Squash Injuries: Ice is still the Queen!

Most squash injuries are not acute or catastrophic – mostly they are “itis'”: usually some type of tendonitis – sometimes a bursitis.  These are usually caused by an increase in training or competing volume to a level beyond the fitness preparation of the athlete.  Although the intensity of training is also a factor – most studies of high volume sports (like squash or running) point to an increase in volume (e.g., miles run per week) as the culprit.

Is Inflammation “Good” for Squash injuries?

Similar to recent sport science discussions on the benefit of stretching as part of an sport warm-up, the role of ice in managing sport injuries is a currently a hot topic.  The most recent controversy involves a scientific study that concluded that inflammation can actually speed the recovery process – the implication bringing  traditional methods of reducing inflammation, ice and NSAIDs, might not be recommended.

For Now – Continue to Ice Squash Injuries

Until this research controversy concerning the use of ice (for example the above study on inflammation was performed using mice as subjects:), I am going to continue to recommend its’ use – here is a copy of an e-mail I just sent out to my athletes – it is one week before our National Championship – and they have not been that great on caring for their “itis'”:

“1.  “itis” = inflammation.  3 ways to reduce inflammation: time (2-3 weeks), ice, NSAIDs.

– we do not have 2-3 weeks.
– NSAIDs impede healing process

that leaves ICE as the only available way to reduce inflammation (the swelling that accompanies inflammation that prevents bloodflow (bring nutrients, eliminate waste) to the injured area.

ICE also reduces pain/soreness – which makes it easier NOT to do compensatory movements of surrounding joints (i.e., because of the soreness you adjust your gait and put additional load on the back when your hip hurts).

If you have an -itis you should (i.e., you are letting the team down if you do not) ice every 2-3 hours during your off-time (i.e., this weekend).

Here is my list of people who have an -itis:

E – wrist/glut
G – ankle/wrist/shoulder
M – knee
H – hip/knee
J – foot/ankle
C – back

Many of you do not seem to “see/get” the connection between your own injuries and practice (“we do not do enough fitness”) – when more than one of you has an injury I have to lower the intensity (and therefore the quality) of practice – it also prevents me from having us do the exact type of training we need to do (e.g., we should have been doing HUGE sprint workouts the last 2-3 weeks).

I also think that some of you do not “understand” fitness properly.  I think many of you see fitness as a very “short-term” phenomonem.  It takes 2-3 months (at least) to establish a base or foundation for more intense training.  So when you show up in October and it is evident that you have not been doing the off-season workouts (sent out officially in August this year – but available 24/7 on our blog and through CP) – and also evident that you have not been playing squash every day since arriving on campus, basically I know we will be in big trouble during the season.

So with five days to go – all we have left is ICE – so make sure you do it!”

Importance of Prehabilitation & Regeneration to Injury Prevention

Now if you look at the above list of injuries (this late in the season) you would have to say “That coach is an idiot!”.  In actual fact, I pay more attention to planning training (with particular attention to training volume and intensity) and injury prevention than most coaches.  We adhere religiously to the CorePerformance training philosophy and do their Movement Preparation and Prehabilitation routines at the start of every practice (we actually have not had one classic ankle sprain or knee injury this year), and specific Regeneration sessions several times a week. We gradually increase the volume of training at the start of our season, starting with two practices a week, adding one practice per week until we get to five per week.

Cause of High Injury Rates in Division III Athletics:  The NCAA

A major part of the injury problem in U.S. College Division III Athletics can be placed squarely on the shoulders of the  NCAA.  If you asked an organization to design a season designed specifically to injure athletes, they could not do a better job!  The NCAA violates all logical training principles of both periodization and long term planning (e.g., LTADs) with the season length constraints (maximum of 19 weeks of coach supervision allowed) that they place on their members.  To “rub salt into the wound” or “insult to injury”, the NCAA has just passed legislation that only allows supervised out-of-season workouts when the person supervising is a NSCA Certified  Strength and Conditioning Specialist (CSCS).  This has serious implications for departments with no budget to hire a CSCS – for example I am the only CSCS in my department.  This places almost the entire burdern of staying in shape in the hands of relatively low-level, low-experience (i.e. the Division III American athlete) people – the young athletes on our teams.

The European club training model, a much longer season (8-11 months) with two coach supervised practices a week, with a competition on the weekend during the competitive phase of the season is a much more reasonable approach to training developing athletes (which the Div. III Americans are). Unfortunately, most decision-makers in the NCAA are not sport experts at all, but mostly administrators with some coaching or sport participation experience (i.e., no formal sport science education), with very little exposure to sport outside the U.S. (the mistaken myth of American superiority:).

Application for Squash Coaches:

  1. Awaiting further research on the benefits of icing – continue to ice squash injuries.
  2. Try to minimize the damage of the NCAA imposed season length of 19-weeks by encouraging preseason workouts, planning carefully and frequent use of prehabilitation and regeneration strategies.

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