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Injury As Opportunity

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INJURY AS OPPORTUNITY


Picture It 

You are mid-way through the racing season, with your eye on a couple of key races and a chance at qualifying for a national championship.  While training one day, you crash on the bike, or sprain an ankle while running.  Does your training and racing season fall abruptly off the cliff? 

Depending on the circumstances, you may be able to take flight instead.  I was inspired to write this column after the following scenario: In my first season of X-Terra racing, I was chasing down a regional age-group slot for the National Championship in Lake Tahoe – having placed well enough in my first two races to keep me in the running.

On a Wednesday, I traveled the 21⁄2 hours to Grafton Lakes to pre-ride the mountain bike course for Sunday’s race – alone.  Following a map of the (as yet unmarked) bike course, I rode well off-course halfway out.  After turning around, I took a short, unscheduled flight over the bars, ending with an abrupt and rocky landing.  With my ribs broken in two places and a “boxer’s” fracture to my hand, I picked myself up off the ground, feeling grateful I had not punctured a lung.

My usual first response to any injury or illness is anxiety over the derailment of my training and the resulting loss of fitness.  This time however, I felt calm and accepting.  Perhaps it was the impending 45-minute mountain bike ride back out to civilization I still had to complete that prompted my positive attitude – a kind of survival instinct response.  Regardless of what caused that shift, I began to transform the injury into an opportunity to respond creatively to my recovery process from the very first moment.

Attitude 

How many times have we heard the saying “Attitude is everything”?  Attitude may just be the most decisive element in our healing power.  Don’t believe me on this one – read Lance’s “It’s Not About the Bike”.  Lance has demonstrated to the world just how powerful attitude and mental resolution can be.  (Note: This essay was written well before Lance’s USADA conviction for doping.) 

As we embrace the shock of realization, we can choose to seek out the opportunity that is available to us through any setback.

Injuries present us with great opportunities to hone the power of our attitude and resolve. First we need a clear assessment of the damages.  Then we can begin to cultivate a positive attitude by acknowledging all that we are grateful for – the physical, mental, emotional and spiritual strength and fitness we still possess, our supportive family, friends and community, the professional services available to us and the monetary assets we have to support our recovery and rehabilitation (such as insurance, a good home, reliable transportation, access to medical facilities and expertise, healthy food, exercise equipment, etc.) 

Whenever we find ourselves wallowing in self-pity, we can exercise our power of attitude by reaffirming our gratitude.  In the first few days of coping with an injury, this is crucial.

Sharing the Opportunity

A significant element of any injury/recovery experience is how we invite, elicit and accept the support and contributions of others.  This begins with our response to the inevitable question, “What happened to you?”  Like our attitude, the quality of our response determines whether we are the helpless, angry, vengeful, resentful victim, or the resilient, creative and invincible master of our destiny.

Each time we share our story, we have the opportunity to empower ourselves with miraculous possibilities that can include genuine support and the powerful prayers and well-wishes of our family, friends and community.  Why waste such an opportunity soliciting consensus for our own pity and shame or for blame on others? 

Be very mindful of the words you choose and the context you create as you share your experience. Is your context one of possibility and empowerment, or one of defeat and diminishment?  This process of sharing is a powerful extension of your attitude.  Humor and compassion are far more empowering than anger and depression – for both you and your audience.

Pain

A significant element associated with any injury is pain.  Initially our reaction is to avoid or alleviate pain quickly.  This can be beneficial when it allows us to relax and rest – essential to rehabilitation and recovery.  It can also be detrimental – when we mask pain in order to train or race at a level that is inappropriate for our current condition.  Pain provides valuable feedback and guidance as we resume training for rehabilitation.  It is a governor of progress that can appropriately help us to regulate the intensity, duration and frequency of our return.

During athletic training, we strengthen our neurological system as well as our muscular and metabolic systems.  A strong nervous system is capable of transmitting signals – whether pain or pleasure – with less fatigue.  

Neurological strength is essential for neuro-muscular coordination. As we let go of our pre-conditioned judgments about pain, we are more able to remain calm and relaxed in its presence.  This can be a valuable skill for racing and training hard.  Injury is an opportunity to investigate our relationship with pain – including our judgments and responses.  It is an opportunity to strengthen our capacity to experience pain without adding tension and resistance to the mix.

Medical Assistance

When appropriate for the injury, it is best to seek necessary medical services through a sports medicine clinic.  These institutions appreciate the value and health of mobility and fitness – implementing protocols that return the athlete gracefully and quickly to an active and mobile lifestyle.  Physical therapists can be invaluable in this process. They are familiar with a wide range of exercises and approaches that can enhance and accelerate recovery.

Balancing Mobility and Immobility

The balance of rest and activity is crucial on the path of recovery.  Traumatic injuries may require days or even weeks of complete immobility. On the plus side, this allows the trauma sites to stabilize and initiate repair.  With the body at rest, all energy is directed towards recovery.  

On the negative side, complete immobility limits the removal of waste and toxins from the injured sites and from the body in general.  The completely immobile athlete experiences hormonal and chemical alterations that can challenge both psychological and physiological balance and well-being.  Mobility is a significant element in our daily health regimen.  Withdrawal from the chemical high we enjoy through exercise further challenges our “attitude maintenance” as we recover.

After a traumatic injury, we set out on a tight-rope, balancing mobility and immobility.  The two conditions are not absolute – we do not abruptly transition from complete immobility to full functional mobility.  Gradually, we orient to general forms of mobility that respect the immobility of the injuries.  As our injuries heal, we masterfully introduce mobility to these sites in a way that enhances recovery and rehabilitation.

It’s helpful to remember the Law of Inertia as we balance on that tight-rope: A body in motion tends to stay in motion.  A body at rest tends to stay at rest. At the onset of injury, it may be difficult to transition abruptly from a rigorous training schedule to complete rest and immobility.  It can be equally difficult to return to an exercise regimen after a period of immobility – even a few days.  As a general guideline, for every 1 day of complete immobility, calculate 3 days of mobility to recover to the original fitness level.

It takes a concerted mental focus to transition back and forth between mobility and immobility.  Think of this as a great opportunity to practice transition skills and to develop mental flexibility – assets that will improve race performances.  

The Sobriety of Tapering and Recovery

These experiences also familiarize us with the processes of tapering and recovery – processes that are essential to peak for a goal race.  In the week before an iron-distance race, I see many athletes who simply cannot taper in order to recover for a race peak – and this undermines all of their training efforts. When we are familiar with the chemical/hormonal “landscape” of tapering and recovery, we are less likely to panic when our bodies feel sluggish and dull, and our sober minds are craving the endorphins. 

We are confident in the knowledge that, come race day, we will be primed and ready.  Mastering the balance of mobility and immobility is a valuable asset as we navigate the path of recovery – whether it is recovery from an injury, or recovery from a rigorous training session.

There are two skills that can assist us in this balancing act: 

“Inner listening” and discernment comprise our ability to listen accurately to our own bodies so that we do not aggravate and prolong an injury. No one can determine more accurately the condition and state of your body than you can. Through inner listening and discernment, you can readily evaluate the positive and negative effects of introducing mobility to the injured site better than anyone. 

Our creativity and innovation are essential as we navigate the path back to full functional health.  Do not undervalue creativity and innovation in your approach to rehab-exercises.  As we develop and learn to trust our intuition, we allow our bodies to guide our minds through the process of recovery and rehabilitation.  This intuitive approach contrasts starkly with our usual domination of “mind over matter”.  The intuitive skills we develop during our recovery process can be valuable for insuring flexibility as we determine our day-to-day training needs – even when we resume our full training program.

Maintaining Aerobic Base

Mobility allows us to exercise our cardio-vascular system and our neuro-muscular systems.  Initially, as we recover from injury, we seek out ways of exercising that can help us to maintain aerobic base as well as neuro-muscular strength and function in the uninjured parts of our bodies.  This first step back into athletic training returns us to a state of motion – helping to detoxify the body, increase oxygen levels in the blood and body tissues, and renew the body’s active chemical state.  This last benefit can do wonders for our positive attitude.

To illustrate some of these principles, I provide the following scenario, based on my experience.  I want to emphasize the value of our ability to accurately listen to our bodies and to respond appropriately to the body’s conditions.  Patience, curiosity and creativity are vital as we navigate the sometimes challenging and technical path to recovery.  

Remember that the goal is recovery.  It does not help to implement a strict training regimen at this time – based on numerically measurable output. To repeat, this is a time for flexibility, patience, curiosity and creativity.

Injury Yoga

Use a yoga-based process to initiate rehabilitation:  Consciously breathe to/through the affected area while slowly and gently stretching and contracting injured muscles, ligaments, tendons and/or joints.  Use your consciously directed breath to circulate energy though the injury. This is a very effective “mind-in-matter” technique that can help to release powerful charges of tension and ease trauma.  It is also an effective way to manage pain without masking it.

A few days after my bike crash, I spent 20 minutes one evening in a quiet dark room with my eyes closed, directing slow deep breaths into and out of the sites of my broken ribs. Simultaneously, I stretched my arm vertically above my head – lengthening the muscles around the rib sites. The first attempt was very slow - perhaps 5-7 minutes.   (Just to extend my arm over my head.)

Gradually, I was able to repeat this arm and thoracic extension in progressively less time, releasing knots in the muscles surrounding the break sites and stabilizing those sites.  After just one “Injury Yoga” session, my ribs no longer popped and jumped – eliminating sudden sharp pains.

I closed my eyes during this process, focusing my all of my awareness inward to the injured sites – really exploring the nature of the injury and the extent of mobility at those sites.  Progressively over the next few weeks, I was able to mobilize the injured sites with less pain and resistance during these quiet, slow- moving sessions.

The First Training Session

As we resume training, priority number one – regardless of the sport – is a cautious, curious and patient approach. The purpose of the first session is to explore the landscape of your injury:

 - Range of mobility for the injured parts 

 - Postural misalignment

 - Dynamic imbalances caused by immobility

 - Limits for weight bearing, impact and vibration. 

No one can assess these factors more accurately than the athlete her/himself – through deep inner listening. However, an experienced physical therapist can be invaluable in determining appropriate rehabilitation training regimes.

In my case, my first aerobic training sessions were on my bike mounted on the stationary stand.  Just straddling the bike was a slow and cautious process. Once in the saddle, I closed my eyes and sat still for a minute - listening attentively to my body. 

This pause helped to fully engage my inner listening, to kindle my patience, curiosity and creativity, and to dismiss the compulsion to produce some quantifiable output. I was riding towards recovery, not sprinting for the finish line of a race.

I began to pedal very slowly and easily, limbering up my legs and abdominals while gradually increasing my respiration and heart rate. A limiter with broken ribs is often the capacity for vigorous respiration. I was pleased to find that in aero position, my ribcage was closed enough at the injured sites to allow me to breathe fairly hard without inflicting pain. I kept that first session short – 20-30 minutes or so – even though I felt strong. 

Remember: patience, patience, patience.

I was elated with the results! Just 4 days after the injury, I had already found an appropriate form of exercise that would allow me to maintain and even increase aerobic capacity.  Feeling invincible, I decided to take my mountain bike for an easy 1-mile ride to the health food store.  

I got to the lip of the driveway.  Just the slight “blip” into the road sent wincing pains through my ribs. That should have been enough of an indicator.  By the time I returned home from the store, I was in misery. In my determination, I ignored my inner listening and suffered a minor setback.

I felt foolish. A moderately intensive aerobic effort on the stationary was appropriate; an easy carefree ride on the road was not. Lesson learned.

Posture and Alignment

We need to keep in mind that proper posture, alignment and balance are essential to
a complete healing. Our bodies have an innate ability to compensate and avoid painful patterns.  Such patterns alter biomechanics and can hinder the healing process. 

This was certainly true with my injury. I had chronic pain in my mid-back near the diaphragm from alignment compensation that hindered my swimming for a full 7 weeks.
During our first training sessions, we must respect the body’s innate ability to compensate, and not force ourselves back into proper alignment and form.  We must also avoid over-training while misaligned.

Get Wet

As creatures of habit, we tend to overlook new and unique alternatives – intent on returning to our normal regimen.  Injury provides us with an opportunity to be creative, curious and flexible.  The pool is a great place to experiment. 

Water-based activities – swimming, water running, aqua aerobics – offer opportunities for aerobic activities that minimize impact and weight bearing. Many health clubs
now offer aqua aerobics.  Don’t rule this out as a training alternative, even if most of the participants aren’t in top physical condition. 

Water running has served many athletes well during rehabilitation.  Many continue to include water running sessions in their regimen after full recovery.  It’s a great way to work on cadence and leg speed. Joan Benoit Samuelson gave great credence and endorsement to “Aqua Jogging” to maintain her fitness post-operatively before she went on to win Olympic Gold for the marathon in 1984.

The locations of my broken ribs limited the range of motion and speed of my swimming. My first sessions in the water were exploratory, brief, very slow and cautious. I used fins to aide in buoyancy, since my shoulder/arm movements were very slow and gentle. Unlike the initial stationary bike sessions, my first water sessions were very gentle and progress was gradual.  It was 7 weeks before I could swim vigorously, without pain or re-injury, and with normal mechanics.

Flexibility and Strength

Maintaining or regaining aerobic capacity is the first essential for recovery and rehab
– followed closely by flexibility and strength. We discussed flexibility in the context of injury yoga above.  

When we stretch to maintain flexibility, we are retaining the “intelligent” process of deeply relaxing the muscles and connective tissues, which allows them to lengthen.  Proper muscle length enhances neuro-muscular function, improving proprioception and coordination.  The conscious relaxation process employed in stretching is valuable for pain management as well as effortless and efficient biomechanics. It should be a part of every training regimen, as well as the rehab process. 

If you do not have a good stretching practice, use this recovery process as an opportunity to initiate one – slowly, patiently and cautiously.

Strength training may be limited during recovery – depending on the nature of the injury. The emphasis again is on caution, patience and creativity.  If you are able to exercise aerobically, rest assured that you will maintain some level of strength, even if you cannot manage a comprehensive strength training program. In the case of my injury, the ribs prevented me from any form of strength work for 7 weeks – but I was able to return with minimal regression.

Volunteer

Consider the opportunity to volunteer for a race while your injury prevents participating as an athlete. It can provide inspiration and motivation to “weather out the storm” of recovery. Helping out at a race gives us a refreshing perspective on the camaraderie of racing. 

Without the self- absorption of our own race performance, we can “take off the blinders” and enjoy the synergy that comes from companionship. This is an opportunity to view competition as a petition for companionship – disarming our typical ego-centric view of competition as “me against you”.  

After the experience of volunteering, we may return to the role of racing as an athlete with a more relaxed and open attitude that enables us to embrace the empowering synergy of this companionship.

Nutrition

In addition to a healthy diet of whole foods, I also include many Hammer Nutrition supplements that enhance my day-to-day recovery, as well as recovery from injury: Recoverite, Whey, Premium Insurance Caps, Race Caps Supreme, Mito Caps, Tissue Rejuvenator and Super AntiOxidant.

Setting Goals

Even without injuries, goals provide us with motivation and rewards for our training efforts. If we are realistic, creative and patient as we set goals on the path of rehabilitation from injury, we can experience the real joy of the recovery process.

In the case of my broken ribs and hand, I was ecstatic with the opportunity to train on the stationary bike so soon after the incident – in order to maintain aerobic capacity and a positive attitude.  (Note: I did not address the fracture in my hand for over a week.  Once I surrendered to the truth - “Its broken” - I went to the Sports Med Clinic.  I took a bike handlebar with me and was able to get the all-weather cast shaped so I could still ride my bikes!)


The ability to swim in the lake (slowly and gently) was a way of gradually mobilizing the injury sites. Just twelve days after my crash, I participated in one of the High Peaks Cyclery Monday Night Mini-Triathlons – the last of the season.  I swam cautiously and slowly, well away from the pack, then hammered the bike leg – passing more people on the bike than I’ve ever passed in any race – and finished with a very easy 5K jog – to keep my ribs intact.

I added a healthy 7 1⁄2 minutes to my best time – something we laughed and joked about at the post race party.  Most of my tri-friends were amazed to see me participating. With the exception of a 10-minute ride earlier that morning, it was the first non-stationary ride since my first painful attempt mentioned above.  Participating in a race – without actually racing hard – is an opportunity to relax and enjoy the companionship, to disengage from the ego’s strong compulsion to “beat” others – to allow others to claim the glory.

Full Recovery

My true post-injury goal race was to be Odyssey Adventure Racing’s Off Road Half-Iron in southern Virginia – 5 1⁄2 weeks after the injury.  The 56-mile mountain bike course was less than 10% technical single track – an important consideration, since I would still have a cast on my hand.  The course was hilly – 7,300’ elevation gain/loss on the bike and close to 1,800’ on the technical trail run. The race would be close to a 3⁄4 iron effort and I would attempt it with minimal base training.

I focused on training sensibly and creatively, with the intention of finishing gracefully without re-injury during either the training or the race.  The focus of my training consisted of specific workouts on the stationary bike – lactate threshold intervals and muscular endurance sessions – followed with short, steep uphill run intervals, walking or jogging gently back down. (The uphill did not generate any painful impact to the ribs, but maintained running leg strength.) 

I also conducted two 8-mile hill climb workouts on my mountain bike up the Whiteface Mountain Toll Road (approximately 3,500’ of elevation gain), and a hilly half-century road ride.  My swim workouts were slow and easy right up to race-day.  Often I included water running sprints to maintain leg speed during these swim sessions.  I was able to do a single 12-mile run 10 days prior to the race and followed that with daily 20-30 minute runs for the next week.

Opportunity

Injury provides us with the opportunity to express and manifest our incredible resilience and determination, as well as our amazing and divine power to heal ourselves.  It is an excellent opportunity to engage our creativity and ingenuity in order to train smarter, not harder.  As we attain well-chosen goals during our recovery, we transform adversity into triumph and affirm our love for this miraculous gift of life.  I am pleased to report that I finished the Odyssey race gracefully in just over 9 1⁄2 hours – fifth overall and first over 40. It was the happiest race of my season!

Originally published in Hammer Nutrition Endurance News, Issue 60, October 2008.


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