GRADUAL PROCESS The key when returning from injury is to progressively expose the body to forces and speeds. Pic: istock
A journey of a thousand miles begins with a single step. We all know the Chinese proverb and have a vague understanding of the meaning. It’s obvious that to achieve anything big, you have to start with something small. Before Michelangelo could paint the Sistine Chapel, someone had to dig clear the land. To run a marathon, you must first be able to run across the street. It seems both deep and patently clear and yet, when it comes to returning from injury, many people seem to ignore the logic.
I couldn’t count how many times I have heard a patient say something along the lines of: ‘I hurt myself, so I rested for a few weeks and it stopped hurting, so I went back to training and it hurt again. Maybe I didn’t rest for long enough.’ At first glance it seems a rational thought, but deeper examination reveals the problems inherent with just resting an injury.
Two key elements of any task are force and speed. You need to know how much effort to put in and how fast to do so. For people who have rested an injury before returning to sport, it is the variation in these two elements that causes problems. Looking at the differences between walking and running highlights the point.
When it comes to force and speed, walking can be considered low and slow. The impact forces when you hit the ground are low, the equivalent of your body weight, and you take around 100 steps per minute. By contrast, running involves impact forces of two and a half times your body weight at a rate of 180 steps per minute. These are just impact forces, the load through a sprinter’s Achilles tendon can be as high as eight times bodyweight at a stride rate in excess of 220 steps per minute.
The key then, when returning from injury is to progressively expose the body to forces and speeds that initially may even be lower than those of walking, and eventually become higher than those of running. In the latter stages of a rehab programme, it’s worth trying to achieve forces and speeds even higher than those required during a match, so that you can be confident of not breaking down when you do return.
How does all of that work in the real world? Let’s imagine you have a calf injury. Your first step might be to do isometric exercises, where the muscle stabilises rather than moves a joint, possibly while lying down so that there is very little pressure on the leg. Once you are sure that is ok, you might try something similar in standing, initially with the weight on both feet, before shifting onto one foot. So far you have increased the load, now it’s time to increase the speed - but to do so gradually.
The next step might be to try some small jumps, initially landing on both feet, then one foot. If there are no adverse reactions, you might progress to a hop, then several hops. Very few sports are played in one direction, so these simple, straight line tasks need to become more complex by adding direction changes to the mix.
Direction changes can of course be incorporated into the jumping and hopping routines mentioned above, or they may become the very start of a running programme. And there it is, now you are running. But running slowly and in a controlled environment, not back in a normal training session. When you are safe and symptom free with slow and controlled running, the next step depends on what sport you play.
Marathon runners might start with runs of five minutes at a time, GAA players with 50 metres and tennis players with five metres. As always, the speed starts low and builds carefully up to race or match pace. Once we can be confident of running at the right speed, it’s time to be confident of running for the right duration, which is where you return to something like a normal training session.
Rest is good, we all know that, it helps a painful muscle settle; but that’s only part of recovery. Once you’ve calmed it down, you need to build it back up. And we all know Rome wasn’t built in a day.
Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.