structured return to endurance sports

Structured Return To

Endurance Sports Marion “ Moose” Herring

Advanced Orthopaedics Sports Medicine Center

Who has pain when they run , bike or swim?

Who has had to stop or alter training because of an injury or pain?

Who has continued to train despite an injury ---- knowing you were doing damage or digging a deeper hole to recover from?

Suppose you are having that magical day. You have trained months to get ready. You have sacrificed diet, family time, and rest to train. You had to buy a plane ticket and hotel. Your race fees and tribike transport was paid. You start having a pain you know is bad. You are on PR pace.

Do you stop?

Suppose you are racing and having that magical PR day. You suddenly feel chest pain. You know if you continue, the consequences could be really bad.

Would you continue?

Understand the mechanism of injury

Athlete Rationalization: A break from activity causes disorganization of the strength and flexibility of muscles

2-3 weeks off leads to significant losses of fitness especially the endurance components

Return takes twice as long as the down time

General Principals of Treatment

When can I run/ride/train again ?

Not

When will I be healed?

The Question Becomes:

Integration:Athlete-SportsMed-Chiro-PT-Coaching

Injury phase

Normal prep for racing

Race

Build phase

Begin workoutModified

Increased Workout

Very Individual

You can kill a career by going to fast

Make a Goal for the End of Each Phase

“You are lucky-You get to do this for fun“

Conrad Stoltz

Healthy Progression

Phase I (3-6 weeks)◦ Goal : to eliminate the pain or stimulus for pain

***Stopping the activity Get the correct diagnosis !!! NSAIDS ( oral or topical), injections ? Ice Active or inactive rest Gentle stretching or Range of motion Deep tissue massage Chiropractic Treatment

Set Your Phase 1 Goals: More time with family, Learn about nutrition, Swim technique or speed, read books, learn Spanish

Initial Treatment

Rest ----Ice------hydration

Initial TreatmentPhase I

Avoid Temptation to Not Rest

Initial TreatmentPhase I

Active Rest◦ Cross training, walking, swimming that does not

cause pain**If cross training causes pain, you need complete rest!

Chiropractor: Active Release and modalities Physical Therapy (with dry needling) Core Strengthening

◦ Yoga, pilates are great for flexibility and strengthening Hot yoga is incredible for flexibility, core, balance,

heat acclimatization Stretching

◦ ***All that does not cause pain*****

Initial TreatmentPhase I

Integration:Athlete-SportsMed-Chiro-PT-Coaching

Injury phase

Normal prep for racing

Race

Build phase

Begin workoutModified

Increased Workout

*Pain or injury is better

Phase II (? weeks): Assume pain is absent

◦ We are beginning our sports specific motion (train coordination of joint and muscle)

****be aware of the pain******

Set Your Phase 2 Goals: Time with family, continue nutrition , Yoga, Core strength, swim , better run or bike technique

Initial Treatment

Too much ◦ 4 x body weight each step

across your hip , knees and feet

Too little◦ Not enough nutritional

ability to train◦ Bone density decline

Just Right ?

Proper Weight

Form and Technique Mechanics of repetitive load Orthotics/Shoes Bike fit General and Specific Strengthening

Phase 2How do I avoid the abnormal stress that led to injury ?

Gait Analysis ◦ Crucial is determining repetitive stress ◦ Cadence (Metronome) ◦ Specific exercises to address these issues

Drill Work ◦ Striding ON

Fitness Goals Limited www.fitnessgoals.co.nz

Shoe Wear

General and Specific Training

Form and Technique

1. Deep Well running*Zero gravity *Good cardio with high cadence *Work hip flexion and careful of extension, straight back, arm swing*Use as a return from injury or supplement**Pete Pfitzinger 9 week plan

2. Under water treadmillUp to 30%

3. Alter G treadmill -50-90% weight bear

4. Running

Aquatic Based Return to Running

Bike Fit

◦ This must fit your flexibility and your race plans

◦ **Not everyone should be “nose down”

◦ Cleat Position

Form and Technique

Integration:Athlete-SportsMed-Chiro-PT-Coaching

Injury phase

Normal prep for racing

Race

Build phase

Begin workoutModified

Increased Workout

**understand mechanism**gait and bike fit **proper strength /balance

Use of a Coach

Develop a Long term and short term plan ◦ Training ◦ Racing ◦ Recovery◦ Journal

Develop An Aerobic Base to build volume and intensity

Phase 3 : Increased Volume

BALANCE

Run Progression in Phase 3

walking

jogging

running

Cutting

Track/grass

gravel

Hilly or uneven

Fitness Challenge to set zones

Use of Run/ Walk Program

***Rules of progression *Each stage should last 1 week.

You can obviously progress the total time by increasing the interval . In stages 1-8 do not increase the interval by more than one.

*If you have pain-skip a run ( 3 days ) and return to the previous stage. If you still have pain at that lower stage please notify your doctor

Phase 3: Increased Run Volume

Stage 4-7 are jogging steady or zone 2 ( no intensity); the walk is good form good arm swing . This should be done no more than 4 times per week.

Stage 4: 4 min run / 1min walk x ___ Stage 5: 6 min run/ 1 min walk x ____ Stage 6: 7 min run/ 1 min walk x _____ Stage 7: 8 min run/ 1 min walk x _______ Stage 8: 9 min run/ 1 min walk x______

Run Walk

Stages 8-10 : the run pace intensity can increase by adding strides focusing on perfect form and, terrain can vary. This should be 75-85 % of normal pace prior to injury. The walk is same as above. You may want to do a shorter steady run without breaks on other training days.

Stage 8 7 min run/ 45 sec walk x______ with ____ x strides @____________

Stage 9 8 min run/ 45 sec walk x _______ with ____ x strides @____________

Stage 10 9 min run / 45 sec. walk x _____ with ____ x strides @____________

Run WALK

Stages 11-14: This progression is meant to realize longer race pace with scheduled rest. This would be normal run walk training for, marathon, half marathon, Ironman or half iron man

Stage 11 7 min run/ 45 second walk x ____ Stage 12 8min run/ 45 sec walk x_____ Stage 13 9 min run / 45 sec walk x ______ Stages 14 and 15: the athlete should decide where they want their

nutrition and interval to match that plan. Build the time to match the event .

Example1 : I plan on running 730/ mile marathon pace and I want to walk for nutrition every 2 miles. That would give 15 min run/ 1 min walk.

Example 2: I plan on running 9 min/ mile for Ironman and walk 30 seconds through the aid stations. This would we 9 min run/ 30 second walk.

Stage 14 15 min run / 1 min walk x ______

Run -Walk

Recumbant

Bike Progression

Trainer

On the road or trails Fitness

ChallengeTo Set Zones

Integration:Athlete-SportsMed-Chiro-PT-Coaching

Injury phase

Normal prep for racing

Race

Build phase

Begin workoutModified

Increased Workout*increase run volume*increase bike volume*Strength/core/yoga*Test to set zones/aerobic base

Our favorite step!

Race Day

Suffer So Good !

Recover !!!!Enjoy What You Do !

Marion M. Herring, MDmherring@advancedortho.me

Injury phase

Normal prep for racing

Race

Build phase

Begin workoutModified

Increased Workout RECOVER

Thanks mherring@aocortho.com