It all adds up
A global view of injury management
Have you ever been out on a training run or ride and something starts to hurt?
I am not talking about pain from difficulty or intensity, but rather the variety that makes you say “That doesn’t feel right”.
Did you immediately attribute that session on that day as the culprit?
If you tripped in a hole, fell on a trail, or got hit by a car, that may be true. However, not every injury that crops up happens this way. There is often more to the story.
Your body is quite robust. If you think about it like a cup, you can fill your body with a variety of stressors that can be processed and handled without overflow. It would suck if every stressful input resulted in our body breaking.
It is when we exceed our limits long-term that the system begins to break down. If the stressors are in excess:
Training
Lifestyle
Sleep
Mental
Physical
your cup begins to overflow and something has to give. Therefore, the pain in your knee, hip, calf, etc that you feel during your standard morning training session might be a culmination of events.
As mentioned in one of my favorite recent reads, The Nature of Training by Manuel Sola Arjona, “It is almost always a process, not a [single] reason…and whatever happens to you depends not just on the last event, but on the entire path.”
What can you make of this?
Everything you do has a cost and we can use this idea to engineer a rational approach to managing or mitigating injury. The coolest part about this approach is that you do not have to wait for a critical point where things are falling apart to take action. You can start today, even if you have never experienced an injury.
An attack from all angles
There are a variety of ways to keep yourself out of trouble. Smart training habits, proper sleep, and a healthy mental state are enough to get you most of the way there.
We like to pay homage to stretching, strengthening, ice baths, and the like to keep our injuries at bay. These are effective means of doing that, but these interventions make up a small slice of the pie.
In other words, no amount of strength training or mobility exercise is going to replace a lack of training structure, or even more important, life structure.
Your goal is to build a robust human of yourself and it requires an attack from all angles. How can you do that, you ask?
Let’s have a look.
Physical
When a patient walks into the physical therapy clinic, the inclination as a PT is to examine the body structures and identify an area that may be leading to injury.
Sometimes I can find a clear deficit such as the strength of one calf, or entire leg, that is different than the other. Or perhaps a remarkable difference in flexibility. We may even be able to make some recommendations concerning running technique or bike fit. However, changes in strength, range of motion, or technique are often a result of pain and may not be the root cause of the injury. We aren’t as strong, supple, or nimble when stuff hurts! What do we do this this information?
That is where a discussion of training habits becomes equally if not more important. If we remember from above, it is the path that leads to breakdown, not necessarily a one-off event. Looking for a mechanical issue is valid, and the rehabilitation will likely include interventions to address decreased strength or range of motion. The investigation also includes asking the athlete about recent increases in volume or intensity, changes in terrain, or a period of higher non-training stress.
Furthermore, successful rehabilitation from injury includes training, both in diagnosing the problem and working toward a solution. Complete cessation from the activity is not always indicated.
Maintaining a load that can be handled is going to keep the athlete within his/her physiological envelope, developing a path that is divergent from the one that resulted in system overload. Once that plan is established, our more traditional strength, flexibility, and mobility interventions can be worked into the plan for enhancing performance rather than patching up an injury. If performance is enhanced in training, you are likely on a better program and less likely to suffer from injury.
We like to use the term “gradual return”, but I would argue that there should be no “return” at all; at least in the sense that you are returning to the same path that ended in an injury. There needs to be a change of habits or context for training. Perhaps we should paint it in the light of new and improved rather than a return to baseline.
Mental
As mentioned before, pain can be complex. A tired body and an overloaded mind may be more sensitive to pain. Something such as strength training is unlikely to solve that conundrum completely.
Another common presentation is an athlete with injury anxiety. This can often cause us to move differently or in a way that avoids pain. This is a normal response but not always ideal. Once the injury has left the acute stages, resuming the activity may be uncomfortable mentally even if there is no physical harm. Easing the uncertainty of this process can be facilitated by working with a professional to help prove that your body can do the tasks you desire. You do not need to go about it alone.
Calm it down, build it up
At the end of the day, an injury typically requires a recovery period and a plan to do things differently in the future. Understanding that the path that resulted in physical or mental breakdown is essential to mitigating a sore knee or flared-up calf. As a physical therapist, I want to be of service to athletes and help them develop this understanding to achieve the peak performance that is desired.
Want to work with me? Head over to eliteedgecoached.com for coaching or to performancerehabkc.com to book a visit for physical therapy.