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Tips for How to ‘Train Right’ and Avoid Injuries During Sports and PT

Image of Military personnel in physical threapy. Senior Airman May Cortez, physical therapy technician, assists Airman 1st Class Kyle Maglalang, medical materiel technician, while performing a row on the Total Body Resistance Exercise Training machine, June 24, 2021, in the Medical Clinic at F.E. Warren Air Force Base, Wyoming. The TRX is used for upper body strengthening and stability (Photo by: U.S. Air Force Airman 1st Class Faith Iris MacIlvaine).

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Sports, recreation and physical training are key to service members' health - physical, mental, and spiritual.

But those activities also often lead to the military's single biggest health problem: musculoskeletal Injuries.

Almost half of service members experience at least one injury a year, resulting in more than two million medical encounters across the military annually, according to a recent report.

More than half of those injuries are related to exercise or sports. Running is the number one cause of musculoskeletal injuries (MSKIs), which are blamed for more than half of all lost duty days across the military, according the report.

How can you avoid MSKIs? What does it mean to train "right"?

Taking a smart approach to training and other physical activities can greatly reduce the risk of injury and preserve your overall health and ability to deploy.

Service members should choose their activities carefully with a specific goal in mind. Stretching and warm-ups are an easy way to reduce risk. And, most importantly: Don't overdo it - pain and discomfort is your body's way of telling you to take it easy.

Whatever sport or exercise you choose, it's essential to do it right. Use good form and technique - getting sloppy or overly aggressive is asking for an injury.

"Motion is lotion," said Air Force Maj. Brandon Wielert, a clinical specialist in orthopedics and the physical therapy chief at David Grant USAF Medical Center, Travis Air Force Base, in California.

"Safe and appropriate movement is like the lotion to our movement system, vital for its sustainability," he said. "If a member is prompt to 'get the job done' at a high volume and intensity and has underlying movement dysfunction, it's a matter of time before they 'break'."

Same thing when service members "ramp up" for a PT test or train recreationally without enough preparation - it's only a matter of time before they break.

"Training 'right' involves a concept we call specificity of training," he said. This means "training in a way that most easily translates for the activity you are preparing for, such as attempting to improve one's 1.5-mile running time for the Air Force Physical Fitness Test."

In that case, many folks attempt to run multiple 5K races in preparation, but "this type of endurance does not best translate to a faster 1.5 mile race and increases the likelihood of overuse injuries," he said. Similarly, different types of jobs have different physical requirements, so they require a different approach to ensuring safe and specific training.

Training "right" also depends on your personal goals, said Navy Lt. Sarah Alferos, a physical therapist with the Physical Therapy/Sports Medicine and Rehabilitation Team at Navy Medicine Readiness and Training Command Pearl Harbor, in Hawaii.

"Whether it's addressing weight loss, muscle hypertrophy, increasing weights with lifting, vertical jump height, flexibility, etc., once you've identified your goals, specific exercise through proper exercise prescription and progressions will safely bring you towards them with minimal injury," she said.

The American College of Sports Medicine and Centers for Disease Control and Prevention recommend performing five days of 30 minutes of moderate-intensity aerobic activity, or three days of 20 minutes of high-intensity aerobic activity, plus working on muscular endurance and strength for a minimum of two days per week.

"Being in the military, it is important that we find a program that challenges a mix of our endurance, power, and agility so that we can perform our jobs without injuries," Alferos said.

"The best way to engage is finding workouts that fit our interests, whether it's group classes, competitive racing or lifting, working out with a partner, or following a workout program."

In addition to training with the correct exercises and technique, frequency, intensity, volume, and duration, all exercise should be followed by a proper rest and recovery period, said Army Lt. Col. Angela Diebal-Lee, chief of physical therapy at

Blanchfield Army Community Hospital at Fort Campbell, Kentucky.

"In a 24-hour period, it is paramount to ensure the athlete is also getting proper sleep and nutrition to support recovery and fueling needs to reduce injury and optimize physical and mental performance," she said. "Training is multifaceted and should be viewed as a holistic process defined by what you do before, during, and after the training session."

And "what is right for one person is not necessarily right for another," she added. "Ultimately, if you are training 'right' then you will be seeing objective progress towards your performance goals."

Overdoing it

Overtraining occurs when exercising at too high intensity or volume, said Wielert. "This is most easily identified with pain and/or an injury."

Performance can actually decline if you train more aggressively than your body can recover from, Alferos said.

A key warning sign is "slight pain or discomfort in an activity which did not elicit pain previously," said Wielert. "This is a 'yellow flag' that you should recognize and listen to with action: either stopping or slowing down."

Military personnel getting their shoulder stabilized
Air Force Airman 1st Class Dakota Alston, physical therapy tech, places kinesiology therapeutic tape on Airman 1st Class Devonte Brown, medical logistic technician, June 24, 2021, in the Medical Clinic at F.E. Warren Air Force Base, Wyoming. KT Tape is utilized to help stabilize Brown’s dislocated shoulder (U.S. Air Force Airman 1st Class Faith Iris MacIlvaine).

Repetitive workouts, lack of proper recovery period, and poor caloric and hydration intake, can contribute to overtraining and injuries as a result.

"You will notice overtraining occurring if you have persistent injuries and body aches, decline in performance, affected mood and sleep," she said.

Rest and recovery are important for optimal performance. This doesn't necessarily mean days of no activity, but of a less intense form of exercise, called "active rest," Wielert said.

"We are capable of putting our bodies through tremendous feats of strength, endurance, and flexibility," he said. "However, over time, these things can put a toll on our bodies. Incorporating rest and recovery will enable us to continue to build our bodies to adjust or accommodate to the stresses we place on it."

Likewise, our body has an amazing way to adapt to the stresses we place on it, he added. "But if we place the same stresses day in and day out, then that decreases the overall variability of movement - our bodies do not grow stronger, but rather, grow weaker."

That's why it's important to mix up exercise routines – they allow more muscle groups in our bodies to adapt. This also prevents boredom and overuse in a single muscle group.

"Providing more variation in activities, whether it is the type, duration, intensity of the activity, will give the greatest chances for our body to constantly improve and deter complacency," he said.

Diebal-Lee added that repetitive workouts without adequate recovery may also lead to overreaching or, in severe cases, overtraining syndrome.

"Functional overreaching is associated with a short-term reduction in performance that improves in a few days to weeks," she said. "This can progress to nonfunctional overreaching - which can take weeks to months to recover from - if functional overreaching continues over time without adequate recovery."

Prevention

To prevent injuries, especially as we age, it's key for service members and active people to listen to their bodies.

"Just as with taking your vehicle in for routine maintenance, the same thing applies with the human body," said Wielert. "As the vehicle gains mileage, more care is needed to ensure it continues to operate."

He recommends checking in with your primary musculoskeletal provider regularly to ensure you're performing activities safely and get recommendations of when and how to change things up.

As we age, warmups, cool downs, and flexibility are of vital importance, he said. For example, warming up with dynamic stretching translates to safer and more efficient movement than static stretches.

Dynamic stretches – such as high kicks, walking lunges, and torso twists - comprise active movements where joints and muscles go through a full range of motion to increase tissue extensibility throughout multiple muscle groups. They prepare your body for activity and promote blood flow, prevent injury, and improve your workout, said Alferos.

Static stretches, on the other hand, involve stretching a muscle or set of muscles to an end point, such as calf or hamstring stretches, and holding it for some time.

"It has been shown that static stretching prior to physical activities increases the likelihood of injuries (sprains, strains, etc.)," said Wielert. These are better after an exercise session to cool down, recover, and assist in clearing lactic acid buildup.

Despite the risks of potential injury, "exercise is medicine," said Alferos. "We recommend avoiding sedentary lifestyles to reduce the effects of arthritic changes and keep you in the fight."

Research in the Journal of Orthopedic & Sports Physical Therapy shows that osteoarthritis in the knees and hips affects about 3.5 percent of recreational runners, but among people with a sedentary lifestyle, the development of osteoarthritis in knees and hips is about 10.2% higher.

"The latest data we have reflects that 82% of MSKIs reported across the Department of Defense were due to inflammation and/or pain (overuse)," she added.

In the active-duty population, lower extremity overuse injuries are the most common, said Diebal-Lee. But generally, knee, ankle, shoulder, lower back, and neck pain are the most common types of MSKIs the physical therapists see.

However, the injuries from overuse are the ones that we can prevent, she said.

"The most common cause of future injury is previous injury; therefore, injury prevention is the key," she concluded.

For more information on overreaching and overtraining, Diebal-Lee recommends the National Strength and Conditioning Association's "Essentials of Strength and Conditioning" book and the Army's IgnitED app, which offers educational opportunities.

The experts also recommend resources available at each military medical facility, including the physical therapy clinic, fitness center staff, and health promotions staff.

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