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Injury Prevention

Prevention is better than cure. 

Load management 

Managing the amount and type of training you do is extremely important. 
A spike in training load is what increases risk of injury, even more than a high training load.
Acute load is what you have done this week. 
Chronic load is average over the last 4 weeks. 
Training stress balance is acute expressed as a percentage of chronic.
Avoid spikes! A spike would be >150%.

Niggle vs Injury 

Sometimes it is hard to tell what pains you need to seek advice for. Any pain or tightness that is persistent for great than 1 week or has a predicable pattern needs to be assessed and treated. The longer you leave it the longer it takes for it to be fixed. Seek assessment and treatment early.

Acute Injury Management

REST, ICE, COMPRESSION, ELEVATION and REFERRAL 

When an injury first occurs the right management early is extremely important. 
REST - avoid any unnecessary physical activity. Physical activity increases your metabolic rate, which can increase swelling and slow down the healing process.
ICE -  20 minutes, every 2hours. Ensure you have something to protect your skin between your ice.
COMPRESSION -  Is the most important! Apply compression firmly and evenly form the body part furthermost away from your heart. Compression should be on all the time, even whilst icing. Beware that it's not too tight. It should not cut off your circulation.
ELEVATION  - Raise body part above the level of the heart
REFERRAL  - seek further advice from your health care professional 

Recovery Strategies 

Recovery during your training schedule and post race is extremely important. The strategies listed below are in order of effectiveness. 
 
1. SLEEP
- Sleep is the most important time for recovery
- Very athlete specific (recommended 7-10hours)
- Hours slept before midnight are more effective than those slept after
 
How to sleep better? "Sleep hygiene"
- Routine - maintain a good sleep/wake cycle by going to bed and getting up at the same time each day
- Naps should not interfere with night time sleep
- Plan food & fluids
- Ensure bed is comfortable and room temp 19-21 C
- Remove screens from the bedroom
- Avoid thinking & planning when in bed
 
2. NUTRITION 
- Prolonged/high-intensity exercise causes breakdown of muscle protein. 
- During recovery phase there is a reduction of breakdown processes and a gradual increase in 'building' processes, which continues for at least 24 hours after exercise.
- The "window of opportunity": Early intake of essential proteins within the first hour after exercise helps to promote the increase in protein rebuilding.  
- Good sources of protein include: lean meats, fish, milk, yoghurt, cheese, eggs, tofu, baked beans, nuts, rice, lentils, protein shakes.
 
3. HYDRATION
- Keep fluid loss less than 1kg or less than 2% body weight
- Sports drinks improve fluid intake. Water good but you must drink to a plan
- Choose sports drinks that have 4-8% carbohydrate, 10-20mmol/L sodium
- Cordial, soft drinks and juice (with >10% carbohydrate) can slow down gastric emptying - not suitable for high intensity activity.
- Drinking too much: hyponatraemia can occur in prolonged endurance events
 
Alcohol
- Acts as a diuretic and will interfere with re-hydration and other recovery processes.
- Alcohol has detrimental effects on skeletal muscle: Impairs "excitation-contraction coupling" of muscles resulting in decreased strength output.
- Recovery: acute alcohol ingestion decreases muscle protein synthesis - a vital part of recovery that occurs post-exercise to facilitate muscle repair and hypertrophy

4. ICE BATHS/HOT - COLD SHOWERS

Cold Water Immersion Therapy has significant benefits in maintenance and improvement of performance over active recovery.  It reduces the physiological and functional deficits associated with delayed onset muscle soreness (DOMS) including recovery of isometric force, dynamic power and a reduction of localised oedema. 
 
Ice Baths (Cold Water Immersion, CWI)
- 15 C is ideal - for a minimum of 10 min 
- body temp and HR will fall about 30 min later (so don't rug up or have a spa or hot shower straight away)
- Duration should be individualised - less body fat will need less time
- Must be done within 4 hours after event, 1 hour best  
- Most effective when the athlete is backing up day after day e.g. a tournament, they will notice the benefits by days 4 & 5
- Measure the temperature with a pool thermometer 
 
Hot - Cold Showers (Contrast Water Therapy, CWT)
- 38 degrees hot:cold 1:1 - 12 min in total. The last one must be cold.
- This is more effective at 24 hours
- Consideration should be given to the environmental temperature as to whether you do hot or cold first.
- It is detrimental (in terms of performance if they are going out again to compete less than 3hrs, but still use other means to get body temp down e/g ice around neck/torso, fan etc. 
- If it is longer than 3 hours between competition CWI can decrease the physiological fatigue associated with prolonged heat.
 
5. FOAM ROLLER
-  Myofascial Release
- Self-release 'tight' muscles and trigger points
- Sustained pressure into the muscle and surrounding connective tissues to eliminate pain and restore movement 
 
6. WARM DOWN 
- "A myth"
-  Has no impact on delayed-onset muscle soreness (DOMS)
- However it is a good place for team debrief, enhance moraletc
 
Things to be aware of on race day:
" Don't try new shoes on race day
" Stay Hydrated - drink to a plan
" Seek treatment early for niggles 
" Treat blisters early - they can create new problems 
" Ice after any new or flared up injury
" Don't try anything new on race day 
 
Please be aware that the advice given is of a general nature. Please seek the advice of your health professional before embarking on any of the above advice.
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Disclaimer: The information regarding Injury Prevention is being provided exclusively by Dynamic Performance Physiotherapy. Wanda Surf Life Saving Club Inc is in no way responsible for the Injury Prevention information. All enquiries should be directed to Dynamic Performance Physiotherapy. 
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