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Cross Training Through Injury

33% of the US Olympic Marathon team has trained themselves into injury in the recent months, with Desiree Davila still a possible scratch.  The oft injured Meb Keflezghi has missed training but should hit the start line relatively healthy in London.  And let’s not forget earlier defections such as Chris Solinsky, Laren Fleishman (who made it to Trials on an eleven miles per week program), and former medalist Deena Kastor.   Add in recent surgeries to Dathan Ritzenhein and Matt Centrowitz, and it’s a wonder Superglue is not the sponsor of USA Track and Field (the United States is not the only country injuring its star thoroughbreds, as Paula Radcliffe recently announced her withdrawal from the marathon in her home nation).

These injuries are a good chance to discuss cross training in the rehab process.  Conventional thinking is that intense cross training is imperative to maintain fitness.  Indeed, there are many anecdotes about athletes training themselves into injury, but managing a great race after cross training for months.  Both the formal and anecdotal evidence is clear that short term cross training can help prevent lost fitness in both highly trained (Eyestone 1993) and untrained subjects (Ruby 1996).   

However, does the attachment to cross training miss some key points about the nervous system?  In other words, you can remove stress from the musculoskeletal system, but was the musculoskeletal system even the primary culprit?  Perhaps the zero gravity treadmill, deep water running, and the elliptical machine are just conduits to prolong the nervous system’s agony and keep pumping oxygen through a circulatory system within a body that is wrecked and whose nervous system is not prepared for healing. 

Recall from previous articles that psychosocial stress is highly predictive of injury and plays a role in the recuperation process (Does Psychosocial Stress Elevate Injury Risk?).  When tissue gets hurt, it’s not only the tissue at fault.  In some respects, the attachment to cross training reflects how our world of endurance sports thinks about injuries as just “body parts.”  Yes we want to preserve fitness, but do we really want to preserve the overtaxed nervous system state within which the injury was allowed to incubate?  Rather than merely swapping out exercises, perhaps what’s needed is a shift in stress altogether (and holding accountable those who caused the injury…). 

This isn’t to suggest complete idleness is a cure, as body weight is itself a reliable predictor of injury (Plisky 2007).  If the athlete lets body composition deteriorate during an injury, there’s a good chance another injury will occur in the comeback.  Lost conditioning can also increase re-injury risk if fatigue leads to loss of motor control or if the body isn’t used to carrying extra mass upon resuming normal training.  There’s no doubting the importance of doing SOMETHING…but should it be intense during injury if we want to get better? 

Dathan Ritenhein is often seen as the poster child for intense cross training during injury.  His storied career has been marked with periods of greatness interspersed with several injuries.  Consider this excerpt from article he wrote a couple years ago:

“I always seem to come back from injuries better than ever, and I feel I have a pretty good grasp on what it takes to get back to peak form quickly.  I think when I am done running I should just coach injured runners and send them back to their coaches ready to go….I have had every kind of injury possible, and have maintained my fitness through each one, but I think the key to maintaining fitness is to always think high intensity!”  

Ritz is undoubtedly one of the greatest American runners in history but is he really suggesting that disabling a body part and cross training instead of running would have yielded better results than being able to run consistently without injury during those times (“I always seem to come back from injuries better than ever”)?  If you keep injuring yourself repeatedly, then you really weren't "ready to go" upon return.  

First of all, with that advice, you’re dealing with a mutant athlete with more talent in his left little toe than most people have in their entire bodies.  Secondly, just because someone has a positive result doesn’t mean they are performing optimally based on what they could have otherwise done.  (Does anyone actually think Ritz’s last minute attempt for the Olympic A standard in the 10000m was ideal for a runner of his talent?)  For every Ritzenhein who manages to claw himself back into form, there are countless others on a perpetual cycle of injury and partial recovery that dutifully cross train intensely through injuries but never fully heal.

If you stress the cardiovascular system in cross training, you’re still putting stress on supporting elements, even if primary concern is a musculoskeletal injury.  Again, not saying you need to stop training, but desperately clinging to cardiac fitness with hours of intense cross training may have overall recuperative consequences. 

That said, there are times when you need to go “all in” and take the consequences.  In Davila’s case with the Olympics looming, perhaps her team believed it was more desirable to take an all or nothing approach (Alter-G sessions), trying to sustain peak form via cross training at the risk of missing the race altogether, versus a more moderated approach that may have restored health sooner but possibly eliminated her from medal contention.

Ultimately, it’s critical to have baseline to determine which bucket the athlete falls into: is it simply a musculoskeletal condition or are the more problems lurking?    Baseline measurement tools range from the $40,000 Omegawave system to simply monitoring subjective observations.  No matter what you use, it’s critical to measure; otherwise you’re just guessing. 

Yes, certain injuries are largely musculoskeletal.  Conversely, musculoskeletal breakdown is sometimes merely one aspect of a body that’s had enough and needs to back off altogether rather than going through weeks of intense cross training.  Overtraining and injury are often bucketed into separate blocks, but frequently they are the same condition with different manifestations.   Approaches to cross training during injury must reflect the subtleties of this distinction.   

References

Eyestone ED, Fellingham G, George J, Fisher AG.  Effect of water running and cycling on maximum oxygen consumption and 2-mile run performance.  Am J Sports Med. 1993 Jan-Feb;21(1):41-4.

Ruby B, Robergs R, Leadbetter G, Mermier C, Chick T, Stark D.  Cross-training between cycling and running in untrained females.  J Sports Med Phys Fitness. 1996 Dec;36(4):246-54.

Plisky MS, Rauh MJ, Heiderscheit B, Underwood FB, Tank RT.  Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors.  J Orthop Sports Phys Ther. 2007 Feb;37(2):40-7.

Comments

Thanks for the post! Finding

Thanks for the post! Finding decent information on training can be so hard.

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