It wasn’t until the autumn of 2013 that a change manifested. It was during a two week holiday back home in Bangalore, India. Feeling strong as ever, I trained for a half marathon, while also putting in the cross-training hours of strength training, spinning and badminton games for ‘recovery’. A month prior, a dull pain occurred in my left knee, which I shrugged off after three weeks of rest that drove me half crazy. My mistake back then was my lack of questioning why this even happened, probably because I was too consumed by going the extra mile, literally. That day on the badminton court, as the top half of my body took a deep twist over my pivoted left knee, there was a snap, a fall, and my immediate realisation to what had just happened.
Having received my MRI scan the same evening, (it was 10PM on Indian Independence Day!), I self-diagnosed my ACL (anterior cruciate ligament) rupture and knew the worst was yet to come.
It was two weeks before my first half marathon, fitness instructor course and a month before my PhD was to begin. I knew all I could do was use the time to understand the real reasons for injury. There were signs, and I had ignored them because I thought that these injuries could only happen to elite athletes or those playing high-level contact sports. Surely if I was putting my body through strength and agility drills, I would be able to cope with a bit of stress during a badminton game, a sport which I have played for years. That is evidently not true.
Fitness is a confusing thing. People often overlook the essential movements they need to be able to perform before they can start workouts safely and effectively. Moreover, how does one know what needs to be corrected if the essential movement can’t be performed? Luckily, there are simple self-tests we can do to make us more aware of this.
Awareness about your muscle imbalances
I would say one of the primary causes of my own injury was my lack of awareness of my muscle imbalances. If I could have been aware of my body and tried to understand what it was telling me, maybe I would have prevented it all together. If I consider why it occurred, I now see very clearly that over the years of strength training, competitive badminton and spinning, my body may have become ‘stronger’ but also more fragile in terms of muscle imbalances.
As women, anatomically, we have wider hips, and our thigh bones tend to curve inwards causing added stress on the knee joints*(1,2). In addition to this we also tend to contract our muscles differently to men in a way that poses stress on our ligaments. Research suggests that for causes unknown, women tend to contract their quadriceps (front of the thigh) much more than men who tend to relax their hamstrings (back of the thigh) when completing movement with high impact, and the contractions of the quads lead to added stress on the ACL in particular*(3). These factors could ultimately result in misalignment and a dangerous imbalance of power between the agonists (quadriceps) and the antagonists (hamstrings) muscles that make us four-six times more likely than men to rupture our ACLs*(4).
This made me go back to the basic questions: Was I aware of how strong my hamstrings were compared to my quadriceps? Was I familiar with the extent of my hip flexibility? Was I creating strength that I couldn’t translate into functional movement? Was preventing injury ever a goal in my workouts? I had to be more aware of my abilities and movement patterns, and it was these questions that really needed to be asked before any injury occurred.
Mobility and Stability – the key drivers of injury prevention
We hear all the time that the key to preventing injury is ‘stretching’ before or after a work out. Although there is some truth in this, the term is used loosely, and it means different things to different people. For example, a recent review of the literature suggests that static stretching before a workout has no benefits in terms of preventing injury on its own*(5).
This is because stretching a muscle is only a small aspect of what is known as mobility, which is what we really need to be focusing on.
Mobility can be thought of as the range of motion of a joint, whereas stretching is purely the lengthening of a muscle. Mobility drills normally comprise of stretching and releasing soft tissue around a joint by foam rolling. But it has the added component of developing enough muscle coordination and strength to perform essential movements, usually through eccentric contractions (lengthening muscle under tension)*(6).
People are often told to ‘strengthen’ their muscles around a joint which is prone to injury, or has been injured. Again, the meaning of this is often misinterpreted. Simply strength training is not going to create joint stability because a strong muscle might still be slow to react to adjust itself and prevent unwanted movement, and what actually needs to be trained is stability itself.
The simple tests
But how do we know what type of mobility or stability to work on if we don’t have a way of screening for dysfunctional movements? Gray Cook, one of the most respected physiotherapists in the world, published a series of 7 functional movement tests or the functional movement screen (FMS) that can tell you a great deal about whether you have any deficits in your mobility or stability7,8. These tests include deep squat, hurdle step, in-line lunge, shoulder mobility, straight leg raiser, trunk stability push up and rotary stability (http://www.functionalmovement.com/exercises).
Although the tests are an indirect way to assess the risk of injury, the great part about these tests is that the imbalances become obvious and would allow you to correct them and measure your progress. Even better, if you have common deficiencies, Cook recommends some key functional exercises to how you can better your mobility and stability overall such as the chop and lift, the Turkish get up, two-armed and cross body single leg dead lift.
So next time you step out for a run or hit the gym or the tennis court, make sure you listen to your body, recognise its abilities and focus on good practise of movement to take it further in the safest way possible.