This athlete longevity series aims to cover topics I think should be involved in the discussion of athlete longevity – topics that I think you have to focus on as an athlete if you want to remain in powerlifting as long as possible.
Injury prevention and management is essential to longevity in powerlifting for obvious reasons. Injuries can set athletes back weeks or months in training or take them away from the sport entirely depending on the degree of injury.
Why is injury prevention important?
Put simply, the more time you spend injured, the less time you can spend progressing as much as you could have been when you weren’t injured. There are also other aspects to take into account like an athlete’s mentality around training after having been injured and longer-term impacts of not addressing or working to prevent injury.
Are preventative measures and prehab work needed for everybody?
A one-word answer would be almost impossible, it’s hardly ever black and white like that. It depends on a huge range of factors like training intensity, speed of progression, total load moved in comparison to bodyweight, recovery capability, time available to the athlete, mentality of a lifter (i.e. do they benefit from the routine of performing prehab work before a training session).
I think there’s a general baseline of attentiveness that’s needed when programming an athlete. For example, when programming bench, pressing volume needs to be taken into account, and back and shoulder volume adjusted accordingly – the same goes for managing lower back loading when looking at adding accessories. You could consider these preventative measures but in the context of this article, I count that to be well thought out programming.
When determining how injury prevention fits with the needs analysis of an athlete, an athletes coach needs to ask the following questions:
How is an athlete predisposed to injury associated with powerlifting ?
Is an athlete at greater risk based on a predisposition to injury?
Is an athlete recovering from an acute or chronic injury?
How can a program be developed that will reduce these risks?
Prescribing specific prehab work, as opposed to general upkeep, is very dependent on how a person moves, their injury history, and several other factors – it may not always be necessary. Biomechanical observations show where an athlete is most at risk for injury. For example, structural differences and imbalances (not only limb/lever lengths) can often let us predict areas of potential weakness and will differ from person to person. Add on top of this the way a person moves and their program demands and you will find a huge variance in what prehab work one athlete will need compared to another if any is needed at all.
What are some red flags that would make you want to take action?
If I notice or if an athlete reports any of the below to me I would absolutely look to take steps to address the pain/injury.
Pain during or directly after specific exercises
Patterned pain outside of exercises
Continual or consistent pain
Long term niggles/issues that have not been addressed
If an athlete has been lifting ‘heavy’ for too long – i.e. they have been consistently overshooting top-end RPEs
If an athlete is displaying inefficient mechanics, i.e. postural and biomechanical issues
Inappropriate clothing, footwear, equipment and environmental factors
What is the body’s response to injury?
When injury occurs, here will be a predictable chemical process of inflammatory response.
The acute/inflammatory stage lasts for 3-5 days. Inflammation is a response to cell damage within body tissue and is a chain of events that aids in repairing, reforming, and sometimes forming new scar tissue. Inflammation occurs when excess pressure, friction, overload, over-stretching, or impact trauma is applied to a certain area. Signs of this stage include, pain, heat, swelling, redness, and loss of function.
The Proliferative phase usually lasts 2 - 5 weeks and is the point at which new tissue (capillaries and lymphatics) is laid down where the injury has occurred, allowing improved circulation and drainage. After this, fast production of fibroblasts occurs which generate in the connective tissue and are responsible for repair.
The Maturation phase is the final stage where repairing tissue regains strength due to increased structural development. This final stage can last from 3 weeks to several months depending on the severity of injury.
What are your first responses to pain or injury in an athlete?
There are several options and as always they are entirely situation-dependent. The degree and location of pain are big factors to consider. On top of this, there’s an element of time where if an injury has occurred we need to allow the trauma to take its course, e.g. allow the natural body’s process of healing to take place to initiate the first stages of healing. This may mean bailing a session if the pain is in a region where it is unavoidable entirely. It will be a case of weighing out the cost vs benefit of pushing yourself through a session whilst injured – you may often find yourself better off allowing your body to enter a recovery state sooner rather than finishing your session and continuing damage to the injured/painful area.
All of the below are possible responses to pain/injury in an athlete, however, they’re not likely to all be needed in one go:
Reduce weight on exercises – thereby reducing demand on the injured area
Reduce the range of exercises – possibly allowing you to perform an exercise without impacting the injured area
Reduce the intensity of training
Change the tempo of movements – this can improve cognitive awareness of a lift and can help with actively performing the correct movement pattern and limiting work that exacerbates injury/pain
Reduce volume on the specific injury area and look closer at secondary areas that will be connected to the pain/injury
What is the rehabilitation process?
Rehabilitation after injury can be broken down into 4 stages:
Reduction of pain and swelling - during this phase the injured individual can use either exercise, physical therapy, manual therapy or a combination of these methods to reduce pain and swelling. Rest and icing the affected area could also be key during this phase.
Restoration of mobility and range of motion - the goal of this phase is to restore the full range of motion to a joint, or to restore a specific movement to full range of motion without causing pain. Work to achieve joint mobility should be started as soon as possible. It is worth noting that taking an overly aggressive approach could actually increase inflammation, hindering recovery, while excessively cautious tactics can cause stiffness in joint articulation.
Recovery of muscle strength and endurance - the aim here is to gradually build up muscle strength through load progression to avoid any potential overloading issues.
Recovery of co-ordination and powerlifting-specific movements - Injury can cause alterations to the body’s proprioceptive mechanisms, i.e. the mechanisms that allow us to sense the spatial positioning of our limbs. Recovering this allows an athlete to regain normal movement patterns. The next step is the recovery of movements specific to the athletes development in the sport i.e. a squat or bench press without pain. This phase doesn’t follow a strict timeframe or routine, but instead is adjusted from day-to-day by the athletes coach in relation to the athletes unique responses to training.
What are the take-home messages?
Don’t just ignore ‘niggles’–rather than opting for the ‘muscle through’ approach - remember this is your body communicating!
Don’t avoid the exercise or jump to removing/changing it for another completely different one – address the issue with your coach and try to work out if/why that movement itself is causing the pain. This pain could very well be the reaction, not the causation.
Have a reason for everything you do- it can be easy to overprescribe exercises and lead to a lack of prioritising the specific high importance movements.
Don’t forget the impact of your external contributing factors- you do a lot outside of your hour of training - (well, plus the other 2 hours of training + eating sweets )
Sometimes pain can be offset. Sometimes pain in an area does not always mean it is the injured area. Thorough assessments in opposing areas and areas in the body linked should be addressed.
It’s never too early to seek further professional guidance, but it can most certainly be too late!
Be proactive, not reactive – Pin-point your weaknesses and areas in need of improvement both as an athlete physiologically and you as a person before they contribute to causing an injury. Obtaining this information and utilizing it individually to you is the most POWERFUL tool.