Thursday, July 29, 2010

Nagging Injuries

this is a blog I wrote for a great site: www.whywetri.net
the site has some great resources for amateur and professional triathletes 

Return from Injury: the missing step

Injuries can be very frustrating.  You’d like to train yet your body is letting you down.  Diagnosis is the first step.  Healing may include therapy, ice/heat, and medication.  I hope you’re looking to rehab from the start to expedite your return to activity.  We’re going to look at a missed step in return to activity that may be holding you back from racing your full potential.

Rehab is crucial for recovery.  Even for surgical repair, studies have highlighted the value of not only rehab but pre-habilitation.  For ACL repairs, up to 90% decrease in recovery time was shown with athletes who started rehabbing even before the surgery.

When rehabbing an injury, you want to remember a crucial order of events:
(1) Range of Motion
(2) Control
(3) Strength.

It’s important not to get ahead of yourself with rehab.  Too often I hear suggestions from therapists and athletes that an injury would have been prevented if the area was stronger.  Ankle or knee sprains are not usually caused by weakness but by the control of the joint.  Hip injuries have less to do with weak muscles, but more often a need to resolve the timing and control the brain has over this complex joint.  Even more surprising, significant injuries can occur within normal ranges of motion, even when a joint that is wrapped and braced.

In the case of injury, the joint or tissue should be assessed for structural integrity and range of motion first.  Of course, you wouldn’t only rehab a detached biceps tendon.  Once you have structural integrity and full, optimal movement of that joint, the next step is control not strengthening.  The brain needs to be able to stabilize and move the area appropriately before adding additional force of muscle building.  Gentle strength improvement is often a gift of chasing stability.  Consider using an unstable surface post ankle sprain: this would encourage the brain to learn to control unexpected motions at the joint.  Simply doing calf raises may strengthen the joint when the brain expects challenge, but does not focus on the cause of the injury: an unexpected change in forces.

For any injury you’re looking to move past, focus on full range of motion first.  Treating scar tissue, adhesions, and painful trigger points is appropriate at this stage.  Follow with a chase toward greater stability than you’ve had before, and finally, consider strengthening the area in a functional way.