Articles

Has Your Training Been Hampered by Injury?
The Key to Resolving Tough Overuse Injuries:
A Multidisciplinary Approach

The 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.