Why Resting Hurts

"I went to the doctor about my sprained ankle and he told me stop exercising completely for three weeks."

Sound familiar? Advice like this is all too common. After experiencing an injury, the immediate inclination - whether it be your own or at the doctor's advice - is to keep the injured limb completely immobilised and rested to allow it to recover. Unfortunately, this pro-tip from your medical professional is less "pro" and more "I'm not sure what your limit should be, so let's just play it safe." In fact, immobilization (complete rest) of a joint has been shown numerous times to result in a slower recovery from injury.

I stubbed my toe!

But when you sustain an injury, moving hurts? How can restricting movement be bad for you?

1) Scar Tissue

When you cut your skin well enough, you'll see a scar form. This is a normal healing response. However, if you've noticed, that scar does not quite act like regular skin. It's quite stiff and less stretchy. Well, the exact same thing occurs in muscle, tendon, and ligament tissue when they get damaged.

So, when we get a good injury, the damaged is eventually bridged by this scar tissue. This is good, because we've now bridged the gap. It can be bad, however, because scar tissue does not form neatly. While the fibers of muscles and ligaments are nicely arranged and run in the same direction scar tissue forms haphazardly and without organization.

======= - Muscle, tendons, and ligaments

######## - Scar tissue

This messy arrangement of fibers results in decreased pliability of the tissue, lower tensile strength (damage resistance against stretch) and increases the risk of reinjury.

The counter to this is, of course, movement. By putting the injured area through early range of motion, we're promoting these fibers to arrange themselves along the fibers of the muscle as their growth follows the lines of stress.

2) Muscle Tone

This is an easier one for people to get their heads around. If you don't use it, you lose it!

Muscle tone and strength begins to decrease within the first week of immobilization, meaning that if you completely avoid moving your ankle and walking for those three weeks post-sprain, your muscular strength will suffer.

Pictured: A more extreme - but not rare - example.

And we're not talking only the muscles immediately surrounding the area. Joints way above or below the area that you've hurt can also take a beating in the recovery stage if not managed properly. It's all too common for young athletes to allow their hip muscles to become weak from favouring one leg, resulting in knee and back problems years later. (It sounds like a tangent to link an ankle sprain to low-back pain years later, but we clinicians see this constantly!)

3) Blood Supply

Angiogenesis is the formation of new blood vessels. During injury, your blood vessels undergo understandable damage your body is going to need to develop new vessels to continue supplying that area with nutrients.

What promotes this formation? You guessed it: movement! Not only will muscle contraction cause more blood to pump to the area in the first place, but it will also help your body to create new capillary beds within the tissue to help that supply reach its destination. In contrast, you can imagine that removing this equation through complete rest is going to deprive the affected area of the blood - and nutrients - that it needs, resulting in longer periods before fully healing.

Putting It To Practice

So, am I recommending that you should hit the gym and do heavy, 1RM squats the day after tearing your quad muscle in soccer? Yeah, no. It's absolutely important that we decrease the volume of load at an injury site during the acute phase and gradually return it back up as recovery proceeds. However, early movement is always going to be one component to maximize the speed of the recovery.

What I'll typically  recommend is range of motion exercises after the first 24-48 hours without any resistance, such as ankle-ABCs or air-curls with the arm. If someone can't completely weight-bear on their leg, then I give them a crutch or cane to allow them to do so at least partially, creating at least partial activation of the regular muscles. From here, we just progressively add on to their range of movement, the resistance, and complexity of the movement until they reach their full recovery.

So just remember this. Whatever your injury, there is something to be done about it pretty much immediately. Don't go rushing to quit the soccer team or cancelling your gym membership, because much of the recovery phase is going to be spent doing your regular activities; just to a lesser volume.

Those three weeks of rest all are well and good, so long as you don't mind them tacking on an extra three to get back to 100%.

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Textbook Posture - It's A Myth

Does this sound familiar?

 "I went to get my spine x-rayed. Apparently my C5 is out by 14 degrees, my T1 by 30 degrees, and T3 by 10 degrees. I've been told that I need 3 months of treatments or else I'll be in pain for the rest of my life."

In the therapy field, I hear this a lot. Someone sees a practitioner for pain, they go get x-rays, CT scans, MRI's, and the works, and then they receive their alarming prognosis. It's hard to argue with a photo. You're taking a real-time picture of what's happening inside the body. If the imaging shows that your spine is out, then your spine is definitely out and you need to do something about it.

Well, maybe.

Textbook Perfection

Every medical professional that you've ever seen learned their stuff from textbooks. When it comes to anatomy and physiology, there are rules to how things are supposed to look. You're overall posture, for instance, should allow you to draw a straight line from your jaw joint through the shoulder, the middle of the hip, to a point just in front of your knee, and then finally to the ball of the ankle. There you go, all in black and white.

Except! The body is not black and white. Everything to do with health is a gray area, and every single body varies. Very rarely do we ever see a person with textbook perfect posture or spine that's free of degeneration. Often, it's the shape of the joints which throw things off. Other times, it's just the functional way your body holds itself due to your lifestyle. Maybe you ARE supposed to have a better posture than you do, but your tight or weak in certain areas. There are textbooks, but there are no handbooks to this. If you deviate from what your Anatomy 101 class says you should look like a little bit, it's no reason to rush to your chiropractor.

Postural Faults and Pain

That being said, if you do have a clear fault in your posture, such as rounded shoulders or an over-arched back, then could definitely be room to correct things. However, whether you're the therapist or the client, it's important that we remember to not stigmatize these imperfections.

I was reading one insightful article about disc bulges, one of the most feared and debilitating injuries that we can speak of when it comes to back pain. As it turns out, however, the images may show that you have a bulged disc, but you might not necessarily have any symptoms at all. Many faults and imperfections are natural, whether from birth or from the regular aging process. If you're asymptomatic, then there's a solid chance that you're going to remain that way, provided that your general health stays in check. I've heard many clients talk about the malaligned ways that their x-rays revealed their back likes to stay in, but guess what; chances are that my own x-rays would show many of the exact same things.

What If I Do Have Pain?

If pain is present, then there is obviously something going on that needs fixing. However, in these cases, let's still remember to pause and take a breath before dropping $900 on 5 months of prepaid traction and manipulations.

Again, malalignments and imperfections are often going to be present whether or not there's pain. Sure, you do want to focus on those areas by mobilizing joints and tractioning to reduce pain and pressure, but even then, those aren't necessarily cures.

Remember, it's more than probable that most of us have a postural imperfection without symptoms. So, if we do have symptoms, doesn't it stand to reason that those faults aren't necessarily the problem? They may not be helping, but more than often, I'm willing to bet there there is a strength imbalance, acute injury, or a habitual, repetitive task that would be much more beneficial to target. The most likely fact is that you're going to rehabilitate to the point that your pain is gone and function has returned before you see significant changes in your posture.

So Does Posture Not Matter?

I wouldn't go as far to say that you shouldn't care about posture or things picked up on your MRI. I'm just saying that visuals and images are essentially one test for your health when, in reality, there's a bigger picture to be painted. Is a person able to function and bend the way they need to? Are they in pain? How old are they and could this just be natural?

The important thing to remember is that posture charts to us and to many health professionals are like Barbie dolls to young girls. They're all fine and good but don't go thinking there's something wrong with you for not looking like that.

Her posture leaves me wondering anyway.

The Icing Controversy

So you're on your Sunday morning jog and you step on a tree root, causing your foot to twist at a delightful 80 degree angle and make a decadent, stomach-wrenching, "pop". Congratulations! You've sprained your ankle. Time to rest, ice, elevate, and compress that sunova'gun!

But hold on! Have you heard the most recent controversy in injury care? Ice, the time-honoured, tried-and-true method of managing your aches and pains, is under new scrutiny on how effective it really is for us. And what's worse, it turns out that the research that we need to help solve the debate is conflicting at best.

What Happens During Injury and Icing?

When you sustain an injury, your body goes through the same reaction every time, varying in degree based on severity. Your blood vessels dilate, fluid moves from the blood to the tissue, and metabolites are sent to the area to try and protect and heal. The problems arise when too much fluid and debris accumulates in the area, resulting in excessive swelling. From that, we get an effect known as "secondary hypoxic injury", which is the continued death of the body's tissue when blood flow is restricted by the swelling. In the end, the afflicted area is more damaged than the initial injury itself caused.

In contrast to this, ice essentially counters the inflammation response. It causes blood vessels to constrict, metabolic activity to slow down, and the swelling can be minimized before it even occurs. And of course, there's the lovely effect of reduced pain.

But What About Recovery?

This is where we run into the controversy. Yes, excessive inflammation and swelling is a cause for increased damage and recovery time. However, we need to stop and think about the fact that inflammation is also the method in which our body heals itself. That blood vessel dilation and fluid flow into the tissue is the way in which nutrients are sent to the area for recovery. By restricting this flow, are we impeding the recovery process?

The answer: Maybe?

Like I said, the research is still conflicting if it exists at all. Definitely, the risk of that secondary hypoxic injury is real, and it seems reasonable that it should be controlled. However, past that acute phase, is there any real need for cold therapy when we, in fact, require those inflammatory reactions in order to trigger tissue healing?

I won't try to pin down an exact answer at this point. There are people smarter than me that I'll leave that job up to. In the meantime, I'm playing it safe in the middle ground. When I see someone sustain an acute injury, I typically recommend ice for up to the first 24 hours. Past that, either no temperature change at all or even the application of heat is what I'll suggest in order to potentiate the inflammatory healing effect without such a risk of an exaggerated swelling response. (And of course, continued movement, the best medicine.)

Take some time to think about it.

6 Weight Training Tips for Sprinters

I've been a running coach for several years now, training both long-distance runners as well as sprinters. I made a recent post about weight training tips for long-distance runners and I wanted to do one about sprinting. While there definitely is a lot of crossover between jogging and sprinting, it should be remembered that sprinting is not simply a jog put on fast-forward. There are very different mechanics and energy systems at work between the two activities.

1) Early Strengthening and Explosive Progressions

One big mistake that speed athletes make is training slow and heavy year-round. I agree that heavy strength training is vital to developing an early foundation, however, that type of training will only go so far. You may have heard the team "Train slow, compete slow", and it certainly holds true. You should absolutely do slower strength training in the early off-season of your sport, but if you don't transition your training towards more explosive plyometric and sprinting-specific training as you get closer to your competition, then you won't be ready to show up and perform.

Whether you have one main sport season during the year or several shorter once spaced throughout, save the majority of the heavy lifts for the earlier period of training. As you progress and get closer and closer to your competitive season, you need to start adding more explosive exercises such as Olympic lifting, box jumping, and actual sprint training to the routine.

2) Target the Glutes and Mind the Hamstrings

The limbs amplify movement. They don't generate it. Therefore, like with long-distance running, the power generation is done by the glutes and assisted by the rest of the leg muscles down the chain.

Take the time to specifically target your glutes during training, through the slow-strength training as well as the plyometric training that we just mentioned above.

Also remember, however, that you do need to take very good care of those hamstrings as well. Being so prone to injury during exertion, preventative conditioning is vital. A balance between the strength to help and propel your body as well as the flexibility for stride-length and prevention of overstretch injuries will be crucial. Eccentric hamstring curls will be handy for protecting you from tendon strains. Heavier lower-chain exercises such as deadlifts will further the progress by training those muscles to be able to contract from lengthened positions.

3) Spend Time on One Leg

Again, like with jogging, sprinting has you spending time on one leg at a time only. Both feet are never in contact with the ground at time. It seems like a minuscule amount of time, but you need to train your body to stabilize the side-to-side shift of the load it's bearing.

Single-legged deadlifts, pistol squats, one-legged glute bridges, they're all handy. As long as you can train your muscles to fire in proper sequence, one side at a time. For those in the gym who only ever do frontal plane exercises on both feet, there's a significant difference in how effectively they're able to coordinate proper balance during activity.

 

4) Proper Mobilization

Being mindful that aggressive mobility drills are not the magic bullet for performance, you will need adequate mobility in order to maximize your running efficiency.

Having poor hip mobility is going to be an obvious hindrance. Whether it's due to poor flexibility, capsular restrictions, or lack of muscular strength, adequate range of motion is a necessity if your stride length is going to be at all effective.

The other main area that I often see being a problem due to mobility restrictions is, surprisingly, the shoulders. If your shoulders are restricted and flexion/extension doesn't occur smoothly, then the tendency is to compensate for the lack of arm swing with torso rotation. If you ever see people running who aren't so much using their arms but rather just rotating back and forth at their chest, this is what I'm talking about. This makes for poor momentum and propulsion and is also a waste of muscular energy.

If you have these restrictions, does this mean you should be aggressively tractioning your joints with bands to try and increase range? Please please please no. It's so unnecessary to mobilize like an overeager Youtube Crossfitter if you're doing proper, conservative exercises that your body will more-willingly adapt to.

5) Remember Your Core

As always, we bring it around back to the core.

I remember the very first time that I did hill sprints as a teenager. The sorest parts of my body the next day were, understandably, my calves, but also, surprisingly, my obliques.

Remember that you're generating an enormous amount of force when sprinting at maximum capacity. Because of this, your trunk is required to do everything it can to resist torque and deformation that the limbs are causing.

For sprinting, however, it's going to take a little more than just planks and side-planks to effectively condition the core. Since sprinting requires such high amounts of plyometric activity, the core needs to be trained specifically against those types of movements. Essentially, we need to turn core exercise into a type of plyometric exercise of it's own.

6) Arms, Bro.

This is an often-overlooked area for runners, and many will skip arm day because, well, you don't exactly run on your hands. (Most of us don't, anyway.)

However, especially in my young runners that I coach, arm strength is lacking to a fault. When you sprint, your arms need to be driving back and forth to counter the movements at the leg. So often, I see sprinters who do not have the explosive tricep activity in order to drive their arms back with enough force. Because of this, the arms become unable to move with enough force to provide momentum to the run and can also slow down the entire stride rhythm due to not being able to keep up with motion at the legs.

The solution, fortunately, is simple. You don't need to adding three tri-and-bi days to your workout routine, but you should have a regular upper body workout with both strength and plyo work itself, just like you do for the lower body. Once you can push-press a significant amount of weight overhead with proper form, then you'll be able to drive the arms effectively when running.

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Sprinting is a highly-demanding and technical skill; therefore, training for it is as well. Simply walking onto the field and running as fast as you can will, unfortunately, not promote the improvements that you're looking for. It requires both the on-field training as well as a specific and targeted routine in the gym. And like anything, practice makes perfect.