‘Injury’ is probably every triathletes least favourite word with 'physio exercises' coming a close second! Yet they are probably also some of the most common! Occasionally we will be told we can't do something. For most of our athletes we rarely "stop" unless we really need to – and that is a final option and we always bring them back as soon as possible. If you do have to stop, pause or limit your training, here are some great bits of advice.
'Physio exercises are boring, repetitive and won't actually make you faster – I just want to swim, bike, run!' is the thought process I am confident that every single one of us has had at least once in our triathlon journey. Equally, I am sure that there has been a moment when you went back to your physio and said, “It was amazing I did my exercises and then the pain has gone!”
So what next?
Just because the pain has gone it doesn’t always mean that you are ready to resume normal training or even reduced training. After a period of physiotherapy, training can be a load too far especially if injury has meant you have been out for a prolonged period of time. Instead there needs to be a more planned and careful return to training programme. You can't necessarily just pick up where you left off. A physio plan should interlink with a strength and conditioning plan all of which is is integrated into the training plan under the watchful eye of the coach. This level of integration between all the experts is very difficult to get right. [Read our how to on knowing a good S&C plan.]
Let's use an example.
I was working recently with an athlete who has had chronic Achilles tendon pains called Karl. He used to be a 1500m runner with some very impressive run times as a junior, yet now as…less junior… he has been struggling for years with Achilles issues and could only ever sometimes run slowly without pain. The easy option was to look at operations, no running (ever) or a constant oscillation of quick fixes.
Fed up with the situation the athlete sought professional advice and for almost six months religiously worked on all the different exercises he was given by the physio and gradually he saw a progression. With the use of a very simple run clearance test, conducted every couple of weeks improvements were slowly made. Following progression to plyometric work and SSC (Stretch Shorten Cycle) work he gradually starting to run again - pain free.
For this athlete his patience and commitment to a physio routine paid off and saw him post a 5km run off the bike in 21 mins and a hilly 10km run by the end of the season without any pain. It was a true demonstration of commitment on his part and deserving of all the really hard work he put in.
When asking him for some advice, Karl had these three pearls of wisdom, or P’s to success:
- Keep Positive – the exercises are to get you back to health, they aren’t punishment!
- Be Patient – don’t kid yourself; you don’t know better than your coach and physio, that is why you are paying them, but do involve them. The more information they have, the better advice they can give.
- Plan – include your exercises and Physio sessions into your training plan and where you have to go “off-piste”, then try and fit it into your routine wherever possible: Do them in queues, while on the phone, waiting for a bus etc etc.
Pragmatically he points out that a niggle is just that – a niggle but an injury is something totally different. Getting advice the minute things don’t seem right can save a lot of time (and money through injury prevention). Being truly engaged with the experts you are working with can make this experience educational as well as more tailored.
So, what can we learn from this?
With the exercises in mind, athletes will probably adapt very quickly. However, part of the purpose of the exercise is to build motor patterns. This means re-educating how your body performs a movement (usually to engage the correct muscle or kinetic chain). All to often, as a coach, working alongside a physio, we see someone rebuilding back up nicely, and then sadly, spoil it by jumping ahead to go for a run because their impatience and frustration got the better of them. The chances are there may not be any immediate problems: no pain, no injury but what they have done is affect the memory of those motor patterns when not ready to do so resulting in taking several steps backward on the road to recovery. Injury or Physio exercises need to also happen in the mind.
When working with athletes, we get that not doing your sport is not anyone’s goal. However, we also recognise that sometimes getting back to the sport is the short term win and the long term loss. Working through injury can have several psychological implications but doing it with a physio and a coach who understands that the aim is to get you fixed for good, not just for the short term is critical. Don't try and do it alone, talk to your coach and get the professional help and guidance you need. [Look into how Performance Psychology can help you survive even the worst possible injury outlook.]
Ali Wilson (coached athlete and fastest female amateur from GB in Kona 2016 and physiotherapist) believes “you need to see the benefit or outcome from the eyes of the patient or client. If they don’t feel or understand it, there is no point in giving it to the athlete. You need to find the exercise that works for them. If they don’t feel it in the right place then why would they do it?”
With these exercises, the movements may seem insignificant, or small, but it is exactly these movements that build up to very complex movement patterns like balance, swimming, cycling or running and if one of these links in the chain is different, then the outcome is very different and usually painful! In this instance, our body completely epitomises the saying: The sum is greater than the parts.
Do you want some help with building all your 'component parts'??
Follow this link to see how we can integrate your coaching with strength and conditioning, physio, nutrition and psychologist to ensure you are always training smoothly. A great training programme begins with an athlete and involves all aspect of their life, not just the training part.