Structured Return To Endurance Sports

1. Structured Return To Endurance Sports Marion “ Moose” Herring Advanced Orthopaedics Sports Medicine Center

2. Who has pain when they run , bike or swim?

3. Who has had to stop or alter training because of an injury or pain?

4. Who has continued to train despite an injury ---- knowing you were doing damage or digging a deeper hole to recover from?

5. 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?

6. 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?

7. General Principals of Treatment • 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

8. The Question Becomes: When can I run/ride/train again ? Not When will I be healed?

9. Integration:Athlete-SportsMed-Chiro-PT-Coaching Race Normal prep for racing Build phase Increased Workout Begin workout Modified Injury phase

10. Healthy Progression • 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

11. Initial Treatment • 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

12. Initial TreatmentPhase I • Rest ----Ice------hydration

13. Initial TreatmentPhase I • Avoid Temptation to Not Rest

14. Initial TreatmentPhase I • 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*****

15. Integration:Athlete-SportsMed-Chiro-PT-Coaching Race Normal prep for racing Build phase Increased Workout Begin workout Modified Injury phase *Pain or injury is better

16. Initial Treatment • 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

17. Proper Weight • 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 ?

18. Phase 2How do I avoid the abnormal stress that led to injury ? • Form and Technique • Mechanics of repetitive load • Orthotics/Shoes • Bike fit • General and Specific Strengthening

19. Form and Technique • 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

20. Aquatic Based Return to Running • 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 • Under water treadmill Up to 30% • Alter G treadmill -50-90% weight bear • Running

21. Form and Technique • Bike Fit • This must fit your flexibility and your race plans • **Not everyone should be “nose down” • Cleat Position

22. Integration:Athlete-SportsMed-Chiro-PT-Coaching Race Normal prep for racing Build phase Increased Workout Begin workout Modified **understand mechanism **gait and bike fit **proper strength /balance Injury phase

23. Phase 3 : Increased Volume • 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 BALANCE

24. Run Progression in Phase 3 Track/grass walking gravel jogging Hilly or uneven running Cutting Fitness Challenge to set zones

25. Phase 3: Increased Run Volume • 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

26. Run Walk • 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______

27. Run WALK • 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 @____________

28. Run -Walk • 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 ______

29. Bike Progression Recumbant Trainer On the road or trails Fitness Challenge To Set Zones

30. Integration:Athlete-SportsMed-Chiro-PT-Coaching Race Normal prep for racing Build phase Increased Workout *increase run volume *increase bike volume *Strength/core/yoga *Test to set zones/aerobic base Begin workout Modified Injury phase

31. Our favorite step!

32. Race Day

33. Suffer So Good !

34. Recover !!!!Enjoy What You Do !

35. Race Marion M. Herring, MDmherring@advancedortho.me Normal prep for racing Build phase Increased Workout RECOVER Begin workout Modified Injury phase

36. Thanks mherring@aocortho.com