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The potentially injurious nature of the lockdown-part II.

In last week’s blog, we examined the idea that the lockdown has been beneficial for our health insomuch as it has allowed most of us to spend more time enjoying some exercise. We also discussed the notion that unless managed carefully, an excess of training can sometimes prove detrimental. We took a closer look at new runner Anna and her self-inflicted Achilles injuries. Self-inflicted because she stopped following good advice from a running app and because she ignored her own need for rest and moderation.

Today, we will discuss a second patient, a high-level triathlete who we will call Tom.

Tom usually trains every day of the week in some form or another. He runs, cycles and swims high numbers of miles every month. Tom does not typically suffer from injuries and enjoys using the gym under the direction of his coach once or twice a week. When the lockdown started, he was building nicely towards the start of the new triathlon season, tinkering his training to ensure he would peak at the first few events of the year.

The lockdown prevented him, and all others, from competing at these events. So Tom, being the dedicated athlete that he is, threw himself into his training with enthusiasm. He decided to use the lockdown as positive enforcement so that he could get even more excellent quality training done. Tom still had his program from is the trainer, and he was able to follow it. The gyms were closed, so instead of spending a couple of sessions per week in the gym, he used this time to do an extra run and cycle session.

Things were going swimmingly for our triathlete. He was feeler fitter and fresher than he had in a long time. He was clocking up greater distances on his endurance days. He was registering faster times on his speed days. On one such speed day during week 9 of the lockdown, Tom was at his local running track performing repeat sprint efforts over 400 metres. He completed this session and decided to run some hill sprints to finish. It was during these hill sprints that Tom felt something tighten in the front of his thigh. He stretched and tried to run it off, but it wouldn’t subside. He had to terminate the session. Once home, the pain grew more troublesome and simple activities like standing up from a low chair became painful.

If we cast our minds back to Anna in last week’s blog, she had suffered an overuse injury affecting her tendons; Tom has sustained a more acute muscle injury. Anna’s injury crept up on her slowly. Tom’s injury presented itself suddenly. Anna had picked up her injury due to not being well-conditioned enough to cope with the new stresses of the running she was doing. Clearly, as a high-level triathlete, Tom has plenty of ‘exercise literacy’ which he could access. Crucially, however, he had not been able to keep up his usual gym sessions a couple of times a week. And it was from this lack of strength work that his problems arose. It is evident that Anna and Tom are training at different levels, but the principles of why they sustained their injuries show some distinct similarities. Tom’s body requires a degree of strength training to allow him to stay in peak condition to keep running, cycling and swimming such vast distances. Working in the gym will enable him to perform better but also safeguards his musculoskeletal system from injury.

When Tom decided to complete some maximal effort sprint training, his power output was more than his deconditioned muscles could withstand (1). Some of the fibres in the muscle tore, resulting in pain and inflammation. This tear is due to a principle of training called the reversibility principle. It describes how a withdrawal of tissue loading (in this instance – strength training), results in a loss of training adaptations (2). This reversibility process can take as little as three weeks to take effect. In Tom’s case, it took closer to 9 weeks. A period of inflammation management and pain control is now needed. Once settled, he will need to re-establish the strength of the affected muscles as well as the surrounding structures which support it. Then he will need some running and bike drills to re-condition his muscles and his limbs before he starts to gradually return to the enormous volume of weekly exercise, which he needs to compete.

I would strongly advise that Tom returns to his gym work at the first available opportunity. I would recommend anyone who enjoys endurance activities to undertake some form of strength work. Even if your endurance activity is purely recreational, strength work will be helpful to improve performance and to keep you exercising injury-free (3). If the gyms remain closed due to COVID-19, then there are home-based alternatives that can also be effective.

A good physiotherapist, a specialist sports doctor or a strength and conditioning coach can give you scientific advice on this and also provide you with tailor-made plans. At Backroom Medics, we have a friendly team of experts who will be delighted to help you with your needs, whether you are a professional or an amateur athlete.

1. De Hoyo, M, et al., 2015. Effects of a 10-Week In-Season Eccentric-Overload Training Program on Muscle-Injury Prevention and Performance in Junior Elite Soccer Players. International journal of sports physiology and performance. 10 (1) pp.46-52

2. Kasper, K., 2019. Sports training principles. Current sports medicine reports. 18(4)pp.95-96.

3. Aagaard, P., & Andersen, J, L, 2010. Effects of strength training on endurance capacity in top-level endurance athletes. Scandinavian Journal of Medicine and science in sports. 20 (2) pp.39-47

Huw Roberts is our head physiotherapist at Backroom Medics. Give him a thumbs up by following him on twitter @HuwDRoberts For regular updates follow @Backroom_Medics #BackroomUnited

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