Off Season Recommendations from the Doctors

author : AMSSM
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We put together a series of questions regarding off season training to the doctors of the American Medical Society for Sports Medicine (AMSSM).  What came back was great information that should help you figure out your off season, to rest and heal, allowing you to come back strong for next season.

At the end of a triathlon or running season, do you see an increased number of people through your practice with running/triathlon related injuries?

"There are two times in my clinic that I see an increased number of running/triathlon related injuries. They occur in the first-time marathoner training at mile 18-22 on their long runs or at the end of the running/triathlon season in veteran athletes. The injuries arise from overuse. Most frequently seen are stress fractures of the foot, lower leg or pelvis, plantar fasciitis, sacroiliac dysfunction, or ankle tendinitis."  - Jane T. Servi, MD

"Yes, triathlons can be a grueling sport (long distances, difficult training regimens) and over the course of a season, injuries can start to creep up.The injuries we see most often after triathlon seasons tend to be lower extremity overuse injuries.  This includes things like ligament sprains, muscle strains and foot and knee problems.  Often these injuries develop from a rigorous training schedule and start as a minor discomfort that athletes usually try to push through.  While this isn’t always an indication that there is a problem, it can be an early sign.  In addition, not allowing for adequate rest between triathlon’s and overly aggressive training schedules can lead to fatigue, poor technique and subsequent injury." - Christopher Aaron Gee, MD

"Yes, there is an incremental increase in the number of injuries I see after the end of the season. Athletes usually present to the clinic several weeks after the end of the season because the injury they raced through is not improving during the post- season recovery period.

The most frequent injuries by far are lower extremity chronic overuse injuries including plantar fasciitis, various tendinopathies and stress fractures.

The most common causes of these injuries are due to a sudden jump in training volume or intensity or a lack of recovery between hard workouts. Athletes who get injured tend to increase their training volume too rapidly before their final race of the season. I have also noticed that some of the injured athletes I see incorporated speed work right before their final race without adequate introduction to high intensity workouts. Traditionally speed work is incorporated towards the end of the season to “sharpen” before the A-race. I endorse incorporating speed work from the beginning of the season and incrementally increasing both the volume and intensity of those speed workouts throughout the season, just as you would increase your long runs incrementally throughout the season.

Another pattern that gets athletes into trouble is doing multiple high intensity workouts on back to back days. I call this “cramming”. At the beginning of the season, athletes do a nice job of putting 1 – 2 days of recovery between high intensity workouts. Later in the season, whether it’s the pressure of a rapidly approaching race or confidence in their fitness, athletes think they can get away with stacking multiple hard workouts in a row. Though at the end of the season we can mentally tolerate multiple hard workouts, our body still requires a certain physiological time to recover and rebuild. Again the message should be that recovery is just as important as the hard workouts, and that this holds true towards the end of the season when athletes are at their peak fitness." - Masaru Furukawa, MD

Following a season of training and racing, what do you recommend as rest or “relative rest” to heal up any small injuries that have been creeping up during the season, to fully heal for next season?

"As with my approach to all sports medicine injuries, there is no such thing as “cookbook medicine,” each individual has different needs. However, a general guideline can be outlined. Additionally, all injuries should be healed during the off season. Two variables determining duration of rest include age and season intensity. Highly intensive seasons, require more time off for recovery both physically and mentally. Most off season recovery plans are broken into at least two categories lasting between 2-4 weeks each.

The first phase is total recovery; absolutely no structured training and no running, swimming or biking. Have fun and participate in some other activity like hiking or skiing as refraining from all activity commonly results in dysphoria. Expect slight weight gain over this time.

Phase two is a return to slow and progressive training. Athletes are frequently subject to overuse injuries when they return to sports too quickly. This is not base training so it is a good time to work on technique training or areas of weakness. Perform a little activity every day, but listen to your body and back off for fatigue or pain. The end of this phase leads back to early base training. Limit training at your easy zone, do not push beyond. This should not feel like a workout. Swim pace should be +8 seconds slower than your 1500 meter pace, running 2 minutes/mile slower than your marathon pace and biking < 65% of your one hour maximum effort. Additionally, performing one discipline per day with the fourth day off, allows four days of recovery time for sport specific muscles." - Jane T. Servi, MD

"It is always a good idea to have a period of relative rest after a season of racing and training. While this largely depends on the athlete and size of triathlon usually a 2-4 week period is sufficient before resuming harder workout schedules. The purpose of this rest period is not only to help recuperate from injury, but also to prevent training from becoming drudgery.  This period can help recharge one’s physical and mental psyche.  It is important to cut down on intensity and during of your work out schedule.  The workouts should be 30 minutes, 2-3 times a week.  This is ideal for generalized well-being and for most triathletes this will be a significant step down from prior training.  Ideally, an athlete should do some cross training during this time to keep up the general physical endurance capacity without returning to the same motions/ activities that occur during training." - Christopher Aaron Gee, MD

"I personally recommend taking two weeks completely off if there are no impending off season races. Being an endurance athlete myself, I found this period to be a nice time to catch up with work around the house that had been neglected, spending more time with my family and catching up on academic work that’s been put on the back burner for several months. If an athlete insists on doing something active, I usually recommend doing sports that are totally unrelated or new to the athlete such as golf, hiking, kayaking or tennis.  

As far how long a rest period should be,  if an athlete completed an Ironman, I usually endorse a solid 4 – 6 weeks of light training or recovery period. If recovering from a marathon, perhaps 3 – 4 weeks and anything shorter can be as little as two weeks." - Masaru Furukawa, MD

Do you see a correlation between injury frequency and the lack of a consistent, general strength program?

"There is a correlation between injuries and symmetry of strength as well as flexibility. While too much muscle bulk takes extra energy to cool and carry, a sufficient amount of strength is required to move your body over 140.6. In general, a marathon runner or a sprint triathlete will have a slighter build than an Ironman triathlete who needs the extra strength to generate power. In an endurance athlete, aerobic capacity peaks out at about 180 milliters of oxygen per kilogram of arm or leg muscle mass, so extra muscle does not improve running performance. However, strength training has been associated with lower injury rates in the back, shoulder, hamstrings, knees and ankles by helping to support the joint leading to decreased impact." - Jane T. Servi, MD

"Definitely.  The major problems we see tends to be overuse injuries and spending all workout time doing the same motions (running/cycling/swimming) which can lead to overuse problems like tendinitis.  Strength training programs can pay big dividends in terms of prevention of injury as well as increasing power and endurance during race day. - Christopher Aaron Gee, MD

"This tends to be across the board, but I do notice that many endurance athletes who come in with chronic use injuries rarely report doing concurrent strength training during their race season. I think this is partially due to strength training not being a fully accepted part of endurance training culture and the other being the time restraints that endurance athletes are under given the volume of training they are already doing. One other observation I’ve made is that those athletes who do include strength training in their regimen are doing, what I consider “non-functional” weight lifting such as bench press, shoulder press, bicep curls, triceps extension, leg extensions and leg curls. These types of strength training exercises are non-specific to running an often strengthen one muscle group in isolation. These types exercises have little to no performance or protective benefit to an endurance athlete." - Masaru Furukawa, MD

Do you recommend any general core or strength workouts to move forward with in the off season to keep injuries at-bay and to make you stronger for next season?

"Strength training should initially focus on core strength and stability, power generating muscles and the smaller (support) muscles that shut down from lack of stimulation during the season. One power group to address is the glute/hip complex which is over dominated by quads during the season. Minimum exercises for off-season training include: gluteus workouts (step ups, squats, lunges or leg press), lat pulldowns, rowing/pushups, abdominal curls, back extension, hamstring curl, leg extension, calf raises, adductor and abductor exercises. Apply the same rule used in all training to a strength program; start slow and progressively increase. Start with 2-3 reps of 10 exercises at weights that do not make you strain to complete the workout. Rest each muscle group 48 hours before working out again. Technique is important and personal trainers can demonstrate this if needed." - Jane T. Servi, MD

"Yes, it is always helpful to keep the core musculature strong and able to prevent injury.  There are a number of various core training programs on-line and each athlete should find one that works well for them.  These include exercises like a modified bicycle, planks, side planks, bridges and supine leg lifts.  These can be done as a circuit 2-3 times each for about a minute.  If this is incorporated into a regular weekly regimen it can help build the core and prevent injury. - Christopher Aaron Gee, MD

"The scientific evidence is limited or non-existent but I recommend many strengthening exercises that involve multiple joints and in an eccentric manner. As with every new form of exercise, I recommend my athletes start with no weights, using just their body weight with 1 set of 15 repetitions. I would then progress to increasing the number of sets, perhaps by one extra set per exercise per week until they reach three sets of 15 repetitions for each exercise. Once that level is reached, and only if they find it easy to complete the work out (one way to know is if you are no longer sore the next day from doing the full session), then start adding weights incrementally or use one leg at a time.

  • Eccentric calf raises – lowering
  • Eccentric squats
  • Gluteal exercises – starting with clam shells on the side then progress to lateral leg raises with the leg in extension. Then standing side steps with bands
  • Lunges focusing on lowering the body in a controlled fashion.
  • There are a plethora of other abdominal core exercises that uses ones own body weight such as various plank exercises with and without an exercise ball or medicine ball." - Masaru Furukawa, MD
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date: December 19, 2013

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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avatarAMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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