Training while injured
dealing with pain in training
"A man searching for his limits is bound to find them."
I have no idea who said this, and Google can't seem to help, but I know that it's a phrase that echoes through my head every time I regard injuries. Because if you challenge your body hard enough, injuries will be part of the deal. And as I mentioned a few articles ago, I am currently dealing with an injury of my own. While it is a particular case, I thought I'd share my experience and thoughts of dealing with this both in specific and general. Because there are lessons to be had, regardless of what tissue is causing trouble.
So I've just had that talk which every athlete hopes to avoid. The one where you sit in the surgeon's office and hear him say "you probably shouldn't be doing this anymore". The short version is that I have unwanted bony growth on the top of my thigh bones - thank you, tennis career - which impinges the labrum between the hip and thigh whenever I squat deeply. And this excessive labrum overstraining has very slowly and gradually progressed until one day I woke up with anterior hip pain. It's not a catastrophic injury, but one that was difficult to get a grip on. Let's rewind five months.
Avoiding pain triggers
Pain initially ebbed and flowed, but it didn't seem to correspond with my training rhythm. It was however slowly becoming more intense. Originally the only movement which clearly triggered discomfort was deep squatting, so I honored my own maxim: if it hurts, don't do it. I did however keep the rest of my training going, because avoiding pain triggers usually goes a long way when catching the injury early on. Unfortunately not this time. When even a few weeks of rest didn't help - I'll explain later why this was to be expected - I knew I needed the help of a physiotherapist.
The first thing my physio pointed out was how underdeveloped my right gluteal muscles were in comparison to the left side (sorry, no photo here). This likely meant that my right hamstring had been overcompensating, which may have been adding to a then already suspected impingement problem due to its mechanical line of pull. Anyhow, my right hip was muscularly speaking out of balance. The idea that followed was to focus on glute function while letting the hamstrings atrophy (yikes) in order to speed up the rebalancing process. What followed were a few weeks of only doing exercises that would even bore 1980's Jane Fonda. I hated every second of it. I knew I should be positively affecting my hip, but pain was close to 24/7 at this point.
Respecting recovery cycles
Luckily the X-ray was made shortly after this. And it proved the impingement hypothesis to be correct. What followed was probably the most important lesson in the whole process so far. My physio reminded me that, while the gluteal strengthening idea was solid, I may have not been respecting the recovery cycles of the soft tissues in my hip. I'll explain.
Standard strength programming usually follows muscle recovery rates, which state that you should be training at least once every few days in order to maximize gains. But this does not account for soft tissues like tendons or a labrum, which can take much longer to recover. Easily up to 5 or 6 days. This explained why training my hips a few times per week, which muscularly felt totally fine, kept irritating that damn labrum. Challenging it was good in order to keep up its ability to withstand force, but it was just too frequent in order for it to be able to recover and (re)build its capacity. Complete rest naturally hadn't helped either, because while it did relieve the overstrained labrum, it also lowered its resilience due to detraining. So resting and then restarting training was bound to keep me in an endless cycle of moving in and out of pain while not being able to consequently train well.
Jane Fonda would approve of this highly effective glute exercise
So there's a new plan now. The idea is to continue to challenge the labrum in order to build up its resilience. Not all out, but dipping my toe in deeper squatting waters just enough to provide a positive adaptation. And infrequently enough (once every 6 or so days) to allow for full recovery. There is a second lower body session in the week too, but that one leaves the labrum be and is geared solely towards building up other structures that support a healthy hip. Great. It has been a bitch of an injury so far, but I'm glad to say that I've been in less pain since I started respecting the recovery cycle of my hip, while my work output is slowly on the rise again.
Special thanks to the two physio's who have been helping me along the way.