How to avoid soft tissue injuries, according to experts

By Melanie Radzicki McManus, CNN

Soft tissue injuries are the bane of any physically active person. They are the most common injuries in sport, can be difficult to heal and often reoccur, according to Sports Medicine Australia. Knowing how to help prevent them is key to staying healthy and active.

Your soft tissues support, connect and surround your bones and internal organs, and include muscles, tendons, ligaments, fat, skin and blood vessels. The most common soft tissue injuries occur in the muscles, tendons and ligaments. Think injuries such as hamstring strains, tennis elbow or ankle sprains. These afflictions often happen while exercising or playing sports, although sometimes they occur from unknown incidents.

Soft tissue injuries are generally traumatic or repetitive. That is, they can occur suddenly — rolling your ankle when you step off a curb, for example — or from overuse. While traumatic injuries are the most dramatic, repetitive injuries are more common, said Mike Matthews, a personal trainer in Ocala, Florida, and host of “Muscle for Life,” a popular fitness podcast.

“Repetitive soft tissue injuries occur when a tissue undergoes more damage than it can heal from over a period of time,” Matthews said. “The ultimate cause of all repetitive soft tissue injuries is simply doing too much, too soon.”

To prevent a repetitive injury then, you need to take a measured approach to exercise and sports. Nix the weekend warrior approach in which you’re inactive all week, then run 15 miles (24 kilometers) on the weekend.

“Moderation is key,” said orthopedic physical therapist Scott Cheatham, a professor of kinesiology at California State University, Dominguez Hills.

It’s also important to acclimate your body slowly to a given activity. “The only proven way to reduce your risk of repetitive soft tissue injury is to gradually increase your workout volume and intensity over time,” Matthews said.

A good rule of thumb: Don’t increase your workout volume more than 10% per week. And every four to eight weeks, give your body a rest by significantly reducing the volume and intensity of your workouts. “This ‘three steps forward, one step back’ approach requires discipline and isn’t always fun,” Matthews said, “but it’s the best way to make your body more resilient and durable.”

Cross-training is another good idea, which the American Academy of Orthopaedic Surgeons endorses. Since your body’s soft tissues are working in different ways or even resting when you bike versus swim or play tennis, it’s an easy preventive measure.

Diet, stress, sleep may increase risk, too

Avoiding soft tissue injuries isn’t necessarily all about training, however. Research suggests major changes in your environment may affect your risk of injury, too, Cheatham said, such as poor nutrition, stress and lack of sleep. Cheatham is also a member of the National Academy of Sports Medicine Scientific Advisory Board.

If you get less than seven hours of sleep at night for more than two weeks, your risk of musculoskeletal injury rises 1.7 times, found a 2021 study published in the journal Current Sports Medicine Reports. So eat well, get plenty of sleep and perhaps skip tough workouts when your stress levels are high.

And what about stretching? Stretching, warm-ups, a post-workout meal and other practices have long been touted to help avoid injury, yet there is no evidence to support these moves, Matthews said. Still, developing a strong core is always helpful, said physical therapist Aime Maranan, owner of Skillz Physical Therapy in Evanston, Illinois.

“If the muscles in your core aren’t strong enough to withstand hours of training, their strength will go down, then the stability of the spine will go down, and then your nerves and soft tissues will be irritated,” she said. “It’s a domino effect.”

Core exercises such as the plank are good, she said, or holding the tabletop position, where you lie on your back with your hips and knees at a 90-degree angle. The quadruped is valuable, too. This exercise involves getting onto your hands and knees, contracting your core, then alternating an extension of your right arm and left leg with an extension of your left arm and right leg.

Yet these exercises have to be performed properly, or ironically, they could cause a soft issue injury. So consult with a professional before doing them on your own to ensure proper form. This could be your physical therapist, chiropractor, personal trainer or fitness instructor.

Take any injuries seriously

If you do get injured despite your best precautions, take it seriously. “Even when people realize they have a soft tissue injury, they often carry on with their program and whistle past the graveyard, hoping it gets better with time,” Matthews said. “More often than not, it just gets worse and worse until it hurts badly enough that the person simply can’t train due to the pain.”

Instead of ignoring that muscle or ligament strain, see a qualified health care provider and expect to spend a few weeks to a month or more recovering, depending on the severity of the injury, your age and other factors. Most importantly, complete your entire rehabilitation process so another injury doesn’t occur, Cheatham said. No stopping the minute you start feeling a little better.

A positive mindset is also key to a speedy recovery. “If you think you will not get any better, you will not get any better. If you think you will get injured again, you will get injured again,” Maranan said. “It starts with your mindset, then religiously doing your home exercises and your post-exercise recovery routine.” And remember, stay mindful to stay true to form.

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