Exercise-induced injury
Finding the Sweet spot between activity and Pain
Image: spinpoi.com
I’m keen on exercise. I love research that encourages this enthusiasm. In the dentist waiting room, I flick through the January 2023 National Geographic and extract this juicy factoid: a 2018 study following up 123,219 health professionals identified five factors for longevity: healthy diet, regular exercise, healthy weight, no smoking and moderate alcohol intake. I glom on “exercise.” In the same issue of National Geographic, I read that Professor Matt Kaeberlein – Director of the Longevity Research Institute of the University of Washington – rates exercise the biggest bang for buck of those five.
I also have a sad tendency to get injured while exercising. I have had many letters from the Accident Compensation Corporation commiserating about my most recent injury and assuring me that care is on the way. What amazes me is that they are so polite – no letter has yet been addressed to ‘The Moron in Auckland who keeps coming back’.
When I was a runner, enthusiasts in our daring urban and bush running group had a range of accidents. Leaping over the chain between bollards, but not quite clearing it. Leaping off the sea wall into the surf (with the running group’s car keys in the ‘safe bum bag’). Putting out hands to break the fall and getting impaled on a random bolt lying in the gutter. Not all of those adventures were mine. But I was the one who fell off the cliff on the Pararaha Stream run. Amazingly there was a manuka trying to get established just a metre down which I could grab and then clamber back on the trail. And there have been three fractures from bike spills – after I took up cycling to give the knees relief from running.
A while back sociologist Ivan Illich described the increasing medicalisation of our world with the catchy phrase “iatrogenic illness” – to describe people who get worse rather than better under medical care. They leave the hospital in worse shape if they leave at all. Is there a similar snappy word for exercise-induced injury? Not that I’ve found. But the syndrome does exist.
Dr Brenda Lobb surveyed Kiwi trampers (at that time Lobb was in the Department of Psychology at the University of Auckland). Respondents from 11 tramping clubs gave her a picture of what tramping for several hours with an up to 20-23 kg pack can do to you. From her paper’s abstract: “Injuries were reported by 74%, with sprains being the most common injury type and knees, ankles and feet the most frequent location of injury.” That’s three-quarters of these good folk suffering something painful in the course of getting out in nature.
A US survey of 771 hikers attempting the 354 km John Muir Trail found that 57% reported illness or injury. The most common problems were blisters, sleep problems and pack strap pain. On average hikers lost 3.5 kg. Those injured were more likely to have a higher BMI and heavier pack. Older people were less likely to be injured. If you and your pack weigh more it makes sense that you will hit the ground (or tree) with more force and do more damage (to yourself) than the lighter people. Or that joints suffer more with the heavy load. But why would age (and experience) be helpful? Author Sue Spano thinks it could be walking poles. Younger people don’t see them as a good look, the older appreciate the benefit of poles taking the load.
Where is the sweet spot between the benefits of exercise and being injury and pain-free?
If you have aerobic and weight training covered there is still the third exercise dimension: stability or balance work. This could be a happy place. Dr Kate Riegle van West found that training older folk to do poi was as good as teaching them Tai Chi. Her PhD research at the University of Auckland showed that study participants had significant improvement in balance, grip strength and attention after training with no difference between Tai Chi and poi. Learn more at spinpoi.com.
"To wield the poi, a lot is going on," Riegle van West says. "It's not passive. A lot of parts of the brain are firing."
A long-term balance training initiative in France with older women (75-85 and living in the community) at risk of falling produced modest reductions in “injurious falls” for those trained compared with controls. The weekly training over two years covered a range of activities including balance.
The proportions of these women who suffer fall injuries are amazing. Forty-eight per cent of the women who participated in the training suffered fall-related injuries over the two years of the study. Meanwhile, 53% of the no-training controls got injured. These researchers also report the injuries of the women who fell while getting to the training sessions, or during or after these – seven (or 2%) of the 352 who were trained had such exercise-induced injuries (including one wrist fracture, one sprained ankle and bruises). That pushes the rate of the trained women who had such falls to 50% - closer to the injury fall level of those who didn’t get the training.
Why would we do this preventative, stability-promoting exercise? Professional ballet dancers suffer high injury rates. A training initiative to “improve muscular strength, coordination, agility, speed and motor control” was offered to dancers, although the researchers noted that this was an extra on top of “heavy training demands”, and that dancers might be reluctant to do further training because of “aesthetic appearance and financial barriers.” I get that.
But it is impressive that the dancers who got with the programme improved on long-term physical measures (such as the “single leg hop for distance”) as well as self-reported dance outcomes.
These examples indicate that training balance and other skills relevant to everyday activities do help, even if that’s just a little help. If your stability exercise is every day or nearly every day, might it help reduce injury?
If you are averse to training – may be because of your heavy existing time demands, aesthetic appearance or financial barriers, could you break the project down and work up to it? Some urban walks including up and down and rough terrain before you do the Milford Track? Biking along a cycle path on a quiet morning before you do the rail trail? Swimming at a local beach before you do the harbour crossing? Even joining a yoga, Tai Chi, or poi session? Those options won’t hurt your aesthetic appearance or financial status.