The cycle of injury
If you are reading this, you have almost certainly been injured before, or are right now. It may come as no surprise to you that whether an injury or trauma is sustained during activity or not, the effects can be more far reaching than simply mobility or your ability to train!
When injured for extended periods of time, we go through what has been likened to a psychological grieving process
This can occur if you do an activity regularly, and are unable to do it. Your identity can be challenged because you are unable to do what you want to do as it is part of who you are. Emotions like frustration, impatience and even anger set in, and making impulsive decisions often lead to the wrong approach to returning to sport and subsequent recurrence of either the same injury, or commonly an associated (new) one!
So, how does this happen? How can you minimise your chance of re-injury, maximise your ability to resist injury, and progress towards your goals?
Due to the wide variety of injuries, either “acute” (usually one off/short-term) or “chronic” (recurring injuries that manifest themselves over longer periods of time) I will use a case study to illustrate the cycle of injury in a fairly new runner:
Case study: Tony P
Tony P is training for his second half marathon. He finished his first after minimal training, but wants to improve his time and his ability to sustain pace.
Tony has increased his training from once or twice a week to four or five times a week and enjoys running with his local club as well as by himself. While doing a higher intensity run, he feels the side of his knee start to tighten, which develops into pain, which forces him to walk. He tries to run again 2 days later but the same thing occurs and he walks home frustrated as he only has five weeks until race day.
Tony is told by his doctor to rest his knee altogether for 3 weeks, and decides to rest for a couple of weeks thinking that if he can get a couple of weeks training in before the race he can still finish and maybe do well. Ten days into his rest, Tony is bored of not running and goes for a ten minute run to test the knee. Although he can feel it a little, it gets no worse and Tony decides to go and do intervals that evening as he feels the pain has subsided and also wants to see his friends at the club. While doing a fast interval, Tony’s knee becomes slightly more painful but not enough to put him off and he finishes the session with some discomfort. A few days later, Tony resumes training but while on a long run he feels his knee in some discomfort. He continues to run at a slower pace for the 6 miles back to his house. In the last 2 miles he can feel an aching in his hip on the other side to his knee. During the half marathon, Tony has to stop as his hip and Achilles’ tendon are sore and running uphill is very painful.
Sound familiar? This is simply an example of the beginning of the frustrating cycle of injury. So, what is the cause, and, even more Importantly, how can it be broken?
What’s really going on?
As Tony has worked at a desk for the last 16 years, he doesn’t bear his weight much, and the muscles that surround and stabilise Tony’s hips are weak. This allows a lots of stress and impact to going through his knees and lateral stabilisers, which are struggling to cope with his new workload. When his left knee hurts, he subconsciously uses his right leg to drive forward placing an increased strain on the hip stabilisers and lower back on the other side. By primarily firing off the forefoot of his left foot, his achilles has now also become inflamed through overwork.
Because the pain is initially not debilitating, and because Tony misses the sociable running, he is drawn not only into running, but running hard when people who he often beats are pulling away from him at training.
One thing leads to another and with the combination of rest and then frustrating return and subsequent injury, the cycle continues and Tony is unable to run regularly without stopping.
Mistakes and solutions
With few exceptions such as chronic fatigue, complete rest is rarely the solution for chronic injury. Resting from impact in this case is wise, but complete rest for more than a few days allows a process called atrophy to occur. This is where muscles effectively waste away from lack of tension, which renders the body more susceptible to injury. Muscles protect and stabilise joints and weakness generally results in instability and collapse.
Increasing strength around surrounding key joints stabilises the pelvis which then protect the knees and ankles. This does not only mean the legs! Even the muscles that hold your shoulder blades together are responsible for stabilising the shoulder girdle which decreases oscillation (bouncing movement) and rotation which increases stress on the knees and Achilles’ tendon. Pain is never acceptable, and even less so if it is increasing over time. Build stability through the sport specific muscular chains over a 12 week period (typically, and depending on severity), and then maintain this with regular strength maintenance. Often calasthenics (bodyweight based) programs are the most effective.
Mistake: Training approach:
Tony hasn’t adopted his return to training; he simply returns when the pain has subsided. Pain is a symptom; Just because there is no pain at rest does not mean the cause of the pain has been eradicated.
Solution: Listen and Build Incrementally
Although returning to running shouldn’t take very long, the duration (amount of time) and intensity (how hard training is) should be reduced and then slowly increased over time during the strengthening phase. By increasing the condition of joints and tendons (what we now call pre-hab) and then systematically building intensity and duration, the body is allowed time and space to adapt and stabilise.
Tonys example is a common one, and illustrates how a small injury in one area of the body can move its way up, or indeed down the body. If you heed the early warning signs and listen to your body, the cycle can often be avoided.
The further into the cycle one goes, the further there is to get out.Prepare your body for the demands that are to be put on it, and enjoy the rewards of a conditioned, healthy body!
If you have any questions, feel free to contact me!