Sports

The most common injury is probably a bruised ego. Aside from that, strained muscles (neck and/or back usually) and sprained ligaments (ankles, wrists, hands and knees usually) are the most common injuries I see. These are often ‘low-grade’ meaning they heal well with a bit of time and movement within pain limits on a foundation of healthy lifestyle factor.

The main mistake we see BJJ athletes making with their recovery is this: their focus is in the wrong area. I know Joe Rogan is always bangin’ on about how important stretching and heat shock proteins are, but these are not where your focus should be! Your recovery should ‘major on the majors’. 

Some of the ‘majors’ for recovery in no particular order might be: 

• Sleep: quantity and quality, 
• Diet: macronutrients, micronutrients, fibre and hydration (Lee et al., 2017)
• general exercise and activity (training load, periodisation, programming variables etc.), 
• mental health status (beliefs, stress, anxiety, depression etc.), 
• social dimensions (relationships, socialisation, support etc.) and 
• work-related factors (work-life balance, financial position etc.).

The major mistake I see across all sports is a focus on the ‘minors’; namely passive interventions (massage, dry needling, cupping, hot/cold therapies etc.). 

Similar to our role in other sports, we can help take the guesswork out of your training and recovery. 

Advice and education regarding training (volume, intensity, frequency, exercise selection, etc.), injury reduction, tracking progress, and working with the coaching staff to facilitate peak performance for competition. Some other roles include stretching (static, dynamic, contract-relax etc.), massage, manipulations and mobility work. These other roles fall into ‘symptom modification’, which may allow some pain relief so the athlete can focus on what’s most important: conditioning and technique development.

It’s nice to see a physio who has cauliflower ear (so they look as ugly as you), knows the nomenclature (so you don’t need to waste time explaining the movements that hurt), regularly trains (so you don’t need to explain why you’re addicted, train several times per week/day and probably won’t stop even if instructed to), follows all the same BJJ Instagram and TikTok accounts, gets spammed by BJJ Fanatics ads, and has also very likely been injured rolling themself!

Anyway, I understand the unique demands of the sport and can provide a more tailored treatment approach with a specific focus on your needs. I’ll know exactly when you’re ready to return to the mats, what positions are safe (S-mount, butterfly, etc) and what training you are suitable for (drilling, bag work, positioning rounds, live rounds, etc.). 

References:

Lee, E. C., Fragala, M. S., Kavouras, S. A., Queen, R. M., Pryor, J. L., & Casa, D. J. (2017). Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes. Journal of strength and conditioning research, 31(10), 2920–2937. https://doi.org/10.1519/JSC.0000000000002122

One of the goals of MMA is to damage your opponent. There are other goals of course, such as controlling the space the fight takes place in (usually a cage or ring), controlling your opponent, and effective aggression (a criteria the judges actually reward!). Arguably however, these are subservient to the goal of damage because it is damage that accomplishes a decisive victory. Damaging your opponent is accomplished by utilising strikes and/or submissions.

MinJoon (2016) looked at 455 MMA athletes through different competitions and was able to compare different locations of the injuries sustained. They reported the results in Table 2 (right).

It is likely no surprise the head and neck feature highly - one presumes punches to the head are more damaging than punches to the knee for example. The arm accounted for >30% of the injuries - perhaps because it is used both defensively and offensively, and can be injured from strikes and submissions. Hand and wrist injuries, such as sprains and fractures, also account for a large proportion of injuries. As the small bones and joints that make up these structures are primarily concerned with precision grasping, tool manipulation, and tactile differentiation, they are susceptible to injury when repeatedly slammed into another person. At the time of writing, a relatively new strike, the calf kick, has significantly risen in prominence. This has resulted in several fractured tibias and fibulas of late (most notably befalling Conor McGregor, Chirs Weidman and Anderson Silva), not to mention peroneal nerve damage (YouTube Sean O’Malley to see this one).

The main mistake we see MMA athletes making with their recovery is this: their focus is in the wrong area. 

The focus for recovery should be ‘major on the majors’. Some of the ‘majors’ for recovery, in no particular order, might be; 

• sleep (quantity and quality)
• diet (micronutrients, macronutrients, fibre and hydration)
• general exercise and activity (training load, periodisation, programming variables etc.) 
• mental health status (beliefs, stress, anxiety, depression etc.)
• social dimensions (relationships, socialisation, support etc.) and
• work-related factors (work-life balance, financial position etc.)

The major mistake I see across all sports is a focus on the ‘minors’; namely passive interventions (massage, dry needling, cupping, hot/cold therapies etc.). 

Advice and education re: training (volume, intensity, frequency, exercise selection, etc.), injury reduction, tracking progress, and working with the coaching staff to facilitate peak performance for competition. Some other roles include stretching (static, dynamic, contract-relax etc.), massage, manipulations and mobility work. These other roles fall into ‘symptom modification’, which may allow some pain relief so the athlete can focus on what’s most important: conditioning and technique development. 

They understand the unique demands of the sport and can provide a more tailored treatment approach with a specific focus on your needs. You also won’t have to spend the session explaining the movement that caused your injury or the movements that hurt - they know the nomenclature! The physio will also know exactly when you’re ready to return to the mats and what training you are suitable for (drilling, bag work, positioning rounds, live rounds, etc.). Lastly, the physio will likely have a personal relationship with MMA injuries themselves and know how to navigate a return to training!

The repetitive nature (80 rpm cadence = nearly 5000 pedal strokes per hour) of cycling, coupled with long durations spent on the bike seat, results in prolonged stress on your joints and muscles. This stress is actually good and will help improve your tissue health! Sometimes however, it can lead to cyclists experiencing discomfort (or even pain) if they are unaccustomed to the stresses or if the body is too slow to adapt to these stresses.

The most common areas of pain are:

• Neck - 49% of riders
• Knee - 42% of riders
• Groin/buttock - 36% of riders
• Hands - 31% of riders
• Lower back - 30% of riders

The experience of neck pain is often related to the sustained posture one must maintain whilst cycling. The neck needs to maintain an extended position whilst cycling. This is because your body is leant forward on the bike, yet you still need to keep your eyes on the road! This extended position loads the muscles and joints of your neck. As above, adopting a more upright posture can reduce the load on these structures and you can progressively revert to your previous position as your body adapts.

This is one of the most common painful areas for cyclists and is most commonly experienced at the front of the knee. The most common cause is PFPS (Patellofemoral pain syndrome). This is where the loads placed on the joint between your kneecap and thigh bone (patellofemoral joint) aren’t well tolerated leading to pain. Some strategies to help reduce pain are changing the saddle height. A saddle height too low increases loads placed upon the patellofemoral joint. Other factors which may contribute are selecting a gear too high for the speed you are riding, meaning you need to produce high amounts of force relative to selecting a lower gear requiring lower amounts of force with more repetition to maintain the same speed. 

Pain around the groin and buttocks is also quite common in cyclists. This can develop from a combination from the pressure of your bodyweight, friction, sweat and heat which irritates the skin. Often this stress can be adapted to and your body just gets used to the pressure on this area. Especially for beginner cyclists, it is common to experience this and as you build up to doing more kilometres on the bike, it usually eases to an extent. Bike saddles aren’t lounges after all and on longer rides some discomfort may be experienced. Some strategies for reducing this discomfort are wearing cycling specific shorts or bib, using a chamois cream (a lubricating cream usually applied to the perineum, inner thighs and other areas you experience friction) and trying to find a saddle suited to your pelvis. These can be helpful in reducing friction and pressure on sensitive areas.

Male cyclists can also experience numbness down there when riding. It is believed that this is due to pressure on the pudendal nerve at the perineum, however this is still unclear. There are some strategies that can be implemented to relieve pressure on the perineum to avoid/alleviate this sensation. Using a no-nose saddle, a saddle with a cutout and standing out of the saddle regularly are effective strategies in reducing the pressure in this area.

This is often due to increased pressure on the hypothenar area of the hand and the ulnar nerve as it passes into the hand where the hand rests on the handlebar. 

Road bike handlebars have three different hand positions : the hoods, the tops and the drops. Placing your hands in each of the different parts of the handlebar stresses your hand in different areas. There is evidence to show the hypothenar region is stressed most in the drops position and may increase the chance of ulnar pain due to the course of the nerve through this region. It may be helpful to regularly change positions on the handlebars between the hoods, the drops and the tops to share the load on different parts of your hand.

Wearing gloves has also been shown to reduce pressure on this area with thinner gloves performing better than thicker gloves.

Other potential contributing factors to this issue are the bike set up - A saddle too high, handlebars too low and increased stem length can increase the weight the hands bear. The bar tilt and type may also affect which area of the hand bears more weight.

Bringing your handlebars closer with a shorter stem and putting spacers on the steerer tube to raise the handlebar height may help by reducing the weight beared by the hands.

Similar to experiencing lower back pain while sitting or standing for long periods, some people experience pain when spending long durations on the bike.

Sometimes, back pain on the bike can be related to your riding position. A more stretched out and leant forward position can make your spinal muscles have to work harder to maintain that position, increasing stress on your back.  A more upright position is commonly more comfortable, placing less stress on your back when riding at the expense of aerodynamic advantage. This can be achieved by riding a more endurance oriented frame, adjusting handlebar position to be higher and closer and adjusting the saddle to be lower or closer (however, when adjusting the saddle position, note that it may affect pedalling efficiency and movement of the knees). Again, this stress is good and can be adapted to so as you get more kilometres under your belt in a more upright position you can start to gradually revert to your previous position if you desire a more aerodynamic position on the bike.

Cyclists can experience foot pain/numbness (commonly referred to as ‘hot foot) especially on longer rides. It usually manifests as a burning pain sensation at the balls of your feet or numbing feeling of toes.This is usually caused by irritation of the nerves that run between the metatarsal bones of your foot (the long bones just before your toes start). There are a few potential things to consider that may cause this irritation of these nerves.

Shoe size, especially the toe box width should be considered. Wearing a shoe too narrow can put pressure on the metatarsal bones, bringing them slightly closer together and not allowing them to fully spread apart, thus increasing the pressure on the nerves between them. Trialling wearing thinner socks and wearing the shoes slightly looser can be a good starting option to see if that makes a difference. Many cycling shoe manufacturers make shoes that are quite narrow and are unaccommodating for wider feet, though more wider shoe options are seeming to be hitting the market.

Using a more rearward cleat position (moving cleats further back towards the heel) can be helpful as well. This will move the point where pressure is most concentrated further behind the ball of the foot, of the painful area.

Many of the above painful conditions can be due to training errors. The human body’s tissues are highly adaptable and can tolerate surprising amounts of load. It is important to allow time for your body to adapt to new stressors. It is common for pain to arise when you start a new activity such as cycling and do too much too soon. This could be either training at too high of an intensity or too high of a volume than your body can tolerate at that particular time. It is best to progress gradually when increasing your training, starting off easier and slowly increasing the amount and difficulty of exercise as you improve.

We can perform a thorough assessment, work out the cause of pain and any deficits which may be contributing factors towards your pain. We will chat to you about your goals, what’s important to you and how best manage your condition in relation to these goals.

We can provide advice about training load, keeping you training whilst managing your painful condition, guiding you through progressing your training appropriately aiming to find a balance between improving your performance and managing pain.

We can also provide exercises to help build up any areas which may be lacking.

Cross Country (XC)

Cross country mountain biking is a more endurance oriented style of mountain biking with focus on riding for long distances across various types of terrain usually not as rough as other types. Hill climbs are often a big part of cross country riding, getting those legs burning and the heart pumping.

Downhill (DH)

As the name suggests, this style of mountain biking is all about going downhill - fast! Downhill mountain biking has riders riding down steep slopes, dodging trees, performing long jumps, large drops in terrain and racing to get to the bottom of a hill as fast as possible to beat the competition.

Enduro (also known as All Mountain)

This one’s a bit of a mix of DH & XC. It features technical terrain and speeds similar to DH riding but riders also have to tackle steep uphill climbs to begin their descents. In events, the uphill sections aren’t timed.

Unsurprisingly, with the more intense nature with faster speeds, tougher terrain and bigger obstacles, downhill mountain biking carries a greater risk of injury. Injury rates for XC mountain bikers have been reported between 7.8-12 and 3.8-12 per 1000 hours of exposure for female and male riders respectively. Injury rates among DH mountain bikers are significantly higher, between 16.8-46.8 per 1000 hours of exposure.

A study looking at injury rates among recreational mountain bikers riding at mountain bike parks reported injury rates up to 15 per 1000 exposures. These mountain bike parks feature obstacles similar to what you would find on a DH track and have riders going at speeds similar to DH mountain biking.

Lacerations and abrasions are very common amongst mountain biking injuries and occur as a result from a fall. A laceration is just another word for a cut. Severity of a laceration can vary greatly from being very minor to quite severe, depending on the location and depth of the cut.

Fractures (broken bones) are another common injury seen in mountain biking. Due to the high speed nature of mountain biking, the level of trauma if a fall occurs can be quite high, enough to fracture a bone. Most fractures occur in the upper extremity, accounting for 93% of fractures and 92% occur in males. The clavicle (collarbone) is the most commonly fractured bone, usually as a result of a fall over the handlebars with a direct impact to the shoulder

Concussions account for 3-13% of all injuries. A concussion is a mild traumatic brain injury (TBI) and can vary in severity. This occurs when there is an impact to the head resulting in a rapid acceleration/deceleration of the brain within the skull, injuring some of the nerve pathways within it.

Terrain: Unsurprisingly, the terrain plays a large role in mountain biking injuries. The irregularity of terrain challenges the rider to maintain their position on the bike. Crashes usually occur when the front wheel gets caught on an obstacle or the tyres lose traction due to the surface being slippery such as on gravel or mud.

Mechanical failure: Equipment failure of bicycle components account for 6-16% of crashes. The most common component reported to have failed contributing to the result of a crash are the tyres, other components such as the brakes, suspension and chain can also fail leading to a crash.

Rider error: Many injuries involve a level of rider error. This usually includes improper judgement of an obstacle, poor technique with body position or braking, excessive speed for a given section of trail and riding beyond one’s ability.

Ensure you are riding within your skill level. While it’s necessary to push the boundaries to develop your skill, this can increase your risk of getting injured. It is recommended to aim to progress steadily, gradually trying harder obstacles/going faster as you improve. Mountain bike trails are given a rating based on the difficulty of the trail. These can be used to inform yourself what can be expected on a particular trail.

Ensure your bike is in top mechanical condition. An unfortunately timed mechanical failure could be disastrous. Familiarise yourself with at least a basic level of bike maintenance knowledge and take it to your local bike shop for regular servicing as required. It is a good idea to do a quick check-over of your bike before every ride to make sure it’s ready to rock and roll.

Familiarise yourself with the terrain you are riding. Ride new tracks slowly at first and build up speed as you learn the obstacles on that trail and how to tackle them.

A pretty obvious one - wear your helmet!

If you’ve been unfortunate enough to injure yourself whilst mountain biking, we can help by conducting a thorough assessment of your injury and work with you to develop an appropriate treatment plan.

If you believe you have seriously hurt yourself, a trip to the emergency department is recommended.

When considering injuries, differences exist between those more likely to be sustained by adults when compared to children. Amongst adult netballers, ankle and knee injuries have been found to be the most common, frequently in the form of ligament sprains, bruising/contusions, and muscle strains (Downs et al., 2021; Hume et al., 2000). Children, on the other hand, seem to sustain more upper limb injuries, such as fractures (Downs et al., 2021).

Of injuries requiring hospitalisation, fractures have been seen to be the most common, causing 29.5% of netball-related admissions (Flood et al., 2009). Of these, anterior cruciate ligament (ACL) rupture was the most common diagnosis, accounting for 760 (16.5%) of netball-related admissions, followed closely by Achilles tendon injury, accounting for 732 (15.9%) (Flood et al., 2009).[1]

If you are a player of the game, these injuries likely don’t come as a shock to you, knowing in full detail the demands of netball. In fact, you’ve probably experienced one (if not more) of these injuries yourself!

In netball, a significant focus is placed on footwork, i.e. foot placement upon catching the ball. Game rules stipulate the landing foot must stay grounded, only moving to pivot. Consequently, many of the common injuries listed above occur during the landing aspect of play (Kovac et al, 2022), particularly after landing awkwardly. Alternatively, other injuries may be caused by player contact/collision, falling during play, overuse, or by being struck by the ball (Downs et al., 2021; Sports Medicine Australia, 2009).

1. Prior to play

Some options to prevent injury, prior to play, include:

• undergo a pre-participation screening by a relevant health professional, such as your physiotherapist, to rule out any musculoskeletal issues that may contribute to overuse injuries in netball;
• ensuring a sufficient warm-up, including dynamic warm-ups to ensure the body is prepared for play;
• using ankle/knee supports, including braces and taping, where necessary;
• wearing high-cut netball shoes, helping to improve stability of the ankle joint;
• ensuring a good night’s sleep (quantity and quality)
• adequate fuelling pre-game (e.g. micronutrients, macronutrients, fibre, and hydration)

2. Long term strategies

For netball players, working on strength, power,  proprioception and skill-specific movements is a well-rounded long term strategy to prevent injury.

Proprioception exercises

Proprioception is defined as the neural process by which the body takes in sensory input from the surrounding environment and integrates that information to produce a motor (i.e. movement) response (Rivera et al., 2017).

Due to the high loads placed on lower limb joints, such as the ankle or knee, during a game of netball, this can predispose them to injury. Consequently, employing proprioceptive (or balance) training to prevent injury, and reduce risk of re-injury, can be a good strategy.

Examples of proprioceptive training for the ankle joint, for example, could include wobble board/dura disc balance training, single leg exercises with the eyes closed, or, for an additional challenge, throwing/catching a ball during these tasks (Rivera et al., 2017). The aim of these exercises is to enhance our ability to adapt to changing environments and subsequently protect the body from injury.

A systematic review and meta-analysis by Bellows and Wong (2018) found that athletes who performed specific balance training had fewer ankle sprains and reduced their risk by 46% compared to controls.

But, the good news doesn’t end there! Not only can proprioceptive training reduce your risk of sustaining a first-time ankle sprain, but it can also reduce your likelihood of experiencing recurrent sprains (Rivera et al., 2017). So, why not do it?

Strength training

While targeted netball exercises have their place, a well-rounded, traditional strength and conditioning program too can improve a player’s movement quality (Kovec et al., 2022). See below for an example of a suitable strength training program, as created by Thomas and colleagues (2017).

You may have noticed the predominant focus placed on lower limb strengthening in the above example strength program. Reason being, netball players require greater lower limb relative strength to overcome the inertia of body mass during play. Strength training can help to improve an individual’s ability to accelerate and decelerate during movements such as jumping, sprinting, and change of direction (COD), with Thomas and colleagues (2017) discovering that athletes who exhibited greater strength levels were able to produce higher propulsive ground reactions forces and impulse during said actions. Suffice to say, increases in strength can improve lower limb control and reduce injury risk and performance decline.

3. Skill-specific exercises

As mentioned above, netball involves rapid acceleration, deceleration and directional changes while exerting considerable force (Coetzee et al., 2014). As a result, players may require additional agility, power and flexibility training. Incorporating exercises that cover these netball-specific components of fitness into training regimes, with a focus on enhancing landing control, COD, and catching passes, can help develop these skills.

Progressions from bilateral to unilateral exercises in multiple planes is recommended when undertaking jump training, focusing on appropriate landing strategies (Thomas et al., 2017). To increase transference to netball, correct landing mechanics and strategies should be emphasised in closed-skill practices before progression to open-skill jump training activities (Thomas et al., 2017).

Another important aspect of netball is power. High-power movements such as weightlifting and explosive jumping movements are beneficial to improve netball-specific performance measures such as sprinting, COD, and jumping, with many similarities seen between the tasks (Spiteri et al., 2015; Hori et al., 2008).

1. Short term (PEACE and LOVE)

When it comes to the treatment of an injury, you’ve likely heard the acronym “RICE”, or “RICER”, thrown around. While it is a suitable approach to follow after sustaining an injury, a limitation of this treatment style is the sole focus on acute management of the injury.

More recently, soft-tissue injuries have been commonly treated using the “PEACE and LOVE” acronym, as shown below. A more comprehensive approach to injury treatment, this acronym encompasses rehabilitation from immediate care (PEACE) to subsequent management (LOVE) (Dubois & Esculier, 2020).

2. Long term strategies

After sustaining an injury, the long term strategies remain the same as before, with an added focus on addressing the deficits around the injury. Exercise prescription becomes more specific, tailored to address the limitations/weaknesses caused by the injury. In this case, seeking help from a relevant health professional, such as a physiotherapist, can be beneficial.

A systematic review conducted by Dizon and colleagues (2010) showed that in elite and recreational athletes, ankle braces reduced the incidence of ankle sprain by 69%. Similarly, another study found that athletes who wore braces had fewer ankle sprains and reduced their risk by 64% compared to controls (Bellows & Wong, 2018).

Of the braces available, lace-up ankle braces have been shown to restrict ankle range of motion during a single leg landing without increasing the load on the knee joint (Vanwanseele et al., 2014), making them one of many suitable options.

Using strapping tape is another good option to stabilise joints. Similar to bracing, ankle strapping reduced the incidence of ankle sprain by 71% (Dizon et al., 2010).

All in all, both strapping and bracing are good options, and the decision ultimately comes down to what you, as the player, are most comfortable with. Alternatively, a combined approach is another perfectly suitable option, if not found to be overly restrictive.

Netball-specific footwear has proven to be another good option for preventing ankle injuries! Sinclair and colleagues (2014) discovered that minimalistic footwear, compared to netball-specific footwear, had the potential to predispose players to an increased risk of injury when assessing running, cutting, and jumping movements, all of which are common to the game of netball.

Netball shoes (otherwise known as court shoes) are a little heavier and more durable than your standard pair of runners. They are also generally a little wider and encompass the foot more, helping to provide side to side stability.

So, all things considered, if you play the game of netball, investing in a good pair of netball shoes seems to be a good idea!

When it comes to recovering from a game, or multiple games, of netball, recovery should focus on the ‘majors’. Some of the ‘majors’ for recovery, in no particular order, might be;

1. sleep (quantity and quality)
2. diet (micronutrients, macronutrients, fibre and hydration)
3. general exercise and activity (training load, periodisation, programming variables etc.)
4. mental health status (beliefs, stress, anxiety, depression etc.)
5. social dimensions (relationships, socialisation, support etc.) and
6. work-related factors (work-life balance, financial position etc.)