Fatigue Is Not a Risk Factor for ACL Injuries: Myth Buster Monday

Fatigue is Not a Risk Factor for ACL Injuries:Mythbuster Monday

Although I have torn my ACL twice, researched ACL injuries for 7 years and presented internationally regonized research on ACL risk reduction. Yet I still know very little about why ACL injuries occur.  However, every day we come a little closer and gain a better understanding the mechanism of this injury.

Although we don’t understand, the exact causes, we are able to identify risk factors for injury that predispose people to be at a. higher risk.  Although many risk factors are backed by research, some are complete misconceptions.  One of the most commonly argued risk factor is that fatigue puts us at greater risk for ACL injuries.  The argument is based around the idea that fatigue will alter our biomechanics in a negative manner. However, the research has shown that the changes we see in a fatigue state actually puts us at a lower risk.  In fact Hewett and Webster(two of the top ACL researchers in the world) foun d that fatigue cared us to demonstrate decreased forces, increased knee and hip flexion.  Each of these puts us at lower risk for injury.

Real world data also supports that fatigue is not a risk factor for ACL injuries.  There is no association between time of season or game qith increased risk of ACL injuries.  Infact a recent systematic review even showed 64% of  soccer ACL injuries happen in the first half of the game

Research

Are Antioxidants Negatively Affecting Your Training?

Are Antioxidants Negatively Affecting Your Training

First and Foremost we must start off with identifying what are Antioxidants? Antioxidants are compounds such as Vitamin C, E etc and have become incredibly popular in recent years, due to its ability to neutralize reactive oxygen species which are though to be responsible for being the root cause of many chronic disease including cancer, cardiovascular disease, neurodegeneration and aging.  Free radicals promote damage to our DNA, which may hinder our athletic performance.

So Tommy, How is taking something that may help prevent cancer, ageing and cardiovascular pulmonary disease a band thing?

When we workout, we generate free radicals. Oh no.  However, free radicals from exercise are good thing, since it triggers our body to build greater protection against physical stress.  When we take antioxidant supplementation , it can hinder our ability to adapt as body is not required to neutralize these free radicals.  Research has consistantly showns that chronic use of antioxidants supplementation with training will negatively affect performance. (How can we improve running performance)

Can Antioxidants ever improve performance?

Although when taken chronically, antioxidants hurt performance,  in short acute use it may actually improve performance.  This is due to the fact that it is able to help fend odd Reactive Oxygen Species that may hinder performance.  Thus, on race days, acute supplementation of antioxidants may be a valuable tool.

Research on this topic

“Increased oxidative stress during exercise results in the production of free radicals, which leads to muscle damage, fatigue, and impaired performance. Despite their negative effects on performance, free radicals may act as signaling molecules enhancing protection against greater physical stress. Current evidence suggests that antioxidant supplementation may impair these adaptations”

“Given that antioxidant supplements (e.g., vitamin E and C) tend to block anabolic signaling pathways, and thus, impair adaptations to resistance training, special caution should be taken with these supplements”

“Acute antioxidant supplementation has been shown to improve performance during high intensity exercise with short recovery intervals”

“With regard to the optimal timing of antioxidant consumption, much of the evidence is pointing towards an acute performance benefit but performance impairment when taken chronically.”

Attention Runners: You Need Strength Training

Attention Runners: You Need Strength Training

70% of Runners will get injured this year

Runners are a unique breed that will do anything to improve their perofrmance.  They will buy the newest shoes, massage guns, normatec boots, goos, etc.  However, there is one thing they will do at all cost….. AVOID THE WEIGHT ROOM.  This lack of committment to the weight room not only contributes to training errors which are the cause of the majority of injuries runner’s experience.  But it also may be the missing piece to taking your performance to the next level. In this blog Ill touch on not only the injury reduction we see when we incorporate strength training with our normal running, but also the expected performance benefits.

Injury Prevention

70% of competitive runners sustain an injury, which prevents them from training for at least 1 week, each year! The biggest thing we can do to prevent injuries in runners is having a well designed training plan.  This includes, increasing mileage and intensity appropriately. Strength training can play an important role in the injury prevention plan as well.  Everytime we take a stride while running our body is absorbing force 3-4 times our body weight.  So we need to be STRONG.  However, most strength and conditioning plans are not effective for runners due to their lack of specificity.   When we think about common running injuries, we think about plantar facititis, achilles tendoniits, Patella femoral pain syndrome, hip and low back pathology.  Our training should be targeted at intervening on the root causes of these injuries. 

Plantar Fasciitis:

between 4.5-10% of runners each year will experience plantar fasciitis.  In this above study, we see that incorporating foot strengthening can significantly reduce this risk of injury.  Many times foot strengthening and mobility work goes hand and hand with calf strengthening mobility(see nxt section) if we are able to get these to work together instead of playing tug of war, we can expect injuries to decrease considerably.  

**My keys to strengthening our feet is getting barefoot and moving on a single limb**

Achilles Tendonitis

Achillese tendinopathy, the chronic condition of achilles tendonitis, is often associated with deficits in endurance and torque of the plantar flexors.  Much of this weakness is associated to the highly neglected soleus  compared to the more thought about gastrocnemius.  The soleus is a much thicker muscle and is the powerhouse for sprinting jumping landing, and all things running. Incorporating lots of strengthening/mobility work of the soleus gastrocs and achilles will help avoid achilles tendonitis.

**Easy modification for alot of exercises is to put the athlete in a split stance with a floating heel. This floating heel will add extra volume of isometric training to the soleus**

Patella Femoral Pain Syndrome: Runner's Knee

In a a previous post, Runner’s Knee, I talked about what you need to do if you are suffering from runners knee.  But when we look at the root cause, it can be high attributed to quad and hip weakness/lack of motor control. The main predictive measurement for at risk individuals is knee abduction moment.  My research that I presented at this years APTA CSM, was groundbreaking in that we were able to improve knee abduction moments(in adolescent female soccer players) for upto atleast 6 month post our 6 week training plan. Our training plan included core strengthening, plyometrics and strengthening.  All of which were centered around strengthening our hips.

**Form is critical for developing motor control to avoid the knee abduction movement pattern**

 

Hip/Low Back Pathology

Our entire body is interconnected an a deficit at one part and can present as an issue at a completely opposite part of the body.  However, hip and low back pathology are highly correlated to each due to all the muscles interconnected in these two segments.  I would argue much of the issues we see are caused by lack of hip extension.  This is usually caused by weak/or inhibited glutes that are unable to create hip extension.  Since our bodies are master compensators, we use our back to get into this extended position. this puts a tremendous amount of stress on our lumbar spine and low back muscles.

**With runners i love spending much of the workout in a spit stance, to constantly be working on hip extension and putting them in a more functional position**

Running Performance

The amount of runners who actually strength train is terrifyingly low, even at the elite level.  Strength training has consistantly shown to increase performance for all levels of runners in all distances. Now this doesnt mean you will be spending every day in the weight room. Instead the effective dosage is 2-3 times a week for ~45 minutes.  This little committment has shown to pay major dividends.

Strength Training has been shown to...

Improve your race time!

These improvements were seen across distances and skill level.  One consistant result between studies is that strength training became more important later in the race.  Individuals who had strength trained performed significantly better at the end of the race.

Improve Running Economy(Fuel efficiency)

Running economy is like the fuel efficency of your car.  Strength training makes it so we need less energy to do the task.  This becomes very important at the end of races and when we begin to stretch out our mileage.

Improved Power and VO 2 max

Strength training also adds to your horsepower.  Strength training and plyometrics have been shown to increase power potential of our muscles.  This improves our top end speed. It also has been shown increase the horse power of our cardioplumonary system byt signifcantly increasing how much oxygen we are able to process.

Final takeaway for Strength Training for Runners:

Adding a small amount of strength training can be a powerful tool that will transform you as a runner.  But remember specificity is  king.  Running will always be the best thing to make you better at running.  Specificity should be used in the weight room as well; we should mimic running as much as possible.  We must make our lifts look like  and demand our body like running.  You can do this by putting ourself or our athletes in a split squat, triple extension , and utilizing reciprocal pattern movements.  The other important thing to remember is, don’t be afraid to  go heavy.  Every time we land while running our body is absorbing 3 times our body weight.  We need to be as strong as possible.  If you have any questions or want to talk more about this topic please contact me on instagram @compass_performance

References:

Petraglia F, Ramazzina I, Costantino C. Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscles Ligaments Tendons J. 2017;7(1):107-118. Published 2017 May 10. doi:10.11138/mltj/2017.7.1.107

Beattie, Kris1; Carson, Brian P.1; Lyons, Mark1; Rossiter, Antonia2; Kenny, Ian C.1 The Effect of Strength Training on Performance Indicators in Distance Runners, Journal of Strength and Conditioning Research: January 2017 – Volume 31 – Issue 1 – p 9-23 doi: 10.1519/JSC.0000000000001464

Denadai BS, de Aguiar RA, de Lima LC, Greco CC, Caputo F. Explosive Training and Heavy Weight Training are Effective for Improving Running Economy in Endurance Athletes: A Systematic Review and Meta-Analysis. Sports Med. 2017 Mar;47(3):545-554. doi: 10.1007/s40279-016-0604-z. PMID: 27497600.

Berryman N, Mujika I, Arvisais D, Roubeix M, Binet C, Bosquet L. Strength Training for Middle- and Long-Distance Performance: A Meta-Analysis. Int J Sports Physiol Perform. 2018 Jan 1;13(1):57-63. doi: 10.1123/ijspp.2017-0032. Epub 2018 Jan 5. Erratum in: Int J Sports Physiol Perform. 2018 Mar 1;13(3):398. PMID: 28459360.

Damasceno MV, Lima-Silva AE, Pasqua LA, Tricoli V, Duarte M, Bishop DJ, Bertuzzi R. Effects of resistance training on neuromuscular characteristics and pacing during 10-km running time trial. Eur J Appl Physiol. 2015 Jul;115(7):1513-22. doi: 10.1007/s00421-015-3130-z. Epub 2015 Feb 20. PMID: 25697149.

Karsten B, Stevens L, Colpus M, Larumbe-Zabala E, Naclerio F. The Effects of a Sport-Specific Maximal Strength and Conditioning Training on Critical Velocity, Anaerobic Running Distance, and 5-km Race Performance. Int J Sports Physiol Perform. 2016 Jan;11(1):80-5. doi: 10.1123/ijspp.2014-0559. Epub 2015 May 6. PMID: 25946163.

addei UT, Matias AB, Ribeiro FIA, Bus SA, Sacco ICN. Effects of a foot strengthening program on foot muscle morphology and running mechanics: A proof-of-concept, single-blind randomized controlled trial. Phys Ther Sport. 2020 Mar;42:107-115. doi: 10.1016/j.ptsp.2020.01.007. Epub 2020 Jan 13. PMID: 31962191.

Should Patients Continue with a Wellness Plan Following The Completion of Physical Therapy?: MythBuster Monday

Physical Therapy is a catalyst for keeping people moving following an injury.  However, due to current limitations in the system, Physical Therapist are typically unable to fully correct the underlying causes of an individuals injuries. Under the current limitations Physical Therapy can serve as a powerful tool to lead people to long term health. This is where a quality wellness plan can become incredibly important in building upon the gains we have made during Physical Therapy.  If you are interested in my Wellness coaching options please reach out and we can set up a free consultation.

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