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Training Around Injuries: What Works for Others May Help You
C. W. Schurman MS, CSCS
Many athletes eventually experience some sort of strain or injury that temporarily takes them out of their regular training routine. However, that does not have to result in long-term loss of conditioning. Keep in mind that the best rule of thumb is to have a good team of health care professionals on your side to help you properly assess what your injury is, how to rehabilitate it, and how to return to sport-preparedness as quickly as possible.
One way to do that is to continue to stay as active as possible while you heal. Below are several real-life examples of injuries that resulted in creative ways to �train around it� without significant loss in conditioning levels, and in most cases, faster return to normal training. These may be useful examples for the avid outdoor enthusiast or athlete who is willing to find alternative methods of training while on the mend.
Broken or fractured wrist
Even if you have to wear a cast for 6 weeks, that does not mean the rest of you has to atrophy and suffer. Good training options that remain available to you include walking, jogging, stationary biking or riding outside at low speeds and on level terrain only, not requiring both hands for breaking; strength training using machines or bodyweight resistance for legs, and selectorized machines (such as pec dec flyes) or wrist weight exercises that do not require gripping. Though the muscles in the affected hand and arm may atrophy slightly, strength can return relatively quickly afterwards, due, in part, to the strength training of the uninjured limb.
Fractured metatarsal in foot
This required a walking boot worn for 1-2 weeks. The climber was able to carefully return to short sessions of weight-bearing Elliptical Cross Training three days after the break. Very aggressive self-rehabilitation and strength training included squats and deadlifts but no unilateral work such as dips or lunges that would overload the healing metatarsal. Climber gradually increased the range of motion by loosening the walking boot within tolerance of pain levels. Climber successfully completed a scramble up Kilimanjaro�s Western Breach route merely six weeks after the fracture occurred.
Arthroscopic knee surgery
Hiker was able to continue with single-leg biking (at a much-reduced level) in order to maintain cardiovascular capacity and decrease atrophy of the affected limb. Subject participated in upper body training for a week, avoiding free weight training that would have required bracing with both legs. Subject returned to gentle 2-legged biking to increase range of motion after one week. Key to recovery was performing free weights strength exercises such as reverse step-ups, gradually increasing functional range of motion to a 10-13� step, and then returning to squats and deadlifts. First major activity three months following the surgery was a full day hike into and out of the Grand Canyon.
This is a particularly feisty �injury� to resolve, especially if you have to spend a lot of time standing. Hiking boots can often provide the most stability, and travel on snow may feel better than standing still or wearing tennis shoes. Active Release Therapy (soft-tissue physical therapy) can be vital to speedy recovery; in this case the climber was able to complete several multi-day climbing trips within a month�s time without long-term detrimental effects. The elliptical cross-trainer (EFX) was the primary option during rehabilitation, allowing for continued lower body endurance training without requiring excessive movement in the foot.
This type of injury is frequently caused by overuse. Self-massage techniques, reduced intensity of training sessions, use of an elbow brace (soft-sleeve, designed to keep the affected area warm when training or climbing in cold weather), and modification of the grip used on pullups and other pulling exercises all are useful in allowing full recovery. If a grip, stance, or exercise position aggravates a strain or injury, try experimenting to find one that feels better.
These admittedly seem to take the longest of any muscle group to heal, especially if they keep getting re-injured. What seems to be the most helpful is a) gradually increasing strength through the full range of motion needed for the sport; b) training for increased rate of reaction in order to deal with any changes of speed or direction that occur during activity; c) maintaining proper form on all lower body exercises, particularly heavy-load or higher velocity exercises such as squats, deadlifts, stiff-legged deadlifts, snatches, cleans, jumps of any kind, lunges and dips; d) including active and dynamic stretching as part of a thorough warm-up; and e) 1-leg strengthening exercises that help improve balance.
Finger tendon strains
Another area of the body that climbers commonly complain about injuring are the fingers. What seems to help is proper taping during recovery but NOT as a preventative measure. If you have any sort of tender finger issues, focus on mantel and stem (pressing) movements, climbing on large juggy holds, and focusing on footwork while the fingers recover. Gradual and progressive grip strengthening for the forearms and fingers; appropriate self-massage of the elbow tendons; performing wide grip pulling or pressing movements using PVC piping or washcloths wrapped around the handles; and stretching the wrist flexors and extensors are other useful options.
Lower back strains
Your immediate line of defense is to prevent muscles from further spasms by stretching, taking ibuprofen, reducing the weight loads you�re carrying or lifting, or working through as much range of motion as possible without any weight. Other things that might help include chiropractic adjustments; maintaining proper form at all times; hydrotherapy (hot tub jet massage) as a preventative measure; gradually ramping up the loads carried in your backpack or workout exercises; identifying and addressing weaknesses in the core (abs, obliques, lower back); and including appropriate strengthening and stretching exercises for the entire posterior chain (muscles in the back side of the body).
The bottom line
Strengthening the opposite limb from an injured body part can result in training benefits and overall reduced atrophy for the affected limb. Sometimes the best thing you can do if you suffer from certain types of injury is to start working in whatever range of motion you have available to you in order to prevent atrophy, promote recovery, and help you return to your activity as quickly as possible. While there are certainly instances where you will benefit from taking time off, the longer you are inactive, the more atrophy you will experience and the longer you may be away from your activity. Try to stay as active as possible within the realm of what your sports medicine doctor and physical therapist suggest is reasonably aggressive.