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HPRC Fitness Arena: Physical Fitness

Injury Prevention Part 5 – The IT Band

The iliotibial band isn’t a piece of equipment—it’s a strong band of tissue that connects your thigh to your lower leg, and it’s prone to overuse injuries.

If you start to notice hip or knee pain during your PT runs, you might be experiencing iliotibial band friction syndrome—ITBFS for short—a common overuse injury. The iliotibial band, or IT band, is a thick band of fibrous tissue that extends down the outside of your thigh to where it attaches to your tibia (your larger lower-leg bone). As with all injuries to muscles and tendons, prevention is key. In most cases, ITBFS is brought on by combinations of factors—such as increasing your training mileage too fast, running on banked surfaces or downhill, pre-existing IT band tightness, and weakness of the lateral hip muscles—so paying attention to all of these is important for prevention. Incorporate some of these methods into your daily routine to help prevent ITBFS:

  • A hip-conditioning program, as recommended by the American Academy of Orthopaedic Surgeons, can help you prevent ITBFS.
  • Self-myofascial release methods such as foam rolling can be helpful with this hard-to-stretch area of your leg.
  • Don’t do too much too soon. Gradually increase your running mileage or workout intensity. Guidelines for healthy adults include: (1) Increase the duration of your exercise program 5-10 minutes every one or two weeks over the first four to six weeks; or (2) increase your weekly training volume by no more than 10% per week.
  • Stretches for the IT band and other muscles of the thigh and lower leg should be held for 30 seconds and repeated three to five times daily.

If you already have ITBFS, you probably notice more pain in the lateral (outside) hip or knee when you run downhill or when lengthen your stride. If left untreated, it also can lead to pain when you walk up and down stairs or sit for long periods of time with your knees flexed. Of course, you should consult with your physician for proper diagnosis and treatment. On your own, however, care usually includes the RICE and ISE methods.

Allowing time for the iliotibial band to heal is important for full recovery, so consider an alternative training routine (take a break from running and cycling) or take time off altogether. As the inflammation subsides, it may help to add stretching and strengthening exercises.

Injury Prevention Part 4 – The Back

Back pain is common among military personnel. Follow these tips to maintain a healthy back and stay at the top of your game.

A 2011 study of musculoskeletal injuries in an Infantry Brigade Combat Team deployed to Afghanistan found that low back pain due to stress and strain on the back (not actual spinal cord injuries) was the most common complaint. Common causes of back injury include overuse, poor physical conditioning, and incorrect body movements when lifting and moving objects. Fortunately you can decrease your chances of injuring the muscles and ligaments of your back. The key is prevention: Stretching is one way to help prevent lower back pain, but it’s essential to use correct posture and body mechanics when you pick up and move objects such as heavy ammo cans! Daily back exercises (from the Mayo Clinic) and stretches can help strengthen your core and improve your posture, and the University of Maryland offers more valuable tips for prevention. If you’re experiencing back pain, however, you need to see a qualified healthcare professional for an accurate diagnosis and exercise program.

Injury Prevention Part 3 – The Rotator Cuff

Injuries to the shoulder are common among military personnel—take steps to keep yours injury-free.

Staying in the physical condition you need for demanding duties and missions means that you are at risk for specific types of injuries, and rotator cuff injuries are common among service members. The rotator cuff is actually a group of muscles key to shoulder movement, including the ability to perform overhead activities. For those who are preparing for the CFT, this includes performing the Ammo Lift.

Warning signs of a shoulder injury can include not only pain and abnormal sounds during shoulder movement but also a decrease in strength and mobility/motion. What can you do about it? First, check with your healthcare provider to make sure that your injury does not require medical treatment. Then:

  1. Rest your injured shoulder! It is important to allow adequate time for healing.
  2. Use the RICE and ISE methods.
  3. Strengthen the muscles that control shoulder movement.
  4. Make sure that you have adequate flexibility of the rotator cuff muscles.

Of course, it’s always better to prevent injuries in the first place. To help reduce your risk of rotator cuff injury, it’s important to develop the strength and flexibility of the related muscles. For specific information on rotator-cuff exercises and self-care, check out these suggestions from MedLine Plus (a service of the National Institutes of Health) and this conditioning program from the American Academy of Orthopaedic Surgeons.

Get to know HPRC better

Learn about all the areas HPRC covers and what “human performance optimization” is.

The Human Performance Resource Center is here to serve Warfighters and their families, commanders, and healthcare providers. If you’ve visited before, you probably know that we focus on “total force fitness.” But do you really know what that means—or how HPRC got started? If you’re curious, check out this PDF that describes HPRC, what we do, and the vast amount of information we cover. In addition, you may have noticed that we use the term “human performance optimization” throughout our site; this article also explains what that means.

Injury Prevention Part 2 – Don’t neglect your ankles!

Injuries to the ligaments of the ankle are very common in the military, but there are some important tips you can use to help prevent them.

Stretching and strengthening the muscles of the foot and ankle can help you prevent (and recover) from ankle sprains. The Foot and Ankle Conditioning Program from the American Academy of Orthopaedic Surgeons focuses on recovering from injury, but it includes well-illustrated exercises that are good for preventive conditioning too. Here are some other exercises useful for strengthening the foot and ankle structure:

  • From a seated position, “pretend” writing the alphabet with each foot, in both upper- and lower-case letters.
  • Stand on one leg on a pillow for 10 seconds and then switch legs. Be sure to have something nearby to grab for balance if necessary.
  • From a seated position, use a resistance band looped to a secure surface, and wrap the other end around your forefoot; then move your foot/ankle forward, backward, and side-to-side, flexing at the ankle.

An ankle sprain involves damage to ligaments—bands of tissue that help hold joints together—in the foot and ankle, usually from the force of landing wrong on your foot. In military populations, ankle sprains are very common, significantly affecting operational readiness. In fact, ankle sprains are more common in the military than in civilian populations and more likely among women than men. By strengthening the muscles in your legs and feet, you can give more support to your ankle in the event of a misstep or an encounter with uneven terrain. The transition from military boots, which offer more ankle support, to traditional athletic shoes may also leave you and your ankles feeling vulnerable to twists and sprains. Start including ankle-strengthening exercises into your daily workout routine to help keep your ankles strong and free from injury.

Injury Prevention Part 1 – The Knee

Knee injuries are common in the military. Follow these prevention tips to keep your knees healthy.

Figuring out knee pain can take some detective work, although injuries are a common cause. For example, sports-related injuries such as anterior cruciate ligament (ACL) tears and chondromalacia (also called “runner’s knee”) can cause pain and affect performance. You can help prevent such injuries by strengthening your lower leg muscles. Strengthening your hamstrings and quadriceps, which cross the knee joint, can give extra stability and support to your knees. Leg exercises such as squats, lunges, curls, and extensions will improve muscular strength and endurance in your hamstrings and quadriceps.

Weight management is also important in preventing some knee injuries. Excess body weight only adds stress to the knees during weight bearing activities, like walking, running or jumping.

Another key to prevention is listening to your body. If you feel that minor symptoms are getting worse, it might be a good time to temporarily modify your training until symptoms subside. For example, if running is part of your cardiovascular routine, consider trying a few weeks of alternate activities that are less stressful on the joints such as swimming or biking.

Is wicking apparel as “cool” as you think?

Clothing made from synthetic material is still popular in the sports apparel industry, with many manufacturers claiming that it improves heat regulation. That’s not what the science says, though.

Walk into any fitness center on base or take note of a group of soldiers training, and you’ll probably notice at least a few people in form-fitting synthetic t-shirts. The sports apparel industry has exploded in popularity over the past decade, with numerous manufacturers now competing to develop, market, and sell the newest pieces of clothing (shirts, shorts, underwear, socks), all geared to keep athletes cool while competing or training in hot environments. Is there any science behind these claims? Does tight-fitting clothing made of “high-tech” materials actually help with heat regulation and enhance athletic performance?

You heat up when you exercise, and sweating is the primary method your body uses to stay cool. Sweat evaporating off your skin is the most important method your body has to cool itself during exercise. High-tech materials are supposed to enhance “wicking”—the delivery of sweat away from the skin surface toward the clothing, which allows for evaporation—and limit the absorption of sweat by the clothing itself. Cotton, by contrast, absorbs moisture, so it’s not considered a good choice for exercise.

To date, there’s no evidence that this high-tech clothing improves thermoregulation when worn during exercise in hot environments. Specifically, researchers found no differences in heart rate or body and skin temperatures when subjects performed repeated 20–30 minute bouts of running outfitted in shorts, sneakers, and either a form-fitting compression or traditional cotton t-shirt. Research has also found that wicking sportswear had no effect on cooling when worn under a bulletproof vest or on a cycling sprint when worn under full ice hockey protective equipment. As of now, the best advice for staying cool during exercise in the heat is to wear lightweight clothing, stay properly hydrated, and listen to your body for signs of potential heat illness. For more information on performing in hot environments, please visit the “Heat” section of HPRC’s Environment domain.

Introducing the injury prevention series

You’ve worked hard to get to the level of fitness you’re at. If you want to stay there, here’s the best tip we have: Decrease your risk of injury!

The physical demands of military life are challenging, and if you’re not prepared, they can lead to injuries. The injury prevention series we’ll be running over the next several weeks will provide you with information and strategies for preventing some of the most common injuries: those to the knee, ankle, rotator cuff, back, iliotibial band and wrist/hand. Prevention is key: Taking time for the small stuff may have big payoff down the road. Much of what the exercises done for recovery after an injury can actually be done to prevent the injury in the first place. Stay injury-free for optimal performance! Check back soon for the first in this series.

Periodization: Mixing up your workouts for more gain

Same old resistance training program not getting you anywhere any more? Systematic variation of your workouts—known as “periodization”—could make the difference.

Have you ever wondered why people who do the same resistance training workouts day after day aren’t getting the results they want? The goal of resistance training is to create an “adaptation response”—that is, to get your body to change in response to the demands. Once your body has adapted to a specific training program, you need to change the demands you place on it. If you don’t, you’ll find yourself eventually reaching a plateau where you don’t make any more gains—or sometimes even lose progress. One way to avoid this common training mistake is to implement “periodization”—the systematic shaking up of your routine (intensity and numbers of sets and reps). This method can optimize your training gains and minimize the risks of overtraining and injury. Implementing these training routines requires a strength training expert, so make sure you seek assistance. For example, the Army has implemented a new program for Master Fitness Trainers. And for more information on strength training, check out the HPRC’s Performance Strategies for Muscular Strength.

What’s the “evidence” behind sports performance products?

Many advertisers of dietary supplements and other sports-related products make claims of enhanced performance and recovery, but a recent review found that the current evidence supporting these claims is mostly insufficient.

The dietary supplement and fitness industries are filled with sport drinks, powders, bars, pills, gels, footwear, clothing, and an array of devices all claiming to provide you with a competitive advantage, whether it be improved performance or enhanced recovery. With the ever-growing popularity of team and individual sports, professional and recreational athletes of all ages are an easy target for these claims. But how many of these claims are backed by evidence-based research?

A recent report now reviews the quality of evidence behind the claims of improved sports performance made by advertisers for a wide range of sports-related products, including sport drinks, supplements, footwear, and clothing. The team identified 431 performance-enhancing claims for 104 products advertised in more than 100 general, sport, and fitness magazines in the UK and U.S. for a single month in 2012. They found that more than half of the advertisements and their associated websites provided no evidence to support the claims of enhanced sports performance. Only 146 references were found, and only 74 of these met basic criteria for research quality and almost all of the 74 were found likely to be biased or lacking scientific objectivity. Only three studies were rated as “high” quality and probably unbiased. Such lack of evidence makes it very difficult for consumers to make well-informed decisions about using performance-enhancing sports products.

This review makes it clear that many of the claims made for sports and fitness products lack reliable evidence to support them and that more and better studies are needed to help inform consumers. In the meantime, consumers should be cautious when reading claims of enhanced performance and recovery and always remember that “true” evidence-based results mean that a substantial number of independent research studies have been performed, with findings that clearly support the claims made by advertisers. Presently, there is still no substitute for sound physical conditioning and nutrition practices.

For more information on dietary supplements and how to choose supplements safely, please visit Operation Supplement Safety (OPSS). For information on physical fitness and conditioning, please explore HPRC’s Physical Fitness domain. The original British Medical Journal open-access article is available online.

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