Earlier in the year I touched on identifying the root cause of an injury, where I discussed some of potential contributing factors for an overuse injury in a triathlete. A key point of this article was that there will be no one factor for an overuse injury, but rather a culmination of many things that lead to that outcome for the athlete. In addition to the risk of overuse injuries, there’s always the risk of impact injuries (bike crash, rolling the ankle, tripping etc) that can also keep a triathlete sidelined. Since injuries within the sport of triathlon are so common, I thought it would be a good idea to go beyond identifying the root cause of the injury and explore the best strategies to dealing with the injury – physiologically and psychologically – to have you back into a full training program as quickly and in the best shape possible.
First thing is first – prevention is always better than a cure. So if you haven’t read my previous article on injury, please have a read before proceeding with this article.
Ok, so you’ve somehow managed to join the 56% of triathletes who experience an injury every 5 years? Now what? What is the best cause of action you can take to mitigate your down time and be back managing a full training load asap?
STAGE 1 – Self Manage
You, the athlete, will be the absolute first person to know when something isn’t right. So you will always be the first person ‘on the scene’, and have a responsibility to respond accordingly. How you respond in the early stages is critical and can have a huge impact on the longevity of the rehabilitation process.
Now let’s hope the first instance is not a situation that requires a CPR qualification (coz you’ll be in no position to do that to yourself!), however some basic first aid is the first port of call (note this applies to an overuse injury and impact injuries). Remember the good ol’ RICER?
Rest. Ice. Compression. Elevation. Referral.
Firstly – immobilise the site of the injury, let it rest. Continuing to train is accepting the risk of further injury and prolonged recovery. If you’re mid ride, or run session – phone a friend (or an Uber) and get a lift home – do not try and ‘soft pedal’ or walk home. Cease action immediately. From there, intermittent icing for the first 24 hours will help to reduce pain and localised swelling (in recent times there is more research coming out to question the value of icing, since swelling is a healing mechanism for the body – however there doesn’t appear to be anything concrete as yet and icing is still trained as ‘best practice’, so ice it is!). Applying a compression bandage or wearing a compression garment can help increase blood flow through the injured site as a means of (again) limiting localised swelling and also support the vascular system to dispose of damaged cells from the injured site. As much as possible, it’s best to keep the injured site elevated to limit the amount of localised swelling. And finally…’referral’…which leads into the next stage…
STAGE TWO – Professional Guidance
It may be costly, but I guarantee it will be worth every cent to you if it means a swift and effective rehab process that’ll get you back out there (potentially months) sooner than if you try and go this alone.
See a sports doctor (I highly recommend Dr Kate Gazzard who is available for online consults and has looked after Jan Frodeno – hello!) or a physio who specialises in the site of your injury and ideally one with a sport / triathlon field of expertise too. Get an official diagnosis. This may require some scans, but without a confirmed diagnosis, any rehabilitation undertaken at this stage would be a guess. Once you know what you’re working with, ask your medical professional for a rehabilitation program and follow it to the letter. It’s a low risk with triathletes, but slacking off on your rehabilitation exercises is only going to prolong your injury and effect your conditioning when you do return to the sport. On the flip side of that – don’t go out and do any ‘extra’. In most cases, more is not better when it comes to rehab and can be equally detrimental to your rehab as doing no rehab at all. Be a good student and follow the doctors orders.
Now is the time to focus on what you CAN do, not what you can’t. If you can’t run, can you water run, use the cross trainer, hike, swim, bike, paddle? What CAN you do? What mobility and strength work should you be focusing on? Ask these questions of your medical advisor, liaise this information with your coach and build your game plan. At no point should you do absolutely nothing – there is ALWAYS something you can be doing. Mentally it will help you knowing you’re doing something to aid in your progress. It can also help the mindset to keep the training ‘routine’ by still waking up at the usual training times, but swapping your training with your rehabilitation.
STAGE THREE – Rehabilitation
Here’s where you start to implement your plan above. No more, no less. You need to do this with the upmost self-awareness. During this stage it is critical to listen to your body. I’d even suggest that you may need to train without music to eliminate distractions to allow you to really listen in closely.
The body uses pain as an indicator that it’s not ‘ok’ what you’re asking it to do. So if you’re feeling pain with an exercise, then cease that exercise and report back to your medical advisor, this information can be quite insightful. In the meantime, move on with other exercises you’ve been prescribed. Focus on what you CAN do.
When you’ve reached a point in your rehab that you can execute all prescribed movement patterns pain free, you’ve got the medical ‘ok’, and you’re able to sustain a progressive loading of your exercise regime, then it’s time to start easing back into a full program.
STAGE FOUR – Modified Return
At this stage you’re cleared from the doctor and your primary reference point is your coach (occasional check ins with the doc may still be required though). Make sure your coach is fully aware of what your doc has had to say and understands your current situation. Working closely with your coach, now you can start a gradual return to a full program. Depending on the severity of the injury and length of time spent in stage 3, you could spend a couple of weeks, months or even longer building back up to a full program. It is critical not to rush this process though. I’ve read that downtime to return ratio is 1:1, but from my experience is more like 1:2 or 1:3 even. So if you’ve spent 6 weeks rehabilitating an injury, you need to be prepared to spend another 6 – 18 weeks getting back up to a full training load.
STAGE 5 – Full Return
By this stage you are able to sustain a full training load consistently for 2 months without any sign of injury – hooray! But now is not the time to get complacent. Depending on the nature of your injury, there’s a chance the site will never quite be the same again (built up scar tissue, reduced range of motion etc), so you need to remain diligent with your recovery regime, which needs to include strength and mobility work to keep your body moving with as much efficiency and power as possible.
Be sure to appreciate this time in your training. It’s quite an incredible feeling know you’re fit, healthy and capable of whatever you ask of your body – be grateful for that. It’s also key to remember how far you’ve come and do what you need to do to avoid going back to Stage One ever again.