Answer to a question

Answer to Question
by Andrew Nelson for www.tricoachandy.com
andy@getfitnyc.com

I was recently presented with a situation from one of the athletes on a women’s triathlon team:
She is a cyclist and a runner who has pain in the knee. The MRI showed significant edema, inflammation, and bursitis. The bursitis was the result of a fall. Inflammation is often the result of trauma; edema is a fluid buildup in the tissues of the body usually the hands, legs and ankles and can be from injury or pregnancy).

As a longtime athlete, she has worked hard to overcome some injuries (Runner’s Knee, most recently) and is concerned about losing the fitness she has gained.
She asked which procedure would get her back racing sooner?
The doctor gave her 3 choices - 1) cortisone shots; 2) 4-6 weeks of immobilization and crutches; 3) PRP, physical therapy, and complete rest (not even swimming).

Here is my take from years of coaching, running, racing, and being an athlete:

1- If you can manage it financially, get the PRP and the PT. Complete rest may lead to a greater understanding of why you race to begin with.

2- If you gained fitness once, you will not go back to “zero” if you take the time to heal. It may seem like you are "losing ALL of your fitness," but the reality is that is just not the case. If you make things worse by not recovering fully then you will be out longer.

3- Treat fitness and exercise as an investment in your body; a long term investment.  There will be ups and downs; as well as plateaus.  Fitness and health are not just for this season or this training cycle. Athletes, especially highly competitive ones, do get injured (in her case it was another bike accident avoiding a car).  

4- You can strength train without mobilizing the knee joint. Straight leg raise w/ankle weights, hip abduction w/cables, straight leg dead lift- all of these will strengthen the hips/legs without bending the knee.

5- Swimming can be done while still immobilizing the knee, ONLY IF THE DOCTOR CLEARS YOU. Swim with a pull buoy and a band around your ankles (and maybe even your knees). It feels strange at first but makes your upper body swim form and rotation come from the hips; where you’re stronger anyway.

6- Take it slow! If you were running 6-10 miles/session before the injury, start with a 1/2 mile easy jog. That’s right, 1/2 mile. Your body will need to reestablish neural pathways for optimal muscle ordering; an efficient gait. This will help the body to break the old injury cycle. If you try to come back too quickly and resume where you left off, you risk re-injuring yourself.

Even great doctors who are athletes often fail to see what great trainers and coaches are able to do to keep athletes moving. I once had a dentist who had been a teacher of Dentistry tell me: “Some dentists were A students and some dentists were C students. At the end of school they were all still dentists.” Coaches and trainers are not all the same; just like any professional.

I understand the head game of an injury (I once took 13 weeks off immediately after being trained for a marathon to recover from an accident). The “career” of an athlete can be cut short, and lead to a lifetime of pain, by not taking the proper down time or doing too, much too soon after an injury. Take time to recover fully from an injury. Sometimes a longer time recovering can mean a stronger next season and a longer athletic career.

Stay Healthy and use a great coach to help you achieve better results for next season.