As you often will here me say, runners are a stubborn, dinged up population. They are so tough that oftentimes they push their body’s tissue tolerance to the limit and end up with injury. While some athletes have the tendency to get mad and spend their “8-10 weeks” waiting for their injuries to heal, the real athletes find solutions that will allow them to keep improving despite being sidelined from specific run training. Of course, running is the primary goal, however, these periods of time away from the sport can be quite productive in the long-term scheme as more time can be dedicated to ironing out inefficiencies and to make changes to the training program that got the runner hurt in the first place.
Over the past four weeks, I have been working with an athlete with a broken fibula (stress fracture progressed to a complete fracture). As it is a relatively common issue, I am going to discuss some of our strategies to keep this athlete as fit as possible, while speeding recovery.
In the initial stages of injury, the priority is to eliminate further risks for injury and reduce pain. This is the job of an MD, who will likely immobilize the lower leg with a cast or boot. It is generally about 2 weeks into the recovery process that I would begin working with an athlete. It can be assumed that a reasonable amount of initial inflammation has been reduced and tissue re-modeling has begun, though it is nowhere near strong. As such, precautions must be taken to prevent further damage and to enhance recovery all while giving the athlete a reasonable training effect. To accomplish our goals, it is necessary to attack the issue from several angles.
1.) Ensure adequate nutrition. Many runners are afraid to gain weight during their injury disruption, so they have the tendency to drastically cut calories. Unfortunately, while it prevents weight gain, this leads to slower healing time. It is absolutely necessary to ensure adequate intake of total calories as well as micronutrients and phytochemicals to help improve recovery time. While some reduction in total intake is necessary, it should only be enough to reach maintenance for your level or exercise or a bit higher. It is also important to help control inflammation with supplemental interventions. Fish oil, bromelain, green tea, and turmeric tend to be a good place to start.
2.) Control atrophy in the injured limb.
At first, this can be as simple as isometric squeezes of the muscles in the lower leg. It is necessary for these to be done through a pain free range of motion. If these elicit any pain, it is too soon to begin. As the structural integrity improves, we can move into other modes including Power Web toe crunches and resisted ankle movements (particularly dorsiflexion and eversion).
3.) Improve tissue quality.
As time away from running greatly reduces the time spent reinforcing the same movement, injuries offer a great opportunity to make headway with improving tissue quality. Tissue work around the injured joint can also improve blood flow and speed recovery when done correctly by a trained professional. I tend to take a knee-up approach on the injured side with our use of the foam roll and tennis ball and leave the work below the knee to the soft-tissue worker.
4.) Improve strength in the healthy limb.
What many people don’t realize is that by improving strength in the healthy limb via unilateral exercise, there is an improvement in the injured limb’s strength as well. This occurs as the nervous system is programmed to prevent asymmetry, and does not want one limb with a significantly higher level of performance than another, which can cause an injury down the road. As such, gains will occur in both limbs with unilateral training. To accomplish this training, we’ll use split squats, single leg squats, hip extensions, single leg good mornings, RDLs, etc on the healthy side. As healing continues, the athlete may even be able to do very light (body weight) bilateral work, which is progressed to light (pain-free) unilateral work on the injured side. This generally is accomplished relatively quickly, as the fibula plays only a small role in weight bearing.
5.) Maintain conditioning.
We use a number of techniques to maintain the metabolic condition of athletes including general strength, body building, unilateral hop, and pool circuits along with the typical use of cycling, rowers, and perhaps the elliptical trainer. As far as machine training goes, rowers tend to be my first choice, as the athlete can hang the injured leg off the machine on top of an AbDolly and use a single leg to push at first, and the movement is so vastly different from running that the likelihood of nerual confusion is almost eliminated. The bike also tends to be well tolerated as well because the emphasis of the force can be directed with a single leg. As the athlete begins to feel better, we will incorporate higher intensity intervals to provide further stimulus.
Hopefully you have gained a few ideas of how to make the most out of your or your athlete’s time away from training. It is worth reiterating that at no point should the athlete be put in a position that elicits pain or puts him at risk of reinjury. When in doubt, don’t.