Achilles, the Injury Prevention Fallacy and the Importance of Identifying Injury Mechanisms

Thetis’ attempt to make Achilles injury proof by bathing him in the River Styx didn’t go entirely to plan. Injury prevention is arguably a bit of a misnomer. There are always those moments in sports / life that are a combination of physics and bad luck not being on your side. However well you prepare, injury reduction might be the best you can hope for. Ironically, or perhaps the ancients were trying to teach us something, the achilles tendon is one of the sites that still gets a lot of attention in the injury prevention dialogue. 

With many methodologies, the solution is to treat the symptom. This involves using a recovery / regeneration approach to alleviate the trauma at the site in question. This may help the athlete but ultimately can only ever be damage limitation at best. A recovery / regeneration protocol is unlikely to outweigh the forces experienced in sport that produced the trauma. If the symptom is chronic, there is an underlying reason why it is presenting itself. Treatment of the symptom is rarely an efficient solution.

Another approach is to target the tissue exhibiting the symptom. The idea is to make it more robust and improve its tolerance for the trauma / load capacity. In many cases this is probably a better approach, and at least strengthens a link in the chain, arguably giving the athlete a slightly better instrument with which to carry out their sport. 

The problem with this approach is that the tissue in question is often not lacking strength / resilience. Typically, the issue is that the structure is being asked to do too much because another tissue or structure isn’t making the contribution it should. This has caused it to become really strong and have pretty good load capacity already. In these cases, it is necessary to integrate something that is asymptomatic into the movement / task. A good example of this can be seen in throwers with poor thoracic extension. Often they try to borrow the movement from lower down the chain and have a lower back issue as a result. Other times the symptomatic problem is closer to the shoulder capsule itself because the shoulder external rotation gets limited help from the thoracic spine. You can release the ql or improve neural input at end range external rotation but it doesn’t solve the problem. Once the problem tissue gets the help it is always supposed to have had, the problem goes away without any localised strengthening, pain management, excessive rest or experimentation with recovery and regeneration.

With recovery / regeneration or localised strengthening you might get lucky, but there is sometimes a better way. The most effective solution, and this seems to be the road less travelled, is correctly identifying unnecessary mechanisms for injury. These mechanisms are everywhere. Some are known, some are incorrectly identified and with others the work still needs to be done. Fashionable concepts of high levels of conscious force production in acceleration might be producing achilles problems that disappear with other approaches. Once again with sprinters, the need for aggressive strengthening of injury prone hamstrings may prove unnecessary once the hamstring isn’t seen as a brake against knee extension. Are these problems you experience with your athletes? You may not need to and it is sometimes possible to coach them out of the problem.The need for almost year round spanish squats, not to mention jumping through pain, might go out the window if the role of the patella tendon in jumps is looked at differently. If Thetis had been given the foresight to do things differently, she almost certainly would have. If you are interested in learning about any of these mechanisms, before they cause problems for you or your athletes, feel free to reach out to us, start a discussion with our team and become part of our extended community of coaches and therapists.

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