Injury recovery: Tips for how to return to training

By Roy Stevenson

Triathlon notorious for causing injuries. Age-groupers have a 56 per cent chance of being injured in any given five-year period. Most triathletes do not know that if they are aggressive about treating the injury and take care of it immediately they will spend far less down time than if they just leave it alone to heal.

If you’ve just been injured while training or racing your first priority is to begin self-treatment immediately. Most triathletes don’t do that – they hope the injury will heal by itself with rest. This usually results in a mass of scar tissue building up in the affected area, which causes problems later and increases the chances that it will recur again.

Immediate self-management of your injury

•  Rest
•  Ice the area for 10 to 15 minutes, several times per day (at least two to three times) for the first three days. Never apply heat to a new injury.
• Compress the area firmly with a bandage (but not tight enough to stop blood flow to the area).
• Elevate the area above the level of your heart when you sleep. Reducing blood flow to the area minimizes inflammation and swelling.
• Stretch the affected area gently if there is no pain.
  If the injury is not severe enough to stop you running or cycling, modify your training. By doing the following steps, there’s a good chance your injury will turn around within a week or two so you can gradually start to increase your training again. Pay attention to your body. If a running injury starts getting sore around three miles, stop at two. You alone can determine how much training is safely within your limits.

Tips to train with an injury

• Cut back to running or cycling every second day (or cut your frequency of exercising days per week by 50 per cent). Avoid running on consecutive days.
• Reduce your distance by 50 per cent. Try jogging, cycling or swimming very slowly for five to 10 minutes to start with.
• Cut back your training speed by one to two minutes per mile slower than normal training pace, or walk if running causes pain.
• Jog on a soft, level surface like grass or dirt trails. Avoid uphill and downhill running. Avoid fast running, races and hard surfaces.

Post training

Always ice the affected area after you run or cycle. Gently stretch the affected area with one or two stretches. Hold each stretch for 15 to 30 seconds. Check your running shoes for excessive wear, and get a new pair anyway.
A good indicator that you are recovering from your injury is how the affected area feels in the morning. If there is no pain in the affected area, or during your training efforts, you can slowly build your training back up to normal levels. However, if it’s stiff, sore and has you hobbling around in the mornings, you may have to take the next step.

Still not getting better?
If, after a week, your pain and swelling have still not receded with your self-treatment and training modifications, it’s time to visit your sports medicine physician. The doctor will diagnose your injury and advise you on whether you need to stop training and start taking anti-inflammatory medications. Your physician may also determine whether you need physiotherapy treatment.
Physiotherapists have likely seen your injury before, so listen closely to their advice and, when they prescribe some home exercises for you, do them. Following an in-home program will help turn your injury around very quickly. Your physio will also perform some other magic on your injury with through various modalities including ice, heat, electric stimulation, ultrasound, massage and mobilization exercises.
You also need to be aware that feelings of hopelessness and frustration may overcome you with enforced time off from training. Often athletes will completely stop all exercise. This practice is highly counterproductive-stopping training completely causes a dramatic reduction in VO2 max, your ability to process oxygen.

But, take heart, because many research studies have found that reducing training shows almost no reduction in fitness for periods of 1-15 weeks, if your training is done the right way. One study found that when intensity of training remains unchanged, VO2 max is maintained for 15 weeks, even when frequency and duration of training are reduced by as much as two-thirds. This means that, if you are able, you can exercise intensely in the activity that does not aggravate your injury and you won’t lose any fitness.

Clearly if you’ve been instructed not to run or cycle by your physician or physio you’re going to have to make some choices about other types of cardio-respiratory exercise you can do. This is a good time to do some cross training. Performing other exercises has the added benefit of developing parts of your body that are neglected by running, cycling or swimming.

Unless your injury is swimming related, (usually in the shoulders), jumping in the pool is an excellent fall back. There’s no impact involved, you can still do high intensity swimming to maintain your fitness and it is one of the triathlon events. Other non -impact equipment such as an elliptical trainer, stationary bike or rowing machine are also good alternatives providing they will not aggravate the injury.

Remember, to maintain your fitness you’ll need to exercise at a high intensity, so aim to get your heart rate above 80 per cent of your estimated maximal heart rate. You can continue with your strength-training program while injured as long as you avoid exercising the affected area. If you haven’t done any resistance training previously, this would be a great time to start strengthening the rest of your body

Mistakes to avoid when returning to training
A common mistake is to rush back into your training program. Never try to catch up on lost days as you’re likely to aggravate the injury again.

Remember, too, that your body is composed of many different systems, all integrated at different levels. Ideally they act as a smoothly functioning unit, but when you are deconditioned or injured and starting up again, some systems are more out of condition than others. For example, you may notice your respiratory system (breathing) returns to condition faster than your muscular system (leg muscles). You need to be patient and wait until the slowest adapting systems catch up with the faster adjusting ones.

Rehab is an important part of coming back from an injury. The canny triathlete listens closely to his body and adjusts his workouts accordingly. Pain sends a clear message that our tissue has temporarily reached its limit. Ignoring this message inevitably ends in re-injury.

Roy Stevenson has a master’s degree in exercise physiology and coaching from Ohio University. He works in a sports medicine clinic in Seattle and teaches exercise science at Seattle University in Washington State.