Injured athletes dilemma

Most athletes have extraordinary high levels of discipline for training when they are healthy but many come unstuck when they are injured. I think that part of the problem is the lack of an appropriate and well considered plan which provides adequate time for injury recovery. This needs to be balanced by a requirement to maintain a reasonable level of fitness. I see this problem more in individual, self-coached athletes rather than team athletes and wonder if it is because of this perceived lack of forward planning. When you are healthy and preparing for an event you can usually plan many weeks ahead. Using running as an example, it is quite likely that a runner preparing for an event e.g. a marathon, will know how far they will be running on any particular day, week or months in advance. Using my own experience as a young man weight training, I would plan a 16 week period and know every exercise, set, rep and approximate weight that I was going to lift. Unfortunately when you are injured some of this effort to plan as concisely as myself or the runner above is either not done at all or not done well. When you become injured the planning becomes different. To assist, I have included some of the traps people suffering injuries often adopt on their return to their sport or activity. These unfortunately often lead to disappointment and a suboptimal outcome.

Avoid these approaches

Do nothing, then test

Lots of runners or lifters will decide to rest for an arbitrary period of time and then run or lift an arbitrary distance or weight. If they can perform the arbitrary feat they feel that they have succeeded. However if they do not pass the “test” then they have wasted valuable rehabilitation time and may have made the injury worse. This is a highly ineffective approach. It will sometimes work but usually fails. Doing nothing while waiting to “test” deconditions the body and increases the likelihood of failure.

Push through it

This is a very common approach which usually backfires. It is actually something that can be done for a few injuries for a short period of time but should be avoided at all costs with others. Pushing through an injury usually results in symptoms becoming worse and an extended recovery period.

Give away activity altogether

This approach tends to be adopted by people who might possess an ‘all or nothing personality’. I put myself in this category. When things are going well this type of person trains hard and with discipline but they struggle to cross train and find difficulty to do other activities when they are injured. They tend to lose condition and their fitness tends to yo-yo.

What you should be doing

Cross train

Just because you are a runner and your injury prevents you from running shouldn’t mean that you cease training. The same is true for any activity. One of the areas that impressed me when I observed and worked with high level athletes was how creative their rehabilitation plans were. Can’t bend your right knee but like the rowing machine? Only use your left leg. Right arm in a cast? Train your left arm anyway. In fact this type of training will have a neural crossover and actually increase the strength of the right arm. Recovering from a lower body injury and need to maintain running economy? Run using an Alter G treadmill.

Learn safe levels of pain

While pushing through is criticised above it may not be necessary or practical to be completely pain free on returning to training. It will depend on the injury of course so seeking specific guidance is recommended. A guideline that I like to adopt for a few injuries such as tendinopathies and plantar fasciitis is the following: It is safe to train with pain IF the pain is less than 3/10 (where zero is no pain at all and ten is the worst pain imaginable) PROVIDED that good exercise technique can be maintained AND the pain settles quickly after the activity AND you are no worse the following day.

Cybernetic periodization

Instead of planning well ahead of time as you would when you are healthy, an injured athlete needs to be planning a day ahead in the context of what they did yesterday. They may also need to make adjustments within a session. It’s okay to have a big picture of where they want to be headed but it’s not possible to predict how your body will respond in a couple of days’ time let alone several weeks. The injured athletic needs to continue to reassess and make minor changes, day to day and within a session. There is a name for this type of training and it is called cybernetic periodisation and has been well documented. It was originally used with weightlifters but it is particularly useful when returning from injury. With this form of periodisation the original pre-planned periodisation scheme is regularly modified by subjective and objective feedback obtained from the lifter’s current performance state. It’s important to start with an easily achievable goal and progress carefully from there. If one day you are in more pain you need to consider what you did in the previous days and how it might have affected you. You will need to adjust your training accordingly and therefore your plan needs to be flexible.