The Injury Issue
‘He who treats the site of pain is lost’ – Janda. Obviously one of the first sites to examine when an injury occurs is the actual site of injury. Immediate first aid is rightly the common occurrence after trauma. However, trying to work out the reason for the injury is a far more complex journey and it is on this journey that we are assisted by ‘connection’.
In his paper The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective, Christopher Powers stated, ‘Given the fact that patients with knee dysfunction comprise a large portion of orthopaedic practice, there is a need to understand the risk factors associated with knee injury as well as primary injury mechanisms. Research conducted over the last decade suggests that the causes of knee injury may have proximal origins. For example, prospective and retrospective studies provide evidence that hip muscle weakness is associated with knee injury. Furthermore, studies conducted by Zazulak and colleagues have reported that impaired trunk proprioception and deficits in trunk control are predictors of knee injury in female athletes. In a recent review of the literature, Reiman et al cited articles that provide some degree of epidemiological, neuromuscular, or biomechanical evidence to support the concept that proximal factors may influence knee loading and, therefore, contribute to injury.’
Here, Powers illustrates the influence of joints and muscles distal and proximal to the injury site as having a profound influence.
When a segment of the body fails to do the job it was designed for it is likely that the responsibility will be transferred to another part in the hope that it can do the task. This is known as compensational shift. In some cases this transferred force or range component of the required action falls upon a body-part that is ill-equipped to do the job and can easily overload.
In some injury situations it is possible that the problem grew from a poor movement pattern which created compensatory movements as the body sought to solve the repeated puzzle of the sports-specific action or posture that it was continuously exposed to. By ignoring (or not looking for) movement inefficiency within the sports-specific action or posture the compensatory movements can begin a spiral towards injury. Be wary of creating the following journey:
Poor movement pattern + inappropriate training and load progression = compensatory movements and postures
Continue the same training = micro trauma
Continue the same training = degeneration and macro trauma
Continue the same training = catastrophic tissue failure
Growth and the Kinetic Chain
For all those dealing with the growing athlete this picture of a connected system of levers, each dependent upon what happens around it, is an important tool in the teaching / coaching tool-box. A watchful eye will readily see the growing child encounter their growth spurt. For the uninitiated it may well be the time that you look on in wonderment as an athlete arrives for training looking, for the first time, like a giraffe.
Do not underestimate the changes that are taking place during this 2 – 3 year period and certainly be ready to adapt and adjust the manner of your teaching / coaching. This is not the place to enter into a detailed commentary on all the details of the growth spurt that leads to that critical period of peak height / weight velocity but it is certainly worthwhile mentioning issues that affect the kinetic chain.
As the long bones accelerate in their growth they often leave behind the growth of the muscle and connective tissue architecture. This can lead to a loss of flexibility and function for a brief time. Add to this the fact that the ‘self-organising’ body is trying to stabilise these ‘giraffe-like’ long bones by creating what one might describe as a ‘protective stiffness’ and the problem of inflexibility may well raise its head. A lack of flexibility at one joint will be transferred along the ‘chain’ as the body attempts to solve the movement puzzle.
For example, if the Ankle joints are lacking in range (often due to an injury, scar tissue, the growth- spurt or any other pathology) during a triple-flexion activity like landing from a jump, the body will self-organise and ask other joints to help out. Under these circumstances we may see the Knees going into valgus to try to compensate for this lack of range. If the Knees change their pattern it will obviously affect the part of the body that the Thigh bones are attached to – the Hips. Now the Hips have to reorganise themselves for the changes beneath them during the ‘shock-absorption’ stage of the landing. Don’t think it stops there – the Spine sits on the Hips and connects to the upper body and will also have to react to the alien patterns of force production, reduction and stabilisation that are occurring further down the movement pattern towards the floor.
These ‘ground reaction’ forces can be considerable every time the feet contact the floor in gait or landing. It has been stated that Usain Bolt experienced 10.5 x bodyweight each time his foot hit the floor as he sped to 9.58sec for the 100m. These are not insignificant forces that the body has to tolerate and so there is the powerful argument that movement must be efficient and consistent and that the total body ‘chain’ should be resilient to the cumulative effect of these forces.
Learning to Move
Movement efficiency can also be described as the neuro-muscular process that puts the body in the right position, at the right time, all the time so it can effectively produce, reduce and stabilise force. Consider this process always in a multi-joint, multi-plane and multi-directional setting. This is clearly illustrated when one looks at the fundamental sports skills of running, jumping, throwing, kicking, catching and striking.
While the young person learns to move by solving puzzles there is also the support of the parent, teacher or coach who should be knowledgeable enough to guide the student to the most efficient answer to the puzzle. This is teaching / coaching at its best when the experienced adult guides the student to the best possible technical model of the movement while at the same time allowing the child to ‘falter….adjust….discover….falter….adjust….discover’ – a powerful process of learning. To help the teacher / coach the body has an infinite number of solutions with which to answer the question and at the same time is governed by certain muscular-skeletal factors which form the basis of the technical model being sought. For example, certain joints are designed for certain actions just as certain muscles are designed for certain tasks. These naturally occurring phenomena form the basis of our technical destinations.
It is interesting to assess comments derived from the research associated with movement learning for example:
..the individual’s capacity to produce and control a wide range of movements bears a direct relationship to the scope of his or her problem solving capacity. Higgins, 1991
The point is that neither skill, nor strategy, nor movement can be imposed – they are derived and evolve as a function of experience by an active participant.
The learner discovers relationships between biomechanical, anatomical, physiological and environmental variables by the application of existing resources (movement vocabulary).
…cyclic process of discovery, mastery and re-application. Whitehead, 1967; Ellis, 1976
From this we can gather that one important means of developing movement efficiency is the solving of ‘movement puzzles’. Put another way ‘failure is an option’. The young person solving the ‘puzzle’ will recruit a series of tools to assist them and it is the process of solving the puzzle that leads to efficiency in the long term (consistency). In simple terms the following process is underway as the movement ‘problem’ is solved:
1. Gain insight into the task
2. Gain insight into the force problem to be solved
3. Fit the force problem to the movement
4. Progressively refine and gain control or mastery
For teachers and coaches to be successful in using this ‘guided discovery’ method with the developing athlete they will need one predominant tool – patience. Even though fixture lists will be present; local championships an attraction; ‘trophy hunting’ a trap, the key is patience. The main reason for this approach is the fact that the aforementioned ‘growth-spurt’ is unique in rhythm and timing for each individual. For some it will be early and for others late in their maturation journey. Add to this the fact that in any given population of young people you will see early maturers and late maturers; fast adapters and slow adapters; fast learners and slow learners and fast recoverers and slow recoverers. With such diversity to accommodate it is likely that patience will be a necessity not just a choice.
In addition to this ‘diversity of adaptation’ issue there is the fact that each developing athlete will present with a different movement competence than their neighbour – a.k.a. the bandwidth of variability. The following graphs illustrate the scores in as Physical Competence Assessment of two football players of the same chronological age.
The question that arises from this data is – is the same training program appropriate for both athletes?
So…….after all this rambling, the point is that the ‘kinetic chain’ is a complex collection of bio-motor components that work together – all the time. Each person adds to this complexity with their own unique neuro-muscular system that is different to their neighbours. Knowing this should assist the teacher / coach in their decision-making when it comes to exercise selection and prescription.
“One size does not fit all”
“Not only does the picture of the jigsaw-puzzle change but the pieces keep on changing”
“Train movements, not muscles”