Tuesday, 29 April 2014

Injury prevention and treatment: lessons learned from 21 years of track and field

As part of my preparation for a workshop on injury prevention last week, I made a list of all the injuries that I’ve had over last 21 years – the length of time that I have been competing in athletics – and one thing stood out to me: I’ve been very, very lucky.  Well I like to think that I have made a bit of my own luck, as I will discuss later, but the list is notably short for a distance runner.

Injuries, take note: the page is already full!

The purpose of listing all my injuries is to highlight injury patterns, causes, and treatment, and to ask myself what I would have done differently.  While the sample size of one wouldn’t pass scientific significance levels, the duration of the sampling gives a useful snapshot into injury.  Before I go on to discuss injury prevention in general, I wanted to highlight a few of my ‘findings’.

I hope that I’m not tempting fate here, but I have never had a stress fracture.  I never trained on the road as a teenager, did so sparingly in my twenties, and now, further into my thirties than I’d like to admit, I still train off-road on a regular basis.  I feel that avoiding the roads until my body was mature enough to handle them, has had a large impact, if you pardon the pun, on my low injury rate.  Regular periods, eating a healthy diet, and having a slight addiction to cheese as a child and a teenager, has meant that my skeleton is in the best possible shape that it can be. 

However, I feel that the biggest factor in not getting injured in the early days was the four week end-of-season break that was enforced on us.  Four weeks of not running was like hell, but it meant that my body got an annual holiday, and I was always rearing to go at the start of the season.  There was some pride to be swallowed in the early season cross country races for which I would not have done as much training as my closest rivals, but these breaks (and occasions of pride swallowing) definitely never did me any harm.

Visual representation of some of the many causes of injury

Unfortunately, the biggest factor in diagnosing and treating injuries is often a lack of knowledge and I definitely didn’t do everything perfectly. These are some of the lessons I've learned along the way:

Lesson 1 - Different tissues respond differently.  Stress fractures and other bone injuries get sorer as a run goes on, while the pain associated with muscle or tendon injuries abates as the body warms up.  Some injuries clear up after a few days, but some need a very gradual return to training, sometimes starting with just a two or three minute run.  When I had shin pain in 2010, I rested for 4 or 5 days, as I had previously done for shin splints.  Bone, with a poorer blood supply than muscle, takes longer to heal and return from bone or tendon injury should be particularly gradual.  Then I'd come back training, feel good, and end up doing 40 or 50 minutes.  Then I'd wonder why I was in agony again the next day.  As I later found out, I had tendinitis  and needed to start with a 5 minute run, and increase very gradually.

Lesson 2 - Listen to the advice that you are given, and don’t be afraid to ask questions.  In 2012 I was bitten by a dog.  There was nothing that I could have done to prevent that injury.  But when the doctor prescribed antibiotics, I decided not to take them (I figured that if I wasn't on antibiotics I'd be back running in 2 or 3 days).  My leg ended up getting infected, and I missed two weeks of training.  As it turns out, the antibiotics weren't a precaution against possible infection, they were a necessity against inevitable infection.

Lesson 3 - Don't underestimate the value of rest.  Soft tissue breaks down during training, and needs time to rebuild and repair.  End of season breaks, easier weeks between meso cycles, and rest days every week or two, will help prevent injury, and allow you time to respond to training   There are no short cuts to success, and a rest day here and there can actually help prevent time out with injury.

Lesson 4 - Cross training isn't always the answer.  Non-weight bearing exercise can be a great way to maintain fitness when injured.  But it doesn't always work.  When I had the aforementioned tendonitis in my shin, I tried aquajogging to maintain some level of cardiovascular fitness, but it actually made the tendonitis worst.  Similarly, I tried cycling last year when I had a niggle in my foot, only to realise that it was my pedals that caused the niggle to begin with.  If an injury is caused by low body weight and over training (e.g. a stress fracture), think about what your body is telling you.  Cross training like mad may heal the injury, but it won't heal the underlying cause.

As time goes on, I'm better able to distinguish between discomfort and an injury, but it's taken me two decades of regular running to get to that stage.  Find a physiotherapist that you trust, and get niggles and pain sorted out before it becomes a major problem.  If in doubt, rest.

In future posts, we'll look into lifestyle factors relating to sports injuries, and deal with how to cope with injuries and other setbacks.

Building core strength and stability is one way of reducing the risk of injury.  To learn more about muscles, stability and injury prevention, get yourself a copy of this great book: 

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