Injury History- Part 2

In this weeks post, we’re going to be continuing our discussion on injury histories. Last week we started to talk about the types of injuries we have as endurance athletes and what that injury cycle looks like as they progress. The majority of our injuries fall into the overuse category, which means they build up over time. It’s that time that makes these injuries unique from other sports. It allows for symptoms to fly under the radar for weeks, months and even years, which keeps us from acting on them. More importantly, it allows the body to compensate by pulling more muscles/joints into the mix. That’s why when we deal with overuse injuries it is so important to look at an injury in two parts: 1) what broke and 2) what caused it.

My favorite way to visualize this concept is to look at the body as one big chain. Picture each muscle and joint as part of this chain from the ground all the way up into the core. The impact of our activity always starts at one end and is then absorbed and transferred up the chain. Efficient bodies/athletes are able to take that impact, absorb it and then send it all the way up the chain. In other words, they are able to use that energy to help propel themselves forward.

So what happens when we can’t absorb that impact properly? We stop using the whole chain the way it was intended to be used. In the beginning that chain is still strong, so we can keep going and start compensating. The problem is that instead of the whole chain sharing that impact, now only certain parts of it are getting beat up. It doesn’t matter how you twist that chain or change it to try and ease that workload. Eventually a link will break. Is it because that link was faulty? Or weak? No, it’s because that link wasn’t designed to work alone. It was designed to work as part of a chain. Simply swapping out that link for a new one won’t change what caused the problem and it won’t reverse how the chain has changed to compensate for that problem.


(Also here is last weeks blank injury history form to get started.)

What to look for in your injury history

1) The first thing to look at when you sit down to look at your history is what are the similarities? Are there patterns?

  • Are all of the injuries on one side of the body?
  • Are they all in one area but different sides? (for example: both knees, both hips, alternating ITB’s, etc)
  • Is it the same injury over and over again?

2) In that first step we’re just looking at patterns. What do we notice on first glance? Did we forget anything? I’m constantly amazed at how much people forget to put on here or what they remember as they really start to write it out/remember. Not sure if it’s an “injury” put it on there anyway. Better to be too detailed than not detailed enough. The next step is to start thinking in terms of the chain. Here are some of the questions I would be asking if you walked into my clinic:

  • Are any of the injuries traumatic? (bike crash, fall, etc). Was surgery required?
  • If yes, did you recover 100% from them?
  • If yes, how many injuries have you had on that arm/leg/area of the body since then? It’s easy to say that everything healed fine when you were able to train and race again, but if you’re looking at a history of injuries since then, it’s time to reconsider those answers. Remember- compensation doesn’t hurt. All it takes is a little bit of residual mobility and strength loss after a big injury to completely change how you move as an athlete.
  • Are the injuries all “out of nowhere”? Do they persist even after treatment and rest? Did other problem areas pop up during the recovery? Did one injury start it all off and you’ve had a list of them since?
  • Are they injuries that happened during a very specific event? Meaning was it during a race or big effort? While the majority of our injuries are overuse, that doesn’t mean we can’t fall victim to the bad luck kind of injuries. These are the ones where you are pushing hard through a combination of fatigue and incomplete recovery and something just gives because the muscles/joints can’t match the effort. Another example of this type of injury, is a sudden and unexpected change in effort. You move one way and accelerate and you’re body can’t keep up so it over/under shoots.

Putting it all together

The primary goal of looking at your injury history is to determine if you a have chain dysfunction or if your injuries are in isolation.  My general criteria when reviewing injury histories are:

  • 2+ injuries on the same extremity
  • An injury persisting for over 6 months
  • The same injury more than two times in your history

Using the worksheet, put an “x” next to the muscle regions in that chain. Blue boxes signify the upper extremity chain and red boxes represent the lower extremity chain. The low back box is purple and a part of both chains.

If you do not meet the chain criteria above, simply put an “x” next to the muscle regions where you have had an injury in the past two seasons. Also put an x in the box above and below that injury. If there is no below, go two above.

For some of you, this step will result in all of the regions having a box next to them. THIS IS OKAY! Seriously. Take a deep breath. It doesn’t mean that you’re a train wreck or that you’re program will be six miles long. It just means, your maintenance/recovery work needs to be a little more rounded. If you started off with isolated injuries and ended up with all the regions checked, that’s okay too. It just means you fell into that chain dysfunction category and didn’t realize it.

The lucky few of you will have no boxes marked. Congrats! That’s either a great track record or you are new to the world of endurance sports and looking for maintenance/recovery advice. In the following posts, we will help you fill in this chart based on your sport and work setup.

When we kicked off this series, I asked for volunteers to donate their histories. The response was huge so first off, THANK YOU. That being said, I couldn’t use all of them in this post/videos. Using only seven histories gave me 60 minutes worth of video. If you sent a history in, you will get feedback on it! I’ll be working on those over the weekend!

Here are some video reviews to help demonstrate the process and to give some thoughts on what I look for:

Where do we go from here

So right now you’re sitting there with a chart with boxes marked and the whole right side of the chart empty. In next weeks post we’re going to fine tune those boxes even more so by factoring in sport specific areas and your work history. From there we tackle the actual treatments and teach you how to use that chart when things feel great all the way to an actual injury.

Maintenance Part Two: Injury History

In this weeks post we’re going to dive into the first and most important step of building your very own maintenance/recovery plan- how to really look at and analyze your injury history. Before we get started though, here is a blank form to download so that you can play along as we go. Print it out and take the time to sit down and really fill it out because this step is important.

As endurance athletes, we are conditioned and even expected to overlook the various aches & pains. It comes with the territory right? So instead of paying attention to our bodies warning signals, we ignore stiff joints and laugh about how we haven’t touched our toes since ’87. We start to believe that our legs will always ache on stairs or that during training it will always take 2-3 miles to “warm up”.  We get so used to accommodating these aches and pains, that eventually we just stop paying attention to them completely. If you do that long enough, you don’t even notice them anymore. The goal of this post is make you think twice next time one of those aches pops up. While the strategy above may allow you to skate along without any serious injuries for years, eventually those aches and pains will snowball into something that does sideline you. The longer you let that snowball grow, the more problems you’ll have to fix.

So where do we start and how do we know what to look for?

Before we dive into some of the volunteer histories, I want to use this post to talk about  the types of injuries that we get and the injury cycle itself.

  • As endurance athletes, the large majority of our injuries fall into the overuse category. Sure, there may be a bike crash or a fall, but for the most part we don’t have to worry about getting tackled by a linebacker or a cleat getting stuck. We don’t have to worry about twisting injuries or even side to side injuries. Our sports move in a single direction- forward.
  • So what does overuse mean? It means that the muscles that move us in that forward direction start to break down. This can be in the form of a muscle strain/sprain, tendon injury, or muscle spasm.
  • One thing I think we’re all guilty of as athletes is looking at our injuries in isolation. When something does break, we don’t stop to figure out why. We just assume that that specific spot broke and focus on fixing it. In the case of a traumatic injury, I absolutely agree, but remember- these are overuse injuries. They build up over time. A better way to think of our injuries is to think of a chain. Each link is a different muscle group and together that whole chain works together to propel us forward.
  • When that chain breaks, what’s more likely? That a single link just malfunctioned or that tension/twisting along the entire chain put enough stress on that link to break it? When you start to look at your injury as broken link on the chain, it’s much easier to see where things came from and get to the cause behind the injury. Until you fix that cause, you are asking for a repeat injury or for a different link on that chain to break down next.
  • How do you know if there is stress/strain on the “chain”? You start paying attention to those aches and pains. They may not be enough to slow you down or stop you from training/racing, but at the very least they should be noted. The aches and pains are our bodies warning signals. A random knee twinge is one thing, but a twinge that starts increasing in frequency or moving around is something to worry about.

Keeping that chain image in your mind, lets talk about what actually happens during the injury cycle with an overuse injury.

  1. Following a hard training day, a monster training week or race effort, we all know what to expect. Soreness. Muscle fatigue. Increased muscle tension/stiffness. These are the bodies normal protection mechanisms. The muscles stiffen up/tighten to protect themselves from further effort and to allow for healing. As they recover, they return to their normal resting tension and length.
  2. If the muscle is unable to recover completely, it will maintain some of that tension/stiffness. If this is allowed to continue day in/day out, that baseline of tension will continue to rise.
  3. That stiffness/tension may not be enough of hindrance to stop you, but it will impact how the affected muscle(s) function. A muscle that can’t move through it’s full range of motion can’t contract fully and more importantly it can’t relax fully. The muscle becomes inefficient essentially. Over time it will lose strength and then coordination will be affected.
  4. The coordination piece is important. Most of the athletes I meet are focused on strength. My problem is my glutes or that my hips are weak. While that is probably true, the coordination piece is more important. That chain propels us forward because the muscles work together through a series of efficient muscle contractions. When that coordination becomes affected, it’s like a car being in the wrong gear. Some muscles are working harder than they should and some aren’t working at all.
  5. As this process continues, the body starts to compensate and the chain itself starts changing. The plus side is that the body will absolutely find a way. The bad part is that now we’re using muscles in ways they weren’t designed to be used. In the short term, this isn’t a bad thing, but we’re endurance athletes. Everything we do is long term and multiplied over millions of repetitions. Eventually that muscle will cause problems. Either it will break down or it will transfer the workload to something else that will.
  6. If compensation is allowed to continue, eventually the body will start to treat that as its normal. Muscles and joints will adjust to try and make that new movement pattern more efficient. In other words, the body starts to compensate for what it’s already compensating for. This is bad. When this starts to happen, now the initial problem starts to get buried by new ones and that snowball gets some momentum.

Injuries in the first few stages of this cycle are easy to fix. You’re dealing with one thing and you can easily assess the chain itself to make sure there aren’t more problems. The further down the above list that you get, the harder it becomes to fix. By step 6, you’re in trouble and looking at some serious down time to fix everything. So how do you know what stage you’re at? By looking at your injury history.

In the next part of this post, we’re going to analyze a series of actual injury histories that my volunteers were kind enough to send in. We’re going to walk through what you should be looking for to help you determine which stage of the injury cycle you’re in. In the mean time, download the form up at the top and fill it out. List everything you can think of! You’re injuries don’t have to be the sidelining variety. They just need to be something that stuck around for a while (more than 1 week).

Gluteal Retraining in Runners: The Missing Link?

I seem to constantly be talking about the importance of looking ‘further up the kinetic chain’ when it comes to getting runners to consider their physical preparation to run. We know that many of the common running injuries affect the knees, lower legs foot and ankle. However, what is coming more and more evident is the extent to which movement at the hips play an important role in determining whether or not an athlete gets injured when running training load increases.

For example recent research has indicated that proximal control is an important factor in Patellofemoral Pain Syndrome, aka Runner’s Knee. Check out this podcast with Brad Neal for more info about recent research in this area.

Getting Results

This will almost certainly not be the first time you’ve heard it… training the abductors and external rotators of the hip (gluteal complex) is an important area, not to be overlooked for runners and triathletes of all types. Do your butt exercises!

The problem for many athletes I meet isn’t one of compliance in doing their prescribed rehab exercises regularly, more a problem of then getting the cross-over in function from isolated / targeted glute exercises to getting them integrated and working effectively during running gait. Too frequently, I meet runners who have done their glute retraining exercises religiously but fail to see the benefits to their running.

For me, there are two vitally important factors in getting the transfer of improved glute function from rehab gym to real running:

Gluteal Pre-activation:

It’s certainly not a new concept in the strength and conditioning world to get athletes performing low-level glute engagement exercises before their chosen activity. The theory being to get the important gluteal muscles pre-activated to enhance their role in the subsequent sporting movement and scenario. This is something I’ve seen great results with in runners.

Crow (2012) tested this concept in a group of 22 AFL players in reference to power output during jumping – a triple extension movement relatively similar to the triple extension we see in stance phase running gait. Their results showed a 4.2% increase in peak power output after a glute pre-activation warm-up.

When we see such a change in output after a glute pre-activation warm-up, this is often an acute (short term) affect. It is the chronic (long lasting) affect of performing these exercises again and again, day-in day-out in your warm-ups for example, that we want to encourage.

Two examples of such exercises:

1) Band Resisted Glute Bridge with Abduction

2) Resistance Band Lateral Walk

After a day sitting down in the office, these types of exercise are excellent ways to improve hip function before you begin to run.

Gait Retraining:

Research tells us that when it comes to improving the common dysfunctional patterns we see in running gait, corrective exercises in isolation aren’t as effective in the longer term as one might hope (more info on this from Dr Christian Barton in this blog post). The key to successful improvement in these movement patterns is a combination of both targeted corrective exercises (strengthening, stretching etc…) and conscious cues and drills to re-educate fundamental aspects of running form.

As I often explain to athletes:

‘…you can do all the glute exercises you want, but if you run with poor posture habitually, and bias your hip flexors and quads, the common quad dominant imbalance will remain’

The inverse is also true:

‘…you can consciously work on form all you like, but if you lack the fundamental strength-endurance in your glutes and hamstrings for example, you’re going to slip back in to bad habits with fatigue.’

I’ve created an Online Running Technique Course to introduce elements of both running gait re-education and glute strengthening, as well as improtant other areas of mobility and control to runners and triathletes of all levels. Check out the Online Running Technique Course.

Simple Take Home Message

This the important message for athletes to take home is to work on both glute activation / strengthening, and the re-education of correct movement patterns to encourage proper glute function throughout functional movement for their particular sport.

Building Your Maintenance Routine- Part One

In this post we kick off a brand new series about building your very own maintenance routine. So let’s start with the obvious question. What is a maintenance routine anyway? Think of it as your own personalized recovery plan. Essentially it’s what you do on a day to day basis when you are NOT injured to ensure that a) you actually are recovering between workouts and races, b) that everything is moving properly from a mobility perspective, and that c) your muscles and joints are functioning properly in terms of strength, muscle balance, and coordination.

An easier way to think of it is as your very own monitoring system. Maintenance routines are exactly that- MAINTENANCE. These are not daily, time consuming, total body routines. These are short, 10-15 minute routines that focus on problem areas that are specific to you, your injury history, your sport, and your work setup.

During this series you can expect to learn:

  • How to effectively look at your injury history and determine where the real problem is. Have you ever noticed that your injuries tend to happen only on one side? Or always in the same area? This is not a coincidence. Think of your body as one big chain. EVERYTHING is connected. If one link is always breaking is it because is it more likely that that link is faulty or that it’s merely the place that keeps breaking due to the strain being placed on the entire chain?
  • What the typical problem areas of your sport are. Every sport, beats up different muscle groups. Knowing which muscle groups to look at is a huge part of the process. They may not be what breaks on that chain, but they are certainly a factor.
  • How things like your work/car setup can impact your recovery. Are you someone who sits at a desk for eight hours a day or spends 60+ minutes in a car on the way to work after a morning workouts? Are you someone who stands all day or who has an active job with lots of ups and downs? Training is a small part of our day compared to the time we spend at work. This plays a huge role in our recovery, like it or not.
  • How to factor all of three of those things into designing a plan that is specific to you, not “runners, triathletes, cyclists” or any other group.
  • How to make that plan time efficient and effective by using a tiered approach to monitor your problem muscles/areas. Let’s face it. When things feel good and muscles are working properly, they shouldn’t hurt and you shouldn’t need to spend much time on them. During this series, you will learn what a normal muscle should feel like and more importantly, what you should be looking for that’s not normal and where. You will learn what your program should look like when things fee good and also what extra steps you need to take when muscles/joints are cranky.

I know I said it before, but let me say it again. I am a firm believer that your maintenance/recovery plan should not take away from your training/racing. It’s not designed to have you stretching before/after every workout or logging hours with your foam roller. Your maintenance plan has three very simple goals.

Goal #1: Find out what your problem areas are and why they act up. That why is huge! What breaks for us as endurance athletes is rarely the problem. Accepting that fact and taking the time to find out the why will save you time and money every single time.

Goal #2: Find out what is “normal” for these problem areas. Some of us are inherently less flexible and mobile than others. That’s OKAY. You don’t need to be flexible like Gumby to be an athlete, but you do need to know your limitations and where in the chain they will shift the workload too.

Goal # 3: Provide you with an easy to follow framework so that you know what to do when things are normal and feeling good, as well as, what to do when things are starting go the other way.

People ask me every day what I think the best injury prevention tool or gadget is. My answer is always the same. The best injury prevention tool out there is YOU. Taking the time to effectively evaluate and respond to your problem areas is the best thing you can do for yourself as an athlete. Not only will that process give a much more honest look at your body and how it’s recovering, but it will give you a list of red flags to look for so that you know when you need to get to work and when you can relax a little.

Okay! Now that you know what a maintenance routine is all about and whats in store for you over the next few weeks, let’s kick this series off with the first video so that you know what you need gear wise!