Tag Archives: plantar fasciitis

The Upside of Injury

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Status Update: “Broken”.

Most athletes and a fair share of non-athletes have been there. The nature of our profession is that for the most part, we see people when they are down and out; our job is to diagnose the damage and to build them back not just to par, but to stronger than they were before the injury. My usual position as a Physiotherapist is to guide my patients from the tough day of diagnosis, through the often lengthy rehab process and safely back into their return to sport. We often get quite close to our patients and as athletes ourselves, ride the journey with them. In 2013 I was unlucky enough to flip the coin and be the one sitting in the sports physician’s office trying to swallow the gravity of my own injury situation: a stress fracture gone wrong following my latest Ironman triathlon. I think in this situation it’s arguably easier knowing less rather than more – I knew before the lovely Dr Chris Ball told me that I was looking down the barrel of major foot surgery, and a very long time away from my beloved sport.

 

 

 

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What it looks like to finish an Ironman on a broken foot…it ain’t pretty!

 

Injury of any kind sucks, and I always advocate well-managed injury prevention program as “Plan A” but in reality, injuries happen – most athletes don’t have the most solid grasp on their self-preservation dial (and hey, I was beating my husband by 2 hours in that Ironman – there was no way I was pulling the pin so close to the end!). Jokes aside, there can be a silver lining. The team you have around you and your attitude are key to getting through the rough patch and flying out the other side as a more resilient and stronger athlete.  As tough as injuries can be, I have learnt over the years from the process with countless patients as well as from my own experience post- foot surgery that there can indeed be a few upsides to injury:

 

  • Learning opportunities:
    • First and foremost, immediate questions need to be asked: What is the best course of treatment for short and long term outcomes? What are my options? (often there are a few good ones, especially where surgery vs conservative treatments are involved). How long will I have off my sport? Will this affect work/school etc?
    • Once a course of treatment has been set that you as well as your health care team are happy with, the less urgent but just as important questions need to be asked: What went wrong? What will I do differently next time? Where is the weak link in the chain? How do we (as in, you and your Physio +/- surgeon and sports physician) build the body back to a point where it’s stronger than before? How can I prevent this from happening again? Do we need to change things upon return to sport (training load, technique, footwear etc)? Knowledge is power, and I cannot reiterate enough that you need to ask and ask until you get the answers that you need; your sanity during your rehab and your ability to avoid injury in the future depends on it. If you aren’t happy with your physio/doctor/surgeon, then find another one – you need to find the best quality care at all costs to get the best results.

 

  • Respect for your body’s boundaries:
    • So you found that mystical line in the sand, the actual safe limit of what your body can achieve; many never find it so you can take one thing away from the situation and that is that as an athlete, you are tough! But going forwards, if your injury was “overuse” in nature (ie stress fractures, tendinopathies etc) then you need to respect that boundary. Learn from it and take note of your body’s cues in future training and racing scenarios.
    • If your injury was more traumatic in nature (eg broken tibia from a soccer clash or dislocated shoulder from a cycling accident), then there’s not a lot more you can do other than accept that playing sports involves risks. Given a choice, you’d still take those risks to sitting on the couch getting fat and unhealthy, right?!

 

 

  • An Attitude of Gratitude:
    • There’s nothing better than that moment your surgeon (or doctor or physio) gives you the go-ahead to do some exercise. Even if it’s technically “rehab” – “I’ll take it!” you yell as you hug them (Ok exaggeration. Only slightly though.) Prior to a major injury you may be guilty of complaining when the alarm clock goes off at stupid o’clock, if it’s cold/hot/raining; if the session is too hard…or not hard enough….If your race didn’t go perfectly, and so on. Afterwards I can honestly say that every single step I take is done with an “attitude of gratitude” – my coach and husband will vouch for the fact that every run is a bonus, every race is a bonus, and I am thankful to be able to have a fit, strong and healthy body again. Hell, I’m even grateful to be able to do the housework these days – taking an independent person and attaching them to crutches for 3 months is enough to send anyone crazy! I have been guilty of treating my body somewhat like a rental car in the past, but I now appreciate it and treat it much more lovingly (Karma, my friends, Karma…).

 

 

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  • Mental Toughness:
    • And by this I don’t mean your ability to push through and “eat the pain” as my husband would say – if you got injured in the first place by pushing too far you definitely don’t need to learn this. But in my experience it’s often the athletes who are able to blindly push through that are also in need of some mental “balance”. I am by no means exempt from this generalisation. I took the time after my surgery to finally learn how to slow down and meditate (I highly recommend it, you’ll never look back), as well as to focus on other things in my life other than training 20 hours a week and working full time. It was not the most fun I’ve ever had – by choice I would much rather be working and training! – but it has taught me a sense of balance which I had never had in my life before, and I think that this has benefitted both aspects of my life well after the initial injury period. For most athletes I would therefore consider the slowing down process as “building mental toughness”, even if it’s not the traditional sense of the phrase.

 

 

  • Absorption of training:
    • A wise triathlete (Emma Snowsill) once said that if you don’t allow your body to rest, it will force you to via sickness or injury. I would put pregnancy in the same category here simply because the reduced training load while you’re growing a human has the same affect – time to let the body take stock. To absorb all the months/years of training it has done, and to build back a little stronger. As physios we educate patients on how a bone will actually be stronger where it broke after the healing has occurred, because extra bone is laid down in the healing process; this is a nice metaphor for the entire healing process of the body. Reassure yourself that you WILL come back from the injury, and that all the training you’ve done in the past will not be gone.

 

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Sesamoid bone graft and 1st Metatarsal dorsiflexion osteotomy on my Right foot, done in 2013 by Dr Ben Forster

 

 

So there you have it, my version of what I’ve learnt through injury in a nutshell. I’ve kept many details of the injury and whole rehab process pretty close to my chest up to this point; as a physio it is not the easiest boat to be in. Physiotherapy may be my “day job” and I certainly love it, but I am first and foremost an “athlete” and in the past have certainly had trouble switching that part of my personality off, even if the Physio part of my brain is telling me something is a bad idea. As I get older and more experienced with both Physiotherapy and Ironman racing, I am learning how to strike the balance but it is always a work in progress. I am very fortunate to have two very patient and understanding men in my life in my husband Patrick Shannon and my coach Scott DeFilippis. Without them I would not be on track to be lining up again for Ironman NZ in 4 months’ time – 1 year post-baby and just over 2 years post foot surgery.

 

Hopefully this post will hit home with a few “broken” athletes out there and help to get you through and back to your passion. If you would like to follow my journey back to the Ironman start line you can find me on Instagram (@KRISTY_SHANNON), I’d love to have you along for the ride!

 

Kristy Shannon

B.Appl.Sc(HMS); B.PHTY(Hons)

Director and Principal Physiotherapist First In Physio  

 

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Fun Run Season is Here – How to Stay Injury-Free!

While other states are shivering into their hot chocolates, we are lucky enough in the far North of Queensland to be experiencing perfect running weather – beautiful crisp and sunny days with minimal humidity in the air. There is no better time of the year to be upping your running training and looking ahead to one of the many fun runs on offer around the area in the coming months.

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Not coincidentally, it is about this time of year that we start to see an influx of running injuries come through our clinic doors. As runners ourselves, we can understand the frustration and stress involved with having to sit out of training or worse, missing your planned race. There are many simple things that runners can do to minimise their injury risk and keep their bodies healthy and minds happy. We’re pretty sure you know all of these , but like most runners, need a simple reminder that you are not “special” – your body is not superman and it does, in fact, need just as much time to adapt to training stimulus as everyone else’s does!

 

  • Training Load

A large proportion of running overuse injuries are caused by simply doing too much, too soon. The classic situation is the runner who has had a few months off, maybe gained a few kilos and not been diligent enough with their strength work, and then decides to do an 8-week training program for an upcoming half marathon or 10km fun run. The first few weeks go by OK with sore muscles and slow shuffling, and then week 3-4 hits and you have shin or foot pain that won’t go away in a hurry…..Sound familiar? While the enthusiasm is great, it is important to “train for the training”. Consider your base level of fitness before jumping feet-first into any training program; if the first week of the training program looks “scary” to you, then you are not ready yet. Running is a wonderful sport for the body but it comes with a high injury risk if you are doing it sporadically. Once you are gradually building up the weekly mileage, give yourself a recovery week once a month, typically reducing the training load to about 60% of your previous week, further giving your body a chance to absorb the training. The healthiest and usually the fastest runners are those who are consistent with their training, year-round, allowing for natural and gradual increases and decreases in their load around race season and off-season.

 

  • Specific Strength Work

Every time you take a step when running, you are literally doing a single-leg squat with up to 4-6 times your body weight going through the chain from your foot up through your knee, hip, pelvis and spine. Think about that. The amount of recreational runners we see come into our clinic who cannot do one quality single-leg squat with one x their body weight – let alone quadruple that amount – is truly scary! Your muscles are very well equipped to take up the excess loads of running so that your joints and bones don’t have to get overloaded; in fact, well-trained muscles will act like springs and propel you forwards with ease and speed. We recommend that all runners do a minimum of 2-3 strength sessions a week, but it must be run-specific ie lots of core, glutes, single leg squat work and lower limb strengthening as well as the all-important balance and flexibility work. A quality session might take you 20-30 minutes, but it will be the best injury prevention investment you can make. An Exercise Physiologist or Physio with an interest in running can help you to design a program that addresses your weaknesses, and most can be done in your own lounge room without fancy equipment.

 

  • Running Technique

If your core and general strength is good, your balance and flexibility and adequate, and you are not excessively overweight, you will have a much easier time achieving optimal running technique. What is “ideal” technique is an often-debated topic amongst the literature, and when it comes down to it, everyone is different and will have a slightly unique “perfect form” that suits their body. Having said that, there are certain key factors that need to be considered to ensure that you are running safely, for both injury management and to increase your speed and efficiency. These include things like high knee lift to utilise the powerful glutes; mid or forefoot strike to optimise the calf muscles as a spring; a leg turnover of about 180 strides per minute (count how many times per minute your right foot hits the ground, then double it); a nice upright torso with a very slight forward torso lean etc etc. If you feel like you aren’t running at your best or you continually get overuse injuries such as shin pain and plantar fasciitis, having a qualified professional assess your running technique could prove to be a worthwhile investment. Coaches, Physios, Podiatrists, and Exercise Physiologists with an interest in running are all qualified to do such an assessment.

 

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Nutrition

Running is a wonderful sport for promoting weight loss and maintaining a healthy body weight. The best runners tend to be the lightest, but that doesn’t mean that you have to look like Paula Radcliffe to enjoy healthy running. If you are more than 5kg above your ideal body weight, be respectful of the extra load on your body as you increase your training load. Also ensure, no matter what your weight, that you fuel well before, during and after your hard run sessions. Optimal nutrition results in faster recovery, better performance and less injuries. Accredited Sports Dieticians are the best people to talk to about fuelling for both running performance and for weight management.

 

  • Shoes

This can be another controversial area that professionals love to debate over. Most qualified health professionals have their opinion on what shoe type is best for you; my advice would be to listen to your body. If you feel like it is hard to run fast, that your shoes are working against you, or that you get a lot of niggles in your current shoes, consider trying something different. I am a fan of the 4mm heel drop shoes and have had great success in them with all of my runners, but as with anything – change needs to be a very gradual thing. If you are used to running in super cushioned, 12mm heel drops and you suddenly swap to a “barefoot” style of running shoes (which I don’t recommend either, unless you weigh 40kg and look like the Kenyan Olympic marathoners), your body will be shocked by the change. You need to allow adequate time to adapt and ensure that you lower your training load and increase your strength work while you change over. I also advise people to have two pairs of runners on the go and to rotate them throughout the week. Most recreational runners doing 40-80km/week will need to change their shoes over every 3-4 months, depending on their weight and the surfaces they train on. This may seem expensive, but when you consider what equipment in some other sports (like cycling) costs, not to mention the cost of a potential injury, it is a relatively cheap investment for foot health!

 

  • Training Surfaces

Try to vary your terrain as much as possible – this is good for load but also a great way of incorporating some strength work and balance (eg. soft surfaces like trail running) into your running. Cement is the highest load for your body to cope with so try to do less than half of your training on it as a general rule.

 

  • Factors outside of Training

This is the one area that runners often neglect. Our training isn’t separate to the rest of our lives, it is included within it. That means if you are tired from lack of sleep, stressed from work or family, or under-fuelled from working through lunch – these things will all impact on your running form and also increase your injury risk. You need to consider how your body feels going into any run – and adjust accordingly. If you are wrecked from work or stress, don’t do that hard track session today; swap it for an easy 5km run and come back stronger for the track session in a few days’ time. I will also add here for the ladies that wearing high heels on fatigued legs is a great way to give yourself a stress fracture – you would be amazed how many times we have seen this in our female athletes! If you must have that big day at the races, at least wear lower heels and stretch calf muscles etc before and after the event.

 

 

The number one take-home point is that the body hates rapid change. The human body is an incredible specimen capable of adapting to remarkable training loads: think about what Ultramarathoners and Ultraman (back-to-back Ironman triathlon events) athletes are capable of achieving. They are no different to you or I – they don’t have magical superpowers that allow them to run 100km. They simply dedicated themselves to the process early in their lives and have consistently added training load to allow adaptation in a slow and planned manner. The bottom line is that our body will adapt beautifully to change, if we allow it time to do so. It’s not exciting, but if you ask any long-time marathon runner, it simply works. So if you’re like me and you idolise those crusty 70+ year-old distance runners that line up beside you at races, hoping that one day you too will be still running happily at their age, then take a leaf out of their book: consistency is the key to a long, happy running life.

 

Happy Training!

 

Kristy Shannon    B.Appl.Sc(HMS); M.PHTY

Physiotherapist and Exercise Physiologist

 

 

REFERENCES

American College of Sports Medicine., American Dietetic Association., Dieticians of Canada. (2009) Nutrition and Athletic Performance: Joint Position Statement. Medicine & Science in Sports & Exercise. 0195-9131/09/4103-0709/0

Barr, K.P., & Harrast, M.A. (2005) Evidence-Based Treatment of Foot and Ankle Injuries in Runners. Phys Med Rehabil Clin N Am 16:779-799

Beck, B.R., Rudolph, K., Matheson, G.O., Bergman, G., Norling, T.L. (2014) Risk Factors for Tibial Stress Injuries: A Case-Control Study Clin J Sports Med 0:1-7.

Buist, I., Bredeweg, S.W., van Mechelen, W., et al (2008) Prevention of Running-Related Injuries Among Novices. Am J Sports Med. 36:33-39.

Van Gent, R.N., Siem, D., van Middelkoop, M. (2007) Incidence and Determinants of Lower Extremity Running Injuries in Long Distance Runners: a Systematic Review. Br J Sports Med 41:469-480.

 

Why it’s Important to Stay Active When Injured

One of the most common misconceptions among the general public is that one must “rest” while injured.  I’ve lost count of how many times I’ve had one of my Pilates clients call to cancel “because they have back pain”.  They should be coming to Pilates because they have back pain!  Often the assumption is that the injured or painful structure needs to “rest”.  Rest from aggravating activities?  Most definitely.  Rest from all activities?  Definitely not.  The body requires blood flow, nutrients from the inflammation process, and gentle movement to stimulate healing.  If this can be done with minimal pain, you have a win-win situation: the body can get stronger while it heals itself.

Conversely, one of the most common misconceptions and fears amongst athletes is that their physio or doctor will tell them to stop their activity when an injury is looming, so they avoid making an appointment.  This often results in delayed diagnosis and treatment, worsening of their condition and significantly prolonged time off their sport in the long run.  The earlier the injury is treated, the more likely it is that the athlete will be able to continue with a modified version of their usual sport – which can mean faster healing, improved biomechanics through careful analysis and correction, and less time on the sidelines.

 

 

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Whichever end of the spectrum you sit at – from previously sedentary to elite athlete – there are a few key points to remember when facing an injury: 

1)      Activity Modification is the key.  Be creative!  Your Physio and Exercise Physiologist will be able to develop a program for you to follow, no matter what the injury, how long you’ve had it, or how you got it.  Even athletes with broken legs can be training hard in the gym and possibly the pool if done correctly.

 

 

2)      Golden Rule: Pain must stay below 2/10.  Some pain is good, and normal, in order for healing to occur.  80% of an injury’s healing occurs in 20% of the time (ie if a lumbar disc injury takes 10 months to get back to 100%, 80% of the gains will be achieved in 2 months, then next 8 months will be spent getting the final 20%).  Why wait the whole 10 months to get back to fitness?  The amount of muscle loss and degeneration achieved in that time may well set you up for a lifetime of back injuries in the future.  Staying fit through swimming, walking, Pilates, etc and keeping the pain <2/10 may well prepare you for a lifetime of less back pain.

 

3)      Athletes will often “train” harder when injured than when not.  Look at it like a time to rebuild the body and to work on any weaknesses that caused your injury in the first place.  Ask an elite athlete how much time they had to lay around and feel sorry for themselves after their last major injury.  Chances are, they will tell you how it was the hardest training they’ve done – hours spent in Physio and Exercise Physiology sessions, the gym and the pool.  Not to mention nailing their nutrition and recovery in between those sessions with extra sleep, massage, ice baths and so on.  We are all designed to be athletes, even if our modern “sitting” lifestyle has made that hard to believe.  So a middle aged man with a lumbar disc injury is no different – he should be doing more activity when injured in order to assist the healing and make him stronger than before the injury.  Look at it like this: the injury is a cry from your body that something is not right.  The rehabilitation process is your chance to fix that, so that you never have to experience it again.

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4)      The same principle applies for joint replacements.  Another very common misconception is that you should “rest” and ease off activity after a knee or hip replacement.  This couldn’t be further from the truth.  In the months leading up to a joint replacement, patients need to be working hard on their muscle strength in order to get the most out of the surgery and to assist in their recovery.  Your Physio or EP will be able to give you the least painful and most safe exercises for this.  After the surgery, the work continues – ever wondered why the Physio is there on day 1 to kick you out of bed and get you walking?  Because the joint will do best if you stay active.  Those “bed exercises”?  Same deal.  We need to wake up the supporting muscles as efficiently as possible for the body to heal well.  The pestering about your pain levels?  Because if your pain isn’t well-controlled, we won’t be able to exercise effectively.  There is always method to our madness……

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5)      Its never too early to see your Physio; prevention is the best cure.  My patients often come in with full-blown injuries, such as low back pain or chronic plantar fasciitis.  When I’m taking their history, they say that they first experienced the pain months ago and that it’s been progressively getting worse, and yet it’s taken them this long to see me.  They sometimes feel as though the problem has to be “serious” to warrant a visit – this couldn’t be further from the truth!  Had they come in when the pain first surfaced, the treatment would have been so much more efficient and the consequences much less significant.  Your physio can also help with prevention of injuries.  If you know you have a job where you sit a lot, then it might be worth chatting to your Physio about some strategies to prevent the onset of neck and back pain – being proactive is the key.  Physios and EP’s are well-trained to work with you to find an exercise program that is safe for your body, that fits in to your lifestyle, and that you enjoy doing.

 

The human body is an amazing specimen, capable of adapting to most things that we throw at it.  Your body puts up with a lot – why not give it something back by prioritising healthy ageing?  You only have one body, after all.

 

Kristy Shannon

B.Appl.Sc(HMS); M.PHTY(Hons);

Director and Principal Physiotherapist – First In Physio

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 REFERENCES                                                                                

Adams, T; Band-Entrup, D; Kuhn, S.; Legere, L; Mace, K. (2013) Physical Therapy Management of Knee Osteoarthritis in the Middle-Aged Athlete.  Sports Med Arthrosc Rev 21:2-10.

Chilibeck, P.; Vatanparast, H.; Cornish, S.; Abeysekara, S.; Charlesworth, S. (2011) Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain.  Appl Physiol Nutr Metab 36: S49-S79

Williams, P. (2013). Effects of Running and Walking on Osteoarthritis and Hip Replacement Risk.  Med Sci Sports Ex

Melov, S.; Tarnopolsky, M.; Beckman, K.; Felkey, K.; Hubbard, A. (2007) Resistance Exercise Reverses Ageing in Human Skeletal Muscle.  PLoS ONE 2(5): e465