Wednesday, March 26, 2014

Some Thoughts on Injuries

     Well, it’s been a number of weeks since my last post and there is a reason for it. Unfortunately, I have forced myself to take a few weeks off due to my nagging knee and now I am now slowly making a return to my usual training program. What started as typical soreness slowly progressed into more serious pain, affecting my ability to walk and run. Despite the absence of swelling, the possibility of a serious tendon tear still worried me. Initially, a few days of rest provided no relief and I decided a full week off was necessary. Still, no progress. The following week, I forced myself to ride my stationary bike for at least an hour every day. However, this was incredibly boring because I've seen all the movies in my collection too many times. My knee slowly began to make progress, but was still far from feeling normal. By the first week of March, it had improved enough for me to do easy runs of twenty minutes every other day with cycling in between. Fortunately, on March 10th I was able to see an athletic trainer at LSU for free. I was shocked to hear that my flexibility was what he would expect from a sedentary person. He suggested I start stretching once per day at a minimum. He believed that my pain was originated from an aggravated pes anserine. The pes anserine is an area where all the muscles of the hamstring group form a long tendon and wrap around the front of the lower medial knee and attaches to the tibia. Lack of proper post run care had led to stiffness in my quads, hamstring complex, and calves, causing other muscle groups to overcompensate leading to injury. The trainer used a combination of pulsating ultrasound and massage immediately followed by a stretching routine. Since my initial visit, there has been significant improvement. Over the past two weeks, I have progressively increased the duration and frequency of running. Most importantly, however, I have increased my post-run activities. Immediately after running, I stretch before getting in the car while my legs are still warmed up. Once home, I use a massage ball to break up muscle stiffness followed with a more intense stretching routine. Since the tenth, I haven’t experienced any knee pain during workouts and the pain associated with stretching has greatly reduced. With this injury, I have realized it’s important to maintain a positive attitude and to use time accordingly. I recommend identifying the cause of the injury, being proactive with treatment, and preventing future occurrences. 
     Taking time to identify the cause of the injury is very important. I believe there are two types of injuries. The first is an immediate injury which is caused by a one-time event. These injuries typically have symptoms that immediately express themselves and the source can be pinpointed. For example, a fall or a misstep. The second type is a long-term injury, which results from continual overuse or muscle imbalance. These injuries typically begin as soreness and escalate into a serious pain if left unchecked. Some muscle soreness is expected from hard training; however, if it doesn't disappear after a period of lowered intensity, something else may be wrong. Long-term injuries are harder to identify. When diagnosing the source of an injury it’s important for us to be honest with ourselves since different types of injuries have different methods of treatment.     
After identifying the cause of the injury, we need to be proactive in treating it. The most important aspect is to take sufficient time off and slowly build back into a training program. If it is an immediate injury such as an ankle sprain, a few days off and some icing may do the trick. However, a long-term injury may require more than just time off and ice. In the case of my knee injury, I had to seek professional treatment. The combination of ultra-sound, massage therapy, the addition of stretching into my routine, and icing have been successful so far. Obviously, everyone is different and so are the injuries we sustain; if it’s something serious, get professional help. If the injury is a long-term one due to poor bio-mechanics or muscle imbalances, it’s important that we try to minimize future occurrences. This can be achieved by simply doing a proper warm-up before exercise and a proper cool-down with static stretching after running. Previously, I was never a fan of stretching. Now, however, I think it is more important, especially important for trail runners. Stretching increases the range of motion our muscles and tendons are able to withstand. Flexible muscles and tendons are better able to absorb the twisting and bending that we subject them to while running trails. Conversely, a tight muscle or tendon with poor flexibility, decreased range of motion, is more likely to break or tear when it twists further than it can sustain. In addition, core strength is essential for every runner. I have always done core strengthening routines in my weekly workouts but since this injury I have been giving them greater focus. I recently picked up a book by Jeff Horowitz called Quick Strength for Runners: 8 Weeks to a Better Runner's Body. What I like about the book is that it offers an eight week program including over forty exercises with explanations on each workout and how they affect the performance of our running. Currently, I'm halfway through the eight week program, doing the prescribed exercises three times a week, and sometimes modifying the amount of repetitions for each workout. Trail runners deal with a variety of terrain that is constantly changing and challenging so I personally believe that a combination of flexibility and strength will improve our ability to run trails efficiently and minimize injury. 
     While this is a personal testimony, I do feel qualified to speak about long-term injuries because I have dealt with several related to over-training throughout the years. However, professional help is usually always the best and is the most advisable. With that said, I do hope that you implement  proper warm-ups and cool downs, stretching, and core strengthening  into your training plan so that you can get the most out of your running and hopefully prevent avoidable injuries in future. Hopefully I will see you all on the trails soon!