Man Down: Training around injury
No matter how careful we are or how much emphasis we place on preventing the possibility of injury, reducing the potential is as good as it gets. We are never risk-free and nor should we be. Within reason, we should always be looking to challenge and ask more of ourselves, and the possibility of injury is a risk inherent to that process.
But when injury strikes, we can do a lot to make the process both as short and painless as possible, giving ourselves the best chance of recovering with no lingering issues. We need to be far savvier than what has been the traditional approach, in which at best there are many missed opportunities to both aid the healing process and, in most cases, maintain your previous level of fitness throughout.
As we have come to see with a lot of our ideas about fitness, we can do a great deal more to optimise our situation. And in staying absolutely true to form here, what we may have thought we were doing wrong was possibly right, and what we thought we were doing right, was probably wrong.
Situation normal so far then.
RICE OR MCE?
Most of us are familiar with the RICE method of injury treatment - Rest, Ice, Compression, Elevation, but even this has been disputed recently with Dr Kelly Starrett a physical therapist from San Francisco airing the possibility that this approach is flawed.
Starrett believes both the application of ice and restriction of movement interfere with the bodies natural healing process - specifically the inflammatory response. The application of ice to an injury, although it is conventional wisdom, is not backed by any scientific studies or research.
The general idea is that this RICE approach is at best partly correct and that both compression and elevation are helpful, but that icing and resting an injury both hinder the healing process..
Starrett believes that applying ice to an injury other than for immediate short-term pain relief is misguided and advocates compression as the means to control swelling. He further suggests mobilising the injured tissue as soon as possible to promote circulation and helping to encourage drainage of waste products from the injury site. We should also steer clear of any anti-inflammatories, as these are simply drug versions of the ice process.
Essentially the idea is that the body knows what it’s doing and we are best not to interfere.
Starret promotes MCE
Move safely when you can, what you can
Compress lymphatics and soft tissues (use bands, muscle contraction, clothing, etc.)
Elevate when you can.
Nobody is suggesting you set off hiking, or start flexing a broken leg, but you can do your alphabet exercises with your rolled ankle, and you can flex your injured leg through its full range of motion. Then as soon as you are able to move without pain you should look to mobilise injured tissue.
Now this debate continues and in the absence of any definitive answer, you are free to make up your own mind, suffice it to say that whatever your opinion regarding the application of ice, it is safe to consider compression to be the most vital step in the process. From that point, proceed as you see fit.
After this initial treatment of an injury has been taken care of, the general procedure goes something like this:
Go to the doctor, get drugs, sit on couch til it stops hurting
See physio and get a rehab program (maybe)
Follow rehab program diligently for approx 3 days.
Proceed as normal but usually with some sort of side-effect/hangover through either limited movement or residual pain.
We can do much better than that.
Training with injury - what you can do
Deciding to spend the next month on the couch is not only unnecessary, but also means you miss the opportunity to aid the healing process, and maintain your level of fitness. Beyond your immediate treatment, you can have a decisive influence over the healing process by determining what training can be done around your injury.
Injury is rarely a reason to prevent you from training entirely. If you injure a shoulder, arm, or any limb for that matter, you still have three healthy limbs, and a core to train. Your training should be modified as appropriate, not abandoned.
All the standard physiological responses to training when 'healthy' can only aid the healing process. Working out on one leg for example:
will still increase blood flow and promote healing.
will still drive insulin sensitivity helping you to stay in shape.
will still drive an anabolic (healing) response throughout your entire system.
Aside from the physical, you also maintain a more positive psychological outlook that can only help your recovery. Inactivity means stagnation - the last thing you want to encourage when injured.
Even if you are only training one side of the body you will not only enjoy the benfit of keeping the ‘healthy side’ strong, but through a process know as cross-transfer, significantly improve the strength of the injured side - without even moving it.
Training a non-injured limb can provide you with a carryover effect to the injured limb, helping the healing process and also helping to rehabilitate you to your previous levels of strength and fitness when able to train as normal again.
Low impact cardio-vascular work will also help to maintain your level of fitness. and a study published in Journal of Strength and Conditioning has shown that people completing exercise programs even though they only trained on one side of the body,lost about the same amount of body fat in each leg - and even more body fat above the waist.
In the search for a silver lining, injury can present the opportunity to work on areas that would otherwise be overlooked in favour of a more conventional workout - the chance to concentrate on those sticking points we all have. Through working on areas that are often neglected you can emerge recovered from injury stronger than prior to it.
The sooner you stop feeling sorry for yourself and get back into training, the better. When you consider the importance of training consistency, it is crucial that your training resumes as soon as possible.
Training with injury - what you can't do
So while there is a lot to be gained by training around an injury, this is not to be confused with training through an injury. We are often tempted to just push through pain. This is always a bad idea and will of course only ever cause us even more trouble in future.
We all have our own 'wear and tear' trouble spots, either from previous injuries that were not sufficiently rehabilitated, or nagging injuries that are minor enough for us to do nothing about them. But while these may present no more of a problem in daily life than when reaching up for a glass, consistent training will undoubtedly uncover them.
What is mistakenly thought of as resilience in our youth is proven to be anything but as we age. We may have been better able to push through, but all we were really doing was sweeping problems under the carpet. As we get older these just become far larger and can result in structural abnormalities such as bone spurs or muscle tears.
If you have pain, do something about it. It's not going to go anywhere and will only ever get worse unless addressed. As above this may require modification to your training program but will rarely mean any more than that.
One of our best defences against injury is awareness. Yes, we want to push ourselves but often people that get injured report feeling as if something was 'off' beforehand. Listen for these signals. If you suspect anything, back off and reassess, there is nothing to be gained by pushing through.
In the event you are injured then just look to make sure yo do everything you can do to optimise the healing and recovery process. You can do a lot. Determine exactly how the injury happened, whether it not it could have been avoided, and what you can do to prevent it happening again.
Depending on the severity of the injury your first port of call should be an appropriate medical professional and obviously none of this information supercedes any advice you may receive from them. You should however be proactive in your recovery and go to your doctor prepared with a list of questions regarding not just what you can’t do in order to facilitate your recovery, but what you can.
Injury must be managed appropriately and completely. Seek appropriate medical advice regarding both the treatment and rehabilitation of the injury - these may from different sources.
Any injury can continue to negatively influence your athletic performance and quality of life well in to the future and by far the the best manner in which to mitigate this impact is to continue your training program.
Consult the appropriate medical professional to evaluate you and help you progress through a regimen of rehabilitation - to full restoration of movement as prior to the injury.
These guidelines are specific to injury and illness is a different story, presenting different stressors to the nervous and immune systems. As long as you don’t have a fever and your symptoms are confined to above the neck as with a sore throat, blocked nose, then training should not present any problem. If you have any type of chest congestion, virus, or infection then you need to rest. Exercise will only run you down and compromise your immune system further.
As always, listen to what your body is telling you.
References:
http://www.precisionnutrition.com/nutrition-for-injury-part-1
http://www.mobilitywod.com/2012/08/people-weve-got-to-stop-icing-we-were-wrong-sooo-wrong/
http://www.ncbi.nlm.nih.gov/pubmed?term=+18212134&cmd=search
Further reading: