Preventing Overuse Injuries

How can I protect myself from sports injuries?

You faithfully wear your goggles on the racquetball court, you never go in-line skating without your pads and helmet, and you stretch like a fanatic, yet you still get sidelined by injuries. What's going on?

Although safety precautions are indispensable, there's more to staying injury-free than avoiding flying projectiles and cushioning your falls. Athletes often overlook measures that can protect them from problems like sore knees and sprained ankles. There's no sure way to take the pain out of sports, but the following advice can definitely help you stay in the game. Here are some tips for preventing the most common aches and pains.

Overuse injuries. Many people associate sports injuries with broken bones and torn tendons, but in non-contact sports, the vast majority of injuries come on gradually. Stress that builds over weeks or months can cause aching kneecaps, stress fractures, shin splints, pulled muscles, strained hamstrings, tenderness in the Achilles tendon, or burning pain in the heel. These problems strike most athletes at one time or another. Doctors call them "overuse injuries," but you don't necessarily have to work out extra hard or long to get them. Worn-out shoes, uneven running surfaces, and quirks of body structure can contribute to pushing your muscles, tendons, and bones past their limits.

Here are some tips for preventing overuse injuries:

• Don't push through pain. Real discomfort is a signal that something's wrong or that you're asking more from a part of your body than it can provide at the moment.
• Increase your workouts gradually. If you're a runner, don't bump up your mileage by more than 10 percent per week.
• Don't run more than 45 miles per week. Running farther than that doesn't pay off: It probably won't improve your stamina, and it definitely increases your risk of injury.
• Run on soft, flat surfaces.
• Alternate hard training days with easy days.
• Get new running shoes every 500 miles. With use, shoes lose their ability to absorb shock.
• If you pronate (the inside of your foot leans in) or have another alignment problem, you may be able to prevent injury by wearing an over-the-counter shoe insert. Ask your doctor if such inserts might work for you.
• Women and adolescent girls should make sure they're getting enough calcium, whether from their diet or from supplements. Stress fractures are 10 times more common in women than in men. Improve your odds of avoiding them by making sure you get enough of the minerals and vitamins crucial to building bone.

Can certain stretches or other exercises lower the odds of an overuse injury?

Many people stretch before and after working out. Stretching helps you to increase range-of-motion and prepare for activity, but according to recent reports in Sports Medicine and the American Journal of Sports Medicine, there's no clear evidence that it will prevent overuse injuries. To ward off these injuries and help existing injuries heal, exercises that actually strengthen your muscles will be far more effective than those that simply stretch them.

Here are some strengthening moves that can help prevent common overuse injuries.

• Pain around the kneecap. Check with your physician if you routinely have pain around the kneecap. If the front of your knee hurts when you climb stairs and stiffens up during long periods of rest, your kneecap is probably being tugged out of its groove during your workouts. Your doctor may recommend strengthening your inner thigh muscles, which tend to be weak in relation to the outer ones. If your physician approves, try this exercise: Stand with your back against a wall and your feet 6 to 8 inches from the wall. Slowly slide your back lower on the wall until your thighs are parallel to the floor. Make sure your knees don't extend beyond your toes. Hold the position for about 10 seconds, or until the tops of your thighs become tired. Stand up straight to let your muscles recover for a moment. Try doing ten repetitions each day.
• Sore shoulder. Swimmers, tennis players, weight lifters, and others who repeatedly raise their arms over their heads often feel pain in the front or side of a shoulder. To prevent that problem, work on strengthening the muscles in your rotator cuff, the muscles in the shoulder that connect to the arm bone. Here's a simple exercise you can try: Do a simple shoulder shrug: Lift both shoulders as high as you can, squeeze them together, and relax. Work up to 25 shrugs twice a day. (See your doctor, of course, if you suffer from regular shoulder pain.)
• Hamstring pull. To help prevent hamstring injuries, try this exercise: To strengthen the hamstring, lie on your stomach, pull in your abdominals to protect your lower back, engage your thigh muscles, and slowly lift one leg. Keep it in the air for two seconds, then carefully lower it and relax your thigh muscles. Try three sets of 10 repetitions each day with each leg.
• Strained Achilles tendon. The Achilles takes a pounding during running and aerobics classes, especially if your calves are too weak to carry their share of the load. To strengthen your calves, stand up straight, raise yourself onto the balls of your feet, then slowly lower. Keep it up until your calves tire. Repeat this routine twice a day.

Ankle sprains. Ankle sprains are among the most common sports injuries, although they are not always caused by overuse. Although there may be an element of bad luck behind most sprains, you can take some steps to keep luck on your side. If ankle sprains are a common problem for you, check with your physician. She may recommend some ankle strengthening or lace-up stabilizers or semi-rigid braces. These devices are particularly important if you lack strength, flexibility, or good balance, all of which can help you avoid injury (see below). By the way, a study at the University of Oklahoma found that -- contrary to popular belief -- high-top shoes didn't lower the risk of ankle sprains.

Are there exercises that can help prevent ankle sprains?

Strength, flexibility, and good balance make an ankle sprain less likely, and you can enhance all of these qualities through stretches and exercises:

Calf stretch. Experts say performing this stretch on each leg before and after a workout session can reduce the severity of any future ankle sprain. Face a wall with one leg slightly forward and one slightly back. With your front leg bent at the knee and your back leg straight, put your hands on the wall and lean forward, keeping your back heel on the floor. Keep leaning until you feel the calf in your back leg extend slightly. Hold the position for 15 to 30 seconds. Then, with both heels planted on the floor, slightly bend your back leg, and hold the position for another 15 to 30 seconds. This shifts the focus within your calf, so you stretch the entire area.

Ankle exercises. Completing three sets of these exercises every other day -- 10 to 15 repetitions per set -- can make your ankles stronger and more stable. Don't forget to do both ankles:

Take a two-foot piece of tubing (or use a rubber resistance band available at sporting goods or medical supply stores), and tie it into a loop. While sitting in a chair, secure one end of the loop around the leg of a heavy table or another solid object, and put the other end around the top of your foot. You should be far enough from the grounded end of the loop for the tubing to be tightly stretched. With your heel on the floor, move your foot upward to the right and then upward to the left.

Now stand with one end of the loop in your hand and the other end around the ball of your foot. Keeping your heel on the floor, lift the front of your foot and then press it down as if you were stepping on the gas, using the loop to provide resistance.

Finally, stand on one foot, lightly touching a chair or table for balance. Slowly lift your heel off of the floor, then slowly lower it.

References

Basic Injury Prevention Concepts. ACSM Fit Society Page. American College of Sports Medicine

American Academy of Orthopaedic Surgeons. Safe Exercise.

Knapp TP, Garrett WE. Stress Fractures: General Concepts. Clinics in Sports Medicine;16(2):339-354.

Ballas MT, et al. Common overuse running injuries: diagnosis and management. Am Fam Physician;55(7):2473-80.