Where do injuries come from...
Watching the Tour de France and the various cyclists that had to retire following crashes and falls got me thinking ‘what causes injuries?’ Most people who come to the clinic ask the question ‘why has this happened?’ As part of our assessment we always try to answer this question because it allows us to not only treat the resulting injuries but also to put a plan in place to try and prevent it from happening again.
Falling from a bike is an obvious cause for an injury, accidents caused by equipment failure or lack of traction between tyre and road caused by wet conditions cannot always be foreseen. Just last week Craig Kieswetter, the Somerset cricketer, sustained a nasty eye injury when the ball got through between the peak and grill of his helmet. Maintaining and setting up your equipment well can go some way to reducing the risk of these types of injuries, but within professional sport where you are always pushing the boundaries they are still going to occur.
The vast majority of injuries that we see in clinic tend not to fall into this category, and on the whole they are as a result of ‘the straw that broke the camel’s back’. A physio friend of mine uses the analogy of the Stone Cutter and I think it sums it up perfectly.
Many common injuries that we see are as a result of an accumulation of repetitive movements. If these movements are performed in an unbalanced way then some tissues are put under excessive stress and strain, which over time will cause them to become injured. If you pull an elastic band repeatedly to stretch capacity thousands of times eventually it will give way, especially if you’re pulling it at an angle, one side will start to fray before the other side!
Movement of our bodies exists in a delicate equilibrium. If we aren’t balanced in our movements then we develop small compensations in order to ‘get the job done’. The body is amazing and will always ‘make a plan’ so that you can function as best you can, but often these strategies are not beneficial in the long term.
Let’s try a little practical exercise –
- Stand up and for argument’s sake let’s say that you have a tight left hip.
- Turn your left leg inwards a little bit to demonstrate this.
- You still have to be able to face the front like a normal human being who does everything in front of them so your body has to compensate by turning a little bit to the left, probably at your lower back or the junction between your thoracic and lumbar spine.
- Because your back is twisted, your neck has to twist a little to the right so that you can still look forward (if you don’t believe me then keeping your left hip turned in and keeping your neck in the same position unwind your spine. If your body has properly compensated to the adaptions you will find you are ever so slightly turning your head to the right.
- We can look at the effect the hip will have on the left knee because of the hip position; the knee cap will have to change its position, the ankle/ foot will have to change its position in order to stabilise the lower leg.
- Everything is affected from your big toe, right up to the muscles in your eyeballs and who knows what caused the hip to become stiff in the first place... it could have been that the neck was really stiff from sleeping funny and the changes all occurred down the line or it could be a stiff ankle joint which has caused the changes up the chain. Or maybe this hypothetical person just always sits with their left hip crossed over the right, or he did a lot of boxing as a child and being right handed the left hip was the one that stiffened up through all the rotation that happened in the joint over and over. Perhaps he/ she had a broken leg as a teenager and has an ever so slightly shorter leg, and also when on crutches for 6 weeks the left hip stiffened up as a result of having to carry the leg around while non-weight bearing. We call this the kinetic chain, the chain of all the bits of your body that work together to make you function.
As you can see unless your physio can trace through every single inch of what has happened to you, every habit you have and every injury you’ve had, it’s pretty difficult to determine the exact cause of why we are how we are. From my point of view it’s most important to get you balanced again, to stretch out what is tight through soft tissue treatment (hands on physiotherapy), the use of a foam roller and stretching. Also to tighten up what is long is very important, if you have too much range in one muscle around a joint this joint cannot be in balance and therefore something is being overloaded. A long muscle is generally a weak muscle and is often just as likely to be injured as a short, tight muscle. It’s all about whether a muscle is capable of doing its job.
My advice to you is that if you have an injury somewhere start to think of all the injuries that you’ve had in the past. Your physio doesn’t need to know every inch of your history, but it is helpful to know that ‘you’ve always had a stiffer right ankle from your cricket days’. Let the physio decide what is relevant or not. And if the physio looks at just the joint affected I would be inclined to seek a second opinion!!
Just remember the Stone Cutter, injuries often have their origins ‘in the first hit’ but don’t present till much later when a tissue can no longer handle the extra stress it is being put under!
Thanks to Kate Stalker and the Sporting Joint Clinic in Derby for the analogy (if you’re injured in the Derby area get yourself down to see Kate).