Injury prevention – Tim Dellwo, DPT, OCS, FAAOMPT

As a fellow firearms enthusiast and competition shooter, I love seeing like-minded folks engage in the passion of shooting. It hurts me to see people sustain injuries while shooting or because of shooting, and no I’m not talking about self inflected gunshot wounds. How many of you have shot a match or taken a class and felt a tweak or twinge in your back, knee, ankles or any other area of the body?

I’m here today to talk injury prevention, specifically soft tissue injury prevention and looking after your body so that you can continue to train and compete at a high level and maybe in future articles how to improve your speed, accuracy, strength, power, motor control and efficiency of movement

Who am I? My name is Tim Dellwo and I am a doctor of physical therapy, a certified orthopedic specialist and a fellow of orthopedic manual physical therapy. In my practice I see a wide gamut of orthopedic injuries from simple sprains and strains to extensive post operative reconstruction surgeries, chronic lower back pain and the like.

Let’s first tackle the least complex types of injuries, minor sprain and strains to muscles, tendons and ligaments. Simply put the muscle body is the part of the muscle that contracts (produces movement either by lengthening or shorting), tendons connect muscles to bones and ligaments connect bones to other bones. Simplistically muscles, tendons and ligaments are predominantly made up of type 1 collagen that responds and resists tension or a stretching force (pulling that structure apart from one or both ends). The muscles, tendons and ligaments ability to resist this stretch come down to how much type 1 collagen is present in the individual muscle, tendon or ligament, the alignment of those collagen fibers,  how resistant that collagen is to stretch (how strong it is), the range of motion available to stretch before the bonds of collagen will start to break.

So how do bonds of collagen break? Well like any structure that resists tension we can use this simple stress/strain curve. Simply put collagen will resist tension stress without deformation up to the plastic stage. Once enough tensile stress is put on collagen it will move into the plastic range where permanent changes occur (this is not necessarily a bad thing – we will talk later about this under stretching), if you cont to put tensile load past the plastic point that tissue will reach its breaking point and tear resulting in injury.

 Injuries to soft tissue like muscle tendons and ligaments usually comes from a fast forceful movement that puts too much tensile stress on that tissue exceeding the max tensile strength resulting in tearing of collagen and damage to the tendon/ligament/muscle. Tearing can be graded in to 3 stages of worsening severity but this conversation is about soft tissue injury prevention not types of soft tissues injuries, so how do we prevent them?

If tearing of collagen occurs with increased tensile load and the length at which that tissue can stretch then we want to improve two things; collagens ability to resist stretch (strength) and the amount that it can stretch (flexibility)

Strength of collagen (its ability to resist tensile stress) can be built by increasing the tensile load to that tissue (in a safe manner) repeatedly over time, think strength training.

(Disclaimer – Strengthening of actin and myosin (contractile portion of the muscle) people typically associate with muscle strength is different and maybe another discussion topic – exercise dosing for different effects, power, strength, endurance etc.)

Take the bicep braci, we know the bicep when it shortens (concentric contraction) flexes the elbow, so when it lengthens eccentrically (tensile stress) it extends the elbow, doing a simply bicep curl with resistance will put tension in the line of stress for that tissue the result is type 1 collagen bonds will get stronger and it will help those fibers orientate themselves in a more parallel alignment increasing the biceps ability to resist stretch and tension. The current recommendations to build strength in the bonds of type one collagen is 3 sets of 15 at a resistance than you can perform eccentrically but not concentrically, this means you can control the weight down but not up, this means A LOT of resistance which if you don’t have a spotter and you don’t perform resisted training regularly this is unpractical. In general if your body is use to resistance training you want to lift the heaviest weight you can 3 sets 10-15 times if you want to improve the strength of collagen. (This dosing recommendation is different for strength (actin and myosin), endurance, motor control, tissue revascularization)

The other variable to consider is type 1 collagens ability to elongate and stretch, think range of motion and flexibility here. If you bicep can tolerate 100lbs of tensile load but cannot stretch more than 20 degrees and you provide 50lbs of tensile force but stretch it to 30 degrees it’s going to tear and you’re going to be dealing with a soft tissue injury. This is the part most males overlook and honestly it’s the most important especially for matches like at the arena. Every match is different with its physical strength requirement you have matches like tactical games where the physical demand is high, and you have other matches like steel challenge where the physical demand is less. The arena match is less physical, you are more likely to encounter awkward shooting positions that require greater range of motion and flexibility vs feats of strength. Who cares that you bicep can tolerate 100lbs of tensile load if you don’t have the range of motion to move it into a stable shooting position so that you can effectively engage your target.

So how do we improve range of motion and flexibility we stretch right? Well yes and no, there are actually 2 different ways to elongate collagen. Remember the plastic range we talked about in the stress/strain curve above? The simplistic way to stretch collagen is to take it into the plastic range and hold it there for at least 30 seconds, think classical static stretching. This has a negative, in that you will break apart shorter bonds of collagen in that tissue and in the short term you will decrease that tissues ability to resist tension, this is why athletes do not perform static stretching prior to high level competition. Static stretching should be performed AFTER an athletic event never BEFORE as performance will suffer. The final way to elongate collagen is ballistic stretching, taking that muscle, tendon, ligament through it range and holding it in the plastic range for a brief moment of time, usually recommended to be less than 3-5 seconds. Because collagen is not being held in the plastic range for prolonged periods of time the shorter bonds of collagen will not tear but will be given a stimulus to elongate therefore ballistic stretching should be performed BEFORE athletic activity. In general static stretching is more efficient than ballistic stretching, but something to consider is that it will decrease tensile loading ability in the short term. Pushing your body into a position that it doesn’t want to go will increases your risk for these soft tissue injuries, if you cannot comfortably obtain some of these shooting positions then you need to work on your flexibility.

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