To start off the year our site theme has been built around injuries: better understanding them, how to reduce them, and how to come back from them. We’ve gathered various perspectives on the topic, from physiotherapists to coaches and athletic preparation specialists. Below are a five key lessons that I’ve taken home from all the experts.
Healthy athletes are built through smart training
Injuries can no doubt be complex. And when we want to develop a plan to reduce or prevent injuries we often take a deep dive into the detail, down to how certain tissues need to be developed and prepared. But complex problems demand simple solutions and my own experience only underlies this: the only major injury I had in my career was as much a result of skipping the warmup as anything on the more detailed level.
When Taylor Lorbiecki started to get involved with the physical preparation planning for basic training at the Air Force Academy more than 10% of cadets were getting injured during the intense 6-week course. To reduce that she didn’t focus on specific preventative work, she focused on the structure:
That is often enough. Warmups, variety, progressions: this is what we call good training. But too often it is missing or incomplete in a training program. If we make sure we get those basics right, we do a lot of the hard work up front when it comes to injuries. Good training is injury prevention.
Don’t mistake the comfort zone for the safety zone
If your training is too comfortable, it’s probably not doing its job. You might feel you are protecting athletes by not exposing them to any risks in training. But sooner or later they’ll be exposed to those risks anyway. And wouldn’t you rather have prepared them for that?
There’s a fine line between pushing your athletes and doing something stupid. The difference comes in quality of execution and the reasonableness of volumes. Sprinting at high speeds in training can help prepare the body for those stresses, but doing so at high volumes and with poor technique will likely increase rather than decrease injuries. We often talk about sprinting as a vaccine, but as Dean Benton and Stuart McMillan pointed out recently, that’s only if the mechanics are there to reduce the risks. Keep that in mind before stepping outside of the comfort zone.
The historic rehabilitation plan involves a healthy dose of rest. Rest is our intuitive response to injury. Break your leg? Put a cast on it and rest. Sprain your ankle? Pack some ice on it, elevate it, and rest.
Bill Knowles describes the return to play process not as rehabilitation, but as reconditioning. Conditioning isn’t the result of rest; it is the result of work. And when you watch him work in practice, as a recent documentary on rugby league player Ryan Papenhuyzen showed, you see first hand how powerful smart work can be. Chris Kilmurray wrote about traumatic brain injuries recently and made the same point: doing something is better than doing nothing.
Work not only helps the healing process, but there is also an added benefit of rethinking rest: feedback. By doing something you get feedback on the injury, both positive and negative. You learn what is happening and how it is feeling. You learn about how the process is going, and you can make the plan even better as a result.
The “can do” attitude
Another tradition in rehabilitation has been restriction. The program is built around what you can’t do. This is limiting in nature, and it also has psychological ramifications on the athlete by always focusing on the negative. Donie Fox and others attempt to upend the rehabilitation model by focusing on what athletes can do. As he put it on the GAINcast:
A good starting point is a short screening to see what the athlete can do pain free, as Donie Fox and Thomas Divilly descibe in their new video lesson. That gives you all the starting possibilities. In other cases the can do mindset also requires more creativity. Dean Benton’s new water-based training module is a perfect example. Does traditional sprinting putting too much load on injured limbs, but running is essential to their sport? Then try out the water, where the many advantages include a lower impact environment for running-based movements.
Forget the plan, find a process
Linear and fixed periodization models have been a frequent target of criticism on this site. When it comes to long-term planning of physical training, as much as we think we can predict, we can’t. Therefore we need more adaptive models that helps us learn along the way.
The world of injury is even more complex and unique, yet there fixed models and progressions dominate perhaps even more. In our most recent HMMR Classroom Video Lesson, physiotherapists Donie Fox and Thomas Divilly look at returning athletes to plyometrics after injury. They have a rough plan in place for common injuries, but they value their process more than their plan. For example they have three levels of markers in the case of calf injuries. Their process helps them identify the starting point, when to exit each level, and where to begin at the next level. If they just give each athlete the same plan it is bound to fail. Each case is unique, so you need a strong process to ensure the best results for each athlete.