#101 Learning to manage injuries

Everyone gets injured. That's a fact. Where we can set ourselves apart from the rest is in how we react when facing an injury. For that, it is worth digging into the question and sharing a few tips. All of it to avoid plunging into the infernal spiral of the recurring injury.

Where does injury come from?

An injury is either traumatic in origin, or the result of poor loading. When it is traumatic, that is, following an accident, we have no trouble recognizing it. The pain is notable and easily identifiable. Depending on the degree of severity of the accident, the injury can be paralyzing. We are not going to dig into traumatic injury in detail, but we recommend consulting specialists to get answers to your questions if you are in this situation. If that is your case, patience is the rule and it is important to take your time to recover from it once and for all. The most pernicious injury is the most worrying one, because it is the result of poor management of your practice. Training consists of stringing together stress/recovery cycles to push your body to adapt and become more efficient. The athletes we are constantly seek to optimize this load/rest balance in order to become more efficient faster. This balance is fragile, and once it is broken, injuries appear. They generally arrive on the sly, and if we do not pay attention to them, they grow exponentially until they force us to stop. The pain associated with an injury should not be considered a weakness, but as what it is: a signal. Pain is your body telling you there is a problem to deal with, whose urgency is proportional to the intensity of the pain. Thankfully we have this signal; in its absence, it would be a straight line toward the destruction of the joint or muscle concerned. So no panic in the event of pain: keep your spirits up and adopt a scientist's mindset to work out what is going on.

Preventing injuries from appearing

Injury appears when the stress/recovery balance is broken. Prevention will therefore play out on both fronts. The best defense against injuries is to train progressively. You must respect the modulation of the mesocycles and plan one day of total rest per week into them. Nobody becomes a great runner overnight; it is a long and highly rewarding process when the first results finally arrive. A personal training plan is the best tool to guide you through your sessions. The design of this plan is detailed in the following article. But if there is one thing to remember from this paragraph, it is that you must not confuse training with competition. Another lever on the stress side is to include muscular development in your training plan. Strength sessions are a tool for avoiding injuries, provided we do not introduce any imbalance. In particular, they help protect the joints and increase core strength, the guarantor of good position and coordination. As for recovery, it is the combination of nutrition and rest. The athlete needs perfect hydration to flush out toxins and supply water to all their cells. Their organism also needs to have all the nutrients necessary for developing the muscles and protecting the joints. A common source of injuries is relative energy deficiency (RED-S), which consists of cutting back meals in order to maintain or reduce your weight. This deficit degrades bone health by reducing bone density and robustness. RED-S weakens tendons and ligaments, degrades recovery and increases fatigue. Rest, for its part, comes through quality nights. Sleep allows the parasympathetic system to repair and rebuild damaged muscle fibers. Recovery also comes through massage. The ideal solution is to get massaged by a professional. That most often gets very expensive, unless you choose your partner well. Nowadays, there are massage rollers and balls, with their associated techniques, for massaging yourself on your own. Not forgetting post-session stretching… On top of keeping a close eye on your training, you have to learn to listen to your body. Listen to the small pains, note their position and their intensity. If you are a beginner, you will have to learn to tell good pain from bad pain, but when in doubt, it is better to ease off. Training means pains appear from time to time, as the body can have a bit of trouble adapting. Nothing dramatic about having sore calves or knees now and then. But if the pain persists in the same spot for several days, you need to become proactive to head off a more serious injury.

Recovering from an injury

You are injured. First, you must stop your practice and use the break to understand the source of the problem. The source of an injury can come from overtraining, from worn or unsuitable gear, or from poor technique:

Walking or running technique can also be a source of injuries. In these cases, the best thing is to ask another athlete to observe you during your efforts to detect any problem. You can also film yourself from several angles and compare with videos of other high-level athletes. Stopping, especially when you are an active person, is never a pleasant moment. And yet, you will have to get used to it so that the injury immobilizes us for only a few days and not a few weeks. The typical athlete's pattern is to stop too late and come back too soon. The result is a discontinuous string of injuries and training that keeps getting interrupted. Beyond two interruptions in the same half-year, it means the source of the problem has not been resolved. During the injury recovery phase, you will have to pay very close attention to your diet. With an activity level much lower than usual, it is tempting to cut back your intake to avoid gaining weight. In that case, you must be very careful not to cut back to the point where the body no longer has access to the nutrients it needs to carry out the repair. Sufficient food intake also prevents the body from raiding the muscles and tendons to feed itself. Moreover, it is essential that your diet be varied and healthy to speed up recovery. Forget comfort food of the fast-food kind if you want to limit the damage. Finally, know that alcohol consumption slows down recovery. Besides no longer using the painful area, eating well and sleeping well, you can take advantage of this downtime to work other parts of your body. If you have an injured foot, nothing stops you from doing push-ups on your knees. Within a certain measure: you would not want to exhaust your metabolism, which needs energy to heal itself. You can also use this time to bring your technical knowledge up to date and educate yourself.

Coming back from injuries

You are no longer injured and you want to return to training. Whatever the length of the layoff, it is inconceivable to come back right where you were. You will need to plan a mini transition phase to ramp back up and resume your training plan. Keep the same microcycle, with a lower weekly hourly volume. Scale it up until you return to your plan within 2 or 3 weeks. Without having forgotten to correct said plan according to the causes of the injury.

When In Doubt About A Running Injury Or Other Issue, Take 3 Days Completely Off

Putting your plans aside at the first sign of trouble
can prevent many issues, while also supporting long-term adaptation

David Roche August 17th, 2020 More than two thousand
years ago, Hippocrates theorized that humans have four different humors: blood, phlegm, black bile and yellow bile. I take this as evidence that Hippocrates spent time at an ultra aid station. Imbalances of the four humors caused
illness. A few hundred years later, Galen declared that blood was the
most dominant humor, and that bloodletting could cure many illnesses. Human history can sometimes feel like the
process of cleaning up messes caused by oddly overconfident men. Bloodletting continued all the way
until the 1800s, and it was used to treat every condition imaginable.
Seizures? Get some of that blood out. Fevers? Someone text the leech
salesman. Coughs? I got 99 problems and blood ain’t one. Eventually, bloodletting stopped when doctors realized that their “A” goal at the next treatment event should be not actively killing patients. The point of that digression is to
provide a lesson that underscores the central thesis of this article—our first impulse as humans is to do something (ANYTHING!) when an issue
arises, but often that’s not the right answer. A first intervention that any athlete can do for non-medical/clinical concerns is taking three
days off.

Bloodletting stemmed from uncertainty.

We don’t know what is going on. We
haven’t thought up MRI machines or the scientific method. But we need to do something. Let’s do something! Similarly, athletes face uncertain
problems all the time. An athlete might be: fatigued, demotivated,
feeling discomfort, sleeping poorly, eating inadequately, dealing with a sense of impending doom or gloom or Zoom. The impulse is to immediately do something (ANYTHING!). Extra tired? Running hard will wake
you up. Sore shin? Doing the one-legged hop test 100 times will give you answers. Eating inadequately and stressed? If you just stick on the
plan, it will all work out. Those are the bloodletting options
that may give us the comfort of action, but could also be mightily
unproductive. Often, the best multi-purpose intervention is just to do
nothing. Three days of nothing special can sometimes be the most
important thing an athlete can do for their body and mind.

This article is talking
about sub-clinical, non-medical issues like fatigue, malaise, minor
pain, the local pizza place closing, etc. Three days off may cure minor
inflammation, but it won’t cure a broken bone or depression or leprosy.

Before getting into the physiology of three days off, a disclaimer. Doctors or other medical professionals
(including therapists) should always be consulted first. This article is talking about sub-clinical, non-medical issues like fatigue, malaise,
minor pain, the local pizza place closing, etc. Three days off may cure
minor inflammation, but it won’t cure a broken bone or depression or
leprosy.

I want every athlete I coach to freely insert 3-day rest blocks throughout the year.

Runners often have the temptation to
push through everything. It’s sometimes a badge of honor. You can’t hurt me because I’m over here hurting myself! But in an athletic life,
holding on too tightly can have negative physical and mental-health
ramifications. When your car may be driving toward a cliff, but you’re
not 100-percent sure, the answer is probably not to step on the gas
pedal (unless you’re sponsored by Red Bull and you’re coming up on a
sweet jump). The 3-day rule for athletes my wife
Megan and I coach usually means doing no structured exercise at all: no
running of course, and also no cross training or lifting or even longer
hikes. There are five primary reasons to take an unplanned three days
completely off without hesitation throughout your training.

One: The body doesn’t know miles, it knows stress.

I think a big reason athletes are
tempted to avoid taking a few days off goes back to those numbers
ticking over in their brains. Three days off will lead to a low mileage
week, possibly low mileage enough to make it a lower mileage month
overall too. That’s lost fitness. But it isn’t. While our brain likes
to think of training in terms of quantified load, our bodies don’t care
about miles run outside of how that adds to overall stress levels. To
the cells, there is usually no differentiation between stress from miles and stress from presentations or midnight anxiety-induced wall-staring
contests. Our Strava training logs quantify
miles and intensity as stress proxies. Meanwhile, our brains and bodies
are constantly integrating and quantifying stress directly through the
nervous system. That stress load interpreted by the nervous system is
what determines adaptation, not the proxy stress load on training plan
bar charts. A little reduction in miles may
ensure the stress bucket doesn’t overflow in the form of health crises.
That one is obvious. What excites me more is that the body may still be able to adapt to higher stress for major fitness improvements even when all of that stress doesn’t
come from running. Three days off can restore stress balance for health
and maximal adaptation.

Two: Short-term cycles of inflammation can lead to long-term negative feedback cycles on the cellular and systemic levels.

Training introduces inflammation into the body. Take any athlete post-workout, give them a blood test, and
you’ll see numbers that would probably scare a doctor if they had been
sedentary. Some adaptation theories are essentially inflammation-centric (though it’s debated and complicated), with that inflammation being the spark that lights the fire for growth.

Chronic inflammation may
lead almost every negative health outcome imaginable, from overtraining
to life-threatening illnesses. Like stress, inflammation cycles can be
unpredictable.

You just don’t want that fire to burn the house down. Acute inflammation may lead to growth, depending on the context. Chronic inflammation may lead almost every negative health
outcome imaginable, from overtraining to life-threatening illnesses.
Like stress, inflammation cycles can be unpredictable. Some inflammation may come from
training, other sources may be immune responses, elevated cortisol,
allergies, nutrition and basically everything else you can think of.
Preventing acute inflammation from becoming chronic inflammation
sometimes requires stopping the cycle fully with time off.

Three: Hormonal imbalances can result from overstress.

A big reason I support every athlete
taking a rest day a week (even if they probably don’t need it) is that
overstress, chronic inflammation and low energy availability can all
have negative impacts on hormone production. For example, a 2019 article in the International Journal of Sport Nutrition and Exercise Metabolism reviewed the literature on low energy availability from training,
finding that it could suppress sex hormones in male and female athletes. A 2017 article in the Medicine & Science in Sport & Exercise journal found men with higher levels of chronic intense exercise and
greater durations of endurance exercise had lower libido, connected to
hormonal variations. It’s possible to control those
hormonal issues with smart, fully-fueled training. But as soon as things feel off, it could be the nervous system sending signals that the
hormonal ship is turning toward an iceberg. A few days may help get
things back on track as glycogen recovers, you have time to sleep, and
stress is controlled.

Four: 72 hours allows for adaptation processes that will only make you stronger.

The big message for skeptical athletes: time off will make you stronger when coupled with focused training at other times. At first as you
start running again, it may feel like you are a hippo with an inner ear
problem. But that is just related to temporary physiological processes
like a slight reduction in blood volume, small neuromuscular changes and maybe even debated issues like a loss of muscle tension. Within a day or two, things will start to normalize and VO2 max or other key variables will only improve from the removal of any
excess stress. The biggest breakthroughs can happen a week or two after
these quick breaks, and that’s not just due to recovery. That’s all
about rest-induced growth.

Five: Time off gives athletes space to evaluate next steps in a healthier way.

After those three days, there’s a
branched decision tree of options. If the problem has subsided and
you’re chomping at the bit to get going, you can ease back in with cross training or easy running, reevaluating as you go. If the problem persists, athletes may take three more days off, start cross-training, or best of all, see a
physical or mental health professional. It depends heavily on why they
are taking time off in the first place.

After three days of the
problem staying the same or getting worse, it may be time to bite the
bullet and get to an expert that can help.

Light fatigue or motivation issues?
Maybe the only way past it is through it, and those three days off will
give you certainty that you’re not being dumb. Pain or mental-health
issues, but you didn’t think it warranted an appointment at first? After three days of the problem staying the same or getting worse, it may be
time to bite the bullet and get to an expert that can help. Time off is not a sign of weakness. It’s a sign of emotional strength. And it may make you way stronger physically too. David Roche partners with runners of all abilities through his coaching service, Some Work, All Play. With Megan Roche, M.D., he hosts a weekly, 30-minute podcast on running (and other things), and they wrote a book called The Happy Runner.