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Rules For Minimizing Risk Of Injury
Posted by Dr. Ben Kim on Sep 22, 2015
The funny thing about accidents is that, by definition, they generally happen without notice. You're going about your business, when, often with an audible crack (even if it's only in your head), you realize that your plans just changed to some degree. This pretty much holds true for most physical injuries, which is why I'm a big believer in being careful about when and how to use my body for physically demanding activities.
Rule number one is that it's generally a terrible idea to partake in vigorous exercise and heavy lifting first thing in the morning, when your blood flow is at its worst. As you sleep in a horizontal position, your heart slows down and your distal tissues receive less overall blood, which is why you tend to be stiff when you first wake up. Only after you get going for an hour or two do the ligaments, tendons, and muscle bellies throughout your body begin to receive optimal blood flow.
One of the best ways to injure yourself is to jump into activities that require sudden turns and twists of your trunk and extremities. Racquet sports, soccer, basketball, and explosive cross-training-type exercises fit this description.
If you want to increase your risk of tearing a tendon, muscle belly, or ligament, lift heavy weights early in the morning. Tissues tear when you put more pressure on them than they can bear, and their load capacity is partly dependent on how well perfused they are with blood.
I know what you're thinking - what if I do a solid warmup before I begin exercising? Won't this decrease risk of injury?
The answer is an emphatic yes. If it's not realistic for you to save physically demanding activities for later in the day, you can decrease risk of injury by doing a thorough warmup that gradually increases your heart rate and fills your tissues with oxygen-rich blood and flushes out carbon dioxide, lactic acid, and other waste products. Just be sure that your warmup doesn't involve any sudden turns and twists of your trunk and extremities. You want to be very gradual and methodical about getting your heart to increase pumping action to prepare your muscles and ligaments to handle greater load.
Rule number two for minimizing risk of injury is this: if you have to carry or lift something heavy, keep it as close to your trunk as possible. The amount of pressure that your muscles and ligaments feel increases exponentially as the object that you are carrying gets further away from your core. The other day, I explained this concept of exponential increases in shear force as distance increases from the load-bearing point to a parent who lifted his 6-year old daughter up by her armpits and swung her from a bench to a chair to have her ankle taped, all while his arms were fully outstretched - it was the perfect scenario for straining a muscle or spraining a ligament in or around his spine.
Which brings us to rule number three: If you must lift and move something heavy, never swing the object around while your feet are planted. The correct method of minimizing risk of injury to the muscles and ligaments that line your spine is to bend your knees, get a hold of the object, lift by straightening your legs while keeping your arms relatively relaxed but with a firm grip, keep the object pressed against your abdomen or pelvis, then move your feet to where you want to place the object, and lower with your legs, not by bending your back.
The common history of someone who presents with a disc herniation is that he was doing something that he regularly does, something not very strenuous, and out of nowhere, he felt and heard a pop, which was followed by vague discomfort that quickly morphed into excruciating pain that left him in bed, unable to even get to the bathroom. How does this happen?
Think of the shock absorber-like discs that lie between your vertebrae as jelly-filled doughnuts. The jelly in the center of your discs is called your nucleus pulposus, while the "dough" that surrounds the jelly consists of multiple layers of protective fibrocartilage that are collectively called your annulus fibrosis. It often takes years of abuse for all of the layers of your annulus fibrosis to get injured to a point where your nucleus pulposus (the jelly) can squeeze through to touch and irritate your spinal cord and peripheral nerves. So it's only natural for people to be surprised that lifting something minor and a relatively unthreatening "pop" can mark the beginning of many months or years of suffering with a disc prolapse.
Which brings us back to the reminder that accidents, by nature, occur without much notice.
It takes a little knowledge and care to minimize risk of injury.
You want to save physically taxing activities for later on in the day if possible.
When you must put significant demand on your muscles and ligaments earlier in the day, you want to be methodical about warming up gradually until you have started to perspire before you begin loading your tissues with heavy weights and demanding movements like sudden turns and twists.
If you do not consider yourself fit or if you have never tried a specific exercise that puts significant strain on your muscles and ligaments, you want to be ultra conservative with how much you do the first several sessions. For example, if you've never been in the V-sit position regularly employed with Pilates exercises, you don't want to do 3 sets of 12 repetitions early in the morning at your first session. Speak with an experienced fitness instructor about strengthening your core with more conservative exercises before tackling positions that feel awkward and have you feeling like you might pull something. When performed properly and for your level of fitness at any particular point in time, strengthening exercises shouldn't fill you with apprehension - you should feel like you are in control the entire time, and that you are using proper form as you create resistance for the tissues that you are striving to strengthen.
It's always easier to prevent injury than to recover from one. It takes a little knowledge and care to minimize risk of injury, but I promise you the effort is worthwhile.
An Afterthought: If you're not already stretching and foam rolling regularly, I highly recommend that you take a look through our archive of stretches and foam rolling exercises here: Stretching and Foam Rolling for Recovery - this would be rule number four to minimize risk of injury: Stretch and foam roll all major muscle groups within an hour of all physically demanding activities to minimize accumulation of lactic acid and other waste products within your tissues.
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