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Training Clients with Lower Body Injuries

By Ray Loh – Exercise Physiologist, Educator for Training Clients with Lower Body Injuries Course

The most frustrating experience of a recreational athlete is the repeated niggling aches, stiffness and joint pain after a routine workout. The problem usually gets worse after a more intense workout which may last for a few days. Rest, massage, foam roll and stretching does help to relieve the symptoms, but the overuse injury returns once the activity is resumed. Then, fitness and performance start to drop due to irregular training, physical activity reduces, and some athletes even started taking pain killers to reduce discomfort. Where are we going wrong and why are we stuck in that cycle?

Injuries, especially overuse injuries are common in active individuals and especially in novices and recreational athletes. Up to 94% of active individuals have reported experiencing some kind of musculoskeletal injury in a lifetime recall. While one can argue that the main reason for overuse injuries could be training errors like doing too much too soon, the main reason found with strong evidence agreeable across most studies is previous injury. It has been shown that most overuse injuries were either reoccurrence or occurred at a new location within the kinetic chain. It seems like existing rehabilitation and sports training before returning to sports might not be adequate or effective enough.

Existing epidemiological studies have shown that more than 70% of injured adults of both sexes still experience pain in a 5 years follow up after completing rehabilitation. More than 20% had even ceased physical activity completely due to the injury (Powers, 2012). In a recent running programme aimed at educating proper training structure for beginner, runners reported that 48% of participants stopped running within 26 weeks due to injury and finds it hard to return to running (Fokkema et al., 2018). The risks of overuse injury increase when activities are performed at an intensity and duration above what our musculoskeletal structure can accept. In other words, overuse injuries occur due to the accumulation of high structural stress with inadequate recovery.

One of the main factors that affect the ability to withstand structure stress is previous injury as it affects the limb’s ability to absorb impact. Higher ground reaction forces were found on the injured limb in athletes just recovered from an injury. Asymmetrical knee excursion and or gait velocity were found in healthy runners who later get injured. When performing a drop jump, landing patterns were found to be different in athletes with a recent injury although they were performing without pain. The asymmetry, asynchronized, and compensated movements reduces the ability to absorb impact and increases the stress on other structures that may lead to overuse injury when performed repeatedly. Thus, it is believed that overuse injuries can be prevented, and one do not need to go the vicious cycle of aches and pains after every workout.

The 3 main skills needed to train well are: effective assessments, exercise programming, and exercise selection.  

1. Conducting regular assessments using the interdependent model and having the skill to identify deficits and compensatory movements within the kinetic chain (hip, knee and foot and ankle) is needed as prospective evidence have showed that existing static assessments in strength, flexibility and proprioception may not be sensitive enough to identify movement deficits.

2. Knowledge of exercise programming at the right quadrant (The four quadrants of strength and conditioning) is also important to train clients at the right intensity so that it is intense enough to strengthen the structure but mild enough to prevent pain and aches which hinder progress and risk injury.

3. Understanding the biomechanics of movements such as squats, can help us select effective exercises that target the deficits and double up the training effects.

Eventually, as a trainer, we should be able to answer the most common questions like “should I convert to forefoot running?”, “how to select the right shoe”, “why my knee should not cross my toe when performing a squat?” and “My knees feel stiff when standing up after prolonged sitting, what type of training should I do to improve the condition?”

Get all the skills and knowledge needed from “Training clients with lower body injuries”, which Ray will be teaching on Sunday 15th September 2019 here at the FIT Singapore academy (TMP Fitness @ Revenue House), from 9am to approx. 5pm.

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