How to Return from an Injury by Charles F. Peebles DPM

Guest Column

The Safe Way to make a Comeback

The worst part of my job is telling someone they have an injury that is either going to alter their training or take them out of competition for some period of time. The best part of my job is seeing someone return to their event stronger and better than before their injury. The “dash” that occurs between injury and the event is the crucial piece of the puzzle and what happens during that “dash” will determine how well and how quickly you can return to top form.

Injuries are inevitable in athletes training for endurance events. A recent Runners World article (October 2006) based on an Active.com survey of 510 competitive runners/cyclists/triatheletes found:

90% had injury in past year

50% out of competition  > 2 weeks

25% out of competition > 1 month
 

When these injuries occur they must be diagnosed expediently and appropriately. Some injuries may be resolved with just a decrease in intensity of training or a modification of an athlete’s equipment. Twenty percent of the injuries which are treated in our office are the result of improper or worn out shoes. Pain that does not resolve with rest or that is isolated to one specific site should be evaluated by a sports medicine physician to determine an appropriate treatment plan.

Once the injury is treated, what does the athlete do next. A patient of mine who lives and trains in Florida recently called after 6 week layoff after a tibial (leg) stress fracture diagnosed just before a big 10K race. We stabilized and began treatment of the injury and she followed up with a physician in Florida and had x-rays which revealed healing of the fracture. She asked about returning to running and the Dr. said “take it easy”.

What does “take it easy” mean to you. If you are Dean Karnazes it means a marathon every other day as opposed to daily. If you had been training for a Marathon and your long run was 20 just prior to your injury, does that mean you can return to running 10 miles right after your doctor says “take it easy”.

We need to define “take it easy” but more importantly we need to make sure the return to activity does not cause the injury to reoccur or a compensating injury to develop. If the injury was due to a training error we need to work with you and your coach to develop a modification of your treatment plan. If it is due to bad shoe choices, that needs to be corrected. If you have poor biomechanics you may need orthotics. Whatever the underlying cause is, it needs to be corrected. It is essential to use this time of healing for solving the problem but also for maintaining fitness.

“Taking it easy” as you recover does not mean “sit on the couch”. Cross training is essential in maintaining fitness. Aqua jogging is a great non-impact way to stay in shape and most closely mimics the running gait. Water creates almost 800 times the resistance of air and therefore keeps the muscles strong and the endurance high as you recover from an impact injury. Elliptical trainers are another great way to stay in shape if your doctor ok’s it. Cycling is an excellent alternative but I usually recommend staying in the saddle to prevent further strain on the feet and legs. Swimming will improve upper and lower body conditioning.

Once you are cleared to run the fun part starts. A gradual return to running and impact activity is the best way to guide your return. Start with an every other day schedule to give your body a chance to recover and cross train on the alternate day. Begin with a run-walk program dominated by walking the first week (2 minutes run: 5 minutes walk) followed by (3 minutes run: 3 minutes walk) the next and then (5 minute run: 2 minute walk) the third and then returning to running full time by the 4th/5th week. Once you are back to full-time running the 10 % rule comes into effect. Do not increase you mileage or speed by more than 10% per week. This allows your body to respond appropriately to the stress placed on it and to build back while allowing your body to have recovery days.

You may find your body is in better shape after an injury if you continue to cross train because you have given it a chance to heal and recover. Unfortunately, injuries are a part of running but by listening to your body, using sound training principles, allowing recovery, and protecting your body with a gradual return to activity you can be an even better runner after an injury.

www.atlantafootandankle.com

"If Life Is A Balancing Act, Why Am I So Darn Clumsy?'

That's the title of a book written by a friend of mine, Dick Biggs, a motivational speaker. Since many athletes have begun venturing into multi-sport events it's important to talk about balance. As I have stated before everything in your life affects your training. In addition to the physical and mental stresses of training we have to add the additional stress of family and work.

If you have small children many times they are involved in activities of their own that require your time and attention. If you have a stressful job or have to drive in rush hour traffic this is additional mental and physical stress.

When you have too much stress in your life it can contribute to physical and mental fatigue. Your body doesn't distinguish between fatigue caused by your job or family and fatigue caused by training, all it knows is fatigue.

In a previous post I talked about setting identifiable, quantifiable and attainable goals. In order to do this you need a plan that not only includes your time commitment for training but also your time for work, family and yes, even relaxation and recovery. In our drive to be our "best" we sometimes do what is "worst" for us. Without the proper balance of all the stressors in our life eventually something has to give, and usually that is an injury or chronic fatigue.

All the athletes that I coach are required to monitor their Morning Resting Pulse (MRP)  each moring before they get out of bed. This is the best and only true way to measure your fatigue level and how your body is adjusting to the training load your are experiencing.

There is a story that goes around the Internet about putting rocks in a jar. Starting with big rocks, adding smaller and smaller rocks, then finally adding sand until the jar is "full". The moral of the story is that you have to take care of the "big rocks" in your life first, otherwise you won't be able to get them in later. You have to identify what those big rocks are. It might be family and children, or it could be work. Since few of us have the luxury of having a sponsor for our athletic ventures our training usually becomes the "sand" we add at the end that has to fit in and around all the other "rocks" in our lives.

So look closely at the stressors in your life and find the balance you need to be your best at all of your ventures including your training. Without sounding like I am soliciting business, this is where a coach can help to be sure that the training time you do have is used to the maximum benefit without overtraining. I have stated before that "under-resting" is the same as "overtraining".

See you at the races.....
Coach Will

As a sidebar to the story about the rocks, after everything has been added and the jar appears to be full, you can still add liquid to the jar. The moral being there is always room for a beer!!!!

AH SPRING!!! COUGH, COUGH!!!

Springtime is one of the most beautiful and difficult times of the year for running. Even if you don't suffer from allergies the volume of pollen in the air combined with the exhaust fumes from cars can be very taxing to your cardiovascular system and even dangerous.

Combine this with the increasing heat and humidity in some areas and this has you looking over your shoulder for the gorilla on your back. As the German philosopher Nietzsche stated, "That which does not kill us, makes us stronger". I don't know if I want to test that theory to its limit, but this concept is correct. If we can get through tough times and remain healthy we will become a stronger runner.

Below are a few hints about how to make it through the pollen and pollution:

1. Take it easy. It takes about 2 weeks of continuous warmer temperatures for your body to adapt to the higher heat and humidity. Use a heart rate monitor and run at the same EFFORT you did during cooler weather. Until your body adapts don't be a slave to the watch.

2. Run early or run late. Running in the morning you will have to deal with more humidity but with less pollen and exhaust fumes. Running in the late evening you will have less humidity but more pollution and heat, unless you delay your run until after sundown.

3. Drink extra fluids. Everyone who lives in an area of high humidity and high temps knows how hot and humid it is during the summer and that they need to drink extra fluids, but during the Spring the extra fluids will also help to keep your throat moist and to clear pollen.

4. Get naked!!! Well, maybe we shouldn't go that far, but you should wear light colored singlets and shorts that allow for evaporation of sweat, but you also need to protect exposed skin from the damaging effects from the sun. One of the best products I have found that provides protection, is waterproof, and allows for evaporation is Banana Boat Sport. (Wonder if I can get a commission?)

5. Be Smart!!! If the pollen or pollution index is in the red zone, think about going indoors or skipping the workout for that day. Exposing your respiratory system to the potential harm from these pollutants is not worth the risk.

See you at the races.....
Coach Will

Up and Running!

Is Spring finally here!! One day it feel like it and the next day we get blasted by a cold wind. Did the groundhog get it right or wrong? It doesn't really matter, but just in case you have been on a reduced running schedule since last fall there are some things you need to consider before you are "UP and RUNNING".

Unless you have been going to the gym or doing some running during the off-season you have lost some of your aerobic base. How much depends on how active you have been. After 2 weeks of no activity you lose 50% of your aerobic capacity and to perform well in races you need to have a solid base because ALL speed is built off of a solid aerobic base. You can't go to the track and do speedwork and expect to become faster if you don't have the endurance to maintain that speed.

Most springtime injuries come from runners trying to return to the same intensity or volume of workouts they did the previous fall without allowing time for the proper build-up. Below is a chart to show you how much time you need to spend in base building before trying to return to speedwork or faster paced running.

See you at the races...........

Coach Will

"To give anything less than your best is to sacrifice the gift."  Steve Prefontaine

Speed Kills – all those who don’t have any !!!

Speed – Part 1

Train First for Distance, Only Later for Speed

 

Since it is always the speed (pace), never the distance, that affects your overall time, it is the distance and not the speed that has to be acquired.

ALL of your speed must be built off of a solid aerobic base, if you don’t have the base you won’t be able to handle the workload for gaining speed, and without the foundation of solid aerobic conditioning any workouts you perform at the track will not have the desired effect.

If I am training a 10K runner they will do long runs of 10 miles, a half-marathon runner will do long runs of 15 miles, and a marathon runner, depending on level of ability, will do long runs of 20-23 miles. During these long run segments I will have the athletes run up to 50% of the distance at the pace they will run in their event. By doing this we build the neuromuscular pathways necessary to hold the correct pace during the event. If you always train at a slow pace how can you then expect to be able to run a faster pace in your event? Also during these long run sessions we are developing additional mitochondria (the engines that drive the muscles), and laying down additional capillary beds to provide oxygen rich blood to the working muscles.

Your body wants to be in a state of “homeostasis” which means it wants to be comfortable. You have an internal “governor” which regulates your effort. If you begin to push beyond your comfort zone this “governor” sees this as a danger and resists by testing your will, trying to convince you that the effort is not necessary. If you push beyond this comfort zone slightly you can convince your “governor” that the extra effort can in fact be accomplished safely and will reset to a higher level.

By continuing to push beyond your current limits with faster pace running, and allowing adequate recovery time between hard efforts you will now be in a position to go to a track and run some intervals. Speed work is not without risks, there are twin dangers of running speed sessions too often and running them too fast. This is a natural trap that many runners new to speed training fall into, they think if one speed workout a week has “X results” then two workouts a week will have “2X results”, NOT TRUE!!!

I have mentioned in the past that a Sports Psychologist friend of mine had on his business card “The Mind IS The Athlete” and this is where going to the track can have a big benefit. By pushing ourselves through short intervals of high-intensity work we train our minds to the fact that we can handle a higher physical and mental stress and the body responds by increasing the amount of endorphins that are released into our body and we get the feeling of being able to work harder and still be comfortable.

Speed – Part 2

While you have probably heard about slow-twitch (ST) muscle fibers and fast-twitch (FT) muscle fibers and Type IIa and Type IIb fibers and how this has a determination on just how fast you can run, all of this probably doesn’t help to answer your question, “How much speed work should I do? How often? How intense? How much volume? What type?”.

Too much, too often, too intense will not accomplish your goal but will only set you up for a potential injury. The primary key to success is doing the correct amount of the type of training that best promotes the desired outcome. In the case of distance running, more endurance and more speed.

The objective of training is to bring the athlete to a peak fitness level at the proper time, with all the requirements for good performance brought along in balance. What this means is that every race can’t be an “A” type race, you need to chose a primary goal and use the other events as tune-up or marker races.

Fundamentally speed is developed in two ways, stride length and stride frequency, there are no other options, look at the stride length of Carl Lewis in the photo above, he has a tremendous stride length. To increase stride length you have to increase the power and flexibility of the legs. This is where weight work and stretching exercises can have the biggest impact. To increase stride frequency you need to develop faster reflex action and better coordination, relaxation, and technique as well as flexibility. This is where track workouts can help.

As noted above, All of your speed must be built off of a solid aerobic base, if you don’t have the base you won’t be able to handle the workload for gaining speed, and without the foundation of solid aerobic conditioning any workouts you perform at the track will not have the desired effect. So to improve your speed you need to run as much as you can in your aerobic zone, which if you are using a heart monitor as I recommend, you will be doing most of your running at 70-75% of your max heart rate (MHR).

Although it is advisable to keep some faster paced workouts in your training throughout the year, the amount of hard speed work your body is capable of handling is limited. If you are training for a marathon you might be able to handle 10-12 weeks of speed sessions but if you are training for 5K, 10K or 15K racing then 6-8 weeks is probably all you will need to reach your peak speed.

Marathon runners should focus more on 800, 1200 and 1600 meter repeats while short distance runners should focus more on 100, 200 and 400 meter repeats. How much volume should be based on your base aerobic conditioning and shouldn’t exceed 10% of you total weekly volume or about 4800 meters for novice runners, 6400 meters for intermediate runners and about 8000 meters for more advanced runners.

See you at the races.........

Coach Will