New Year, New Me, New Injury

As another year ticks by, many of us take stock of what’s gone well and what hasn’t over the last 12 months. Health and physical fitness are natural areas for reflection with wine, cheese and long spells inside out of the cold and dark fresh in the memory, and a slightly tighter belt as reminder.

Consequently, January sees common groups of patients at West London Physiotherapy. Those finally looking to work on their back or knee pain. Those hoping their issue won’t stop them skiing or running the London marathon. And those with great intentions of starting to exercise or shifting some Christmas-induced weight.

I encourage patients to make positive choices for their health in being more active or eating better. However, unfortunately we see many fall victim to injuries of overload such as Achilles tendon pain, shoulder tendon injuries and stress fractures. Sharp change from a period of well-deserved rest and refuelling to new, higher intensity or more frequent exercise alongside a decrease in energy intake from switching to salads or cutting out bread and pasta puts significant stress on slightly weakened structures, with perhaps a little more stress on them from extra weight. Such overload injuries, where too much is asked of tendons or bones before they can adapt, often require a period of rest to settle – much to the irritation of those keen to get fit!

As such, I recommend the following to those starting new exercise programs in January:

  • Start small

Our body adapts well to exercise, but adapts faster to inactivity. This means you can lose fitness twice as quickly as you gain it. Whilst this can be frustrating, it’s better to acknowledge your limitations in the short term than overshoot and have to stop training entirely.

  • Allow days off between training the same muscle group of activity

In a previous blog on tendons, I mentioned the tendon cell response after heavy exercise can take three days get back to normal. This means they can react negatively to overly frequent sessions and particularly so after you start afresh or have had a break. Bones react to training too and are more likely to develop stress fractures with frequent sessions without adequate rest. Your body needs to recover between sessions, but particularly between faster, heavier loading like running and jumping. I usually suggest a day off between training the same muscle group, and two days off between impact training if you are new runner or HIIT trainer!

  • Train on feel

Weight lifted and time to run a certain distance are great ways to objectively monitor your training progress. But, deconditioning after time off means it’s better to consider your feeling of how a weight or pace feels, as opposed to trying to keep to your previous levels. You can track this intensity of training using heart-rate monitoring like smart watches, or otherwise simple tools like a scale out of 10 called a rating of perceived exertion. Start with moderate intensities, around 4-6/10, and progress your workout levels as you adjust to training.

  • Progress slowly

Luckily, the body can bounce back from time off and allow quick training progress. For reasons I have mentioned before, I advise repeating training sessions or keeping the same program for at least two weeks before progressing. This allows your body to react and adapt to training, meaning you can identify any issues before overdoing it.

  • Seek advice from a nutritionist/dietician or your GP before making big dietary changes

Simple changes after periods of excess, like reducing alcohol, cheese or chocolate consumption, probably don’t need medical advice. But January often sees patients try going vegan, low carb or alike. Your body needs building blocks to function well and adapt to training, even if it has a few more of them then you would like. Increasing energy use through exercise and reducing supply can contribute to injury, and so it’s best to seek appropriate advice before making big changes.

If you’re having issues getting back to training, please make an appointment to discuss your tendon, knee, hip and shoulder issues in particular. Pains which are much worse getting up in the morning, stopping you weight-bearing or affecting your sleep are most important to get assessed and treated. I also love to talk about training and so welcome consultations to discuss getting started or planning appropriately.

Train well!

Liam McCloskey

Sports & Musculoskeletal Physiotherapist