Forewarned is forearmed
Matveev A.A.: “ They shout about the beneficial effects of sports on every corner, but as a doctor, I consider it fair game to give you counter-examples from our practice.
There are a lot of athletes among our patients. There is a common belief that playing sports is always accompanied by pain, and injuries at the initial stage usually give minimal discomfort and do not interfere with continued training. As a result, athletes dismiss the problem as a normal part of the training process .” As a result of excessive stress, our joints and their “immediate environment” suffer. There are different types of injuries. They can affect ligaments, bones, cartilage, joint capsules and nerves - individually or in combination. Soft tissues are damaged by excessive stretching, twisting, bending, or impact forces and respond with inflammation. The nerves that serve the tissues in turn signal the damage with pain—an unpleasant but absolutely necessary bodily defense mechanism that alerts us to the onset of a serious problem.
But not everyone immediately pays attention to the problem.
This applies primarily to athletes who consider slight discomfort to be a normal part of the training process.
All the moving parts of the body that are used during training are subjected to repeated stress over long periods of time and eventually fail. Grueling, exhausting training, nervous and physical stress, premature aging due to extreme loads, numerous injuries and a whole bunch of occupational diseases. All this is the price of success in sports. Over time, repeated trauma and inflammation take their toll and cause degeneration of the affected structures, leading to chronic pain and dysfunction. At this point, the tissues are no longer restored naturally. Irreversible changes occur in them, they degenerate, and the damage becomes incurable. If the joint is affected, then at the final stage, non-surgical treatment methods can no longer relieve the pain, so often the only option is joint replacement surgery. Overuse injuries include bursitis, strains, impingement (impingement syndrome), inflammation, joint hypermobility, stress fractures, and tendonitis.
Some injuries in athletes have specific names: “runner's knee”, “tennis elbow”. Cyclists face problems in the hip joint, the reason being poor circulation in the hip area. Football players and skiers are more likely than others to experience damage and rupture of knee ligaments. This list can be supplemented and supplemented...
Every second case in our practice is a rupture and damage to the ligaments of the knee joint. In such cases, we perform arthroscopy to repair the knee ligaments.
Muscles and tendons. How to Improve Sports Performance and Avoid Injuries
Translator: Tatyana Arkharova
Editor: Veronica Rees
Source: Bas Van Hooren
Tendons transmit force from our muscles to our bones, and proper interaction between muscles and tendons is very important to an athlete's performance and injury prevention.
When a muscle contracts (tenses), the tendon stretches and remains that way as long as the muscle contracts. When a strong muscle pulls on a “weak” tendon, it can become very stretched (Figure 1). This, in turn, can lead to microtraumas and ruptures in the tendon fibers.
When a tendon is pulled frequently and does not have time to heal, it can eventually lead to injuries such as tendinopathy . As a muscle becomes stronger and larger, the tendon must “adjust” to prevent overexertion and associated damage. Increasing the stiffness of the tendons allows them to stretch less and serves as a protective mechanism.
Strong muscles need tough tendons.
Fig.1 Top images. Left: Imbalance between muscle and tendon. A muscle that strongly stretches a tendon. Right: Balance between muscle and tendon. Contraction of the muscle reduces tension in the tendon. Below: Microscopic images of stretched rat tendons. A - tendons without stretching with smooth, parallel collagen fibers; B - slight tendon sprain characterized by some deformation of the fibers; C - moderate stretching, expansion of the space between the fibers is observed; D - strong stretching, unevenness of fibers, increased space between fibers.
Imbalance due to training
Muscles and tendons adapt to mechanical stress and are sensitive to mechanical stress. The process by which a mechanical stimulus is converted into a biochemical response is called mechanotransduction .
, adaptation occurs . But the timing of adaptation and the mechanical stimuli that cause these adaptations may differ between muscle and tendon tissues. Recent in vivo experiments have shown that high-intensity training leads to adaptations in tendon tissue. It was also shown that a moderate duration of exercise (3 seconds + relaxation) led to better adaptation, as opposed to a shorter duration (1 second + relaxation) or a longer duration (12 seconds).
Therefore, training, especially plyometric low intensity training , can lead to an imbalance between muscles and tendons, and ultimately lead to injury.
Is there evidence of an imbalance?
In a recent cross-sectional study, Mersmann et al found that volleyball players had greater imbalances in the strength of the knee extensor and patella muscles compared to otherwise active people of the same age. The authors suggested that this imbalance may contribute to patellar ligament injury resulting from plyometric training.
A tendon that is too “weak” in relation to a stronger muscle can lead to a tendon injury, but a tendon that is too tight in relation to a weaker muscle can also lead to injury. A stiff tendon is less likely to stretch, such as the Achilles tendon during running.
Sports performance
A “weak” tendon can lead not only to injury, but also to poor athletic performance, as performance decreases due to faster contraction of muscle fibers. As a result, strength indicators are worse. A tendon that is too tight can also lead to poor performance. Therefore, finding the “golden mean” not only reduces the risk of injury, but also has a positive effect on the athlete’s performance.
What is needed for balance?
Imbalances can be avoided with regular strength training. For exercises to be effective for muscles and tendons, they must meet several criteria:
1. Mechanical load:
In vivo experiments indicate that a stretch of about 5% is optimal for training tendon stiffness. These results are consistent with other recent work in which commensurate stretch resulted in the largest increase in phosphorylation.
In both in vivo and in vitro experiments, lighter loads (with less load weight) resulted in less adaptation/phosphorylation. To obtain sufficient stress on the tendon, the muscle must contract strongly. Using a weight greater than 85-90% of the maximum voluntary contraction results in a strong muscle contraction and enough stress (~5%) on the tendon to cause adaptation.
2. Load duration:
With a short duration of loads, for example, as with plyometric training, the adaptation process in the tendon tissues is reduced. In vivo studies show that contraction durations of approximately 3 seconds with a rest period of 3 seconds result in tendon adaptation, indicating efficient mechanotransduction (the process through which forces and other mechanical signals are converted into cellular signals).
Shorter (1 second) and longer (10 second) contractions resulted in decreased phosphorylation.
3. Rest period:
Unfortunately, no in vivo studies have been conducted to determine the optimal rest period between sets. Only in vitro experiments have examined the effects on tendons of repeated training without rest and with a rest period of about 6 hours. Evidence suggests that a minimum of 6 hours of rest is required between tendon workouts.
4. Other factors:
Although the type of contraction—concentric, eccentric, or isometric—is not of primary importance when it comes to tendon adaptation, it is important to consider some of the advantages and disadvantages of different types of training.
With dynamic - concentric-eccentric - training, the tendon experiences heavy loads only for some time. Therefore, it is recommended to increase the duration of the exercise to approximately 6 seconds so that the stimulus is sufficient for effective mechanotransduction. You can also do exercises that put a lot of stress on the tendons, such as bending your knee to 60 degrees while performing a squat.
The advantage of isometric training is that the duration and intensity are easier to control compared to dynamic exercises. The exercises can also be more easily modified to avoid injury to the tendons. Isometric exercises are recommended to be performed 3 times a week with approximately 2 minutes of rest between sets (Fig. 2).
Figure 2. Tendon training
It has been suggested that low mechanical load training, such as calf raises, may lead to an imbalance between muscle and tendon strength because low mechanical load has a greater impact on the muscle than the tendon. A recent systematic review found that high-intensity strength training has potential benefits over eccentric exercise for Achilles tendinopathy, although the effect is small .
Several studies have used relatively long durations of muscle contraction to treat tendinopathy. For example, Rio and colleagues found that isometric muscle contractions reduced pain over the long term in people with patellar . However, recent studies have not found the same effect in patients with Achilles tendinopathy.
Tendinopathy can cause injury, and when the injured tendon is stressed, the healthy tendon tissue “protects” the weaker and injured tissue. Since healthy fibers are strained more, damaged ones do not receive incentives to adapt. This can be solved using the so-called “stress relaxation”. As the intact collagen fibers slowly relax, the damaged tissue becomes more “stressed” and thus adapts.
Gelatin
Collagen fibers under a microscope
Recently, it was shown that taking 15 g of gelatin in combination with ~225 mg of vitamin C one hour before exercise leads to an increase in collagen synthesis compared to placebo. This can be used for injury prevention or during rehabilitation in combination with the previously described exercises.
A recent study of 18 people found that exercise therapy for Achilles tendinopathy produced better results with 2.5 g of gelatin taken 30 minutes before exercise.
We also remind you that hydrolyzed collagen has greater bioavailability. 15 g of collagen hydrolyzate per day is equivalent to 15 g of gelatin, and even more due to better absorption.
Additionally: SMT - Scientific approach produces collagen hydrolyzate of excellent quality in different tastes. One serving contains 5 g of the necessary substance - 3 servings can replace the gelatin with vitamin C described above. You can order collagen at home using the link.
WHAT IS IMPORTANT TO KNOW ABOUT LIGAMENTS, MUSCLES AND TENDONS
Ligament rupture and tendon damage
Tendons and ligaments are bundles of fibrous connective tissue that hold parts of our body together.
Tears of ligaments and tendons are called sprains. A more serious injury is their complete rupture. Ligament and tendon tears trigger inflammation, a complex cascade of biochemical reactions at the cellular level that the body uses to repair damaged tissue. This also damages blood vessels, which leads to bleeding, and nerves, which causes pain, sometimes very strong. Rest and immobilization are necessary conditions for injury healing. Within a few days, the process of tissue restoration begins. Granulation tissue begins to form at the site of injury. Granulation tissue contains macrophages, fibroblasts, vascular growth factor and cellular factors that repair damaged tissue. Around the fifth day, the formation of new collagen, the main component of ligaments and tendons, begins. The process is disorganized early on, but as the resulting collagen intertwines with existing tendon fibers, it takes on the shape of a normal tendon. During the final stage of the healing process, collagen forms vascularized fibrous tissue and the integrity of the ligament or tendon at the site of the tear is restored.
Muscle overload
When you overload your muscles, they trigger anaerobic glycolysis.
This is the name of the physiological condition when the muscle that normally breaks down glucose using oxygen (aerobic glycolysis) is no longer able to do so. As a result, it breaks down glucose without consuming oxygen. A by-product of this method of energy production is lactic acid. Accumulating in the muscles, it causes pain, a feeling of heaviness and sometimes cramps - in a word, everything that we consider muscle fatigue. Your muscles should be working, not burning. As soon as they start to burn - STOP, TAKE A BREAK! Stop training before muscle injury begins, not after this point. By not overworking your muscles during exercise, you have a much better chance of staying healthy, living a happy life, and not ending up in a hospital bed!
The types of injuries listed are just a few of the common injuries experienced by professional athletes. The best ways to prevent them are to anticipate and avoid them.
Risk factors
The risk of sprains increases significantly in the following situations:
- when an athlete skips warming up before a hard workout
- with low physical activity, when muscles and joints begin to weaken
- violation of technique when performing exercises or during games
- excessive fatigue, which reduces the quality of movement control
- With age, muscle and tendon structures lose strength and elasticity
- during pregnancy, when there is a hormonal imbalance.
Main symptoms
Each type of sprain may have its own manifestations, which should be properly distinguished.
For ligamentous injuries:
- pain is felt in the joint area, it intensifies with palpation
- soft tissue swelling is observed
- possible hematoma formation
- mobility in the joint is impaired.
At the same time, the swelling spreads very quickly and can fill the entire area around the joint, blocking its movement.
Crick:
- severe pain when trying to move
- swelling and hematoma
- formation of a dense structure in the area of injury
- dysfunction of the damaged muscle.
For mild injuries, mobility is restored on its own within two to three days. More serious injuries should be accompanied by medical attention and specialized treatment.
How do you know if a serious injury has occurred?
She has characteristic symptoms:
- acute pain and rapidly developing swelling
- inability to lift or bend the injured limb
- pathologically large range of movements is possible
- there is deformation or curvature of the injured area
- the appearance of foreign structures in the form of bumps, bumps
- numbness, loss of sensation is felt
- the above symptoms continue for more than two to three days.
Severe injuries to the musculotendinous system may indicate a rupture that will not heal on its own. Also, hidden bone fractures are possible, requiring careful examination and examination by a traumatologist.
In this case, rehabilitation can last from several weeks to six months, depending on the severity of the condition.
Arm and back stretching
Forearm and shoulder stretch: Move one of your arms to the opposite side of your body. The correct thing to do is to try to press your hand as close to your body as possible and feel the tension. Hold the stretch for 10-15 seconds. Repeat on both sides five times.
Triceps stretch: Raise your bent arm with your elbow up and try to reach your shoulder blade with your palm.
You can stretch your triceps by moving your arms back.
Simple bends effectively stretch the entire spine, from the neck to the tailbone. Bend over without bending your knees and reach for your toes. Hold down for 10 seconds, rise up correctly and smoothly and perform the movement 5 times.
Perform the twist while sitting on the floor with your back straight. When making slow turns of the body in both directions, you need to monitor whether there is tension in the sides. When turning, the muscles of the abdomen, back and shoulders are involved. You can help yourself with your hands. Try to feel the pectoral muscles as well, actively expanding your chest. After the body is twisted in one direction, pause for 15-20 seconds, then take the starting position and turn in the other direction.
Exercise to stretch the lower back muscles: Sit on the floor and bring your legs together. Tilt your body, gently rounding your back. Keep your knees on the floor and grab your heels with your hands. Fixation for 30 seconds, then starting position.