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Wellness Wednesday – Caring for Sports Injuries Part 2

Wellness Wednesday – Caring for Sports Injuries Part 2

For this week’s Wellness Wednesday we’re featuring a guest post from our good friend Bill Lockton. This post is the second in a series of three from Bill to help you deal with sports injuries.

HOW TO CARE FOR SPORTS INJURIES – by Bill Lockton

Part 2: Managing the Condition

Last time we talked about treating the symptoms, and next time we’ll talk about uncovering the cause of the problem and trying to fix it. In this section, we’ll investigate managing the condition.

The shape of the overall discussion is that you’ve got to reduce the symptoms so you can function in life, and then see if there is some way you can manage the condition so that you can continue to do what you want to do. Finally, you need to figure out what caused the problem in the first place to see if that is something you can correct so that the condition does not return again and again.

To repeat the summary of Part 1 – The whole point of this discussion is that we want to be able to start living our lives again, whether we’re athletes who can’t stand sitting still, or the vast majority of people who simply want to be able to go about their lives without pain and discomfort. If you’re on this site, we already think that you are the type of person who doesn’t really have the time, patience, or inclination to be laid up or hobbled by injury. However, before you can start exercising or doing much of anything again, the affected area has to feel better, and the first way to do that is to deal with the symptoms. The main things I and my athlete friends and clients recommend are R.I.C.E., anti-inflammatories (I prefer non-drug types but will take an OTC substance on occasion), and sports massage.

You can read the full post by clicking here.

Now that we’re caught up, let’s talk about managing the condition. For some of you reading this, this will be the shortest of the 3 parts because the truth is that often you can’t do anything to manage the situation. As an example, there could be structural damage that has to heal before you can do anything. Often, however, there are conditions that allow you to continue. We’ll take each separately.

Some conditions have to be waited out. If you have a broken leg, you have to wait for the bones to heal. If you tore a muscle, tendon, or ligament, you have to wait for the fibers to reconnect. Many times there just isn’t anything you can do in the sport until after you’ve healed – but that doesn’t mean you have to give up entirely. There are still other activities you can do that can help keep your fitness up so that when you have healed, you’ll be able to come back more quickly.

You could consider it an opportunity. Years ago I threw thousands of unreimbursed dollars at various physical therapists telling them their task was to heal my Achilles tendon, and they made me stop running for 6 months. When I’d tell that to my running friends, I had a hard time keeping myself from laughing at their expressions. They looked so concerned, and would often put a hand on my shoulder or arm and just be so … earnest with their sympathies. They were imagining themselves in a similar situation – or remembering themselves in one, and I think what I was probably experiencing was their pity. In contrast, when I explained the situation to my triathlete friends, they’d light up and say something like, “Cool. Now you get to work on your biking and swimming!” I think that story brings the point home brilliantly. Just because you can’t do one thing doesn’t mean you can’t do anything. When I was allowed to run again, I hadn’t lost fitness, so within 6 months I was setting records at all my running races, from 10Ks up to 24-Hour Runs. Just because you can’t do the thing you usually do doesn’t mean you can’t do anything. (For the runners reading this, and we all know how into numbers you are, I took 1.5 minutes off my next 10K, 22 minutes off my next marathon – qualifying for Boston for the first time, and added 13 miles to my 24-hour performance – taking me from something like 24th in the nation to 8th American Male.) Never begrudge the time off. You’re likely to come back stronger than ever. Tim Broe, the 5,000 meter runner, did that before the 2004 Olympics; he took 6 months off and came back to be his fastest. Taking the time necessary to heal works in your favor.

So what if you can’t do what you would ordinarily be doing? Find a different way to keep your fitness up. Upper body injuries don’t stop you from using your legs. You may not be able to grip the handlebars on a bike, but you can walk, and you may be able to run. There are always alternatives you can explore. Lower body injuries can sometimes be managed, but even if they can’t, there are all sorts of upper body activities you can still do.

Some conditions may not need waiting out. If your injury isn’t too bad, you may still be able to participate in your sport. Having said that, if you can afford to take off the time and let the injury heal better, you are more likely to be back up to full performance sooner than if you continued your sport.  Sometimes, we can’t – or don’t want to – take the time off. There are possibilities –

Let’s use Achilles tendonosis as an example. It’s probably the issue I get asked about the most, and is the issue with which I certainly have the most personal experience. The problem is that when the Achilles tendon has been stretched farther than it can accommodate without strain, you get tissue breakdown and that results in pain. If it had been damaged in the past and you didn’t take the time for it to heal properly before starting to stress it again, you may also have done what I did – encapsulated scar tissue inside good tissue, which may well have resulted in restricted range of motion. Here’s how bad it can get – 2 different orthopedic surgeons told me I had damaged both of my Achilles tendons so severely, I could never run again; if I ran, they would snap! I believed them for years, but eventually tried running again, and all of my accomplishments have been achieved running on those 2 damaged Achilles tendons. I have to be careful to not stretch them unduly, so modify my behavior accordingly: It means I had to find a way to sneak up on my speed without doing flat out hard running because my Achilles can’t take the deep stretch that comes with sprinting; It means I had to become a student of proper form; It means I had to be very careful going uphill to keep my ankles from bending too deeply, so learned to shorten my stride by increasing my turnover; It means I often put little heel lifts in my shoes so my ankles don’t bend quite so much (I’ve sometimes put in 2 heel inserts – in both shoes, by the way, to maintain symmetry – in order to be able to run that day); It means I can’t walk barefoot if they’re hurting. (Women have an advantage in this regard in that they can wear heels. Whatever negatives people have about wearing high heels, it works for Achilles issues.) If I do all this, even if my Achilles are flaring up, I can usually still run. Sometimes you just don’t have the luxury of taking time completely off, but if you’re careful about it, you can still manage.

When you look at the list of things I do in order to manage my chronic Achilles tendonitis, it can seem somewhat extreme. I understand that. But, realize that I have a choice: I can do all of this and still be able to run, or I can give up running altogether. I like running. It has become a part of my life and so I’m willing to put up with some discomfort and tediousness in order to be able to do it. It’s my primary form of play, has become part of my work, and makes up a huge part of my social life. I am a runner. I just happen to be an injured runner who has learned to manage his injuries to the point that I’ve achieved quite a lot. Unfortunately, in my case, it seems I’ve gone beyond the point of being just injured – all because I didn’t deal with my injuries properly the first time. As a result, it’s more accurate to now describe my issues as structural damage – but the good news is that even they can be managed.

Similarly, you may be able to find ways to continue to do what you do. Explore alternatives. Ask around about whatever your specific issue is. Other people may have had success working around whatever is going on with you.

For those who do have Achilles issues or other leg issues, I’ll go through more completely just what techniques worked for me. The above section was the short version. If you’re not interested in the long version, skip to the paragraph that invites you to rejoin the conversation – although you might find the principles appropriate for you.

With Achilles issues, the problem was caused by the tendon stretching more than it was able to without being harmed, so if you can avoid over-stretching it, you let it heal more quickly and may even be able to continue to do that activity. With running, every step you take stretches the Achilles of the rear foot, so don’t stretch it so much. The longer your rear foot is in contact with the ground, the deeper the stretch on the Achilles, so the first fix is to pick your back foot up more quickly. If you pick it up before your stride opens up behind you, then you may be able to get away with not stretching it much at all. A quicker turnover solves a lot of form issues as well, so it is a useful technique to learn. It’s somewhat similar to cycling in this regard, where it’s known that a quicker cadence results in less knee stress; cyclists can use less power more often to get the same force over time as the person who exerts a lot of power less often. It’s easier on the knees to not “mash” the pedals (the next time you go for a ride, watch the cadence of the people you see. The ones with the quicker cadence are likely the more experienced riders.) With running, a shorter, quicker stride will put less stress on the Achilles than a longer, slower stride. Just think about picking the back foot up more quickly. If you were to time it (and I do periodically), count how many times your left foot strikes the ground in one minute. You want it to be 90 or more.

What else would cause a deeper stretch on the Achilles? Speed work. The issue is how deep a stretch the trailing foot goes through. When you’re running, for the bit of time your foot is on the ground, you travel through space. If you’re running slowly, you don’t travel through as much space. If you’re running faster, you travel through more. That’s the definition of speed, isn’t it? Distance over time. Your turnover is the same in both cases, but when you’re running faster, you cover more distance. That means your back foot is farther behind you when you pick it up. Farther behind you means it is going through a deeper stretch. Consequently, I learned I’m not able to sprint. My Achiiles just won’t support that. Instead, I have to sneak up on my speed by pushing my aerobic threshold. I can only run “quicker”, not fast, which may be a partial explanation for why the longer the distance, the better my placing relative to the field. It’s turned me into a “strength” runner. If my Achilles weren’t an issue, I’d love to do real speed work, but I can’t so I don’t. If you have this issue, it will be much less stress on your Achilles to run at a more moderate pace – and for the time being, as long as the Achiiles are an issue, I’d give up speed work altogether.

Is there something else that would cause a deeper stretch on the Achiiles? Running uphill. The ground is leaning toward you, so just to stay upright, you have to have a bend in your ankle; you’re starting off close to “in trouble”, and then as you stride up the hill, the bend gets deeper. You’re better off running in the flats while the problem is still going on. If you need to be developing the leg strength that comes with hill running, substitute walking up stairs instead or using a stair climber.

You can relieve some of the pressure on the Achilles by making sure the muscles connected to it are longer so they don’t pull on it as much. How do you lengthen the muscle? Appropriate stretching can work for that. I emphasize “appropriate” because while the Achilles are inflamed, stretching them would not be a good thing to do, you’d just be increasing the damage. But, you can stretch the muscles that attach to them and relieve pressure that way. Foam rolling can do that, too. Trigger point work on knots in the muscles can work for that (I use a hard ball for that). Sports specific massage can also work for that. My joke about sports massage is that sometimes you just have to pay someone to hurt you more than you’re willing to hurt yourself! It doesn’t need to hurt, however. Instruct the person working on you how deep or how gentle you want it. They can be brilliant in this regard. My range of motion is always much better after sports massage, and my level of discomfort is always much less.

You can lessen the depth of the stretch your Achilles goes through when you run by making sure your heel doesn’t get all the way to the ground. That will keep the ankle from bending quite so much. Support shoes (generally called “Stability” or “Motion Control” shoes) tend to have more built-up heels and so are useful for this; barefoot and minimalist shoes would not and should be avoided while having Achilles issues. In fact, don’t walk barefoot at home while the Achilles are sensitive for just this reason; always wear shoes when the issue is making its presence known. You can buy heel inserts at your local pharmacy that will help boost the heel a bit. Harder ones are better because they won’t collapse under the weight of your body coming down on them, so don’t look for the softest, most cushy ones. A podiatrist can make some for you as well. When training for some key races, there have been times when my Achilles sensitivity flared up so much that I put in 2 inserts in each shoe to avoid as much stretch as possible. (As I said earlier, to maintain symmetry in the body, whatever I do on one side, I also do on the other.) If I could have afforded to take some time off, it would have been better, but I was training for key events and, frankly, with the amount of damage I have, it’s not reasonable to expect there to be no issues. Consequently, I continued to train, and was able to do so by doing all these things. Taken together, these practices kept me from continually aggravating the situation. Usually, within a week or two, the extra-ordinary measures I was using could be backed off somewhat – and I had been successfully able to train in the interim.

Everyone who skipped – you can come back in now.

There is more to do, however. You can support the part of the body that has been weakened. Taping helps a lot. My PT taught me how to tape my feet and ankles when I had an almost debilitating case of plantar fasciitis. I remember well his telling me that it was only uncomfortable, not dangerous, and that as long as the pain wasn’t too great, I could run on it without being concerned I was causing damage. You’ve seen many athletes in the Olympics using some form of taping to support weakened muscles. I recommend having a professional do it for you, but once they’ve done it for you a few times, you may well be able to do it for yourself. It doesn’t fix the situation, but can give you just the amount of extra support you need to make it through whatever you’re doing. There are a lot of different kinds of tape available at sporting goods and medical supply stores. Some are more rigid than others, some more elastic. You should find out from a good physical therapist which would be best for your situation and have them apply it for you. Watch carefully so you can replicate it yourself.

Body workers become almost essential the heavier the workload you’re experiencing in your training. Because my issues have to do with restricted range of motion, I have people work on breaking up the scar tissue in my body and lengthening the muscles so there’s less pressure on the tendons and ligaments. Deep tissue work has broken up a lot of the adhesions in my legs, and Active Release Techniques, aka ART, is one modality that has helped tremendously in regaining range of motion. I do a lot of work on my own, particularly with foam rolling, but even still, my habit is to go in once a month for maintenance. When I’m in heavy training, I’ll bump that up to twice a week, and then weekly as I get closer to the event.

Talk to your body worker. Tell him or her all about your issues, what your plans are, and what you’d like to get out of the sessions. Both physical therapy and sports-specific massage are extremely useful in this regard. I’m going to talk a lot more about both in the ‘fix the problem’ part next time, but they come into play here as well. Regular, targeted sports massage enabled me to get these broken Achiiles to qualify for the Boston Marathon for the first time and almost got me on the Team USA to the world championships of the 24-hour Run – the longest race that has countries competing for a world championship (I came in 8th at Nationals; need to be 6th, but that was a huge improvement over the prior year’s 24th.) Not only did it help keep me in training, but kept me fresh enough to compete well in the events themselves.

To summarize, if you can take off the time to rest the injury, that would usually be the best thing to do. Don’t throw away your fitness, however. Do something else to keep it up, and when you are finally able to come back, you’ll be much better off for it. In some cases, you won’t have a choice. Structural damage will need to heal before you can use the body part, so you’ll be forced to do other activities.

Some injuries can be managed. I discussed Achilles issues in depth, but the same principles come into play with many injuries. The key is to understand what the injury is and what kind of motion makes it worse, and then see if you can find a way to do that activity while limiting the offending motion. With Achilles tendonoses of all sorts, there are ways. With plantar fasciitis, there are ways. With many knee issues, there are ways. The necessity here is to make sure that you aren’t continuing to injure the body part while doing what you’re doing. Realize that you’ll still have to do all the symptom-treating modalities discussed earlier, because the symptoms are still there while you’re doing this. And then you’ll need to look at what caused the problem in the first place and deal with that.

In Part 3, we’ll look will be how to fix whatever it was that is causing the problem so that once it has healed, there will no longer be a problem to deal with or overcome. That’s next.

 

About Bill Lockton:
Bill Lockton is a running coach and ultramarathoner whose career has been the design and manufacture of additive-free nutritional supplements and skincare for health food stores. A 2-time Boston Marathon qualifier, he came in 6th in the 2003 Badwater Ultramarathon, the world’s toughest footrace, in its hottest year, and came in 8th American Male at the 2006 24 Hour National Championships. He is a fixture in the LA athletic community, active in the LA Leggers Marathon Club, LA Triathlon Club, and Nike’s Club Run LA. To contact Bill for coaching or nutritional supplements go to www.Lockedonhealth.com.

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