Has
Your Training Been Hampered by Injury?
The Key to Resolving Tough Overuse Injuries:
A Multidisciplinary ApproachThe Athlele’s Source December
‘96/January 1997
By Douglas Wisoff, Physical Therapist Have
you had or do you now have a recurrent injury that fails to respond to a typical
therapeutic approach? When this is the case there is usually a combination of
factors that form the background of the problem. Although what seems to be the
cause of the injury may only be a single event, this event is only part of a bigger
equation. Treating this kind of injury involves solving the equation by understanding
the factors, how they interweave and how to work with them. Here the team
approach to rehabilitation has an incredible advantage due to its inherent holistic
nature. An injury then becomes a learning opportunity for the athlete to gain
insight into and unwind the more hidden elements of their problem. The background
factors can involve issues in body usage, training principles, a variety of mental
and emotional components, and nutrition. It is then very likely that this injury
and the overcoming of obstacles presented by it can have the very favorable outcome
of improved performance, increased enjoyment of sports involvement, and longevity
as a competitive or recreational athlete. Elements that form the background
of an injury often appear as faulty biomechanics. Distortions in posture and structure,
and imbalance in strength and timing of skeletal muscles play a big role here.
It can be obvious or subtle that an individual is using their body in such a way
that the forces of impact become congested in the involved area causing tissue
damage. The psychological aspect cannot be ignored either. Mental and/or
emotional components can be at the root of the problem, be a result of the disability,
or some mix of both. In either case a lack of confidence will make recovery more
difficult. This lack of confidence can maintain a muscular tension resulting in
brittleness in movement and an increased vulnerability to injury. Finally
, the importance of a well-devised training program can’t be over emphasized.
Training error usually counts as an important factor in overuse injury. CASE
STUDY: Jeff is a talented collegiate runner, however he had been able to
run only a few races during his entire four years. At the time he came to us,
he was still on scholarship and eligible as a fifth year senior to compete in
the cross-country season. I first saw him in June of 1995. At this time he had
not run for nine months due to a recurrent severe case of bilateral shin splints.
His goal was to compete in the fall cross-country season. This meant being competitive
on a top-level team that had been training 90-115 miles a week all summer.
Upon first seeing Jeff we did an evaluation. This involved an interview, analysis
of posture, walking and running gait, and evaluation of muscular balance in the
low back, pelvis, hips and legs. We were looking for the immediate cause of injury
for starters, but more important to true improvement was how all the factors observed
related in the equation. Jeff came into our office with a glimmer of hope (we
had successfully helped a close friend of his, also a competitive college athlete,
overcome severe plantar fasciitis), but his general mood was downcast and pessimistic
because he had tried a lot of healing options without results. We found
muscular weakness and imbalance in some key pelvic and hip muscles. Along with
that was an observable lack of mobility in his hips and pelvis. When running he
substituted a strong "snap out of the ankles" to compensate for the
lack of strength and mobility in his hips and pelvis. It was this "snap"
which gave him the speed to become a high school state champion and a Junior National
10,000 meter Champion. Over time, reliance on his powerful forefoot takeoff would
fatigue his calf, decrease his ability to absorb shock through his legs, and leave
him vulnerable to injury. The four years of disappointment over what appeared
to be failure to live up to his dreams and expectations was a major contributor
to the overall problem, casting a shadow on his normally optimistic nature. This
was seen in his posture as rounded shoulders, as well as a habit of holding his
head and looking down. This affected his breathing and resulted in a lack of energy.
It appeared in his running form as a bearing down, which increased the stress
on the front of his legs and knees, adding to the already overburdened shins.
The original injury that set the stage for the kink in his college running career
was precipitated by an increase in asphalt and concrete surfaces after a summer
of trail running. Since that time Jeff was unable to train over fifty miles a
week without the return of his symptoms. We began the rehabilitation process
with a series of neuro-muscular exercises to help Jeff develop an awareness of
the imbalance in his hips and pelvis. At the same time these exercises mobilized
this area, which is crucial to the development of power and stride. With
increased mobility and strength from the powerful muscles of the hips and pelvis,
he was able to give up his reliance on his calf muscles for speed and power. As
for the chest area, we wanted to get it open, and get him breathing fully. With
an open chest area and more uprightness in his posture and running form he could
eliminate the bearing down. Jeff was empowered by his ability to sense how
he was using his body and to establish a command by which he could begin to make
improvements. As he began to master what he was being taught with practice, his
rehabilitation transitioned from clinic work to training. Therapist and coach
were exchanging insights and strategies to advance him toward his goal as quickly
as possible. Rapid increase in mileage and intensity was necessary in his case. The
last obstacle was his mental apprehension around high mileage based on his history
with the pain and injury. The mutual confidence and respect that had developed
between us during the process allowed for an easy transition through this danger
zone. By this time he was confident in his new running form, his ability to command
and direct forces in his body, and his sense of fluidity. Coming from way
behind, Jeff was able to meet the challenges of fall training with and racing,
moving up the ranks and finally establishing himself on the team at the Big Eight
Cross County Finals.
© Copyright 1996
by Douglas Wisoff. All Rights Reserved. |
