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January 1, 2012
Don't Push It: Training and Injury
Advice from an Ironman and Orthopedic Surgeon
Mark Kwartowitz, DO, Lederman Orthopedics
As a marathoner and Ironman, I've experienced the discomfort training can bring.  Pain is the price endurance athletes pay for what we love to do.  We expect it.  We accept it.  We even welcome it in the name of performance improvements.  Yet, when pain goes beyond typical muscle or joint soreness, we often ignore it for fear of what it will mean for our season.
As a sports medicine doctor and orthopedic surgeon, I treat pain.  I've seen hundreds of athletes at the high school, college, age group and professional levels in my 10 years of experience.  When we're injured, the common thread through all of us is the desire to heal as soon as possible and to continue on with our seasons.  Yet time after time I've observed five common errors that patients make when they have a serious injury requiring medical evaluation.  All five have the potential to end an athlete's season and lead to long-term consequences.
1. Seeking Treatment Too Late.
Seeking treatment for an injury two weeks before your race is not the ideal time.  There are usually only two choices at this point: racing in pain and possibly causing further injury or not racing at all.  Neither is ideal for different, yet obvious, reasons.  The majority of injuries in endurance athletes are due to overuse caused by the repetitive nature of swimming, biking and running.  Overuse injuries have plenty of treatment options that give you the most potential for a successful season.
2. Not Trusting Your Instinct.
Athletes collect copious amounts of information.  I think that's great.  I enjoy exchanging information with well-informed patients and helping them sort through what might be best for their specific conditions.  The downside, though, is they often do not trust their own instincts.  They are certain they have a serious injury but try to convince themselves otherwise (thinking they have shin splints when it's a stress fracture, for example). This often happens when patients realize the amount of healing time needed for a more serious issue and that scares them.  Training doesn't always need to stop; sometimes easing-off of the injured area during treatment is all that's needed.
3. Looking for a Fast Fix.
I often have the difficult task of presenting both surgical and non-surgical treatment options to patients.  Most athletes automatically fixate on the time spent off from training that rest and physical therapy require and jump to what appears to be the quick fix: surgery.  Don't dismiss conservative approaches.  Certainly surgery is a proven route toward fixing injury, but it doesn't correct the body's structural imbalance caused by injury like physical therapy can.  Conservative treatments, alone or in combination with surgery, may provide lasting results and less time will be sacrificed in the long run due to repeat injuries.
4. Not Following Through.
Conservative approaches, like physical therapy and other non-invasive treatments, often require multiple in-office visits over several weeks or months.  I've worked with athletes who don't attend sessions or go less than the prescribed amount.  This may be due to personal or work-related conflicts and/or insurance coverage and cost.  Patients might express frustration during follow-up visits at their lack of progress and, in turn, I become frustrated.  It's important to be honest with yourself about recovery time and to view treatment as an important component of your training.
5. Not Embracing Alternative Activities.
Endurance athletes live by their training schedule.  When sidelined, many don't take the initiative to train in alternative ways.  Recovering from surgery or during physical therapy can be an ideal time to try yoga, Pilates and other activities that can aid healing and return balance to the body.  Increasing flexibility, lengthening shortened muscles and strengthening your core with these exercises can benefit endurance athletes.
With no swimming experience and only a 9 =-month training program, I was very fortunate to have avoided serious injury while training for my first Ironman.  I attribute my great season to listening to my body, easing off the intensity or mileage when needed and training with an experienced group.
I encourage endurance athletes to view their pain as a training partner rather than as an opponent to out-race.  Pain is nature's feedback and your body's warning system.  Listening to that feedback ensures you will reach the finish line for many years to come.
Next Multisports Article: December 28, 2011
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