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High-quality studies support an increased rate of ACL injury on synthetic playing surfaces in FOOTBALL,

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Why My Concern For Player Safety Is Much More Than COVID-19

Originally Published July 12 2020 (https://compasshealthperfo.wixsite.com/mysite/post/why-the-concern-for-player-safety-should-be-much-more-than-just-covid-19)

I want to start with the irrational sport’s fan in me is ecstatic and feels as though my prayers have been answered with sports coming back. However, the physical therapist, researcher, and data driven part of me is nervous, scared and critical of the decision. Every day it feels as though a new college athletic department, professional sports team is suffering from the devastating effects of Covid-19. To name a few Clemson University , University of North Carolina, Kevin Durant, Patric Ewing, Nikola Jokic, Ezekiel Elliot, etc. However, there is another player safety concern that the mainstream media and the general population as a whole is not focusing on; These athletes may be at a significantly higher risk to suffer severe career altering injury.

As we all know the world has been shut down for the last ~4months, and the sports world is no different(unless you are Tom Brady, but going down that path would be like going into the wrong house). Most people in the media have made the argument that this extra rest will help players recover from injuries and will help the players be refreshed from the extra time off; and this may be true for players that were suffering from nagging injuries. However, it does not take into account the inability in the timeline of return to competition for athletes to get their training workload and intensity to match that of game and practice.

Covid-19 is in a league of its own in how it has disrupted sports and all preparatory training for it. To understand its possible effects we must look at situations that have also caused disruptions to the season, with the closest examples we have in recent memory being the 2011 NBA and NFL lockout. During the NBA lockout, Tim Hewett, one of the world’s top experts on ACL injuries, as well as former director of sports medicine research at Ohio State University and former director at the Mayo clinic, was very vocal about the risk of injury these players were going to experience when they came back from the lockout. His precautionary warnings stemmed from an editorial that Dr Hewett and Dr Gregory Meyers among others published in the Journal of Orthopaedic & Sports Physical Therapy, titled “Did the NFL Lockout Expose the Achilles Heel of Competitive Sports?” In this publication they presented astounding results from the injury rates in the 2011 NFL season that was affected by the lockout. Between the years of 1997-2002, the NFL saw on average 5 achilles ruptures per year. In the first 12 days of training camp upon return from the lockout, the NFL saw 10 achilles tendon ruptures (5 were rookies, which is very interesting as achilles ruptures typically occur in athletes who are 30+ years old) , then 2 more during the first two preseason games. As Dr. Hewett predicted the NBA was no different, but saw a much greater increase in ACL type injuries. In the season prior to the lockout the NBA saw saw just 3 ACL injuries. During the shortened lockout season the NBA saw 11 players go down with major knee injuries(most notable, Derrick Rose during the 2012 playoffs).
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Now that a problem has been presented, the researcher in me wants to understand the mechanism of why this significant increase in injuries is occurring. The answer is most likely multifactorial and no doubt can not be fully explained. There are some hypothesis’s that can be used to explain these results though. The number one reason is that injuries occur when the load/force an athlete experiences is greater then the capabilities of the tissue it is stressing. With this players during these disruptions in training and sport do not have proper amounts of time to increase their physical capabilities to match those needed during a competitive sports situation. Another factor that affects athletes during lockouts and pandemics is that many are unable to access the team’s medical personnel to help them recover from existing injuries, which left untreated can lead to neuromuscular deficits and imbalances. These neuromuscular impairments will get amplified during high intensity competition. Finally, players may just be “out of shape”. This may help to explain why we saw so many rookies being injured, as they do not understand what it takes to stay in professional shape.

I was optimistic that we were not going to see as large of a spike in injuries as I have heard discussions from some very smart people over the last few months on how teams can help “flatten” the injury curve. However, after the first weekend of watching European Soccer, and seeing countless injuries, the realist in me kicked in. Now I fear this disruption will be even worse. This was reaffirmed while listening to Pardon my Take’s interview with Trevor Baur, pitcher for the Cincinnati Reds, where he was discussing how many players had not been working out, thrown a ball or taken a swing since Spring training got canceled back in March. This led me to brain storm reasons why this time will be worse. Listed below are just some of my thoughts.

  1. It is 2020 and it seems like anything that can go wrong will go wrong.
  2. A Lot of players did not have access to their gyms or personal trainers
  3. Games are going to be much more intense
  4. NBA and NHL going straight into Playoffs(basically)
  5. Shortened MLB season(each game in theory is now worth 2.7 games)
  6. Medical Staff may be hyper focused on Covid 19 concerns and may have limitations on how much pre/rehab they are able to do with the athletes inorder to limit interaction time.

With all this being said, we can hope and pray for the safety of all players. I hope the medical and training staff has listened to the experts, at least more than our government, to help protect our athletes against injury and disease.

How to get into Running…Safely

Running’s popularity has been steadily increasing since the 1970’s and based off of working at a running store, it has exploded during this pandemic.Running has allowed people to get out of the house, possibly away from their children and in the fresh air.This is fantastic as running is not only one of the most popular but also one of the most efficient ways to achieve fitness and improving ones longevity. The down fall of running is injury risk is extremely high; with some reports having 80% of runners sustaining an injury each year.

Why does running lead to so many injuries?

Majority of running injuries are not what we would consider “acute” injuries, but are instead overuse injuries. This is due to the continuos high forces that the body has not been properly adapted too. During running our body is subject to forces that are typically 3 times our body weight. These increased repetitive forces lead to injuries that include, stress fractures, soft tissue strains, shin splints, neuromuscular issues etc.The good news about “overuse” injuries are they can typically be avoided with proper precautions.

What do new runner’s do that lead to overuse injuries?

Go hard every single day

We have all been there. Post holidays, your grandma has single handedly made you put 12.6 lbs on and you look in the mirror and you think I am going to run every single day. Bad news is you haven’t run in months, and no doubt are going to hurt yourself, which then will leave you sidelined for weeks while you try to recover.

Poor Footwear

Although the primary intervention most runner try to implement into their shoes is having either a “stability” or “neutral” shoe and including insert in it to help limit pronation; however there is “Little evidence for pronation and impact forces as risk factors despite being considered primary predictors of running injuries.” The best predictor to reduce injury according to recent research is choosing the shoe based off of comfort. A 2015 BJSM study “Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’” found “Shoe conditions that are more comfortable are associated with a lower movement-related injury frequency than shoe conditions that are less comfortable.” And “Shoe conditions that are comfortable are associated with less oxygen consumption than shoe conditions that are less comfortable.” So moral of the story is find a high quality running shoe that is most comfortable for you, it will lead you to perform better and get injured less.

Only training in the sagittal plane..

Running for the most part occurs solely in the sagittal plane, aka only going forward and back. The bad news is we need to train the muscles that help us going side to side and rotationally, to help prevent injuries.The Hip musculature, specifically the glute medius, helps control knee from going into knee valgus. Excessive knee valgus has been linked to Patella Femoral Pain Syndrome and IT band syndrome; two of the most common running injuries

Lack Baseline Strength

Most people who begin to run typically do not have proper strength in the core and lower extremity to withstand the demands of running. Improving strength in the lower extremity and core will allow for greater work capacity. This increase in strength will not only reduce injuries, but also improve performance.

How to properly get into running safely?

Start slow

Walk run progressions are my favorite way to get people back into running. This may include running for 1 minute and walking 2 minutes then gradually progressing with increasing running time and decreasing walking. Another bit of advise is to slowly build your mileage up. The general recommendation most people give, is you do not want to increase your mileage by more than 10% per week.

Schedule easy days

Every day doesn’t have to be 100%. Instead include plenty of days that you are slowly jogging and can maintain for 30+ minutes. A great way to find that perfect recovery pace is to find a pace that you are comfortably able to have a conversation at. This will not only help aid in your recovery, but it will also help build your aerobic base.

Go get yourself fit for shoes

Shoes can play a critical role in keeping a runner healthy. As I mentioned above finding a shoes that is comfortable is most important. Another side notes for when you are preparing to go get running shoes.

1. You typically want your running shoes to be a little bit bigger than your lifestyle shoes. This extra room is to help allows your foot to expand while running to properly absorb forces,

as well as to leave some room for when your foot begins to swell

2. Running shoes should only be worn for 300-500 miles. After this they begin to lose some of their cushioned properties and put you at greater risk for injury.

3. Consider getting two different pair of shoes. This is in part because shoes cushioning needs 24 hours to “recover” after each run. As well as different shoes are made differently, thus challenging our body’s in new ways. When we wear each shoe, this will be working different muscles and may lead to less overuse injuries.

Cross train

Biggest tip when lifting to supplement running, is to lift heavier. To stimulate proper adaptations to reduce injury we must lift heavier with runners.Most runners, focus on high reps, however what is the purpose as your already do this plenty of volume with your running.Instead go heavier and challenge your body in a new way. Another tip, if possible is to try to spread your lifting and running sessions out by at least 4 hours.This will help limit the interference affect.

Make it enjoyable

There is no point in doing anything if you don’t enjoy it. So find a friend, or my favorite a local brewery with a running club and make it enjoyable. If we are able to make exercise more communitive and enjoyable, retention numbers would significantly improve. Although I don’t agree with all of Crossfits principals, one thing they are extremely successful with is making it a communitive environment which offers new members a wonderful support system.