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For this week’s Wellness Wednesday we’re featuring a guest post from our good friend Bill Lockton. This post is the third and last in a series of posts from Bill to help you deal with sports injuries.
HOW TO CARE FOR SPORTS INJURIES – by Bill Lockton
Part 3: Uncovering the Cause – and trying to fix it!
In Part 1 of this series we discussed ways of treating the symptoms of your injury so that it heals quickly and limits you as little as possible. In Part 2 we discussed how to manage the injury so that you might still be able to do your activity to some extent, and what to do if you can’t. Today we’re going to look at why you got injured in the first place to see if we can discover how to avoid being injured again in the future.
This is an important topic, and one that athletes often overlook. Too many think they can just be passive about it, that if they just wait long enough for the symptoms to go away (meaning it doesn’t hurt so much that they can’t take the pain when they do their activity), then it’s all done. Issue handled. That’s not necessarily the case. There was a reason the injury showed up in the first place. If yours was the result of an accident like falling off a bike, stepping into a hole while running, being in a car accident, etc., then there may not have been the kind of cause we’re going to be talking about here – but still read on because that accident may itself have caused a condition that left unattended could result in more injuries down the road. If your injury showed up for no apparent reason, however (e.g. you’ve been doing what you’ve been doing for some time without any problem and now all of sudden something is hurting), then you have to do something about it. When it starts to make changes to your form, continuing on is likely to be creating other issues. Being passive won’t work. It’s time to take action to deal with it.
Although I’ve said it before, allow me to repeat that my first piece of advice is to let it heal. You would like the issue to resolve before getting back into full activity. Coming back too soon could do something like what happened to me, encapsulating scar tissue inside of good tissue. Coming back too quickly often leads to chronic conditions, and that’s something you don’t want. You don’t want to have to deal with the issue forever. Get rid of it first. Then start building the new tissue.
The problem with just waiting until it doesn’t hurt anymore is that the reason it hurt in the first place hasn’t changed. If you continue to do whatever it was that caused the issue to show up the first time, it will come back again.
That’s important enough to repeat, but let’s say it another way: If you’re using your body incorrectly, it’s not going to work right and at some point it will break down. It’s that simple. If you haven’t fixed that, the injury that resulted from not using your body correctly will recur. Doesn’t that seem obvious?
The problem is that most of us don’t really want to do anything different. We just want the discomfort to go away enough so we can go back out and do the things we do. We look for some sort of magic to fix it for us, whether it be in the form of a magic pill, someone’s magical hands, a magic device/shoe/equipment, or magical thinking. The all too typical reaction is to throw money at someone or something and ask them/it to do the work instead of doing the work ourselves. And so the cycle repeats. If you’ve read through to here, though, we know you’re not that kind of person. You actually want to know what to do, so let’s get to it.
Using the body incorrectly usually boils down to 3 things:
When you hear someone mention the term, “overuse injury”, they are referring to these issues – basically every injury that’s not the result of some immediate trauma. Rolling your ankle while running because you landed wrong on a root on the trail would be an example of an immediate trauma. Having shooting pains in your knee show up now that your mileage has crept up past a certain point would be an example of an overuse injury.
There are several things you want to look at. As a coach, my experience is that most below the waist running issues people report are form-related, and cleaning up the flaws in the person’s form almost always gets rid of the problem. When I say “most”, I literally mean almost every one of the ones I see. It can be very dramatic sometimes. I’ve had several cases of people whose running was hampered by shin splints, and when I’ve asked them to show me how they run, I have been able to make a simple adjustment to their technique that has eliminated the issue on the spot. There is a reason shin splints happen, and if you stop doing the few things that cause them, you stop having them. That’s the case with most form-related issues.
Continuing to use running as the focus (the same principles apply to any sport, though, so non-runners pay attention, too.), almost all children run with what I consider good form. As a substitute teacher, I see kids of all ages running around playgrounds during recess and P.E., and I pay attention to them as they play. They practically universally demonstrate the same mechanics I see in almost all elite runners – but in hardly anyone else. I’ve puzzled about how that could be, and have come to the conclusion that somewhere along the path, we became so sedentary in our lives, stuck behind desks the way most of us are, that we quite literally forgot how to run. When later in life we take up running as our “new” athletic endeavor, at that point the only way we really know to move our body through space any more is by walking. So, when we start ‘running’, really what most people end up doing is a version of walking, but walking with a little hop between steps. When I teach form and technique clinics, really what I’m doing is re-teaching people how to run like a child. The impact when you land on your foot when you run is much greater than when you walk, and those forces have to go somewhere. The way kids and the elites run, it passes under them, but the way the “walkers with a hop” run, it jams back into their bodies. That continual impact wears away on the body, and whatever part of the body is weakest is where the problem will show up. For one person, it could be the ankle, for another, the knee. Someone else might have an issue with their IT band. Yet another could have a hip issue. (Can I get a “piriformis”? Or even a “sciatica”?) If I can get them to stop jamming their leg back into themselves with every step, the problems almost always go away. Form related issues.
If you are having issues biking, it could be fixed as simply as getting a good bike fitting. If your bike isn’t properly fit to your body, then the forces are being misdirected and you could be putting too much stress on your joints, particularly your knees. You also could be putting too much stress on your knees by riding with too low a cadence and mashing hard on the pedals as a result; if you are mashing and your knee is out of proper alignment as well, you are really risking trouble. Get a good bike fit!
If you’re having issues swimming, it’s almost always form related. In the sport of triathlon, swimming is currently known as being the most technical of the 3 sports. That dates back to the Olympic swimming coach Doc Councilman from the U of Indiana in the ‘60s being the first person to talk about there being such a thing as proper form in swimming, that the laws of physics apply, that swimming is all about reducing drag forces and using motions that convey more power than others. (I say “currently known” because I think that running may share that distinction in the next few decades – and I credit Nicholas Romanov as being the ‘Doc Counsilman’ of running because he was the one to introduce the conversation that there is a proper way to run, that the laws of physics apply to running, too. As has happened to some degree with Counsilman, future understanding may move a bit away from Nicholas’ original proposition, but the genius of both men was in the initial recognition of the issue and creating the conversation. ) Swimming is very technical and takes coaching to do correctly. It’s not a natural function for most of us. Consequently, many people who swim a lot end up having shoulder problems. Clean up your technique!
Get the point? If you keep working your body in the wrong way and do a lot of it, eventually problems will show up. Cleaning up the form often takes care of it if the injury has happened already, and can keep it from happening if you learn proper form before you get injured.
The other way of getting overuse injuries is by increasing the stress on the body too much. It’s easy to do. Simply make too big of an increase in the workload at some point. The key to training is to increase in baby steps (did you ever see the movie, What About Bob? “Baby steps” always makes me think of that movie, which means I’m always chuckling when I say it.) If you only increase the workload a little bit at a time, that small incremental increase doesn’t stress the body too much and so will be easily accommodated. Increase it too much, though, and you shock the system. You always want to avoid getting into the realm of “too much”. What does that mean? If you have only been running 5-6 miles at a time, don’t suddenly jump up to 18 miles your next run. And if for some reason you were to do that, then ease the workload somewhere else – like run more slowly or spend more time taking walk breaks so that the change in total stress you put on the body isn’t more than the body can accommodate. A little increase can be tolerated somewhat easily. A big increase may not be.
You may have been injured in the first place because there was a weakness somewhere along the kinetic chain; it could be that one muscle group was relatively weaker, which caused another muscle group to take on too much of the responsibility for your activity. Once you’re injured, the injury itself is likely to create a muscular imbalance; some part is weakened because of the injury, some other parts are overworking to fill in for the missing part, and your form has likely been shot to pieces as a result. This is where a good physical therapist (PT) comes into play. Their specialty is finding the weaknesses and designing programs to strengthen them. Keep looking until you find one that will do that for you. Remember in one of the earlier posts I said I tend to think of PTs more in the realm of cure than managing conditions? This is why. I also said I tend to think of sports massages more in the realm of treating symptoms and managing the condition than curing the problem, but they can be useful here as well. In fact, PTs often use them. Scar tissue buildup could easily be the cause of restricted range of motion, and is just one example of something sports massage can help fix.
There can also be modalities that offer cure, so investigate those. I’ve been participating in a research project using a specific protocol for the last 24 weeks that often heals people’s Achilles issues, and if it doesn’t fully heal them, at least leaves them feeling better; the perception of pain can reduce or even disappear even if the structural damage is still there. I delayed sending out this last post because I was waiting to see my results. If you didn’t read the earlier posts, the issue in my case is chronic Achilles tendonitis diagnosed in both ankles, and I was told in 1992 the damage was so severe, I could never run again. As strange as this may sound, I’m actually grateful for having that diagnosis. It’s led to a lot of great things for me. As a result of my injuries, I’ve become somewhat of an expert in treating the symptoms and managing the condition so that I could run – and I did that well enough that I was competing at the national level in runs that can’t really be described in any better way than to say they are stupidly long (more than one hundred miles). Even more, it also led me to become a student of proper form because my Achilles are so thrashed that I cannot afford to run incorrectly. I was admitted into the research project even though I didn’t strictly fit the parameters of their study. They had never met anyone who had run so much on such damaged Achilles (or with such high level results), and thought it would be interesting to see what kind of results I might demonstrate. The results are in, and they were a bit disappointing. My Achilles are not cured, both still showing significant thickness. There was minimal structural progress. However on the plus side, I am much stronger for having done the exercises they’ve had me do daily (and will continue to do, only fewer times per week now). I can tell it has changed the way I use my feet and toes, and I’m looking forward to seeing how that translates to my run. If all I get to claim from the work is less discomfort, I will still be very pleased. I just have to remember to not do my usual “too much, too fast, too soon” and instead progress in baby steps, as above. Those with less damage than I have typically show better results structurally than I did, and I may yet as I continue on with the work. The protocol I have been following is attempting to cause remodeling of the tendons so that there is no longer an issue. You would likely have had much better results than I did, because you haven’t cemented the problem by doing ridiculous races on already thrashed Achilles. So, investigate for such modalities. High level PTs who are plugged into academia are good people to ask. Mine knew of a research project at USC he was able to get me into, and that’s how it happened for me.
So, to sum up –
If you want the injury to disappear and never come back, you need to figure out why it appeared in the first place, and then do something about it.
If it was the result of an accident, then there may not have been an underlying cause for the initial occurrence, but now that you’ve been injured, the injury itself may be the cause of a future injury. It needs to be addressed.
If the injury just showed up, perhaps under the classification of what we call “overuse injuries”, then there was a cause. Either you did “too much, too fast, too soon”, or there is a likely form issue. That needs to be addressed. Simply cleaning up your technique may well take care of it. Find a coach who knows how to do that (most don’t touch technique, though, so be sure to ask questions.). Actually go to the trouble to learn how to do what you do correctly. Sometimes the form issue may be a result of some sort of imbalance and won’t clear up until you address that. A PT would be my first choice to help with this, with or without sports massage. Once you finish with the PT, you still may need to work on correcting your form because your musculature and neural pathways are used to doing it the “wrong” way. You may need help learning to re-pattern everything to support proper form. Just don’t ask the PT to teach you. That’s not their area of expertise.
To bring home everything I’ve said in this series of posts, let me apply the points to myself so you can see how it works in real life:
My issue is chronic Achilles tendonitis in both ankles which requires almost constant maintenance. It is so severe that two orthopedic surgeons told me I could never run again, but 7 years later I gave it a try and have achieved some success at it. If I pay attention and do all the work, I am usually able to run without too much discomfort. However, as a result of stepping into a depression on a 20-mile run about 8 months ago, I tweaked my right Achilles so much it has kept me from running for quite a while. My already damaged Achilles was injured further.
So, how do I treat my sports injury?
First, I’ve been working on my Achilles a lot at home and have periodic visits with my sports massage guy. I do appropriate stretching, use my foam roller and hard ball. (My sports massage guy offers free clinics that will teach you how to do all of this for yourself and your training partners.) I even occasionally do some work on a balance pad, though I probably should do more. Then my PT got me into a research protocol that offered some potential to improve my condition. I leapt at that! I gave up running while rehabbing because the stress applied to my Achilles by the protocol was as much as they could handle. Just because I couldn’t run didn’t mean I couldn’t do anything, however, so I’ve been biking on my trainer several days a week, walking several days a week, and throwing in some strength training. Most weeks I walk more than 20 miles for the week, hitting 30 miles one week. Doing all this, I’ve been putting in 6-8 hours of weekly training.
Now I’m starting to incorporate a little running into my walks. The first time, I told myself I was going to walk 6 minutes and then run for just 1 minute (remember – baby steps!), but frankly had a hard time restraining myself and ended up running more. I was on a hilly 4-mile route, so I only ran on the flats or downhills to avoid as deep a bend on the ankle as I would experience if I ran uphill, and it felt great! Then I tried turning a 6-mile walk on the flats into a similar 6:1 walk/run – but did some 2-minute and one 3-minute run portions, and it felt great! In fact, I probably ran too fast, but it was the first time in ages I had just let myself run my natural speed without thinking about it, and it was awesome. The next time I did significant mileage, I actually held myself to walking 5 minutes and then running 2 minutes, and it also was great. I again just let myself run however the body felt like running, only controlling the time and watching for any symptoms. I’m pleased with the progress. So far, so good. The group of 40-60 people I’m training for the LA Marathon (depending on who shows up each week) thinks they’ve seen me out there trailing them on occasion, but I tell them it was just a mirage – and don’t tell my PT they saw me! They keep asking me if I’m going to join them “next week”, and the answer is No. I’m going to progress slowly, and it will take however long it takes. I will continue to R.I.C.E., symptoms or not. I will continue to work on myself and get the sports massage I need. I will continue to make sure my whole body is strong and that there are no weaknesses anywhere along the kinetic chain. I will continue to keep the stress down on the body by only increasing the workload in baby steps. And I will continue to work on and pay attention to my form, because everyone who is serious about what they do practices their technique daily. Tiger Woods worked on all the aspects of his golf game all the time, probably still does. Michael Phelps certainly does with his swimming. The concert violinist/pianist playing Carnegie Hall works on technique every day, and no matter how good they may be often still takes lessons. Olympic athletes refine their form day after day with their coach’s help. Like that, I work on my form all the time, as should you. And I will continue to add in some nutritional support with healthy eating, vitamins, some natural anti-inflammatory supplements, and some joint repair products that contribute more of the building blocks to help heal my tendons.
And did I say already that I will continue to work on my form? I repeat it to remind myself how critically important it is for me, because I don’t have the luxury of being sloppy with it.
There is life after injury.
I hope these posts have given some of you inspiration that things can be different. I hope you found a lot of useful information that you can apply to your own case. If you haven’t experienced any significant issue yet, congratulations! The problem when you’re not injured is that you think you never will be, and so don’t really pay as close attention as you should. That’s just being human. We all do that. My advice is to read these posts as if you were already injured. You may learn how to avoid ever having an injury, and if by some chance you’re not that lucky, then you’ll have a good idea of what to do and how to treat it. I am living proof that there is life after injury. I didn’t do anything significant in sport until after I had for all intents and purposes permanently damaged both of my Achilles tendons. Some specialist saying you can’t do your sport anymore doesn’t mean it’s true. Everything people know me for happened after being told I could never run again. In fact, it has reached the point that now there are people who know me first and foremost as an athlete, with everything else I do in life coming after that. So, yes, there is life after injury – but wouldn’t it better to not be injured in the first place? To not have that injury be chronic? Avoid injuries to the extent you can, speed that recovery up if you can’t, and get rid of whatever the cause was for the injury. Train smart. Train safe.
My best wishes to you.
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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