The ups and downs of exercise

Many of us know exercise and activity are good for us. It slows the ageing process and increases our wellbeing and happiness. Too, exercise enhances our ability to think clearly and improves our sleep quality.

When you begin an exercise routine and increase the duration of time that you exercise, it is important that you perform it safely to reduce the possibility of exercise-related injuries.

I’ve treated plenty of people who launch into an exercise program with great enthusiasm and commitment.  And inadvertently, they irritate old injuries or create new ones.  It can be quite demoralising when this happens. People most at risk of exercise-related injuries are newcomers to exercise or those who have been inactive for a while and then return to exercise.  For example, novice runners who begin a running program face a significantly greater risk of injury than more experienced runners. Once injured, many people abandon their commitment to exercise.


Finding a balance: the Goldilocks Principle

After participating in strenuous physical activity — particularly something new to your body — muscle soreness is a common outcome. But with bouts of rest, your muscles can recover, adapt and yield a stronger body over time. This type of initial soreness typically resolves in a day or so. However, when exercise pushes your body past its abilities, exercise-related injuries may occur, particularly in the joints.

When applying the Goldilocks Principle to exercise:

1. Too little or infrequent exercise may provide minimal benefits for your long-term health.

2. Too much exercise, by pushing your body too hard or too quickly, may result in exercise-related injury.

3. Just the right amount, intensity, and type of exercise with adequate rest can improve fitness and reduce risks of exercise-related injury.


The overload syndrome

The injuries I am referring to in this article are those that occur in the absence of a single traumatic event such as a fall or trip.  Frequently, the pain or injury seems to appear from nowhere after exercising.

In these circumstances, the typical cause is excessive overload – or an excessive demand placed on a certain body part or body system.

When the applied physical load (exercise duration, intensity, or load) exceeds your body’s capacity and tolerance, strain and overload on the tissues often manifest as pain and injury. This is termed an overuse injury and often presents as tendinopathy, muscle strain, or even a stress fracture of the bone.


The cumulative injury cycle

Often, overuse injuries are not experienced until three to six weeks after a new training regime has been initiated. Once the initial pain subsides, you assume that the injury has healed.  After all, rest and recovery are important, and allows body parts to adapt.  However, upon resuming your exercise routine again, you experience a repeated flare-up.  And these repetitive injuries get worse with each occurrence. Load capacity is the tolerance of the body (the bones, muscles, and tendons) to adapt to different loads including exercise. Optimal loading occurs when enough load (exercise) is applied to the tissue structures – muscles, bones, ligaments, and tendons – to promote maximal adaptation to improve strength and function without overburdening the tissues which leads to exercise-related injury. It is a constant balancing act between applying enough load (or doing enough exercise) to improve strength and function and the capacity of those tissues to respond to the applied load. Often this depends on a number of factors detailed below.


What influences the load capacity your body can handle?

1|  Age is a primary factor, as older adults are at greater risk of exercise-related injuries.  This has been demonstrated with older runners. Older adults are more likely to experience soft tissue rather than bony injuries such as tendinopathies and muscle strains. As we age, our tendons lose their stiffness and become less tolerant to quick changes in loading and increased bouts of exercise. Additionally, as we age, we lose muscle mass and strength. Muscular strength has been shown to be protective of injuries and so age and declining strength can increase the risk of injury as we lose these protective properties.

2|  Pre-existing injuries can increase the risks of damage to the body when returning to exercise. Runners have a significantly high risk of injury if they have had a previous injury.

From a clinical perspective, when patients report a previously injured area (even those injuries sustained years earlier) they often, describe the injured area as never being ‘quite’ the same or as strong compared with the uninjured and identical area on the opposite side of their body.

A typical example is a middle-aged woman in her 50s presenting with a left calf strain and signs of Achilles tendinopathy following the commencement of a hillwalking program three weeks prior. She also reported that she experienced a left sprained ankle, 10 years previous. Her left calf strength had never returned to its pre-injured level.  Although she was aware of this, it didn’t inhibit her normal day-to-day function. Now, after starting a hill walking program in an effort to become healthier and fitter, the left calf weakness has led to a tendinopathy injury.

3|  Muscular strength has been shown to be protective against exercise-related injuries. Stronger muscles and tendons have greater load capacity than weaker muscles and are more resilient to potential injuries.


How can you prevent exercise-related injuries?

Just as important as the load capacity, the training load will also influence your risk of exercise-related injuries. This is something you can control. Strength is a critical factor to help avoid injury. Other factors that play an important role include the intensity of the exercise, how often you exercise, and the cumulative loading.

To help you with this has a multitude of programs to guide you safely through the process of improving your strength.

The next blog in this 2-part series will provide valuable information about how to prevent injury with exercise, especially when starting on a new program with the classic dos and don’ts.