Updated: Jan 4, 2020
Most of the issues I deal with when managing people with injuries stem from not having the right information. You can find the heart of a lot of issues in health and fitness that stem from information, or lack thereof. So what follows is an attempt to put some less wrong information out there for you to consume.
It seems as there are two rough groups that I deal with on a day to day basis as a physio and strength and conditioning coach.
1. People (or athletes) that do too little during injury
2. People (or athletes) that do too much during injury
Before we start, I am in no way proposing that everyone fits into these categories, I hate reductionism and would be the first to warn against it. But, for us humans who inherently have poor appreciation for complex concepts, spectrums are nice to deal with. So the above two groups sit on either end of an injury behaviour spectrum, that is either helped or hindered by health professionals, strength and conditioning coaches and fitness professionals of all types. The below ‘categories’ are taken from a well-known physiotherapist Adam Meakin - The Sports Physio.
Setting the background of your injury
This is not a step by step recipe to follow for you when you get injured, and I must warn you that recipe approaches rarely work when it comes to injury, but this doesn’t mean you can’t understand as much as possible about your injury and take control over your own health. In order to understand the important steps to take after you are injured, you must first get educated on something called training load.
Because sport is varied, training load is varied but the below concept can broadly be applied to all training programs. Originally proposed in rugby league by Gabbet et al in 2005, this concept is critical to understanding why some injuries may happen. It isn’t the whole puzzle, but it does really link to what you might want to think about following an injury. In a landmark paper in 2016, Tim Gabbet made clear, what is an important relationship between an athlete’s acute to chronic workload ratio (Ref). This has long been an observable trend in other sports like rugby union (Ref), cricket (Ref), baseball (Ref) and is now backed up by approximately 60 studies across many fields like military and first responder occupations (Ref) .
You’ll see in the graphic below that there is a well defined ‘sweet spot’ of this acute:chronic workload ratio, established over years of data gathering by Tim Gabbet (Ref, Ref). This sweet spot exists in the range of about 0.8 to 1.3, which if you follow this through to a reductionist solution, basically means that what you’ve done in the last week of training should be roughly equal to what you’ve done in the last 4 weeks. But importantly what this DOESN’T mean, is that you need to do the same thing for your entire training career, it means this ‘sweet spot’ concept guides you to avoid spikes and troughs in load - increasing or decreasing the intensity of your training (or your workload) too rapidly.
There are a few key takeaways from the above information:
1.The ‘sweet spot’ concept of your acute:chronic workload means your training plan and programming should always look like smooth ‘arcs’ rather than erratic up-ticks or down-ticks.
2. This ‘sweet spot’ concept DOES NOT mean that high training loads will cause injury, which is a common misconception. In fact, there is good evidence to show that having a tolerance to higher training loads can be protective against injury (Ref). There may be a point of diminishing returns with higher training loads, but at the moment the best evidence we have is that as long as there are no severe peaks and troughs, high training loads with adequate rest and recovery is the best path to performance (Ref).
3. The ‘sweet spot’ concept is an individualised concept as it depends on arbitrary training units (which may be an oversimplification of what is actually going on), which are gained by using this method, so this can in theory be applied to many sports and training programs:
How hard you consider your training sessions to be during a week (Rate of Perceived Exertion) X the number of minutes you have trained.
Why might training during an injury be important?
Resting for too long results in a de-training effect, pushing your chronic workload down (training loads go way down), which in itself has been shown to result in an increased injury risk (Ref, Ref, Ref). Not to mention, doing nothing results in losing strength and weaker athletes have been shown to be at increased risk of injury (Ref, Ref) AND re-injury when returning to play (Ref). What it might look like if you don’t train during an injury then is as follows:
Importantly, the progressing back into your sport or activity after this time off may result in a ‘spike’ in load that we’ve learnt is associated with increase risk of injury.
“It’s the volume that you miss out on and the process of increasing this too rapidly when returning to the field, gym or tarmac and trails that both contribute to risk in injury and rehabilitation”
In many injury risk modelling, the simple fact of having a previous injury puts you at an increased risk (Ref, Ref, Ref). And this may be due to lots of reasons, but one could be the practice of missing out on important training load and a ‘spike’ in load in returning from injury.
So let’s take a closer look at the initial group of people that I encounter following an injury;
People who do too little following an injury; the perils of rest
Rest and recovery are essential to performance (Ref) and are some of the very first thing you should ever receive advice on from a health professional immediately following an injury. So please don’t hear what I’m NOT saying.
What I’m NOT saying here is that you can’t miss sessions and you need to catch up your training load, because that is a recipe for disaster. But if you don’t train enough during the course of your injury and rehabilitation, you are placing a bet and putting all of your money on red in a game of roulette. A better option is to spread out your risk, and continue to load where possible.
Some key practical takeaways for this group are:
Partake in as many training sessions as you are safely able to without pain once your body has recovered and rested enough to allow this to occur
Ensure you continue to enjoy your training sessions by modifying them around your injury
Reduce the volume or intensity of your sessions (which are modified due to injury) if you must, because remember, something is better than nothing.
People who do too much following an injury; no ‘she won’t be right mate’
This approach is an altogether different story to deal with, and one which comes with its own set of issues. Once again, rest and recovery are absolutely key ingredients in any athletic performance or training program. Take it often and make sure you take it seriously, because if you don’t recover well, you are literally training for nothing. Your body needs a surprisingly long time to recover from a normal workout, let alone an injury (Ref).
“Besides, there has never been any convincing evidence that more is better; better is better (Ref, Ref).”
I know better than most that rest and recovery following an injury are a somewhat difficult pill to swallow, but it is an integral process to let the body do what it is best at - adapt and heal. For a nice read on the art of resting read here. There may be a risk that you can even prevent the injured area from healing properly and adding to the problem, but on this point I would like to comment that many health professionals would be too quick to strike fear in the hearts of patients with this, which adds to the general public’s confusion about their body and their training. Call this a common sense approach; if you know something is hurting, it’s not rocket science, it just means the body is letting you know about the need to take a look at your training practices. I’m not saying it isn’t complex and doesn’t require some help from a health professional, but I am saying it’s nothing to be scared or confused about, because it’s well within everyone’s grasp to understand and self-manage in the future.
Some key practical takeaways for this group of individuals:
Seek advice and listen to health professionals when they talk about rest and recovery, they may know what they are talking about. And again, as long as you don’t rest for too long (avoiding the pitfalls above), then you are doing the best thing for your body.
Partake in some modified sessions as you want, reduce your training volume and intensity, because that way you are still doing something rather than nothing.
Enjoy the benefits of rest and recovery, change your mindset around this, because it can only add to your performance in the end.
So, training during your injury is important and the risks of doing nothing then spiking your training load in returning to the field or track are real. But, if you don’t give your body the space it needs to recover, then it can’t heal what you have injured. If both of these extremes can do some simple things to meet in the middle a little more, when it comes to training during injury, we could have a whole lot less business on our hands, which in my view is a good thing.
A cautionary note
The above documents a really simplified version of looking at load and injury risk. When looking at injury risk and load management it is really important to understand that we have so many variables, which interact in all sorts of different ways, that it becomes incredibly complex really quickly. So at the moment, our best evidence and research really isn’t all that good at appreciating the entire problem anyway, and it may soon proven to be incorrect BUT at the moment, it is approximately the best we have. Always, always, take injury risk and load management information with a pinch of salt as it is incredibly individual and depends on a lot of contextual factors like your training history, your stress levels outside of training, the time and temperature and many, many more (Ref).