What does it mean to be injured? How do we know if we are injured? What are the signs, and are they always the same? How bad is the injury? How does it make you feel? Does it mean the end of the road for you and your sport? How long will it be before you can train as you did before? Will you ever be able to race again? Will you ever get back to where you were? Can we become better athletes after an injury?

These are all thoughts that swim around in peoples’ heads, sometimes on an endless loop throwing up feelings of fear, anxiety, anger, and frustration because, in many cases, when an injury happens a sort of panic can set in.....how did this happen? Everything was fine yesterday, but now I am in pain - why, what could have caused it? Without a proper understanding of causal factors, it is not uncommon for people to try to ignore it, or to avoid acknowledging it - this will go away, right? Of course, we know that it will not.

So, at what point should we act? What should we do and when? What do we need to know? Here is what Coach Tracy Cook would advise.

This article was originally posted on Tri Training Harder and was written by Tracy Cook Sports & Remedial Massage Therapy

 

 

Having a basic knowledge of what injuries are and how they are often caused.

An injury generally refers to damage to any part of the body, either to the structure (skeletal) or to the soft tissues (muscular-skeletal); this can inhibit ‘normal’ mechanical movement.

Although there are plenty of ways to sustain an injury, there are two leading causes: direct, the result of an external force to the body, such as breaking a collar bone from a fall, e.g. from a bike, and indirect, attributable to an internal force within the body, such as muscle tear or strain caused by poor performance technique, or inadequate training preparation.

 

How do we know when we are injured, and what are the warning signs?

Does knowledge of the potential causes of the injury help us to avoid them? What do you need to know to prevent future injuries? How do you know if you are injured – it is not always obvious? And what are the signs? Still more questions that we commonly ask ourselves, albeit rhetorically.

For the most part, and unsurprisingly, the first signs of injury are commonly pain, reduced movement, swelling and bruising, etc. This is the body’s way of telling you something that you have done, or are doing, is causing harm. You will typically experience some level of pain or discomfort that has inhibited one, or even several, muscle groups and it can be a sign that early warning signs were missed, or ignored, and that something needs to change.

Early warning signs often present themselves as mild forms of intermittent pain - tightness and stiffness at rest, and/or during movement; skin tender to touch, or low-level niggles, or twinges that will not go away. We may accept them (without change), perhaps shrugging them off, or putting them down to age. A swift response to the first signs of an injury is essential to avoid further damage!

How do you measure the level of injury, and are the signs always the same? For the most part, they are not. However, one thing they all have in common is pain to varying degrees of intensity: it is often through pain that we determine the level of injury that we have sustained.

 

What is pain, and how can it be interpreted?

By definition, “pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage, or described in such terms.” (1) Simply put, pain is the body’s way of raising awareness and protecting the body from further harm. Understanding and knowing your body, and how it responds to stress and overload, is valuable in helping to reduce the risk of injury. When your body is experiencing any form of pain, no matter how small, it should not be ignored.

Pain is a signal from the nervous system telling the injured body part (area) that something is wrong: a message that tells us that the sight of injury is struggling to respond in its usual way. It is an alarm bell, the body’s response to ‘trauma’, an inbuilt protective mechanism that is saying, STOP, before further damage is done! Failure to respond quickly and appropriately to these alarm bell(s) will inevitably lead to a more severe type of injury.

Although pain intensity is most often used as the primary indicator of severity, a high level of pain is frequently associated with acute accidental injuries. But it is usually a low level of lingering pain caused by overuse that needs attention before it takes a chronic turn and takes much longer to heal and, in extreme cases, may leave the body with irreversible damage.

 

So, what should we do?

In many cases, injury is tough to deal with, particularly when you have been working so hard towards a goal: the hours that you have sacrificed and what you have endured working towards your goal, to then suffer injury! The training had been going so well! How could I get this far and then suffer injury weeks or days before an event?

Gutted is a term often used to describe how we feel: huge disappointment, sometimes devastating, and later followed by regret for a lack of preventive self-care. The more significant the challenge, the bigger the sense of loss. All the opportunities we ignored: perhaps a lack of training discipline, the missed sports massage, pushing too hard, because you felt good, playing catch up with missed sessions because of work or illness. Does any of this ring a bell?

Not having answers, or fully understanding how the body responds to stress/load, and its effect on soft tissue disadvantages us in terms of knowing the best thing to do... ignore and continue to the extent possible? Find another training mode that lessens the pain? Reduce or stop training until the pain recedes? Seek help or advice? Sadly, the latter is frequently our last port of call, for many reasons: afraid of making a fuss over something perceived to be nothing; knowing but not wanting to take action, or just being in avoidance because that is easier than facing something difficult head-on, but then being forced to deal with it!

You may have consulted a physician or sports therapist only when all other alternatives had been exhausted when, in hindsight, that should have been the first port of call. Why do we do this? Fear of not being in control, perhaps? The only way to stay in control is to find out what is happening, understand its cause, and follow the right course of treatment and programme of rehabilitation.

This is the surest and shortest route to getting back to normal. To do otherwise is to let days or weeks go by as you try to find ways to minimise the pain and carry on training or hope that it will just go away. Instead, training becomes inconsistent, fitness levels reduce, anxiety and frustration levels increase, and you may remain blind to what is happening and even further away from recovery and a return to full fitness.

 

How do we return to full fitness?

What is the most effective way to respond to an injury no matter how insignificant it might seem? Seeking appropriate advice in the first instance is critical. The information we receive by doing so is an invaluable first step to change. Doing something different to achieve a positive outcome, both physically and mentally: this is where the healing journey begins so that you can return to full fitness. Following these three simple steps will set you on the right path:

• Step 1: seek advice, listening to and understanding the advice
• Step 2: act upon the recommended actions; and
• Step 3: actively immerse yourself in the process

Along this journey, you will discover the different stages of healing, and how treatment optimisation and rehabilitation are focussed on bringing about a safe return to your sport (strength, stabilisation, and proprioception). Over the following days, sometimes weeks, as you follow a ‘return to fitness’ plan, your mind and body will start to feel differently (better).

As you start to feel and see progress being made, you will be motivated to stick with the plan; you will have come to trust, safer now in the knowledge that you have acquired and processed. Your confidence will build as the program does its job and you will start to notice changes in your sense of well-being as your body starts to feel better than it has in a while, and you will then start looking forward to getting back to the things you have had to give up for what might feel like a very long time. A fresh start, a new way, a different way to achieve your goals that enables you to achieve more from your training, perform at a higher level and to keep injury at bay.

 

So, what have I learned: wouldn’t it have been better not to be injured in the first place?

Whilst engaging with your ‘return to [injury free] fitness’ plan, you should experience a gradual shift in your understanding. You will start to feel more in control as your knowledge and understanding about your training and ideal preparation conditions for competition improves. This should enable you to make better choices about how to best to schedule your training, and prepare for events, whilst reducing the risk of injury and, ultimately, bringing enjoyment back to your training. You should return to full fitness feeling more robust, more resilient and aware of how to improve your physical and emotional needs.

 

What would you do differently since your recovery? What has changed for you?

Many would agree that there are also aspects of their [pre-injury] lifestyle that they might approach differently, post-injury. There are power and knowledge in self-awareness that can improve confidence in a better and more constructive way to train.

Following the trauma of injury, made better by a successful treatment and recovery phase, you will be more informed, and you will be more confident in your abilities, as you take back the control that had seemed lost in the early stages of your recovery. You will understand:

• The importance of rest, both mentally and physically
• The common causes of injury, direct and indirect
• How the injury occurred and what the next steps should be
• The treatment plan
• The likely recovery time [if you stick to the plan]
• The rehabilitation required to return to full fitness
• When you can [and the conditions for a safe] return to full training
• How to train differently, taking more informed choices about training and competing

So, counter-intuitive as it may seem, there can be more collateral benefits to experience of injury than you might have thought, none of which may have become apparent had you not become been injured. Whilst your experience of injury may have been distressing and debilitating at the time, in retrospect, it might have been a blessing in disguise, if you learned the lessons that it could teach.

 

(1) International Association for the Study of Pain