The Cause (of injury) Lies Elsewhere

There are several factors that contribute to performance and risk of injury, among them is skill and fitness. For the purposes of this article I would like to focus on fitness and its affect on risk of injury. It is often hard for me to help people understand that a hip that is not working well can lead to a shoulder problem. In other words, a seemingly unrelated body part (through the kinetic chain) can affect the performance of a body part that is on the other end of the body.  A study published in 2013 (1) performed on high school and collegiate baseball players who had ulnar collateral ligament (UCL) tears (elbow ligaments on the inside of the elbow), illustrates this concept. This study compared healthy baseball players to those who had been diagnosed with Ulnar Collateral Ligament tears.  To quote from the article, they found, “Participants with a UCL tear demonstrated decreased performance for their stance and lead lower extremities during the Y Balance Test”. “In addition to balance, the Y Balance Test is reflective of lower extremity strength and neuromuscular control.” Neuromuscular control is the ability to control the body in motion. Neuromuscular control requires the coordination of the qualities listed below:

  • Flexibility – The ability to for joints to move. Can your body get in the best position needed to perform the task/activity at the highest level needed without exposing you to increased risk of injury.
  • Stability – I like Dr. Charlie Weingroff’s definition – Control in the presence of change. Can you control your position well enough during the task/activity to allow your body to express its flexibility, strength, and power without undue fatigue.
  • Strength – Can you produce the force necessary to perform the task/activity without compromising your position.
  • Power – Can you produce the force quickly enough to perform the task/activity.  Most people think of this as a purely athletic part of fitness, but it also would include recovering from a stumble without falling. Your body has to produce the force quickly enough to keep from falling.
  • Endurance – Can you sustain adequate force development to maintain proper position during the task/activity.

These qualities are all affected by and expressed through neuromuscular control. Missing one of theses qualities can cause dysfunction in other qualities. While the findings in this study do not prove cause and effect, they do present strong evidence of a relationship between limitations in the lower body, and upper body dysfunction and injuries.

Another example of a seemingly “unrelated” body part is presented by Greg Dea, a sports physiotherapist from Australia who recently worked for the FIVB World Cup Winner’s, Chinese Women’s Volleyball team. In his article, “Knee injury- Bulletproofing The Volleyball Knee”, (2) he shows a case study of how dysfunction in a “distant” body part causes problems elsewhere. In this example Chinese outside hitter Yang Fang Xu injured her right knee. This knee injury is set up by the painful dysfunction of her left shoulder.  Because she cannot strike straight overhead (check out the video and freeze frame included in the article, she is forced to lean her upper body to the right. The position forces her into a single leg landing (instead of a double leg landing) on her right side. In addition, the posture she lands in makes it more difficult to recruit muscles that support the knee. The result is not pretty.

Many great athletes are so great at compensating for their dysfunctions that we don’t notice it until they get hurt. Therefore fitness along with other factors (ie. Sleep, recovery for stressors, nutrition, etc.) are not only part of performing well, but also avoiding injury. You can’t participate very well when hurt, at least not for very long. Dr. Charlie Weingroff explains it this way, “When someone requires physical rehabilitation, it indicates that one of more systems in the body were not resilient to a stressor of some kind.” (3) While this article has referred primarily to athletes, the same principles are true for everyday activities. All activities require fitness, the more aspects of fitness we posses, the fewer compensatory movements we will have, and the less likely we are to suffer injury or even breakdowns in our health. Make sure when you begin your fitness program to have a professional screen your movements and monitor your progress. Doing so will ensure that your fitness professional and you will know what kinds of training you can do at a high intensity, what others need to be done at a lower intensity, if the program you are using is helping you reach your goals while maintaining a high quality of movement, and if you need help from a healthcare professional.

  1. https://www.ncbi.nlm.nih.gov/pubmed/24256174
  2. http://www.otpbooks.com/greg-dea-volleyball-   knee/?ref=15&utm_source=Facebook&utm_medium=Social+Adv&utm_campaign=Content+Greg+Dea+Knee+Injury&utm_content=Ad+14
  3. http://www.out-of-network.com/blog/why-rehabilitation-and-fitness-should-be-delivered-in-parallel

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s