The Biomechanical Injury Cliff

Forget the fiscal cliff….!
The spectrum of biomechanics…. who is most vulnerable to fall off the injury cliff?
Possibly more interesting for me as a clinician is that how is it that some people have been hanging on for such a long time with such poor mechanics without injury?
Should we intervene in a preventative fashion to address these suspected faults? Is the age-old question, and highlights the ever-growing debate about whether there is a role for screening to help injury prevention.
The reason I have been thinking about this problem is that over the last couple of months I have had come into my clinic a handful of serious runners. Guys (yes they were all men) who over a 3-4 year plus period, have been competing in marathons, ultra marathons, ironman’s etc, but who have all ended up seeing me as there world has coming crashing down around them (metaphorically speaking…in most cases at least) having picked up some sort of significant injury.
On all of these occasions these have been an ‘repetitive overload’ type injury, where there was not one single, large event, but a cumulative build up of discomfort, which on one run result in a tip from tolerable to unbearable. And, on every single occasion, I was genuinely shocked as to how poor these guys biomechanics where.
It made me therefore wonder several things….
1. If we had optimised their biomechanics from an early stage in their running career, could these injuries have been prevented?
2. Is it in fact just a problem with training load, as all these recreational athletes had been running with these mechanics for many years without problems?
3. And with that, if they had been surviving with these mechanics for so many years without problems, do we really know what optimal mechanics really are??
My thoughts are these, that without a doubt if we had optimised his biomechanics from an early stage in their running career the cumulative stress going down through the lower limb will have been reduced, and thus the risk of injury reduced…
That said however, mechanics are not the end of the story. I have seen people with wonderful mechanics still break down from injury as the training volume has been poorly tailored to them; their allotted recovery time, the quality of their recovery and their lifestyle away from the treadmill/road.
As with all things that we don’t fully understand, but believe we at least have a better understanding of than no understanding of at all, the problem is likely to be multifactoral…finding which factors are the key factors for you come down to the skill of being able to listen to your body, or the skill of somebody being able to listen to you and you being receptive to take this on board and act on it appropriately.

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