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situations can occur in an instant through some accident or contact with something or trip or fall and none of us can truly create a physical activity environment that is completely safe from these occurrences. These injuries, in a sense, can be classed as uncontrollable. Injury can also occur after a journey of mishaps and accrued errors in movement and training and these we class as controllable. This article focuses on controllable injuries and the illustrations are primarily taken from the world of sport and physical activity although the execution of lifes daily tasks at home and in the workplace also forms an arena where controllable injury can take place. In sport, we often observe and measure activity in terms of the speed, endurance
or power that underpin the sport-specic movements on view. The 21st century provides us with extensive technology to measure just about everything, and we now see an army of practitioners surrounding the athlete as they journey towards the holy grail of repeatable excellence. As advantageous as all this measurement is, especially when we can measure the speed of movement, the distance covered, the forces received and delivered, the patterns of ground coverage, the passes and tackles achieved and the technical skills and errors accumulated, the more it can shield us from the real issues that surround the controllable injury cycle.
MECHANICAL EFFICIENCY
The body is designed to move in a certain way, a series of interconnected levers, stabilised and moved by muscles and fascia. Certain body structures are designed for certain tasks sequences of muscle actions have the ability to produce, reduce and stabilise force in a complex environment that react to all the senses the human body has at its disposal a never-ending cycle of neuromuscular activity that links
Br J Sports Med July 2011 Vol 45 No 9
Editorial
the brain to the body and the body to the brain automatically and reactively. This is the world of mechanical efciency where each constituent part plays its role in a well-ordered, sequential, sympathetic operation that maximises the role of each individual part in a complex system of connection. What has this mechanical efciency got to do with controllable injuries? Plenty. In simple terms, the body creates movement in a pattern whereby each part plays the role that it was designed for. As one part stabilises, another might move, as one part exes another may extend, as one part rotates another may bend all in an efcient and coordinated sequence that maximises each part of the pattern.
sets of exercises designed to improve performance now become the enemy as they create microtrauma in those body parts that are doing things they were not designed to do. Little may be seen by the coach as this process continues. The body keeps on adapting and compromising to carry out the tasks and to the untrained eye all appears to be ne. Continue the training load and the microtrauma continues its journey to macrotrauma and unfortunately can continue until catastrophic tissue failure occurs. The usual response is that the injury or accident came out of the blue, was a surprise, everything was going well. A quick x by the sports medical team, a bit of rest, a few drills and back to the training process is the usual order of the day. Discerning practitioners, however, see things a little differently and have a different approach to the performance environment. They do not assume that everything is well, they question the assumption that just because the person is carrying out the physical tasks that all is well. They look deeper into the area of mechanical efciency by assessing the aforementioned movement patterns. They guarantee movement efciency; in fact they must guarantee repeatable movement efciency, before considering the training frequency, density and intensity. From this position of movement, efciency can grow the process of creating injury resilience by the progressive adaptation to the appropriate load. The body will have to compromise less, nd less inappropriate solutions to movement puzzles, and work and move more efciently, quite a number of qualities to consider in the whole scheme of things.
Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed. Accepted 20 May 2011 Br J Sports Med 2011;45:684685. doi:10.1136/bjsports-2011-090243
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Copyright of British Journal of Sports Medicine is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.