Once a month, I will be doing a Q&A with a medical professional or fitness professional in regards to injuries. As endurance athletes, injuries are almost always bound to happen at some point or another that will force us to take some time off of training and racing.
Let’s be honest, injuries suck. They prevent us from doing what we love, we end up in pain (sometimes unbearable pain), they are expensive to treat (even with benefit coverage, physiotherapy and chiropractor treatments add up quick and can really hurt you pocketbook) and have an overall negative impact on every aspect of our life.
This month’s spotlight on injury feature is one I’ve personally had to deal with: back injuries. I ended up with an extremely unstable right SI joint due to my cycling accident. Add on top of that, I’m hyper mobile and was riding a bike that was not fitted properly so I was riding in extreme flexion which put more stress on an already unstable SI joint. It took me seeing different chiropractors, massage therapists and physiotherapists until I ever got a proper diagnosis. All the while I kept training, racing and kept damaging more and more ligaments around my SI joint. It got so bad that after I raced the Triathlon World Championships back in 2008, every time I got on my bike, I would start to spasm. No matter what I did, I was in chronic pain.
Today, I am quite excited to introduce to you all the physiotherapist who was finally able to not only diagnose my injury is the reason I am back racing. Her name is Dawn Payne and she is a specialist when it come to back pain and back injuries, and specifically when it comes to cycling. Enjoy!
1. What are the 3 most common type of back injuries you see with endurance athletes?
The most common type of back injury for endurance athletes is mechanical low back pain. The most common joints that cause this type of pain are the facet joints (the joints in the back), the sacro-iliac joint (part of the pelvis) and the hips.
2. What are the causes of these injuries?
Mechanical pain is usually caused by one or more of the joints moving too little (hypomobility), whether it is due to muscle tightness and shortening, the joint capsule shortening (covering around the joint), a muscle imbalance, overuse or trauma like a fall off a bike. Sometimes with a trauma or long term strain on a joint, an athlete will have a hypermobility, which is when a joint moves more than normal.
3. What is the healing process like for these injuries and what do athletes need to know about whether they should be continuing to train and race with these injuries?
Healing time varies on the cause of the injury. If an athlete has pain that lasts for a few hours after a workout and settles down quickly, then typically continuing to train and race is safe. If an athlete has pain that lasts for several days, doesn’t decrease with time off, is getting worse or just not going away, they should seek medical advice. Having an assessment by a medical professional who understands the demands of the sports is important so that the athlete can get appropriate advice about the specific cause of the pain, how to modify training, whether they should continue to race and how ultimately return to full activity if a period of time off is required. I personally do my best to keep athletes active and doing some form of their sport. I think this is an important part of the healing process and is important mentally for most athletes. Having said this, it is also important that the athlete respects their body, the healing process and what needs to be done to resolve the pain and injury – whether that is changing their activities for a period of time, doing specific rehabilitation exercises, or going for treatment. Their commitment to healing and doing their part is the key to a successful recovery.
(Due to how bad my injury was, I was forced to take a full year off of racing and training. I was not able to bike, run or do any lower body weights. I remember being in tears when Dawn told me I had to take a year off and looking back, I wish I would have done it sooner.)
4. As someone who has had a back injury, it can be both frustrating and devastating to an athlete. What would you say to an athlete dealing with a back injury to help them stay mentally positive?
Here’s the deal. In every set back is an opportunity for growth. I have had athletes who had stress fractures and couldn’t run for a few months before an Ironman. However, this gave them an opportunity to improve and focus on their swimming and cycling which ultimately gave them a leg up in the long run. On the days when it just doesn’t feel like anything is getting better, like it will never change and you are so tired of the pain, try some of these:
Focus on what has improved – even if it is a small improvement like you could do 10 reps of an exercise with out pain rather than 8 reps.
Focus on what you can control. For example, you can control your commitment to do whatever it takes, you can choose when, where and how you do your rehab, your can determine the meaning you give to this injury (are you focused on how much having an injury sucks or are you focused on what you are grateful for? You still have 2 legs, 2 arms and a head on your shoulders).
Think about what could be great about this injury. Is it giving you an opportunity to increase your flexibility, which will make you a stronger athlete long term? Do you now have time to commit to improving your nutrition or learning something else that will help you grow as an athlete or person?
Chunk it down. Choose smaller steps on the path to the ultimate goal. Pick milestones that you are working towards. For example, you are returning to running and the goal is to run a 10km race. Start with a goal to run 1km pain free by X date. Once you achieve the goal, set the next one and adjust your time frames as you go.
Remember you have an infinite amount of resources. Talk to friends, colleagues, other athletes who have had set backs in their life and how they got through it. You will be amazed at the power of connecting with them and learning that we all have times in our lives that are challenging and that is how we grow and develop depth as people which is what truly makes us interesting. You never know, you may be an inspiration to someone else one day.
How you can apply the lessons of having an injury to other parts of your life. Where else in your life can you apply patience, persistence, determination, surrender, commitment etc?
Always remember to focus on what you CAN do rather than what you can’t do. I promise you, there are many people in the world worse off J
Last but not least…I believe life happens for us not to us. How is life happening for you in this moment??? What are the opportunities that could come of this?
5. What treatment options are available for different back injuries?
There are several treatment options for mechanical low back pain.
i. Physical Therapy treatments including, manual mobilizations and manipulation, soft tissue release, IMS, Acupuncture for pain, rehabilitation exercises (stretching and strengthening), taping, activity modification and advice.
ii. Chiropractic treatment is also an option and can include manipulation, ART, and various other treatment modalities.
iii. Massage Therapy is very beneficial whether an athlete has an injury or not, this is a helpful treatment for training or racing recovery and injury prevention.
iv. *For athletes who have a hypermobility, they may do well with prolotherapy. This is a very specific type of injection to help tighten the ligaments around a joint. Be sure to consult with a physiotherapist who is familiar with this type of treatment to see if you are a good candidate for a referral.
(I have personally have had to go for 12 rounds of Prolotherapy with getting about 20 injections into the ligaments in my low back and glutes. It honestly is the only reason my back is strong and stable today and how I’m able to race again)
6. What can people do to prevent these injuries from happening?
Maintain core strength and overall muscle balance and flexibility of the whole body are the cornerstones of musculoskeletal and low back health. Also, smart training, ensuring adequate rest time between workouts and races (overuse injuries are rarely about overtraining, it’s about under resting!), listen to your body, don’t let the little “niggle” turn into a raging problem. Catch it early, get treatment and take care of yourself.
7. Can a person with a back injury ever fully heal from it or is it something they are going to have to deal with for the rest of their life?
Yes, absolutely they can heal, however, depending on the injury, some people will have to maintain a rehab program to ensure ongoing health of their back.
8. Can an athlete who has suffered from a back injury ever return to competition and can they ever get back to a high level of competing?
YES, absolutely! The majority of the athletes I have treated have chosen to and been able to return to a high level of competition.
9. If someone wants to know more about back injuries and back pain, how can they get a hold of you?
Email : firstname.lastname@example.org
I want to thank Dawn for sharing her knowledge on this issue. Back injuries can be incredibly frustrating and painful to deal with but with the right treatment and rehabilitation, you can get back to doing what you love. I am living proof of that!