Management of an Injury
Year Date:
Sunday February 21, 2010 17:15
A very important topic, one which I am going through (still).
Its a priority for you to 'treat' your injury as soon as possible. Also identify and acknowledge that you do have an injury.
To many people 'carry on' with a 'problem' with the attitude that it'll just go away, or, just ignore it. There is only one result with those view points.
Background
If something's 'not right' and your not sure its always a good idea to 'take a breath' and access the situation.
On doing that and then finding out (recognizing the fact) that something is 'amiss', it is very important that you try and re trace your steps to the point before your injury (problem) started (if you can).
Now this might not be as simple as you think. Why? well because it might have been going on for a while without you noticing.
Top Tip(?) - Keep a diary(!) If you record your day to day efforts and note anything out of the ordinary, you might be able to re trace your steps.
So after experiencing the above, I shall 'scribe' my own case and my actions. Hopefully (maybe) it might help someone in some way.
Tech Speak
Just as a footnote this article is in 'basic language'. By that I mean I hold no qualifications towards the 'problem'.
I could 'rattle' on naming various areas of the body, but would you all know what I was on about? Maybe so maybe not. Simples is best!
Test Case 1 - Personal Experience
History:
A good starting point is my training for the Half Marathon (Nov 16th 2009). During that training (14wks) I had the 'normal' problems (tweeks) which I manage in he normal way (rest/reduce).
One (1) normal problem (calf) which 'rears' its ugly head nearly everytime I train for a running race, has I think been sorted out. How? well again by asking around and seeking advice. My point of pain was identified (possibly) by the wrong type of running shoe. For years I have been using Saucony and not really looking to change, but after talking to Paul Le Verdier, who has been treating numerous patients with various injuries, he mentioned that after looking (reviewing) his logs kept for his patients, Saucony shoes were very much 'involved' in the majority of injuries (allegedly). So a suggestion was to change shoe and see how 'we go'.
This I did, changing to Asics, and as of this date (Feb. 2010) I have had no problems. The shoes have been used for the final weeks building up to the Half and of course the Half it's self.
Onwards:
Going on from that and moving from running to cycling (winter program) for the coming season (2010) I changed my summer frame for the winter frame (normal practice) and found no real problems. It wasn't really until the second (2nd) week of December that I noticed that my back was 'playing up'.
Now, of course as you do, I just put this down to the change of frame and the more 'regular' bike work (during the training for the half I used cycling as cross training, maybe once/twice a week) so, I suppose, I ignored it and allowed it to 'fix it's self.
First (1st) sign? Second (2nd) week of December 2009.
The Problem:
So as mentioned my back was playing up. The pain was mainly on the right hand side, but basically lower back area. This 'spread' across the lower back and became very aggressive.
So (as we all do) I leave this alone assuming that it'll go away.
Why?
Well at that time the pain ONLY appeared whilst cycling. Every other training discipline (Running/Gymwork/Swimming/X Training) had no such problems. So in fairness a reasonable thought.
As Time Goes By:
The situation is getting worse. Back spasms are now occurring. Complete stiffness, unable to bend over fully, time to look at the problem.
So what's changed then?
Ok thinking backwards the bike frame has been changed (winter for summer) but this has never been a problem (previous years), but hey ho lets check that then.
Measurements taken, all seems in order, mechanically sound, shoes, cleats all checked. So that's the bike done then?
Well no not really, because here's the next problem.
Changes
All looks ok with the bike, but you still change things, albeit small, maybe a seat post height, seat position. And before you know it the bike's all of a mess.....
You see whilst you think the changes are small you end up doing 'a lot more' than you think! This in turn could create another problem if you are not careful.
So Where Now?
Time is moving on, 2010 race program is written, and the problem is still here. Everyone who 'races' knows that you have to put in a good winters training (where all the hard work is done) in order to 'race' well when away.
So the affected area is still bad, time to go 'professional'. An advert offering a free assessment on 'your back' appears in the JEP, not a bad idea to take up this offer.
Never been to a chiropractor before, try anything to get this sorted.
By starting to use professionals, you should always involve all 'areas' of the medical profession, if you need to.
Don't just accept one piece of advice (unless of course it works!), research your problem, via the internet (a wonderful tool).
Personally (as this page is on my experiences) I spent many an hour 'cruising the net' entering as many variations to my 'problem' as possible to see what came back. Yes a lot of this information is not worth following up (you'll soon get the idea) but its always worth 10 minutes of your time.
Professional Advice
The list of professional help is long. Ranging from my personal Doctor, Chiropractor, Physio, Pain Management Clinic and of course Word of Mouth!. All taking my history on board and trying to 'solve the puzzle'.
First Up
The chiropractor makes an assessment and some recommendations. These I take on board and act on. Extra sessions to re-align my back are undertaken, but with the honest truth being that it might not be the cure.
Everything (using old x-rays) seems to be in order, disc's, spinal cord, etc. So we are looking at another reason for the pain.
Referral is the next option (Pain Management Clinic) from the Doctor and then maybe my other exercise programs.
Other Area's
Again the research system is working overtime, any other changes in my training program? something I might have missed?
No obvious pain has been felt and to be honest I always stick to the 'if it hurts don't do it' theory.
So with time moving on I reduce and change my Abs workout. Less rep's and no 'full sit ups'. With the full range of movement doing a sit up, you do 'compress' the disc's, maybe this is an 'on going' issue that has finally taken its toll(?).
Leave the rest of the programs alone.
Too Many Changes
The main problem is making to many changes at once.
If this occurs and you find your problem is resolved you might find that because of the number of changes made at the same time, you cannot 'pin point' the exact reason for your problem.
And Onward
The Pain Management Clinic sheds little light and a referral to the Physio's department is next.
This is done and again nothing really new. All the 'back area' is fine (all departments agree) and now I'm running out of options.
So where do we go from here? Bearing in mind the time is now Feb 2010! Only 2hrs in the saddle and the 'problem' occurs. Sportives are out of the question for obvious reasons.
Back to Square One
'Bite the bullet' and re-start. Now this is helped by a 'word of mouth' comment from a fellow cyclist, who 'fell foul' of a similar 'problem' a couple of years ago.
It's something that I've been very 'amiss' with (chiropractors words!) and involves a muscular problem.
A Sports Massage is a very worthwhile thing, even if you only do a little exercise.
Possible Cause/Cure?
The 'IT Band'.
'The iliotibial tract or iliotibial band (a.k.a. Maissiat's band, IT Band) is a longitudinal fibrous reinforcement of the fascia lata. It is attached to the anterolateral iliac tubercle portion of the external lip of the iliac crest and to the lateral condyle of the tibia. The figure shows only the proximal part of the iliotibial tract.
The part of the iliotibial band which lies beneath the tensor fasciæ latæ is prolonged upward to join the lateral part of the capsule of the hip-joint.
The gluteus maximus muscle and the tensor fasciae latae insert upon the tract'.
(That is the one and only time 'Tech Speak' enters this page!)
Actions To Take
As mentioned lets go back to square one. By that I mean everything, the bike, my back, everything.
The bike goes into the shop to be re aligned if needed. A visit to my Chiropractor to make sure everything is ok and aligned and an appointment with my Sports Masseur.
The IT Band is a muscle that needs attention and massage, why?, well because it can get shorter and 'tighter'(lay terms) and affect the lower back (sound familar?).
In the mean time use of a 'Foam Roller' (borrowed from the Chiro) to 'release' the muscle.
OUCH NOW THAT HURT!
Twice a day (+ ordered a couple from the 'net') and a trial on the bike. Of course its not going to be cured overnight (the source of this information mentioned that it was a couple of weeks before he felt benefit from a massage and that further massages were essential!).
To Break or not to Break?
So after a visit to my Sports Masseur (the first of several) and a lot of hard work on my 'IT band', which was noted to be 'tight', just how hard do you go?
By that I mean the effort on the bike. Its a couple of days before I can get on the bike, which should be useful (always have a full 24hrs doing nothing after a massage anyway).
So with the weekend fast approaching its time to 'bite the bullet' and get out there.
My thoughts? Well just go for it. I know the areas where my 'problems' appears - Time/Distance/Type of route - so just ride.
Over the Saturday and Sunday - 455 minutes and 192k done - a tester if ever I'd seen one.
Assessment - Early Days
Ok so let's re-cap on the weekends efforts. Obviously the 'pain' is first on the agenda, with the result of that being positive. Its not going to go away overnight, I know this, but the feelings are good and the pain eased. After Saturdays ride (92k) I also knew that Sunday was to be important.
Why? Well after 'resting' for a couple of days the first day back is always 'easier' and the results 'seem to be good', therefore Sunday will be important. Its not a case of expecting the 'pain' to return, but its a case of being 'aware' that it might, and therfore being prepared for a 'downer'.
Two rides into one for Sunday (Hill work and Power circuit) now that should 'sort the men out from the boys' as it were! The back pass's the test, yes a few 'twicks' and a few stretchers take place, but on the whole the 'problem' seem's to be easing.
Again I stress that this is long('ish) term, not an overnight fix. I have another session on Monday (massage) and then another couple of days off the bike.
Set Back?
02/26/2010
Three steps forward, two steps back.
Whilst things were looking 'rosey in the garden', we (I) seem to 'stumbled' and the spasms have returned.
Is this a major problem? Can't answer that at the moment, or in fact why have they returned? Again something I can't answer :(
The training has not changed (in any shape or form) and, as far as I know, I have not 'tweaked' anything. Yes I still realise that this is an ongoing problem and its not a 'quick fix'.
Patience and monitoring is the name of the game now.
Next week (28.02.10) is the 'red week 100%'. I think I'll have a better idea by the end of that!
03/01/2010
The spasms seemed to have lasted for just one (1) day. Really don't know why. Not as bad as the original spasms, but annoying still the same. Further sports massage today (makes 3 now). The back is still 'uncomfortable' and not yet ready for 'racing'.
03/10/2010
It now looks unlikely that the IT Band is the 'sole' cause of the problem. Whilst the sports massage is working (flexability and stretching) the area of the lower back is still not 'right'.
Pain Management clinic is next (this was held over until IT band treatment). Personally an x-ray wouldn't 'go a miss'. Hopefully I might be able to 'suggest' this.
Needles could be a way forward?
03/24/2010
Time has passed and to be honest, whilst the pain has eased, the 'problem' still exists.
So as far as the Pain Management Clinic goes its back to basics. By this I mean we have a few more back exercises to undertake every day and patience is the name of the game.
Of course I now realise that complete rest from the bike is the only way to 'repair' the problem. But because of the races entered and training camp arrange its going to be my decision to 'make or break' the problem.
Majorca then France and finally Italy will see me till the end of June. At that time I will make the final decision to either stop biking or carry on. If I stop then I will return to running with a view to doing the Jersey Marathon.
So till then I'll bid you farewell..........................................
Saturday April 17, 2010 19:34
Going on from the above (update really) situation is still the same, with now the Amsterdam Marathon (Oct 17) the running aim.
Adjustments on the bike = adding a 140cm stem and correcting the various measurements (saddle height + stem to saddle).
On riding this morning (3.30hrs) the back was a little better. I have 2 more days (back to back) and hopefully I can assess the changes.
FYI, the Pain Management Clinic agree with me that at the end of June, I hibernate the bike and turn to running (its the only way really).
Giggle time - Fancy a sing song?
Catch up
As you can see from the above date we are now in 2011. The problem still exists, but I feel (crossing fingers and toes) as of this date (27.06.11) there could be a light at the end of the tunnel.
By that I mean at last something that makes 'sense' (well to me at least) has be found.
Prior to this a couple of things have taken place, so I'll update from the date Jan '11.
The long awaited knee operation (arthroscopy) took place on Jan 26th 2011. This was undertaken via Day Surgery and had a recovery time of six (6) weeks (minimum) attached to it.
This was followed to the date (in fact extended by two{2} weeks) which included, under no circumstances(!!), any leg work to be done for at least three (3) weeks after the op.
Recovery was done under the guidance of a Personal trainer (Pt) Dave Maddocks (Jersey Rugby Club 1st team Prop.). Upper body workouts were undertaken and the time did seem to go by quicky. Strength work on the legs was allowed after the third week, by means of resistance work in the pool.
Theories
In short the 'thought' that the knee op 'might' resolve the back problem was quickly dismissed. No need to dwell on that
Onwards we go
With the above being true the next thing to do was to stop riding for a year (@ least). So therefore a bike sale must (did) take place ( one [1] to go, a mountain bike) not for a profit but just sell.
Bikes gone and now concentrate on the running side of my training (aims).
One step forward.......Six steps backwards.....
As the above say's its been a bit of a nightmare. No soon as I got going something 'tripped' me up.
I must say that I realised that I would have a problem. A learning curve for anyone else.
Why?
Well because of the op in January and the lack of training, my weight took a northwards route. Doing just upper bodywork and doing no cardio work (of any substance) my body mass and body fat left me at least 5kgs over my 'fighting weight'.
So therefore any return to running would mean that I am training off a 'big weight'. Therefore prone to injuries (calf, lower leg, etc). This (unless drastic measures taken) has to be realised by myself (and any others who find themselves in similar circumstances).
Hence 1> and 6<......................patience is required.
Aims were drawn up, and subsequently missed. This again was understood by myself.
Light at the end of the tunnel?
As the dates passed the concentration was still on running (and still is). An injury to the left calf put 'pay' to a lot of things (never had a problem with the left handside, always used to be the right side) and resulted in a period of rest (four{4} weeks) being imposed.
During this 'rest period' (now into June) I had one of those 'spasms', which resulted in me not being able to move again.
This 'spasm' did not go away like previous ones (a few stretchers) and required me to seek help.
My original chiropractor has now fully quailfied in the art of advanced acupuncture, which has been a 'long time thought' of might regarding the back.
With the spasm not going 'away' I was fortunate to get an appointment quickly and explain my problem and thoughts.
Pin pointing exactly where the pain was a train of thought was reached.
That being - Ligament and Nerve damage - might be the underlying problem. The stretches that I used to get 'relief' from might just have been 'lucky'.
True the relief wasn't a 'straight fix' it still took time after.....maybe just maybe.....
Where now?
Well another appointment for some 'pin pricking' is booked. The results from an MRI taken mid June need to be looked at (by my chiro) and an assessent taken.
Repair work(?). Now this is not easy, especially in my line of work. Normal circumstances would result in rest and no agro of the 'damaged area'.
My running program (after 4 weeks off) has just started, real easy. Aims have been set.
Still as of now, running does not affect the back problem, but, as we know I have to monitor my calf problem. This requires me to 'think' that I am just starting running for the first time.
Weight loss is also on the 'market' during the running (return) period. This is to include four{4} weeks of no bread or pasta and plenty of fresh fish and salad.
Starting weight - 87kgs as of this date 27.06.11 - aim 84kgs by the start of the 'proper running' program - 31.07.11
For information
Strangely enough (and a bit scary if you look at the names involved) an articule in the Velo News website offered up some information, which was similar to my 'problem'.
The articule - here - does have some similarities, a bit worse than mine, but.......
Further Pin Pricking
Following on from the above 'bits', I have had now my secound session of 'pin pricking'.
The outcome has been 'favourable' and the 'train of thought' regarding the injury is also 'favourable'.
It seems that I have a small 'pea sized' amount of muscle ( a knot really) that when 'annoyed' grows and compresses against the pelvic bone, this in turn presses up against a nerve(s) and ligament(s) within the surrounding area.
This then restricts my movements (hence last thursday).
Repair Work
So what to do?
Well basically what I have been doing (regarding stretching and re hab) with the extra bit of 'icing like mad' (go live in a fridge I believe the ciro said!) and massaging the affected area twice a day (tennis ball and golf ball!).
The 'train of thought' is its like rolling out some pastry with a lump in it, just got to get the lump out.
Bikes
The situation is still the same and a good idea. At least 12 months off and assess then. The running (touch wood) is going ok, with a couple of aims being targeted. More on that (those) later...............
MAJOR SET BACK
As the year goes on I wonder what I have done wrong(?).
On Monday night @ work whilst doing a short (10min) run on the running machine (@.5 incline 10.5kph), my Lateral Meniscus 'snapped' inside my left knee.
No warning was felt, it just went. A visit to the A&E (Monday) and the doctors (Tuesday) confirmed the injury.
The result of this injury is 10 days full rest to see if the swelling goes down. If not then surgery is required. Even if the swelling goes down a visit to the specialist is recommended.
Worst case scenario is the same as the beginning of the year (I believe).
But that only starts if and when I get an appointment this year(!).
Mental Issues
Needless to say I was not in a 'good place' on Monday/Tuesday. This year has 'hurt' and been difficult.
Yes I know other people have worse 'problems' that the one(s) that I am (have) facing, but my mind 'drags' over and over to why(?) every time I take one(1) step forward I get 'whacked' six(6) steps backwards.
'Have I trained and Rehabbed correctly?'
I believe so, but it raises questions I suppose.
The next big question is 'How to rehab after this operation' (if required).
D Day 15th July for swelling, and whenever I get to see the specialist.