Lower extremity overuse injuries

The Training-Performance Puzzle: How Can the Past Inform Future Training Directions?

Over the past 20 years, research on the training-load-injury relationship has grown exponentially. With the benefit of more data, our understanding of the training-performance puzzle has improved. What were we thinking 20 years ago, and how has our thinking changed over time? Although early investigators attributed overuse injuries to excessive training loads, it has become clear that rapid spikes in training load, above what an athlete is accustomed, explain (at least in part) a large proportion of injuries. In this respect, it appears that overuse injuries may arise from athletes being underprepared for the load they are about to perform. However, a question of interest to both athletic trainers (ATs) and researchers is why some athletes sustain injury at low training loads, while others can tolerate much greater training loads? A higher chronic training load and well-developed aerobic fitness and lower body strength appear to moderate the training-injury relationship and provide a protective effect against spikes in load. The training-performance puzzle is complex and dynamic-at any given time, multiple inputs to injury and performance exist. The challenge facing researchers is obtaining large enough longitudinal data sets to capture the time-varying nature of physiological and musculoskeletal capacities and training-load data to adequately inform injury-prevention efforts. The training-performance puzzle can be solved, but it will take collaboration between researchers and clinicians as well as an understanding that efficacy (ie, how training load affects performance and injury in an idealized or controlled setting) does not equate to effectiveness (ie, how training load affects performance and injury in the real-world setting, where many variables cannot be controlled).

Low back pain and other overuse injuries in a group of Japanese triathletes

OBJECTIVE

To document the incidence of low back pain and other overuse injuries in a group of triathletes, and to investigate any associations with various physical and triathlon related factors.

METHODS

By means of a questionnaire, the physical characteristics, training habits, and the incidences of overuse injuries of 92 Japanese triathletes (70 males, 22 females) were documented. Student's t and chi 2 tests were used to determine the significance of any associations with injury incidence, as well as differences between subjects experiencing or not experiencing low back pain in the previous year.

RESULTS

Low back pain was experienced by 32% of subjects in the previous year. The majority (54%) of low back pain episodes lasted under seven days, suggesting mainly soft tissue involvement, and 19% lasted over three months, suggesting involvement of the intervertebral discs. Weekly trunk flexor muscle training frequency was significantly greater (P = 0.035) for the low back pain subjects. Close to significant differences for average weekly cycling time, trunk flexor muscle training time, and low intensity aerobic training, as well near significant associations for weight training and average weekly triathlon training load, were also found. No other factors were significantly associated with low back pain. Low back injuries accounted for 28% of all injuries. Only the knee was a more common single site of injury (33%).

CONCLUSIONS

The three most common injuries suffered by the triathletes were of the knee, back and shoulder. The low back pain suffered by many triathletes could be of a potentially serious nature. It is suggested that cycling is a major risk factor for low back pain in triathletes.

Sports injuries in children and adolescents

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Intensive training in young athletes

An increasing number of children take part in organized sporting activities, undergoing intensive training and high level competition from an early age. Although intensive training in children may foster health benefits, many are injured as a result of training, often quite seriously. This paper reviews some of the areas of research dealing with intensively trained young athletes, and focuses on physical, cardiovascular and muscular effects, sports injuries and psychological effects of intensive training. It is concluded that measures should be taken to modify present training and competition schemes to avoid the deleterious effects of intensive physical activity on these children.

Overuse injuries in ultraendurance triathletes

Overuse injuries represent the largest percentage of sports-related injuries requiring medical treatment. These injuries represent a substantial health issue for the millions of adults who have made physical activity an integral part of their lifestyle, but may be even more important to those pursuing ultraendurance exercise. The purposes of this study were to report the type and incidence of overuse injuries in ultraendurance triathletes and to relate training practices to injury occurrence. Data was gathered from the responses of 95 competitors (75 men, 20 women) in the 1986 Hawaii Ironman Triathlon who completed a training and medical history questionnaire. In this sample, virtually all (91%) sustained at least one soft tissue, overuse injury during the previous year's training. The area of the body most frequently involved was the back, but the most common pattern was to have multiple areas involved. Because of the consistent combinations of injuries, mechanical abnormalities, such as diminished shock absorption, may have contributed to injury. Training habits were extremely variable and not directly related to either the incidence or type of injury.