Injuries Part 3: Intrinsic Factors

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In Injuries Part 1 there was a brief introduction to my experience of recent injuries and an overview of intrinsic and extrinsic factors. The latter, extrinsic factors, were covered in more detail in Injuries Part 2. I'll now take a look at intrinsic factors that could contribute to injury.

Fitness: if you're unfit (either cardiovascular or muscular endurance), lacking strength or flexibility then you're letting yourself become one step closer to being injured. A fit individual who has adequate recovery and rest days in their training programme, has good nutrition intake and limits alcohol/drugs is preparing their body as best they can. If you're not resting sufficiently then your muscles are likely to be suffering from repeated microtrauma which does not repair properly, leaves muscle fibres laid down haphazardly and at greater risk of injury.

Technique: if it's poor you'll be prone to injury – simply because your body is designed to function well when you are biomechanically sound. Over-use or muscular imbalances reduce the biomechanical efficiency. In running for example, muscular imbalances can lead to over-pronation and increase your risk of ankle sprains.

Body Composition: if you're overweight your joints are going to be stressed. There's no easy way to say it – you just have to move more and eat less (or eat better). Burn the calories and ditch the weight so your fat to muscle mass ratio is optimal. There is also the concern for individuals who are too lean – repeated stress through exercise or just a repeated action on atrophied muscles is not good – the muscles are just not able to cope. Remedy this by increasing strength and fitness suited to the sport or exercise you are undertaking.

Anatomical Variants: skeletal alignment abnormalities (some say they feel “wonky”) can come from either training incorrectly or because of genetics factors. Leg length discrepancies is a common example – either your legs are structurally different lengths when measured by a trained professional, or you have imbalances (either above or below the hips) causing your pelvis to be unbalanced. Either way, postural deviations lead to faulty biomechanics, and as said above, this puts you at greater risk of injury.

Gender: Whether you're male or female, we cannot change this, nor the fact that there are differences in how the bodies of the different genders function in terms of aerobic capacity, muscular strength, body fat percentage and hormonal activity. Whilst there are always exceptions way outside the normal range, on the whole these all impact on exercise and training.

Age: if you're young your body may not be fully developed – a classic injury for young lads who play a lot of football is Osgood Schlatters disease – too much stress on the tibial tuberosity (where the quadriceps muscles attach below the knee) occurs because of excessive quad use and the patella tendon becomes inflamed. Its most common in young lads due to rapid growth and enthusiastic high level playing of football. In teenagers there are growth spurts to contend with and the body changing rapidly. In mature athletes changes in endurance and flexibility occur, some declining and some increasing – particularly if someone has been involved in their sporting activity all their lives. They'll be more accustomed to the level of activity, have the knowledge and endurance to sustain those for longer and have the experiences behind them to know how much they can push their bodies.

Past Injuries: whenever the body is injured it has the potential to leave scar tissue, not necessarily visible on the surface of the skin, but deep fascial restrictions that can lead to muscle imbalances and dysfunction. These are not always that apparent, but left untreated can lead to pain, discomfort and injury. Some injuries, for example sprained ankle ligaments, will also leave structures (particularly the ligaments) weaker than they were originally and the risk of re-injury is higher. Strengthening weak muscles can help: don't think a few exercises once a week will help - this takes time and dedication for your rehabilitation to be effective.

Also tied into past injuries, though something that we can't necessarily do a great deal to prevent, is musculoskeletal disease, e.g. arthritis such as ankylosing spondylitis which affects the joints of the spine. Adjustments to both training and exercise are most likely to be necessary. Delayed Onset Muscle Soreness (DOMS) is a whole issue of it's own, and we've blogged about it elsewhere. Needless to say it's a big issue and not to be underestimated.

Psychology: your mental attitude towards training, exercise and injury play a big role. Whether you're motivated to undertake rehabilitation seriously or not can impact significantly on the outcome – try returning to exercise too soon, before your body is repaired, perhaps because you're overly keen or frustrated and re-injury is more likely. Pressure from parents, coach or peers can also lead to some people not fully listening to their body, pushing too hard and getting injured and then returning too quickly. A good coach shouldn't put pressure on an athlete, but they could inadvertently do so if they're fired up and focussed on winning a championship for example. This all ties in to how confident you are and how you deal with, or react to stress. As an inexperienced youth you're more likely to want to please the coach or your parents, or not let them down because they've invested time and money into your training.

Competition with others - be that fighting to keep your place on a team, or your position in the championship, or just competition with yourself when you want to beat a PB – all add up to more pressure to get back into the game sooner....or they could be the cause for over-training in the first place which can lead to injury.

None of the intrinsic factors work in isolation (either with themselves or the extrinsic factors). An inexperienced and young female track runner might just want to prove her worth in the championship race and push herself too far, or be pushed by others. Here we have Technique / Age / Gender / Psychology already as factors that might lead to this athlete being injured, and that's before we know if she's got any musculoskeletal imbalances (Body Composition) or Past Injuries, or whether she's received suitable coaching so she is strong and well trained for the sport she's playing (Fitness), the surface she's running on (Environment) or whether the Equipment she is using fits/is suitable.

To summarise, the factors which could influence whether or not we suffer an injury are:
extrinsic: environment, equipment and training/competition
intrinsic: fitness, technique, body composition, anatomical variants, gender, age, past injury and psychology