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Warm-ups injury prevention

Warm-ups: Worth the effort?

Most of us – coaches, trainers, athletes – buy into the ‘self-evident’ benefits of performing a warm up before our training sessions, and if we’re ever questioned on it, we rattle off something along the lines of ‘get my body ready… loosen up the muscles… get the blood pumping… it helps prevent injury’.

But does it? Although injury prevention is frequently cited as the main reason for undertaking a warm-up, the reality is that no one knows if it makes any difference. Now, Andrea Fradkin from Melbourne’s Monash University has undertaken a systematic review of studies completed over a 40-year period (Does warming-up prevent injury in sport? The evidence from randomised controlled trials, Journal of Sports Science and Medicine2006: 9, 214-220).

Surprisingly, she could find only five papers that had investigated the effects of warming up on injury risk and physical activity. Three of the studies found that the warm-up significantly reduced the risk of injury, while two studies found that it did not. This finding may not set the world alight, but it includes a couple of interesting observations:

* In the three ‘positive’ studies there was a greater focus on exercises that increased body temperature. In the ‘negative’ studies, the warm-up focused heavily on the stretching component.

* In the three positive studies the reduction in injury was related to participant age and type of physical activity undertaken. In the two other studies subjects had a wide range of ages and activities.

* In one of the negative studies, poor compliance among the warm-up group (68.4%) was a potential limiting factor.

From Fradkin’s review we can draw the following practical implications:

* The weight of evidence is in favour of warming up in an attempt to reduce the risk of injury.

* The potential for reduced injury rates may be greater if the type of warm-up relates directly to the activity subsequently undertaken, and where the participants are of similar ages. The warm-up should be sport-/activity-specific and tailored to the age of your client/group.

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Frozen peas: do they work?

The application of ice after an acute soft-tissue injury is accepted clinical practice, even though the strength of evidence supporting the use of cryotherapy in the management of this type of injury is generally poor. Lets face it, while we all do it, there is little agreement about what is the right protocol for applying ice. How long should we apply it for, and how frequently? For the first time, researchers based in Northern Ireland have conducted a controlled study that stringently compares two different cryotherapy protocols (Cryotherapy for acute ankle sprain: a randomised study of two different icing protocols, British Journal of Sports Medicine, 2006: 40, 700-705).

The following two protocols were used:

* Standard ice application, consisting of 20 minutes of continuous ice treatment performed every two hours. This duration of treatment has been recommended in the literature and is also commonly used in clinical settings.

* Intermittent applications, consisting of 10 minutes of ice treatment followed by resting the affected part (ankle) at room temperature for 10 minutes, followed by a further ice treatment for 10 minutes.

Both groups repeated the treatments every two hours during the first 72 hours of injury.

The study found that intermittent cryotherapy for a mild/moderate ankle sprain significantly reduced the level of subjective pain on activity, one week after injury, compared with the standard protocol. Although there was no significant difference in terms of function, swelling, or pain at rest, the study has highlighted that shorter intermittent applications of ice may enhance its analgesic effect after an acute ankle injury.

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DOMS: can anything be done?

Japan is an emerging nation when it comes to sport science, and recently a team based at the school of health and sport science at Funtendo University have provided me with some ammunition (Effect of aqua exercise on recovery of lower-limb muscles after downhill running, Journal of Sports Sciences, 2006: 24(8), 835-842)to convince people that the pool is the way to go if you want to return to training quickly after a bad case of DOMS (delayed onset muscular soreness). I am a huge fan of aqua exercise, yet it seems that, in the UK at least, many coaches and athletes still need convincing about the benefits of training in water.

In the Japanese study, 10 distance runners with DOMS were divided into two groups. The aqua exercise group performed 30 minutes of walking, jogging and jumping in water on three successive days while the other group rested. The study found that aqua exercise facilitated the recovery of physiological functioning of the leg muscles after high intensity eccentric exercise (muscle power, muscle stiffness and muscle soreness were all shown to recover more quickly after aqua exercise compared with just resting).

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Warm-ups injury prevention