Structured Return To Endurance Sports
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Transcript of Structured Return To Endurance Sports
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Structured Return To
Endurance Sports Marion “ Moose” Herring
Advanced Orthopaedics Sports Medicine Center
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Who has pain when they run , bike or swim?
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Who has had to stop or alter training because of an injury or pain?
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Who has continued to train despite an injury ---- knowing you were doing damage or digging a deeper hole to recover from?
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Suppose you are having that magical day. You have trained months to get ready. You have sacrificed diet, family time, and rest to train. You had to buy a plane ticket and hotel. Your race fees and tribike transport was paid. You start having a pain you know is bad. You are on PR pace.
Do you stop?
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Suppose you are racing and having that magical PR day. You suddenly feel chest pain. You know if you continue, the consequences could be really bad.
Would you continue?
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Understand the mechanism of injury
Athlete Rationalization: A break from activity causes disorganization of the strength and flexibility of muscles
2-3 weeks off leads to significant losses of fitness especially the endurance components
Return takes twice as long as the down time
General Principals of Treatment
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When can I run/ride/train again ?
Not
When will I be healed?
The Question Becomes:
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Integration:Athlete-SportsMed-Chiro-PT-Coaching
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout
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Very Individual
You can kill a career by going to fast
Make a Goal for the End of Each Phase
“You are lucky-You get to do this for fun“
Conrad Stoltz
Healthy Progression
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Phase I (3-6 weeks)◦ Goal : to eliminate the pain or stimulus for pain
***Stopping the activity Get the correct diagnosis !!! NSAIDS ( oral or topical), injections ? Ice Active or inactive rest Gentle stretching or Range of motion Deep tissue massage Chiropractic Treatment
Set Your Phase 1 Goals: More time with family, Learn about nutrition, Swim technique or speed, read books, learn Spanish
Initial Treatment
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Rest ----Ice------hydration
Initial TreatmentPhase I
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Avoid Temptation to Not Rest
Initial TreatmentPhase I
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Active Rest◦ Cross training, walking, swimming that does not
cause pain**If cross training causes pain, you need complete rest!
Chiropractor: Active Release and modalities Physical Therapy (with dry needling) Core Strengthening
◦ Yoga, pilates are great for flexibility and strengthening Hot yoga is incredible for flexibility, core, balance,
heat acclimatization Stretching
◦ ***All that does not cause pain*****
Initial TreatmentPhase I
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Integration:Athlete-SportsMed-Chiro-PT-Coaching
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout
*Pain or injury is better
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Phase II (? weeks): Assume pain is absent
◦ We are beginning our sports specific motion (train coordination of joint and muscle)
****be aware of the pain******
Set Your Phase 2 Goals: Time with family, continue nutrition , Yoga, Core strength, swim , better run or bike technique
Initial Treatment
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Too much ◦ 4 x body weight each step
across your hip , knees and feet
Too little◦ Not enough nutritional
ability to train◦ Bone density decline
Just Right ?
Proper Weight
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Form and Technique Mechanics of repetitive load Orthotics/Shoes Bike fit General and Specific Strengthening
Phase 2How do I avoid the abnormal stress that led to injury ?
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Gait Analysis ◦ Crucial is determining repetitive stress ◦ Cadence (Metronome) ◦ Specific exercises to address these issues
Drill Work ◦ Striding ON
Fitness Goals Limited www.fitnessgoals.co.nz
Shoe Wear
General and Specific Training
Form and Technique
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1. Deep Well running*Zero gravity *Good cardio with high cadence *Work hip flexion and careful of extension, straight back, arm swing*Use as a return from injury or supplement**Pete Pfitzinger 9 week plan
2. Under water treadmillUp to 30%
3. Alter G treadmill -50-90% weight bear
4. Running
Aquatic Based Return to Running
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Bike Fit
◦ This must fit your flexibility and your race plans
◦ **Not everyone should be “nose down”
◦ Cleat Position
Form and Technique
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Integration:Athlete-SportsMed-Chiro-PT-Coaching
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout
**understand mechanism**gait and bike fit **proper strength /balance
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Use of a Coach
Develop a Long term and short term plan ◦ Training ◦ Racing ◦ Recovery◦ Journal
Develop An Aerobic Base to build volume and intensity
Phase 3 : Increased Volume
BALANCE
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Run Progression in Phase 3
walking
jogging
running
Cutting
Track/grass
gravel
Hilly or uneven
Fitness Challenge to set zones
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Use of Run/ Walk Program
***Rules of progression *Each stage should last 1 week.
You can obviously progress the total time by increasing the interval . In stages 1-8 do not increase the interval by more than one.
*If you have pain-skip a run ( 3 days ) and return to the previous stage. If you still have pain at that lower stage please notify your doctor
Phase 3: Increased Run Volume
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Stage 4-7 are jogging steady or zone 2 ( no intensity); the walk is good form good arm swing . This should be done no more than 4 times per week.
Stage 4: 4 min run / 1min walk x ___ Stage 5: 6 min run/ 1 min walk x ____ Stage 6: 7 min run/ 1 min walk x _____ Stage 7: 8 min run/ 1 min walk x _______ Stage 8: 9 min run/ 1 min walk x______
Run Walk
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Stages 8-10 : the run pace intensity can increase by adding strides focusing on perfect form and, terrain can vary. This should be 75-85 % of normal pace prior to injury. The walk is same as above. You may want to do a shorter steady run without breaks on other training days.
Stage 8 7 min run/ 45 sec walk x______ with ____ x strides @____________
Stage 9 8 min run/ 45 sec walk x _______ with ____ x strides @____________
Stage 10 9 min run / 45 sec. walk x _____ with ____ x strides @____________
Run WALK
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Stages 11-14: This progression is meant to realize longer race pace with scheduled rest. This would be normal run walk training for, marathon, half marathon, Ironman or half iron man
Stage 11 7 min run/ 45 second walk x ____ Stage 12 8min run/ 45 sec walk x_____ Stage 13 9 min run / 45 sec walk x ______ Stages 14 and 15: the athlete should decide where they want their
nutrition and interval to match that plan. Build the time to match the event .
Example1 : I plan on running 730/ mile marathon pace and I want to walk for nutrition every 2 miles. That would give 15 min run/ 1 min walk.
Example 2: I plan on running 9 min/ mile for Ironman and walk 30 seconds through the aid stations. This would we 9 min run/ 30 second walk.
Stage 14 15 min run / 1 min walk x ______
Run -Walk
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Recumbant
Bike Progression
Trainer
On the road or trails Fitness
ChallengeTo Set Zones
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Integration:Athlete-SportsMed-Chiro-PT-Coaching
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout*increase run volume*increase bike volume*Strength/core/yoga*Test to set zones/aerobic base
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Our favorite step!
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Race Day
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Suffer So Good !
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Recover !!!!Enjoy What You Do !
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Marion M. Herring, [email protected]
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout RECOVER
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Thanks [email protected]