Musculoskeletal

Physical Therapy

Key predictor of injury: Previous injury and lack of sleep

What's the best predictor of injury? Several other people have already commented on this one and I'll kind of echo their thoughts a little bit with a little caveat so yes. Previous injury is always going to be the best predictor of injury. But I would also say that an athlete's sleep also contributes greatly to their injury, there's there was a research article forget when it was published but something astronomical In terms of your risk of getting hurt, if you were not sleeping, you know, seven to eight hours athletes that slept less than that were seven or eight times as likely to get hurt compared to athletes, who didn't. So that's something that you have full control over. So if you're looking for low hanging fruit to not get injured, make sure that you're sleeping.

Previous injury and quality of sleep are the best predictors of injury. Sleeping seven to eight hours is key for athletes to stay healthy and reduce their risk of getting hurt.

https://assets.anyquestion.com/raw/upload/zlho9ij6awek3nvag4th.vtt

The best predictor of injury is previous injury. This is a widely acknowledged factor that can indicate an increased risk of future injuries. However, I would also like to add that an athlete's sleep patterns can significantly contribute to their risk of injury. Research has shown that athletes who do not get sufficient sleep, typically seven to eight hours, are at a much higher risk of getting hurt. In fact, athletes who slept less than the recommended amount were found to be seven to eight times more likely to experience injuries compared to those who prioritized proper sleep. This is something within your control, so if you want to reduce the risk of injury, ensuring you get enough sleep is a crucial step to take.

How do you address the challenges of rehabbing injuries in a high-stress, high-performance environment such as elite level swimming or triathlon?

Unlocking peak performance: Rehabbing injuries in high-stress sports.

How do you address the challenges of rehabbing injuries in a high stress, high performance environment such as elite level swimming or triathlon? So this is majority of what I see on a daily basis in our clinic. And I think that how I deal with it is you need to number one, be really confident in your skills as a provider. But you also need to be a really effective communicator so that everyone's on the same page. And I think that talking to the athlete with confidence breeds confidence about their rehab and having a successful outcome. Unfortunately, PTs as a whole aren't a super confident bunch. And how we talk to people is kind of like maybe a little bit more of a concerning or anxious conversation and breeds some anxiety about their injury versus coming up with a plan and executing the plan and having a lot of confidence in the plan. And athletes respond really well to that. So I think on top of just being a really sound clinician and feeling strong in the fundamentals, you need to be confident and communicate confidently as well.

In order to address the challenges of rehabbing injuries in a high-performance environment, it is important for providers to be confident in their skills and to be effective communicators. This means talking to athletes with confidence about their rehab and having a plan of action that is executed with confidence. Doing so will help alleviate any anxiousness or concerns the athlete may have.

https://assets.anyquestion.com/raw/upload/lkqoxbdalwqgtyi2cm0x.vtt

Addressing the challenges of rehabbing injuries in a high-stress, high-performance environment like elite level swimming or triathlon requires a combination of skills and effective communication. As a provider, it's important to have confidence in your abilities and be a strong communicator to ensure everyone is on the same page.

When working with athletes, instilling confidence in their rehab and the potential for a successful outcome is crucial. Unfortunately, as a whole, physical therapists may not always exude confidence, which can create anxiety for the athlete. Instead, it's important to develop a plan, communicate it confidently, and execute it with conviction. Athletes respond well to this approach.

In addition to being a skilled clinician and having a solid foundation in the fundamentals, being confident and communicating confidently are key factors in addressing the challenges of rehabbing injuries in high-performance environments.

What can I do to prevent headaches and neck pain when I’m on the aero bars or drops?

Avoid headaches & neck pain on aero bars or drops: bike fit & mobility key

What can I do to prevent headaches and neck pain? When I'm on the Aero bars or drops? This is a great question. Number one, you need to get yourself a proper bike fit if you don't have a good bike fit for your for your body and your book ability, then you're going to run into problems, almost everywhere. So that's, that's number one, number two, you know, there's a couple things that can that can contribute to Back pain. So when you're in that position we're thinking that your thoracic spine, or your upper back Mobility May if you have, we call it a kyphosis. So a little bit more of a rounded upper back position. That's going to limit your ability, to get into that Arrow position and it's going to put more extension stress on your neck, which is going to irritate the joints in your neck. So working on thoracic Mobility is a great tool. You can do things like that with a foam roller. Be easily. And then I would also really look at just in general your cervical Mobility. So how well does your neck move side to side? Lateral side bending but even protraction and retraction movement forward and back with your head. All of those things play a role in your cervical spine is joint mobility and how well they're going to be able to tolerate stress over a long period of time. If You're out on your bike for, you know, two, three, four, five hours in that position. That's a long time on a joint. Doesn't want to move. So, if you're cranking that joint into an end range position for that long, it's probably going to get pretty angry. So checking your overall neck and thoracic Mobility is something that I would really look at

To prevent headaches and neck pain when riding aerobars or drops, getting a proper bike fit and checking your thoracic and cervical mobility are both important. Doing exercises with a foam roller to help improve thoracic mobility such as side bending and protraction/retraction of the head can also help.

https://assets.anyquestion.com/raw/upload/xklyl4mwuhgnujyjvykg.vtt

To prevent headaches and neck pain when using the aero bars or drops on your bike, there are a few things you can do. First and foremost, ensure that you have a proper bike fit. A good bike fit tailored to your body and flexibility is essential to avoid problems.

Additionally, consider your upper back mobility. If you have a rounded upper back position, known as kyphosis, it can limit your ability to get into the aero position and put more stress on your neck. Working on thoracic mobility can help. You can use a foam roller to improve your thoracic spine mobility.

It's also important to assess your cervical mobility, which refers to the movement of your neck in different directions. Ensure that your neck can move comfortably from side to side, bend laterally, and perform protraction and retraction movements. These movements play a role in the mobility of your cervical spine and its ability to tolerate stress during long rides.

Remember, spending hours in a fixed position on your bike can strain your joints. If you continuously stress your neck joint by keeping it in an end-range position for an extended period, it's likely to become irritated. Therefore, checking and improving your overall neck and thoracic mobility is crucial for preventing headaches and neck pain while cycling in the aero position or drops.

How do you balance seeing signs of injury with actually preventing them? What principles have worked best in practice?

Preventing and Treating Injuries: Expert Tips for Balance

I'm not quite sure what this question is asking, but how do you balance seeing signs of injury with actually preventing them and what principles have worked best in practice? So I think that what this is saying is, you know, when should you go about treating an injury versus being kind of in the preventative injury realm? And in my opinion, if you're involved in any kind of a sport, you should be working with a PT on a semi-regular basis, at least to continue to work on some of your asymmetries and a lot of your weaknesses, really. I think that it's not uncommon for people to feel little niggles here and there that aren't necessarily a sign of injury. It maybe is related to the progressive overload and their body's response to it in some way, but it's not necessarily a sign that we need to change anything about the training. Maybe we need some more recovery modalities in there, but I think that in general, everyone should have some kind of a prehab prescription program that they're kind of working towards every week, but then managing their recovery appropriately when those signs of injury do come up.

Working with a PT on a semi-regular basis to continue to work on weaknesses and asymmetries is an important part of balancing treatment of injuries with prevention. Everyone should have some kind of prehab prescription program that they're working towards and managing recovery appropriately when signs of injury come up.

https://assets.anyquestion.com/raw/upload/qemvvl94w21yy0uzrspj.vtt

To balance seeing signs of injury with preventing them, it is important to work with a physical therapist (PT) on a semi-regular basis, especially if you are involved in sports. This allows you to address any asymmetries and weaknesses in your body. It is common to experience minor discomfort or niggles that may not necessarily indicate an injury but rather a response to progressive overload. In such cases, it may not be necessary to change your training routine, but incorporating recovery modalities can be beneficial. It is advisable for everyone to have a prehab prescription program that they consistently work on each week while also managing recovery appropriately when signs of injury do arise.

I feel like there’s a pebble or rolled-up sock in the ball of my foot when I run and bike. What would cause this?

Triathletes Beware: Nerve Irritation Causes Foot Discomfort

So this is actually something that I see a ton with triathletes mostly because of the type of Footwear that they that they choose to wear whether you're running or cycling. So what can cause this, is there are nerves that kind of run through the metatarsals of your foot and that can become compressed or irritated with excessive motion or sometimes people will actually develop, you know, Whispering or the nerve will actually become thicker in that area. Either way, there's irritation to the nerve there, you might have heard the term neuroma before that's typically, what is going to cause something like this. And the number one thing that I would tell you is to try to find a shoe both for running and cycling where your toe box is a little bit wider and it sounds funny but you can actually sleep with like the little pedicure toe spacers. If you sleep with those on, we can start to kind of just open up the space between the metatarsal and try to provide a little bit of some relief there. There are. There are also metatarsal pads or you might have seen them called metatarsal cookies that you can put in the sole of your shoe to kind of cause more of a splaying of those metatarsals while you're wearing your shoes, so that there's less pinching and there's kind of a little bit more space around that nerve. Beef. But in general, I would go and get evaluated for something like this. So you can kind of decide what course of treatment is best for you.

A common issue with Triathletes is nerve compression or irritation in the metatarsals of the foot, which can cause pain. Treatment includes finding wider toe-box shoes, sleeping with pedicure toe spacers, and using metatarsal pads or "cookies" to increase space between the metatarsals. It is advised to get evaluated for treatment.

https://assets.anyquestion.com/raw/upload/awpzsgaucj0xhoe9d7db.vtt

I often see this issue in triathletes due to their choice of footwear for running and cycling. The sensation of a pebble or rolled-up sock in the ball of your foot can be caused by compressed or irritated nerves that run through the metatarsals. This can result from excessive motion or the development of a thicker nerve in that area, known as a neuroma.

To address this, I recommend finding shoes with a wider toe box for both running and cycling. Additionally, using pedicure toe spacers while sleeping can help open up the space between the metatarsals and provide relief. Metatarsal pads, also known as metatarsal cookies, can be inserted into the sole of your shoe to create more space around the nerve and reduce pinching.

It's important to consider getting evaluated by a professional to determine the best course of treatment for your specific situation.

How can I tell between exertional pain and injury or symptoms of something wrong?

Deciphering Exertional Pain: Sharp vs. Dull - Know When to Stop

I really like this question, I have to kind of teach people how to decipher this a lot and sometimes I teach coaches how to decipher this with their swimmers or athletes as well. How do I tell between exertional pain and injury or symptoms of something wrong? So the biggest giveaway for something simply being exertional. Pain is that once you're done doing that set or that exercise, the pain goes. Right. It's not lingering for an hour or two after you're not necessarily feeling it the next day, if something is wrong or your get, you're actually developing an injury. You're probably going to have symptoms of something that's actually sharp in nature. If you're experiencing sharp pain. That's usually not something that I encourage people to work through. But if it's kind of just this dull achy soreness that, you know, in terms of swimming, if you go and touch the wall, now you're the pain kind of subsides a little bit, I'm not too worried about that as an athlete, you're going to have to work through little things like that, every once in a while but generally the quality of the pain, it being sharp or not, or experiencing anything. Like numbness, that's all stuff that I would say. Let's, let's back it off a little bit. So this is really kind of a trial and error thing with all athletes, you get to know your body really well and you should be able to kind of make that decision.

Exertional pain is typically a dull, achy soreness that will go away after the set or exercise is completed, while injury-related pain is typically sharp and will linger for an hour or two after the activity. Numbness can also be a sign of something wrong, so it's important to pay attention to the quality of the pain and back off if needed.

https://assets.anyquestion.com/raw/upload/aunljhbiasjfwojc1vvb.vtt

Differentiating between exertional pain and injury or symptoms of something wrong can be challenging, but there are some key indicators to consider. When it comes to exertional pain, the biggest giveaway is that the pain subsides once you finish the set or exercise. It doesn't linger for hours or days afterward. Exertional pain is often described as a dull, achy soreness that may temporarily alleviate when you stop the activity.

On the other hand, if you're experiencing sharp pain or symptoms that are sharp in nature, it's generally not advisable to push through it. Additionally, if you're experiencing numbness or any unusual sensations, it's important to take a step back and reassess.

Ultimately, it's a trial and error process for athletes to understand their bodies and make informed decisions. Pay attention to the quality of the pain, whether it's sharp or dull, and listen to your body's signals. If in doubt, it's always best to err on the side of caution and seek professional advice.

Neither AnyQuestion nor its Experts provide medical advice, diagnosis or treatment or otherwise provide professional healthcare services.

Physician disclaimer

Nick Hadinger answers your Physical Therapy questions. See all the advice Nick Hadinger has and get answers to your own Physical Therapy questions.

Follow me on AnyQuestion

Dr. Nick Hadinger is an Arizona native and licensed physical therapist with expertise in orthopedic and sports rehab. He holds a Doctor of Physical Therapy from Northern Arizona University and an undergraduate degree from the University of Arizona. As a former Division I athlete, he competed at the US Olympic Trials in 2012 and now races in triathlons. Nick specializes in non-operative and post-operative injuries involving the shoulder, back, hips, and knees, aiming to keep his clients active. He is certified in various techniques, including Dry Needling, Blood Flow Restriction Therapy, and Functional Movement Screen (FMS). He is also a certified USA Weightlifting Coach and a member of the NSCA and the USA Swimming Sports Medicine Network. He has been a Clinical Instructor for doctoral students at George Fox University and the University of the Pacific.