanted to, moreover needed to, run. The app was also indicating distances which she now found too easy. She felt like she needed to go further to push herself. With the excellent weather, she was sometimes running in the mornings and evenings, making the most of the sunshine and the long days.
Everything, it seemed, was going so well for Anna until she noticed a niggling pain in her heels one morning when she stepped out of bed. She thought nothing of it – the pain even improved the more she walked on it. She went for a run, and the pain was there for the first mile but then subsided, and she finished her race unperturbed. But the next day, the pain was back. And worse.
It lasted longer when she went running. It was worse when she woke. The first few steps of the day were agonising. Running became so painful that she had to stop.
For all of her good intentions, she was now unable to keep up the running routine.
Anna’s story is not unusual. She was training hard. But was she training smart? Her body was not accustomed to the levels of exercise, the intensity, the duration which she was demanding of it. She even made the error of changing her biomechanics (her footwear) halfway through the routine.
So let’s break that down a bit:
She was not used to running. Not at all. So to suddenly start running was a shock to her body. One, however, that she could easily cope with when she was sticking to the framework outlined on the ‘couch to 5k’ app. The app was programming intensities, distances and rest periods which would allow her body to acclimatise to these new activity levels slowly. The rest days would ensure that she prepared her body for a new level of intensity or a greater distance every week.
By ditching the app, she dismissed the sensible advice. She started inflicting too much load on her musculoskeletal system (the body system comprised of muscles, joints, bones, ligaments and tendons, which is tantamount to human movement). All of these structures need a gradual amount of stress to become capable of moving without breaking down.
If the stress applied is not gradual enough, and there is not enough rest between the repeated exertion, then the structures will produce a pain response (1). Pain is uncomfortable, but it also limits the excellent function of the musculoskeletal system.
In the middle of all of this, she also bought new trainers, which in itself, is not a bad thing. However, her old running shoes were probably offering very little support to her feet, whereas her new shoes came with the promise of providing maximal support to her feet. Neither pairs of shoes are dangerous in isolation. It is the change from one extreme to the other which presented the problem (2).
Anna developed a common overuse injury called Achilles tendinopathy. Essentially, this is extreme disorganisation of the tendon tissues which run from the calf muscle into the foot (3). Tendinopathies can present themselves in numerous locations such as the gluteals (muscles of the bottom), patella tendons (at the front of the knees), the hamstrings (the back of the thighs) as well as the Achilles in the heels and numerous other sites.
Anna now needs a period of relative rest and will need to re-address her training plan. Once her pain has settled, we will be working on improving her function and strength. Only then can we formulate a program to allow her to achieve her goals of running again at intensities and distances. We will also implement a home-workout routine to ensure her body is well-conditioned to perform her running activities.
We will be, in effect, taking a massive step back to enable Anna to move forwards again, which seems such a shame after all of the hard work she has already put into getting fit. Unfortunately, it is a necessary evil in this instance.
The guys at Backroom Medics can provide expert planning and advice for your training. Likewise, they are happy to discuss all of the things mentioned above from strengthening programs to rest days to running training plans.
Look out for part B of this blog where we will discuss patient 2 – a high-level triathlete.
Gabbett, T, J, 2016. The training - injury prevention training paradox: Should athletes be training smarter and harder? British Journal of Sports Medicine. 50. Pp. 273-280.
Vincent, H, K, & Vincent, K, R., 2020. Considerations in the selection of running shoes. Clinical care of the runner. Pp. 95-99.
Longo, U, G., et al., 2018. Achilles tendinopathy. Sports medicine and arthroscopy review. 26 (1) pp. 16-30.
Huw Roberts is the head physiotherapist at Backroom Medics.
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