Understanding Common Soft Tissue Injuries in Endurance Sport

No matter how smart you train, endurance sport comes with the risk of soft tissue injury. Here’s how to understand soft tissue injuries so you can recover better.

In an ideal world, you’d enjoy a lifetime of biking, hiking, running, and swimming without so much as a twinge. But pushing the boundaries always comes with an element of risk. For endurance athletes, the most common risk is injury.

If you do get injured during training, your first port of call should always be a sports injury professional. But it helps to know what you’re dealing with and what exactly is happening to your body. The more knowledge you have about your body, the better you can cope with injury when it happens (and the more likely you are to apply the right kind of treatment).

In this article, we’ll look at soft tissue injuries: those which affect the tendons and ligaments, muscles, and cartilage.


What Is Soft Tissue Injury?

“Soft tissue” generally means the bits of your body that aren’t skeletal tissue (bones) or organ tissue. But for the purposes of this article about injury, we’ll be talking about muscles, tendons, ligaments, and cartilage.

The most common injuries in endurance sport are those which affect soft tissue (if we ignore road rash for the time being!) Strains, sprains, and tears are familiar terms to any endurance athlete. Let look at exactly what they mean, why they might happen, and what you should do if you sustain a common soft tissue injury.


Understanding Your Body’s “Soft Tissue”

Muscle tissue is one of the most obvious types of soft tissue in the body. There are well over 640 named muscles in the human body, from the very obvious (your biceps, pecs, glutes, and quads) to the smaller but very important ones (like the psoas and the teres major) and even the ones you can’t see in on the surface.

The human body has different types of muscle: skeletal muscles are responsible for moving parts of your body, visceral muscles are controlled by the autonomic nervous system, and cardio muscles are in the heart. For this article, we’ll be looking at skeletal muscles, which are made of individual striated muscle fibres activated by motor nerves, all of which is surrounded by connective tissue. The primary job of your skeletal muscles is to shorten (produce contractions), so your body can move the way you want it to.

Did you know: the smallest skeletal muscle is the stapedius, found in the ear where it stabilises the smallest bone in the body. It’s about 1mm long.

Tendons connect skeletal muscles to the bone so they can be a pulley system for various parts of our body. Unlike muscles, tendons are made of elastin and collagen. They are very strong and stiff (which can be both a pro and a con when it comes to injury!) Tendons also have a smaller blood supply than muscles.

Did you know: your Achilles tendon (which attaches your calf muscles to your heel bone) is the thickest tendon in the human body. It can be responsible for more than 50% of the force you produce when taking a running stride.

Ligaments are short, tough sections of connective tissue which connect bone to bone, where they act to hold joints together and give more stability to your skeleton. They are made of elastin and collagen, but contain less elastin than tendons (this is why they are move so much less).

Did you know: the strongest ligament in the human body is considered to be the iliofemoral ligament, which connects the hip bone to the thigh bone. Its tensile strength can be in excess of 350 kg.

Cartilage is the kind of rubber-like padding that protects the ends of bones. It covers the end of long bones at the joints, and is part of the rib cage, intervertebral discs, ear, and nose. We are born with more cartilage than we have as adults (some of it forms into bone), and the high water content of cartilage decreases as we get older.

Did you know: cartilage doesn’t have any blood supply, nerves, or lymphatic system.


Sprains vs Strains

They sound similar, but these two types of soft tissue injury are completely different. A sprain affects the ligaments, whereas a strain affects muscle tissue. You could have a sprained ankle, but not a strained ankle, and strain your hamstrings (but not sprain them).


Skeletal Muscle Injuries

Muscle tissue injuries are the most common type of soft tissue injury you will encounter as part and parcel of a sporty lifestyle. You are most likely to strain a muscle, but you could also suffer a muscle laceration or muscle contusion.

Muscular injuries usually occur when the muscle is forced to stretch beyond its natural ability, or if the force put through the muscle is more than the force it can produce. This leads to the muscle fibres separating, and a muscle strain occurring. Strains can be grade 1, grade 2, or grade 3. You will usually feel a sharp pain, followed by a sense of stretching or movement that feels unfamiliar and strange.

A grade 1 strain means that fewer than 5% of the fibres have been damaged, whereas a grade 3 strain is a rupture of the muscle (and can often require surgery).

The most common tendon injury is tendonitis (also called tendinopathy), where the tendon has been overloaded by movements like running or jumping over a period of time. As an endurance athlete, you are most likely to experience tendonitis below the knee, on the sole of the foot, or in the Achilles tendon.

The main issue to recognise with tendon overload injuries is that the reason for the injury is that the tendon couldn’t cope with what you were asking it to do. Rehab exercises and load modification is a huge part of treating tendon injuries. Any problems with tendons should be treated holistically, also looking at the muscles, movement patterns, training load, training surface and other significant factors.

Ligaments can be over stretched during endurance sport, which will cause the tough fibres to separate and a ligament sprain to occur. A grade 1 ligament sprain is a microscopic sprain with relatively little soreness or swelling, and a grade 3 sprain is a rupture with a lot of soreness and loss of instability to the joint.

Cartilage injury typically occurs from acute stress on the joint, from wear and tear, or from trauma to the area. Minor cartilage damage can improve with rest, but major cartilage loss and deterioration may require surgery.

With any form of injury, it’s important to stop doing the thing which caused it to happen, before you seek the help of a medical professional and/or appropriate sports injury specialist. But now you are armed with this knowledge about different forms of soft tissue, and common sporting injuries, you will be better equipped to handle the rest and rehabilitation period.

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