Soft tissue injuries and what the Bears are doing to prevent them

The Chicago Bears, as well as other NFL teams, have been plagued by key players missing significant playing time due to soft tissue injuries. Alshon Jeffery famously suffered four different soft tissue injuries in 2015, and while he did fight through them, they cut into both his playing time and his effectiveness.

What ARE soft tissue injuries exactly? How do they occur? How do sports medicine staffs work to try to reduce the risk of injuries? How does healing from them work, exactly?

Since I happen to be married to a college teacher & physiologist who works at an major university* (see footnote), I asked her the following question: "Soft tissue injuries, we hear about them all the time, but physiologically what exactly are they?"

"It's a mantra of physiology," she replied, "we always remodel, and we remodel in ways that respond to recent stresses."

"When you build a house," she said, "the same molecules will still be part of the floorboards fifty years later. But when you build a bone, you do it by building a 3D network of protein fibers, then hardening them with calcium minerals. Every day, your bone cells add a fiber here, remove a fiber there. The overall size and strength of the bone may not change, but the individual molecules are being broken down and rebuilt all the time. The same is true for other tissues: muscles, tendons, ligaments, hearts even."

"Exactly how much you rebuild, and how the cells place the new molecules depends on signals they get. Growth hormone and testosterone, for example, encourage more rebuilding in general. Some of the signals are much more local. When you lift a heavy weight, you get tiny little tears in the muscle fibers. The immune system comes in to remove the damaged bits (that's why you get sore), and in the process they release signals that tell the cells right around them to rebuild more strongly."

"That's why lifting weights makes you stronger. It's also why keeping up with training is a big step toward avoiding soft tissue injuries torn muscles and tendons, strained ligaments, and the like. An athlete who stays in training is constantly stressing his muscles, joints, bones, ligaments, tendons. They keep rebuilding stronger. Then when he kicks up the intensity in training camp, cutting harder and being hit, the new stresses are less likely to cause injury."

"The athlete who's been on the beer-and-pretzels circuit on the offseason has been rebuilding, but without recent stresses to create signals to regrow stronger, his soft tissues have been rebuilding weaker and weaker. When he does those harder cuts and hits come....he's likely to break."

The Bear's solution? Here are some recent stories in the media about steps Chicago is taking to help reduce the amount and severity of soft tissue injury:

Finley: Bears trying to tackle soft tissue injuries - Chicago Sun-Times - One player says it’s changed the way he’ll work out for the rest of his life.

Emma: Bears’ Alshon Jeffery Working Hard In Personalized Offseason Regimen - CBS Chicago
Jeffery is working on personalized workouts with renowned trainer David Alexander.

Korman: The Bears have actually been focusing on preventing soft-tissue injuries this season - Bears Wire
You wouldn't know it if you looked at Alshon Jeffery's 2015, but the Bears have been focused on preventing soft-tissue injuries

How does what the Bears have to say tie in to the basic physiology? "The things the Bears are doing are the obvious and essential things," she states about the media articles that cover the Bear's training techniques.  "For example, stretching encourages appropriate remodeling by stretching or breaking the tightest of the newly remodeled fibers to keep the joints flexible.  Good hydration helps prevent the injuries in the first place, since well-hydrated muscles, tendons, and ligaments will stretch further before they tear.

"Using foam rollers after workouts improves blood flow," she continued, "bringing in more of the immune cells that will remove the debris from the micro-tears and the raw materials that the cells require to do the rebuilding.  Most importantly, appropriate levels of rest have to be built in to allow the rebuilding to occur.  Working as hard as possible all the time leads the athlete to break down more than they can rebuild, degrading his condition and making him more susceptible to catastrophic injury."

"The key is in how well they encourage the right behaviors; and it sounds from the quotes as if they're doing that with some vigor. So, that's all to the good," she said.

Once a soft tissue injury occurs, it can have anywhere from a minor effect up to a season-ending situation.

According to Mitchell, "Once you are injured, if you continue to play it is expected to eventually heal, but with two important caveats: 1) Healing is likely to be slower, as it's a two-steps forward, one-step back thing at best. Even the micro-injuries that are a part of normal exercise responses represent setbacks to full healing. and 2) The risk of re-injury and additional injury are both high during the healing process. The newly repairing tissue is laid down first and reinforced later, so it's much more likely to tear apart if you stress it between lay down and reinforcement."

One of the knock in the past for some Bears players is that they got too far out of shape in the off-season, which made them more injury prone... but how much time off is too much?

"As to the 'how far out of shape' question: Having a short period of full rest and a longer period of reduced intensity after a hard season is originally helpful, as it allows those small injuries to heal fully," she said. "Once past that (a couple of weeks?) you want to not train any harder than you can recover for the rest of the off-season... but you get maximum protection from going as hard as possible without outstripping your recovery ability. That's going to vary with type of exercise, and vary among athletes too; but if they're being honest with themselves (or carefully tracking times and weights) they can notice when they're wearing down instead of building up and back it off a little."

"That." she states, is "the big value of individualized programs for specific athletes. Work loads and types can be adjusted based on what the athlete can do without crossing the line into overwork, and the type of training can emphasize what that athlete needs to optimize his own playing style, or shore up his own weaknesses (including previous injuries)."

"Periodicity training, where you go pretty darned hard for a week or two then reduce intensity for a week (or whatever time periods you're using) then rinse and repeat, are popular because you get benefits of hard training but enough rest not to get over-use injuries or start the season worn down."

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*Jeanne Mitchell has more than 20 years experience at teaching human physiology, pathophysiology and many other upper level courses for medical students and the sports medicine program at Truman State University. Truman state is consistently ranked in the top colleges in the nation for value (Princeton Review had them #9 in the nation in 2015). Jeanne Mitchell is an extreme-sports athlete who has played and officiated flat-track roller derby for 4 seasons before concentrating on reffing. She suffered a significant soft tissue injury in 2013 following an illegal hit on the track.