Dealing with Overuse Injuries

As triathletes, we’re lucky enough to worry not about just one injury but many. Most of these injuries will be common overuse injuries.

It was 4 a.m. and Felix felt pain. For two days Felix and the other three members of his team, Tierra Alta, had been traipsing through the natural environment in Venezuela. On horseback, on foot, rappelling cliffs, through water, hiking, trail running - it was an outdoor athlete’s dream and worst nightmare all rolled into one.

Adventure racing is the sport of the elite or crazy - you choose. Sometimes it’s both. But the multisporting event patterned after the now famed Eco-Challenge lures people from all over the world to test their athletic ability against the one opponent that never gives an inch – Mother Nature.

Team Tierra Alta was in fourth place overall, its golden moment was shining. But Felix was in pain. His left knee was on fire. Each step was like shards of glass sticking into his body.

He tolerated the pain while horseback riding. He played through the pain while walking and carrying two backpacks up steep hills and down mountainsides. He’d even done cycling, figuring the pain would go away because he wasn’t on his feet. It didn’t. Felix was experiencing the unthinkable for every athlete – a debilitating injury, an injury that no matter what you do you cannot do anymore. 

Your mind says 'yes' but your body, well, it sings a different tune. By the time Team Tierra strolled into the second control point, the doctors took one look at Felix and said he was done.

It wasn’t until months later Felix would learn he had Iliotibial Band Friction Syndrome or ITBS. It wasn’t until months later when his mind realized that ITBS was going to sideline him. In the end he would recover. In the end he would get well. But at that time he had to realize that he would no longer run. That he would no longer compete in racing. That he would have to wait it out. It wasn’t until months later that he psychologically accepted those devastating facts.  And that’s when the real adventure began

There’s No Crying in Training – Is There? When the realization that an athlete may be sidelined because of an injury it can be a devastating moment. About a month ago Jessica was running when she noticed a pain in her ankle. After a while she thought it would go away but it progressed getting worse as she ran. Weeks went by and her injury deteriorated to a pronounced limp. She couldn’t run anymore. “I hate it,” Jessica said. “I feel like my body is losing shape and that the progress I’ve made so far is all for naught. It feels depressing,  frustrating and really reduces my energy level.” For Felix knowing he would be sidelined by ITBS was devastating as well. But it didn’t sink in right away. Even though he couldn’t walk he still felt he could race. “I can’t say that it hit me by surprise,” Felix said of his injury. “I had been walking lop-sided, feeling pain every step for nearly three days – from dusk until dawn. I had plenty of time to think that a longer recovery might be necessary. In the back of my head, I believed I’d be back in business in no time.” Dr. Tracy Ray, from the Alabama Sports Medicine Institute, said sometimes the psychological effects of an injury are worse than the physical effects for some athletes. “I’ve seen athletes that will go through the grieving process that you see when someone loses a loved one,” he said. “Denial, anger, there are stages of grieving over an injury.” Dr. Ray says when that happens his clinic tries to intervene getting the athlete to see a sports psychologist. Talking it out with someone who understands your loss is often a good way to guard against further frustration. - Ovetta Sampson

Looking for Treatment

Feeling pain while training isn’t always the kiss of death for an athlete. When you’re putting 20 miles on your feet a week, or pounding out six miles in the pool, you can expect to feel some aches and pain.

“You don’t always have to see a doctor at the first ache or pain,” said Dr. Tracy Ray, a sports medicine physician at Alabama Sports Medicine Institute in Birmingham, AL. He’s also a trainer for the American Medical Society of Sports Medicine.

“If it’s something that’s seems to be moving beyond soreness and its real pain, then you need to pay attention to it.”

If you do need a doctor, Dr. Ray recommends speaking to one that is well versed in sports medicine. Primary care doctors or orthopedic doctors are good but they may not know the unique circumstances that athletes encounter during training and that could lead to misdiagnoses. (Find a Sports Medicine Doctor Now.)

When Felix finally left the racing fields for the doctor’s office he was misdiagnosed twice before finding out that he had ITBS.

“I was told that I had a patellar injury and that therapy and two weeks off would get me running again,” Felix said. “Obviously they were wrong. After those two weeks of massage therapy and no training I showed very little signs of improvement. I was devastated.”

It took minutes for his third doctor to diagnose him correctly with ITBS.

ITBS is one of the most common overuse injuries an athlete can have. Inside your knee there’s a stretchy rubber band-like string of tissue that extends from your thigh down over your knee and attaches to the inner and larger of the two bones between your knee and your ankle or your tibia. This is the illotibial band. This thick band of tissue slides over your knee each time you bend or straighten the knee. Doing this repeatedly, as with running, causes friction and leads to inflammation.

Doing It Too Much

Many beginner triathletes are susceptible to ITBS because it occurs when you run too much. Many beginners aren’t runners and they often end up sidelined with ITBS or shin-splints, another common running injury.

But as triathletes we’re lucky enough to worry not about just one injury but many. For new swimmers the danger is a rotator cuff or other shoulder injury. And anyone who’s ever been a newbie to cycling knows that falling off your bike trying to negotiate your clipless pedals is a rite of passage that incurs injuries.

Though all these injuries are different they do have one thing in common they’re caused by overuse.

“Everything you’re going to see in an endurance athlete is going to be an overuse injury,” said Dr. Tracy Ray. Of course the best way to recover from the injury and get back on the road is to not use the injured part. But for triathletes, adventure racers like Felix, and other cooky people who decide that one sport just isn’t challenging enough not training is the kiss of death.

“Rest is a four letter word for these type of athletes,” Dr. Ray said. “They don’t want to hear that at all.”

Training While Recovering

Treatment for ITBS Here are some weblinks to help you treat ITBS: Sports Injury Bulletin - ITBS Iliotibial Band Stretch ITBS.info Quick Solutions for ITBS

So you’re not going to stop training but the good ole’ doc says you gotta’ rest your injury. What do you do? The simple answer is to cross train. But there’s a way you can cross train that will allow you to maintain your current level of fitness, heal your injury and possibly even improve your ability in another sport.

For Dr. Ray’s patients he advises them to cross train, including doing the offending sport in different venues.

For example, Dr. Ray sees a lot of knee injuries. As any good doctor will do he tells athletes to stay off the offending body part. But he gives them what he calls “relative rest,” instructions.

“Anything that you can do that does not hurt is OK,” Dr. Ray said. “Maybe they can’t run 35 miles a week but then can run 10.” If they can’t run on asphalt Dr. Ray says run in the pool. Running in water can help you work on speed work while giving your joints a break.

Brian Mackenzie, the Senior Track and Field Coach for the United Kingdom, helps his athletes maintain their current level of fitness while they’re injured by using comparative time cross training. In his alternative training program, Mackenzie equates time in one sport for time in another.

Say you’re an injured runner. Usually you run eight miles a day. Now you can’t. On Makenzie’s program you would replace that running with swimming adding a mile swim to your training regiment to make up for the loss of running. How much of the other sport you do is based on time. The average track runner runs 400 meters in one minute. It takes about one minute to swim 50 meters. So one mile in the pool equals about the same cardio energy of eight miles on the pavement. You, of course, can adjust for your speed but the point is to cross train with a purpose. Check out his program.

“I have found that if I can keep an athlete on aerobic work without impact to the injury then the aerobic condition can be maintained or improved,” Mackenzie said.

That’s exactly what worked for Felix. After being sidelined with the ITBS injury Felix began swimming, a lot. Soon his doctors said it was fine to begin cycling in low gears. Although he wasn’t running, he was staying fit. It wasn’t soon after this than Felix began to think about doing a triathlon.

“I figured since I was swimming and cycling and soon would start running, I would end the year and celebrate my recovery by treating myself to a triathlon,” Felix said.

Hmmm. A triathlon. Now that seems like the perfect cure to what ails you!

For more information about treatment for common sports injury check out Sports Injury Bulletin.com