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Where does injury come from?
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Defining load and capacity
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Origins of injury
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Mitigate injury
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Rehab injury
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Concepts to keep in mind
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Where does injury come from? Whether you’re suffering from a traumatic injury or a chronic issue, such as increasing joint pain or muscle tension, it’s important to recognize indicators that your MSK system is not functioning healthfully or optimally.
Even BEFORE symptoms arise or an injury occurs, many people have under-functioning MSK systems, which can occur due to:
Repetitive activities
causes tissues to adapt for specific movements. For example, if you’re a cyclist, your MSK system will primarily optimize for cycling-specific positions but may have difficulty when participating in other sports or activities.
Not moving the joints
through a wide range of motion daily leads to reduced neural activity and declining quality of all the joint tissues.
Static positions & daily postures
creates stiffness, shortening and thickening of tissues. For example, this is experienced with tight hips or a stiff neck after sitting all day.
Imbalanced training programs
can cause greater loads to be sustained on some joints and tissues while others don’t get loaded enough.
These can lead to joint mechanics becoming compromised, motor control declining and the nervous system over-protecting.
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Defining LOAD and CAPACITY The load-bearing capacity of your tissues, cells and joints determines how healthy they are and how well they will function.
LOAD CAPACITY
What is load?
Any mechanical force applied and placed on a tissue EXAMPLES: Weight, intensity, speed, volume
What determines capacity?
How much load a specific tissue can absorb without becoming compromised This includes the capacity to: • Overcome a specific load • Recover from repetitive efforts • Move through a range of motion with control
If the load you place into a tissue EXCEEDS the capacity of that tissue to handle the load, an injury – whether acutely or chronically – will result.
Injury results when ... 4
Tissue load > tissue capacity Joint load > joint capacity
Movement load > movement capacity
ORIGINS of INJURY Most injuries are due to one or more categorical deficiencies Passive range of motion
Generally regarded as FLEXIBILITY or the amount of motion you can be “stretched into”
Usable range of motion
The amount of ACTIVE range of motion of which you have control and ownership
Other considerations that can lead to injury or reinjury • No treatment plan • Wanting a “quick fix” • Lack of proper warm-up • Imbalanced programing • Physically doing too much
Motor control
The process of initiating, directing, and grading purposeful voluntary movement
Tissue capacity
The amount of load that a tissue is able to absorb through exercise, movement or posture
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“You’ll always regret not training the positions you become injured in.” -Dr. Andreo Spina
Most people become injured doing things they haven’t trained their body or their tissues to do well. To mitigate injury, improving the capacity of our entire MSK system is key. This includes:
Remodeling fiber organization
Improving tensile strength of tissues
Increasing motor unit recruitment
Creating a healthier environment from both a cellular and neurological perspective
Our connective tissues are dynamic and adapt to what WE tell them to do. Fortunately, this is relatively simple to do. 6
Best ways to mitigate injury Perform rotational movements daily.
These should be done at the outer limits of each joint’s range of motion, executed slowly and with control.
Pay attention to and train your end range control.
Most of us spend a lot of time training our mid ranges of motion but it’s the end ranges where injuries occur (stopping/starting, beginning/ending of a lift). Training those few degrees will not only improve control at the end of your range of motion, but it will develop strength in your mid ranges as well.
Spend time in positions that are challenging for you.
One of the best ways to improve connective tissue stiffness is to use the time and tension principle. Find positions in which you feel tension and spend some time there. As your mobility improves, increase the time spent.
Keep your brain and body familiar with movement.
The brain won’t allow you access to ranges of motion it thinks you can’t control. The more you move and challenge your movement, the less your brain will try to protect it. 7
“The path by which you became injured is the same path through which you should rehabilitate it.� That might seem counterintuitive but if you do become injured and your tissues have been compromised, you need to rebuild and remodel them in the directions you want to reinforce them. For example ... If you sprain your ankle, you must apply load to the injured tissues in the direction and within the range of motion which initially caused the injury. This teaches the tissue how to get stronger and resist those forces should they be placed in that position again.
This is crucial for two reasons: Tissues that have been injured typically have a disorganized fiber arrangement which doesn’t allow them to function like normal, healthy tissue. Rehabilitative exercise remodels them into an organized, functional arrangement again. Forces placed into tissues teach cells how to behave and respond and train tissues how to adapt to specific loads, thereby improving their load-bearing capacity. 8
Best ways to rehabilitate injury
Determine the specific tissues which were injured and/or which are the source of the dysfunction
Apply tension over time in the specific direction of the adjacent tissues so that new fibers are rebuilt and remodeled in the optimal way.
Examples include: • Joint capsule • Tendon • Muscle
Methods include: • Purposeful active range of motion • Sustained passive range of motion • Isometric contractions at end ranges • Eccentrically controlled exercises
Progressively increase the tension applied as the injured site becomes stronger. Examples of ways to increase tension: • Load • Speed • Frequency • Intensity
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Keep these concepts in mind ‌ Injuries will not get better just by resting them. Your pain and inflammation may decrease but if your injury is due to unhealthy or compromised tissue, you need a rehabilitative program to restore them to pre-injury function again.
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Stretches held under one minute are not adequate enough to produce changes within tissues. They must be held for 2 minutes or longer OR combined with isometric contractions. Pain is not normal but it’s not always indicative of the source or cause of your injury/dysfunction. You must be evaluated by someone skilled in musculoskeletal exam.
All injuries, no matter how mild or severe, should have a treatment and rehabilitative plan.
Injury care Get started: All associates: • Follow the MSK Campaign SharePoint site and join the Yammer group. • Check out our online mobility routines: Total Body Cars, Assess Your Mobility, Lower Extremity Mobility, Upper Extremity Mobility, Spinal Mobility. • Would you like mobility exercises accessible on your mobile device? Click here for more information about MyWellness. • Listen in to the Injury Care or Concussions podcast episodes.
KC-based associates: • Participate in a Bulletproof Joints class in the Healthe Fitness Centers. • Injured? Schedule an appointment with an Athletic Trainer or Chiropractor by logging into HealtheatCerner.com. • Schedule a Motion Capture by logging into HealtheatCerner.com.
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