Long Term Management of Overuse and Athletic Injuries

There’s a lie of omission out there in the fitness world. That is once you get injured you do some work and then get better and that is the end of that. Here’s the thing though these injures actually tend to be pesky little buggers and just keep threatening to pop up again and again. After your first injury you may be surprised to find out it’s something you have to manage long term. Injuries are actually more like orchids than ferns meaning that if you don’t take constant care of them they will just not work out long term. Here’s the thing though once you know that managing an injury long term is totally normal it becomes a lot more possible.

I have a bad knee, really a not so great left side really, due to an accident when I was 16. It used to be just a twinge but 4 years ago it’s fallen into the ‘needs constant attention’ category. For me the biggest key is consistency. No matter what I get a run in once a week and that keeps the knee happy. When I take a month off I pretty much have to start rehabbing it from the start again. I also keep ‘checking in’ on how it’s feeling pretty much on every run. If it’s acting up I resume the PT exercises, foam roll and I always tape it up. When I increase my milage I do all those things and more consistently no matter what.

Define success

It is important to define what successful management of your injury means to you. Is it to be able to return to your sport at or above the level you were before, do you need to be 100% pain free or do you just want to be able to keep participating on some level. These are just general categories to think about and decide what that means for you. When it comes to me personally as long as I can keep running without dealing with too much pain I’m good. Some is okay but I don’t want to be wincing on each step. But … I’d also like to get a hair faster over time and maybe keep doing longer races for as long as I can. If you just want to stick with your weekend runs that’s cool too. Just make sure you have an idea of where you want to come out of your injury when you’re just starting your journey.

Get a proper diagnosis

This is important so that you can work through the next 3 steps but that doesn’t mean you have to run to the doctor. There are lots of other professionals that can diagnose you like physiotherapists, some trainers and yes of course the doctor. You may also deal with a reoccurrence of an old injury if you know that is exactly what you’re dealing with then you don’t necessarily have to run to the doctor again. The danger of not knowing exactly what you have is that you do all sorts of hard work and it’s all down the wrong path. It’s also good to have a professional checking in with you from time to time.

Pain medication

Pain medication seems like a great option for dealing with ongoing pain, the thing is it’s not really. I wrote a whole post about it here. Using anti-inflammatories is just a Band-Aid that will only keep you running in the very short term. In that short term you very well might make the problem worse. Taking medication should be limited to just a few days to get past a little pain at the most. Really it’s more appropriate to deal with the occasional kind of all over soreness after a hard workout rather than the kind of pain that comes from injury. You certainly shouldn’t be relying on medication more than once a week or for more than a week at a time.

Get serious about recovery

First of all take rest days it’s actually important but if you’re dealing with an ongoing injury do more! The options are endless, foam rolling, other low impact activities replacing some of your training, epsom salts, KT tape and preventative PT are some of my favorites. Others swear by compression gear, ice baths, yoga and strength training and supplementation are other popular choices. Try it all for a few weeks, see how it feels and keep what sticks… forever.

Don’t do the same workout on consecutive days

So triathlon right? That is a great option. If you avoid doing the same workout one day after the next you avoid stressing your injured muscle day after day. You don’t have to do this forever but while you’re getting signs of a flare up it’s a great idea. You could tweak the scheduled days of the week of your training plan or even swap out a recovery run for a bike ride or swim. This tip goes well with the idea of giving yourself enough time to train for the next challenge. So even though you might use a 16 week marathon plan give yourself a few extra weeks for wiggle room AND take extra time to build your base before you start.

Orthotics

Certain injuries, only certain injuries are helped long term with orthotics. If you want to find out about your condition hop onto google scholar and search for your condition and orthotics or talk to your doctor. For some injuries speciality orthotics make a big difference in preventing a reoccurrence for others it doesn’t really help. So if it’s not going to be a good option for you then you can move on. On the flip side if orthotics ARE really helpful for your condition then it might be worth doing your very best to make it work.

Keep doing the exercises

At some point along your injury journey someone, probably a physiotherapist, will give you a set of exercises. You’ll be told to do them for 6-8 weeks but it’s a good idea to bust them out a few times a week kinda forever. It’s a good idea to go for a few sessions with a professional and maybe again to check in from time to time but if you have a good handle on things. Most of us don’t have the time, money and or insurance coverage to do every single PT session in front of a therapist. It’s not really necessary though. If you want to prevent a relapse and especially if you’ve already had an old injury act up  Keep doing those exercises after you feel better and ideally forever. You can dial back on the days per week you do them though.

Follow the 10% rule or less

Everybody wants to collect the medal not everyone wants to train for the race though. Enter the 10% rule. That rules states that you should only increase your milage by 10% a week at the very most. The same only 10% more than last week rule follows for other sports too. Plenty of athletes want to skip some of the hard work and then push harder later and end up breaking the rule. Remember though 10% is a maximum. If you’re dealing with an injury increasing by less than that 10% might be your best bet. Be prepared to up your milage more slowly than you may have done in the past.

When it pain dials up back down

If I could only give you one tip this would be it. If your injury acts up again start by taking a little break from your sport. It probably doesn’t have to be long break just a few days or a week really. Cut back at the first sign of injury and you’ll end up taking way less time off then if you let it get worse. If you push through you’ll just end up back where you started. Even if you’re working a training program for a really big race still take a break. If you don’t you might miss it entirely.

Track your symptoms as you return

If you’ve taken a break or been injured before and then come back from it you already know it’s not a straight line. Lots of injuries get better then a bit worse, then better again. As you return to your workouts you can do one of two things either be really dramatic about the setbacks and freak out or minimize them and end up pushing through something you shouldn’t. You can even do those two things after just one workout alternating back and forth in your mind. At least I can. As you return and if you are prone to reoccurrences its a really good idea to keep a log of how your knee or whatever is feeling. That way you can objectively look back and see if you’re going forwards or backwards over time. You might say record at what point in your workout where it started to hurt and how much it hurt on a scale of 1 to 10. Really you could make a case that once injured you should do this forever…

Should you have surgery

There was a time that having that gnarly scar over your knee was a runner’s badge of honor. Every ‘real’ runner had one. In fact I think the aunt and uncle I looked up to who made me realize running could be a thing both had one of those scars. Well in the past doctors were way more likely to recommend surgery. It turned out that surgery wasn’t as great a cure as one would think it would be when it was studied long term. Other, more simple and less invasive things worked better. Yup, we’re talking PT exercises and even rest. If those things don’t work for you over the long term then, and only then, think about surgery. Do your own research in peer reviewed journals, get other opinions and be really honest. Have your done EVERYTHING you could possibly do get better without it?

Because here’s the truth somewhere between 20 and 30% of surgical patients have unsatisfactory results and a few more see no change. Could you even lower your expectations for success and still be happy. For example maybe you really wanted to run a sub 3 marathon. Could you instead be happy at 3:15 or focus on the half instead and still love running? In other words think long and hard about going the surgery route. If you do though a bit over half of people are actually satisfied with the results in a the long term. However if you do have a surgical intervention and you’re not happy with it consider a second surgery as most are satisfied with the result after a second surgery in the long term.

I really think we should re-frame how we talk about injuries for a number of reasons. So many athletes give up when they aren’t just magically healed at the end of the month forever. If we were honest that sometimes it takes ongoing effort maybe fewer people would drop out disappointed. Do you have injuries that require some level of constant care and attention? What are your top tips for keeping your knee/ankle/body part in good working order?

Read what I read:

Christopher et all 2006. Practical Management: Nonsteroidal Antiinflammatory Drug (NSAID) Use in Athletic Injuries. Journal of sports medicine.https://journals.lww.com/cjsportsmed/Abstract/2006/03000/Practical_Management__Nonsteroidal.15.aspx

Schepsis, et al. 1994. cal Management of Achilles Tendon Overuse Injuries A Long-term Follow-up Study. The American journal of sports medicine. http://citeseerx.ist.psu.edu/viewdoc/downloaddoi=10.1.1.921.4454&rep=rep1&type=pdf

Wilder et al 2004. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clinical sports medicine. https://media.gradebuddy.com/documents/458444/2dac5b36-81aa-47c6b2e8-24c18ffa9e68.pdf

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