#49 -- Training for Injury Prevention with Matthew Smith, DC CES

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Matthew Smith, DC, CES

Dr. Matt Smith is a sports chiropractor, strength coach, and the founder of EverAthlete, an online strength training, injury prevention, and recovery resource for outdoor enthusiasts. Matt has been a trusted coach and consultant to some of the best athletes and highest performers in the world, helping them navigate injuries and perform at their best. 

EverAthlete website: https://www.everathlete.fit/

Instagram: https://www.instagram.com/everathlete/?hl=en

Part 1 — Breathwork for Recovery (episode 48) — https://www.wiseathletes.com/podcast/48-breathwork-for-faster-recovery-matthew-smith-everathlete/

Part 2 — Injury Prevention for Older Athletes

Older Athlete are particularly vulnerable to injuries:

• Many years to accumulate movement problems and muscle imbalances
• Past injuries from accidents
• Too much time sitting
• Too little cross-training
• Slower healing 

Summary

(1) Do assessments to identify body areas that need work

Example: Lunge Movement Assessment:  

Lowering the body down so the back knee comes close to touching the floor.  Then stepping back to the original position. 

A few things we look for in a test like that are: 

• (1) torso control:  Does the torso stay upright or does it drop down towards the floor, towards the knee as you go through the movement.
• (2) lower body:  are the hips (and torso above) shifting from side to side, and do the hips stay level?
• (3) front foot points straight ahead
• (4) front knee to point straight ahead in line with 2nd and 3rd toe (vs. pointing inward our outward relative to the foot)
• (5) overall movement should look smooth and stable

When we see a problem, we do further breakout tests to fine tune the finding.  Do they struggle with hip or ankle mobility or lumbar stability?  Deficiencies in those areas can lead to a “messy” lunge.

(2) How to avoid injuries:

1. Focused efforts on individual muscles that need to be addressed (based on assessments) in order to allow proper movement patterns: 
   1. tissue work (foam roller) 
   2. stretching (lengthening tight muscles) 
   3. activation (such as using bands to turn on muscles creating muscle imbalances)
2. Practice standard movements until competent (check out Matt’s Instagram or Website for details)
3. Mix up training: use of strength training as cross-training:  healthy exercise to build balanced strength into the body for greater resilience as well as to learn proper movements that don’t lead to stressful movements (and pain or poor performance). Force the body to adapt to a variety of movements…to bring the body back to balance.  If we focus too much on one sport we become unnaturally adapted to that limited movement set.  Reduce the cycle of repetition.
4. Periodize your training.  Undulating the load over time…each week up through each annual cycle.  Have a buildup, a peak, and then a recovery phase.  Build time into the plan for cross training (for balance) as well as recovery (for repair of biological systems).  Without this expedites the breakdown of the athlete.
5. Add daily tissue recovery practices.  Restore tissue mobility, joint mobility, core stability control.  Lead to less compensation issues.

How to: Start the day, prepare for exercise, get into recovery asap

• For a morning routine, just to start the day feeling a little better:  Use slow, light, full body movements to check in with your body to see how you feel and if you have soreness or tightness.  Then address any issues:  foam rolling, light stretching, some activation.
• Preparing for a workout, it’s more of an excitatory routine.  You are building in more neuromotor demands as you go.  Start with tissue work (like foam rolling), then core activation (bird dog), then dynamic stretching:  light lunges, light squats, jogging back and forth, side shuffling.  Things to open up the body in motion.
• Post workout:  is more about recovery.  Stimulate the parasympathic system to re-build toward the next workout.  Do breathwork to calm down.   Light tissue work, static stretching holds for longer periods of time, long and deep breathing patterns.  Just get things to calm down as fast as we can.

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Discussion Notes (not a transcript but my notes from the discussion)

Q:  what is your approach to helping athlete avoid injuries?

A few different things to do:

(1) tissue work and stretching and activation technique using bands ….like what you’d see in a rehab setting

(2) strength and cross training.  Healthy exercise can help with past injuries as well as make the body more resilient.

If done the right way.

Q:  what is the “right way”?

We leverage compound movements and cross training.  We like to provide the body with practice in a range of compound movement needs (demands of the exercise).  Squat pattern, Hinge pattern like a deadlift, or a pull-up.  

Q:  What I hear from other experts is:  before you should try to get strong, you have to learn to move properly.  That moving improperly, from past compensations or whatever the source of the improper learned movement patter, is the source of a lot of chronic problems. And, we don’t want to get stronger in that patter, we want to learn a proper movement pattern first.  Is this what you are saying?

Yes.  Part of the reason cross training like strength training for endurance athletes works is that it pulls athletes out of their repetitive stress patterns. 

We can leverage movement patterns to give athletes a foundational way to bring their body back to balance and out of normalized stress patterns, and once they achieve competency with no or low weight, they can start training to get stronger in the proper movement patterns.

If you are a cyclist who has spent a lot of time in a seated, flexion position:  rounded mid-back position without cross training….you may have lost the ability to stand fully upright:  full range of movement through the hips, turning glutes on.  This is a problem.

The brain has different programs to activate muscles for particular movements.  When we sit too long in one position, it tends to dampen the response to the brain’s movement programs.  By leveraging movements in the gym that require full hip extension, you can begin the retrain the body to move properly with a full range of motion.  This will provide a huge benefit over time in performance, avoidance of pain, longevity in the sport.

Q:  I’m looking for general good advice for the older athlete.  What can we do to be healthier longer?  Do we need to think about posture?  Is poor posture a sign of a problem in movement patterns?   And, what general thoughts about movements that a person could try to see if they have a problem, such as a body weight squat:  can’t go down far enough, etc.?

Posture is generally regarded as a static thing vs. dynamic.  We focus on the dynamic…how people move.  Anytime we start to work with a new athlete, we do movement assessment.  See how well they are able to move their body, core stability, overall strength, neuromotor control.  I’m looking for spinal control, lower body control, and fluidity throughout the movement.  Then I create a mobility program to address what I see that would help them as an athlete.

Q:  Can you provide any details to help a person to be able to tell if they need help?

Yes.  Let’s do a lunge.  Lowering the body down so the back knee comes close to touching the floor.  Then stepping back to the original position.  A few things we look for in a test like that are: 

1. torso control:  Does the torso stay upright or does it drop down towards the floor, towards the knee as you go through the movement.
2. lower body:  are the hips (and torso above) shifting from side to side, and do the hips stay level?
3. front foot points straight ahead
4. front knee to point straight ahead in line with 2nd and 3rd toe (if knee moves inward, it signifies a stability issue or movement pattern problem)
5. overall movement should look smooth and stable

When we see a problem, we do further breakout tests to fine tune the finding.  Do they struggle with hip or ankle mobility or lumbar stability?  Deficiencies in those areas can lead to a “messy” lunge.

Q:  These sorts of problems lead to “Overuse” issues?  What is the take-home for the listeners?

If you are running into pain issues (knee, lower back) or your performance is not what you want, one of the causes could be an underlying movement deficiency.  There are a lot of professionals who can evaluate movement and identify how each person can improve how they move, and how they are positioned on bike.

Q:  if they already have chronic pain or recurring injuries, then this sort of poor movement pattern could underlie that?

Yes.

Q:  even if they don’t have pain, if the movements are not optimal, it might be a matter of time before there is an injury or lack of performance.  So testing yourself or by a professional is a good idea.

Yes.  Pain tells us there is a problem but the pain doesn’t help us to understand what the problem is.  for example, a swimmer with elbow pain can be caused by poor mobility or stability of the shoulder.  The shoulder is causing a poor movement in the elbow so you have to work back to the root cause to really solve these problems.

Chronic injuries do not come out of nowhere.  The body is resilient, and it takes a lot of poor movement to cause pain to show up somewhere.  Don’t wait for the pain to arrive.

Q:  But often people don’t seek help until they have pain, right?

True, but that is why we try to offer improvement in movement patterns to head off pain.  Taking the lessons learned from working with athletes in rehab and created programs to allow athletes to find deficiencies that might later result in pain. 

Q:  Is Overuse injury a real issue?  I’ve heard it both ways.  Is overuse only related to improper movement being used over and over?

No.  There are several ways to get overuse injury.  Improper movement is only one.  If you increase your activity level too fast, even using proper movement, you can also damage yourself.  Also, you need to allow for enough recovery and healing after workouts or you can get “overuse” injuries. 

 Best Advice:

• Mix up training.  Use cross training to force the body to adapt to a variety of movements…to bring the body back to balance.  If we focus too much on one sport we become unnaturally adapted to that limited movement set.  Reduce the cycle of repetition.
• Periodize your training.  Undulating the load over time…each week up through each annual cycle.  Have a buildup, a peak, and then a recovery phase.  Build time into the plan for cross training (for balance) as well as recovery (for repair of biological systems).  Without this expedites the breakdown of the athlete.
• Add daily tissue recovery practices.  Cross training and recovery.  Restore tissue mobility, joint mobility, core stability control.  Lead to less compensation issues.

Q:  Here’s my summary of what you said.  

• Make sure you are moving properly so that when you are putting stress on the body, the stress is not creating damage
• Do some cross training so you are not always engaging the same stress over and over
• Leave enough time for recovery…each day as well as over time.  
• And if you are trying to get better, make sure your peaks in performance are separated by valleys to allow for healing and repair and adaptation.  Don’t always go for PRs

Q:  What about flexibility?  What should I do in the morning to loosen up after being immobile for a long night of sleep.

For a morning routine, just to start the day feeling a little better:  start with some foam rolling to activate tissue and get fluids into the tissues.  Then some stretching and activation work to reinforce the elasticity and elongation from the tissue work.  To improve how you feel during the day as well as to create better performing muscles if done regularly over time.

Use slow, light, full body movements to check in with your body to see how you feel and if you have soreness or tightness.  Then address any issues:  foam rolling, light stretching, some activation.

Q:  What about warming up and/or cooling down after exercise?

Preparing for a workout, it’s more of an excitatory routine.  You are building in more neuromotor demands as you go.  Start with tissue work (like foam rolling), then core activation (bird dog), then dynamic stretching:  light lunges, light squats, jogging back and forth, side shuffling.  Things to open up the body in motion.

Post workout:  is more about recovery.  Stimulate the parasympathic system to re-build toward the next workout.  Do breathwork to calm down.   Light tissue work, static stretching holds for longer periods of time, long and deep breathing patterns.  Just get things to calm down as fast as we can.

Q:  Why stretching after workout?

Relates to getting the body back into a normalized state after hard work.  So after a hard workout.  Muscles might feel tight, and need stretching or activation (turn on muscles) to address muscle tightness elsewhere.  Want to normal length / tension….to muscles that are over stimulated.  Also relates to fascia, ligaments, tendons.

Q:  How does pain come into this?    Low, dull pain vs. sharp pain?

Do you start with pain?  Hopefully you are being guided by a professional.  If you have pain that is lasting for more than a week or two, you should be seeing someone for help who is a sport minded healthcare professional.

Escalation of pain should be temporary at most.  Foam rolling can cause temporary pain that disappears once the activity stops.

If you are are pain free, and you do a mobility or stretching routine, you should stay pain free.  You might feel soreness if you are not used to it, and that pain should not last more than 48 hours.  You should not feel sharp pain at any time.

Q:  how can people find you and EverAthlete?

Instagram:  @everathlete

Website:  everathlete.fit