injury resilience - let's control what can be controlled!

7/29/2019 Injury Resilience - Let's Control What Can Be Controlled!

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Editorial

situations can occur in an instant throughsome accident or contact with somethingor trip or fall and none of us can trulycreate a physical activity environmentthat is completely safe from these occur-rences. These injuries, in a sense, can beclassed as uncontrollable. Injury canalso occur after a journey of mishaps andaccrued errors in movement and trainingand these we class as controllable. Thisarticle focuses on controllable injuries andthe illustrations are primarily taken fromthe world of sport and physical activityalthough the execution of lifes daily tasksat home and in the workplace also formsan arena where controllable injury cantake place.

In sport, we often observe and measureactivity in terms of the speed, endurance

Injury resilience lets controlwhat can be controlled!Kelvin B Giles

Historically, resilience was used in childpsychology to describe success against theodds, to describe an individual resource ofresistance and latterly has been used evenin monetary policy as the adaptive abilityof an economic system to absorb or cush-ion against loss. Let us though considerthe term in a sports medical setting.

Injury is feared as much by recreationalparticipants as the high-performance ath-letes, as they negotiate the trials in dailylife. In this editorial, I focus on two forms controllable and uncontrollable injuries.

An injury can be defined as any physi-cal state that impairs movement. These

or power that underpin the sport-specificmovements on view. The 21st centuryprovides us with extensive technology tomeasure just about everything, and wenow see an army of practitioners surround-ing the athlete as they journey towardsthe holy grail of repeatable excellence.As advantageous as all this measurementis, especially when we can measure thespeed of movement, the distance covered,the forces received and delivered, the pat-terns of ground coverage, the passes and

tackles achieved and the technical skillsand errors accumulated, the more it canshield us from the real issues that sur-round the controllable injury cycle.

MECHANICAL EFFICIENCY

The body is designed to move in a certainway, a series of interconnected levers, sta-bilised and moved by muscles and fascia.Certain body structures are designed forcertain tasks sequences of muscle actionshave the ability to produce, reduce andstabilise force in a complex environmentthat react to all the senses the human

body has at its disposal a never-endingcycle of neuromuscular activity that links

Correspondence to Kelvin B Giles, Movement

Dynamics, Langford, Biggleswade, BedfordshireSG18 9PS, UK; [email protected]


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Editorial

the brain to the body and the body tothe brain automatically and reactively.This is the world of mechanical efficiencywhere each constituent part plays its rolein a well-ordered, sequential, sympatheticoperation that maximises the role of eachindividual part in a complex system ofconnection.

What has this mechanical efficiency gotto do with controllable injuries? Plenty. Insimple terms, the body creates movementin a pattern whereby each part plays therole that it was designed for. As one partstabilises, another might move, as onepart flexes another may extend, as onepart rotates another may bend all in anefficient and coordinated sequence thatmaximises each part of the pattern.

THE START OF INEFFICIENCY:NO SHORT CUTS

What happens if this efficiency or coor-dination suffers some interference orunwanted external influence? Sedentaryliving leads to a deterioration in the energysystems of the body; postural changesthrough sitting and slouching for hours ata time as we read all the numbers, see allthe pictures and listen to all the tunes fromall the modern technology are the sourcesof many of the contributory factors to thecontrollable injury.

Within a fast-tracking, quick-fixingsporting world where immediacy ofresults has taken the place of patience

and long-term planning, the errors keepon stacking up. Mechanical efficiency the cornerstone of human movement has been relegated to insignificance inthe quest for skill, speed, stamina andstrength. We now see a career structurein sport where we see speed-specialists,endurance-specialists, power-specialists,skill acquisition-specialists, et al eachone seemingly oblivious to the fact thateverything they try to do must grow froman effective and efficient base of mechani-cal efficiency.

WHY DO WE TRAIN POOR MOVEMENT?

Take a moment to consider what hap-pens when a required movement patternis unsound and is then exposed to the fullmeasure of our modern day sports spe-cialist who operates in a narrow band ofexpertise and only has this one experi-ence a thousand times. For example, with

triple-flexion and triple-extension of theankle, knee and hip complex forming thebasis of all gait/locomotion (think sprint-ing, running, hurdling, acceleration, decel-eration, stopping, starting, agility, evasion,jumping, landing), it seems obvious thatthe neuromuscular pattern that coordi-nates this fundamental movement will notreact kindly to any errors. What we mustunderstand is that any error in this move-ment pattern does not shut the systemdown, like a blown fuse might stop yourkettle from boiling. The body is an incred-

ible self-righting mechanism and in theface of a movement pattern error (whetherconceived through poor lifestyle and pos-ture or an inappropriate bit of teaching orcoaching), it will keep going. The bodywill recruit a series of compromises tocontinue the work being asked of it. It willask certain muscles to change their roleand do the job that another should havedone. It will ask a muscle group to stabilisewhen it really should be moving just as itwill ask a muscle to move when it shouldbe stable. It will alter the joint sequencesand re-route neural signals just to survive

the implications of the poor movementsequence that originated through someshort-term or long-term error.

If this is the only implication of a poormovement or posture, then perhaps it isnot too serious a condition for us to beconcerned about. Wrong again. Rememberthe specialist? The person appointed toget an improved result in performance?The training process now adds to theproblem by continually exposing thispoor movement pattern (now mechani-cal inefficiency) to a load. Repetitions and

sets of exercises designed to improveperformance now become the enemy asthey create microtrauma in those bodyparts that are doing things they were notdesigned to do. Little may be seen by thecoach as this process continues. The bodykeeps on adapting and compromising tocarry out the tasks and to the untrained

eye all appears to be fine. Continue thetraining load and the microtrauma contin-ues its journey to macrotrauma and unfor-tunately can continue until catastrophictissue failure occurs.

The usual response is that the injury oraccident came out of the blue, was a sur-prise, everything was going well. A quickfix by the sports medical team, a bit of rest,a few drills and back to the training processis the usual order of the day. Discerningpractitioners, however, see things a littledifferently and have a different approachto the performance environment. They donot assume that everything is well, theyquestion the assumption that just becausethe person is carrying out the physical tasksthat all is well. They look deeper into thearea of mechanical efficiency by assessingthe aforementioned movement patterns.They guarantee movement efficiency; infact they must guarantee repeatable move-ment efficiency, before considering thetraining frequency, density and intensity.

From this position of movement, effi-ciency can grow the process of creatinginjury resilience by the progressive adap-

tation to the appropriate load. The bodywill have to compromise less, find lessinappropriate solutions to movement puz-zles, and work and move more efficiently,quite a number of qualities to consider inthe whole scheme of things.

Competing interests None.

Provenance and peer review Not commissioned;externally peer reviewed.

Accepted 20 May 2011

Br J Sports Med2011;45:684685.doi:10.1136/bjsports-2011-090243


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Copyright of British Journal of Sports Medicine is the property of BMJ Publishing Group and its content may

not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written

permission. However, users may print, download, or email articles for individual use.

injury resilience - let's control what can be controlled!

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