The Pulse


Why You Get Hurt

by Patrick Reynolds

If you meet someone at a dinner party, there's a short list of topics you can discuss without getting into too much trouble. Where are they from? What do they do? Do they have children? How do they know the hosts? I'm lucky in that when I meet people, and they find out that I run a fitness company, an additional set of topics opens up. What's their current condition? What are their fitness goals? Do they have any injuries? It's this last question that people really latch on to.

It turns out that people love to tell their stories about how they got banged up. They'll stand and show me what action makes the injury hurt. They'll show me scars. They'll go over their surgeries in detail. I've even had several people pull up their x-rays on their phones!

I'm not complaining. I'm an enthusiastic injury-story collector. I'm always interested in how the human body can be damaged and patched up. Every story gives me a new set of data points to understand how to better care for these messy bags of bones and muscle we live in.

Over the course of thousands of stories, I've seen a trend appear: Skiing.

Skiing seems to be responsible for about half the injuries I hear about. At the top of that list are the classic ACL or MCL tears. This is when the femur and tibia end up going in different directions with a lot of force, as when you're turning on a ski slope. The small ligaments connecting these two large bones can't withstand the strain and tear or snap completely. In the blink of an eye you go from a downhill hero to a hobbling mess with months of surgeries and recovery in front of you. And even when you're back on your feet, most people say that the knee never feels quite the same again. This is by far the most common injury people share with me. But skiing breaks a lot more than ligaments. I've met people with meniscus tears, dislocated shoulders, stress fractures, and an endless parade of broken collarbones. What is it about skiing that's so hard on the body? Is it a particularly dangerous sport that you should avoid?

Before we answer that question let's look at the other half of injuries I hear about. Here's a sample (all true stories!)

"I started playing basketball again last year. I went up for a jumpshot, and when I came down my ankle just rolled over. I can't put a lot of pressure on it anymore."

"I ran a couple of marathons in my forties. I really enjoyed it but I blew out my knees so now it's just the elliptical for me."

"I was moving the refrigerator and felt a stabbing pain in my lumbar. Herniated my L4-L5 disc."

"I was at the gym and did this new type of lift that I saw in a magazine. I felt my lower back just give out on me and it still bothers me to this day."

"I was in yoga class and we were doing variations from full Pigeon Pose. I really went for it and ended up with a torn groin muscle."

"It was Thanksgiving and we were playing football in the backyard. I felt a weird crackling in my shoulder. Turned out to be a broken rotator cuff."

"I went for a big run to the top of the mountain on our last vacation. My shins have bothered me ever since."

Can you see the common thread between all these stories? The culprit behind these injuries isn't basketball, or running, or weight-lifting, it's novelty. In each case the person was injured doing something that was outside of their usual pattern of physical movement.

The body is in a constant feedback loop. You ask it to do a task, it does the task the best it can, and if the task puts it under strain it mobilizes new neurological pathways and builds additional lines of muscle to prepare for the next time you do that task.

There's no better example than spending a few years carrying your kid around. I remember when my daughter was a newborn and weighed just about 4kg (9lbs), my arms and shoulders would absolutely burn as I rocked her to sleep. Now she's around 16kg (35lbs) and I can lift and carry her for long periods without feeling any muscle burn at all. What happened to my body in the intervening years?

The first thing that changed is that my system got better at carrying a kid-sized load. With each repetition of the task, my brain and body got more organized for the job at hand. The first time I awkwardly held my daughter, I was probably overusing my biceps and deltoids, and underutilizing my traps and lats. After a few years of the same task, my brain had learned to spread the load much more efficiently. I "got smarter" at carrying the kid.

The second thing is that my body created new muscle to aid me in this strange new activity. As any parent can tell you, the first few years you have a kid you see impressive gains in muscle tone on your shoulders and arms. Not only was this new muscle, it was weighted towards endurance tasks (holding a load for several minutes) vs. explosiveness (throwing a punch).

The result is that over the course of a few years I was able to quadruple the amount of weight I could comfortably hold. And it happened in a smooth curve, because my daughter grew at a slow and steady pace that my body and brain could keep up with.



Contrast this with the types of activities that people get hurt doing. Most injuries occur when someone makes a sudden jump in their activity level; for example, getting out on the basketball court after a long absence.

When you do this, you're getting the worst of both worlds. Your brain hasn't had the chance to get smart about how it does the tasks you're asking of it. You're using the wrong muscles in the wrong ways. On top of that your muscles haven't been conditioned to take on the strain you're introducing. Landing from a jumpshot requires your calves and quads to safely decelerate into the arch of the foot, all while your core stays tight to keep your body upright and centered. If your basketball game is rusty, your brain can't get the right muscles to fire at the right time, and those muscles that do fire are underpowered. You end up landing wrong and rolling the ankle. Just like that, your basketball days are over, at least for a few months.

Which brings us back to skiing. Skiing and snowboarding are the perfect storm for injuries. Not only are you dealing with high velocities and strong forces, you're almost guaranteed to have long breaks between your outings. There aren't a lot of places on Earth where you can ski year-round. Even for an enthusiastic skier who goes every year, there might be 8 full months of off-season. And to make matters worse, there aren't many things in regular life that approximate the tasks your body needs to perform in a downhill ski session. The strength gained from picking up my daughter translates well to picking up other things, like a bag of rice or a piece of furniture. It's much harder to find an analogue for the muscles needed during a ski turn or mogul run.

When you add up the high speeds, strong forces, and novelty of a skiing trip, your body is dancing right at the edge of injury. Most of the time you stay within that margin of error, but it only takes one time to put you out of commission!

What's a person to make of this information? Can we never do anything fun again? Do we all need to stay at home, sunk into a bean bag chair with a pillow over our heads? Not at all. What I want you to take away from the thousands of injury conversations is this:

Be cowardly.

You can replace your car or house. You can move to a new country and start a new life. But you're stuck with the body you've got. Once it's broken, it's never going to be quite as good as it was before. When you're facing a binary choice like this, caution is the order of the day. Avoid any activity that's asking your body to make a sudden jump in physicality. Work your way into things and never, ever fear the stigma of sitting a session out. 

If you're feeling driven to do something beyond your ability because of your own competitiveness and ego, swallow your pride and dial back. Maybe you'll have to call a moving company to move that fridge. Maybe your friends will snicker as you take the bunny slope. Maybe you'll have to walk the last half of that marathon. But only YOU have to spend the rest of your life in your body. In 2 years you'll have forgotten all about that time you didn't go hardcore. But if you go too hard and get hurt you'll definitely remember the injury. It will, in fact, become a part of you, giving you painful taps on the shoulder every day and whispering "I'm still heeeeere." 

I use the phrase "be cowardly" because I want you to think of being careful and cautious in the worst, most shameful way, and deal right now with how that stings your ego. Get over it. What you really want is to be a healthy and happy person, and an injury is one of the quickest ways to throw that out the window. If your goal is to do serious and intense exercise, you've got to be smart and follow that gentle curve that lets your brain and body prepare for what's to come. This isn't just advice for middle-aged people who need to learn to slow down. I've spoken to many a young athlete who has seen a promising career ended by putting too much stress on their still-developing body. These injuries change the entire course of people's lives.

The irony is that when you take this advice and train up for activities correctly, you'll actually be able to enjoy them for much longer and at a higher skill level than someone who goes too hard too quickly and ends up on the injured list. Stay humble, stay smart, and stay safe out there! If all goes well, when we meet at a dinner party you'll have absolutely nothing to tell me except "I've never felt better!"

Caveat time: While most injuries occur during weekend-warrior type activity, there is of course a class of injuries that come from repetitive stress causing excess wear and tear on the body. However, even these repetitive stress injuries often become a debilitating problem when the person has a particularly big day. For example, you might have a mild case of tennis elbow, but it only became a serious, debilitating problem after that one weekend when you spent all day playing a round-robin tournament. In these cases too, being cautious and not taking on an unusual level of your chosen activity will save you a lot of heartbreak later.

Finally, no matter how well you prepare your body, plain old bad luck is still a factor. The right amount of force in the right place will damage even the healthiest body. The fact that these bad luck events are out there should give you even more motivation to stay injury-free. There's enough aches and pains waiting for you in the rough and tumble of life that you don't need to add to them through your own errors! Good luck!



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