Wild Health Episode 47 – The Injured Athlete with Anne Linton

Coincidentally, as this blog post was getting ready to be published, Anne was having shoulder surgery. She will be spending her recovery time taking a lot of her own advice that is featured in this podcast. In the featured photo, she is seen riding a stationary bike with a raised stem, to alleviate strain on the injury. We hope she has an easy going, optimized recovery period!

We are all athletes, and we may get injured at some point. Anne and Mark break down their experience with injured athletes.

If there’s one thing every athlete, and most patients, have experienced, it is coming back from an injury. Today there are a few people on the podcast to discuss how to come back from an injury in a way that makes sense and is effective: Mike and Mark from Wild Health, and Anne.

Anne is an avid cyclist and a retired MD. She’s performed at a high level as an athlete and brings perspective as a coach and also from her personal experience with injuries.

In her 30’s Anne had a ski injury requiring ACL reconstruction surgery, recovered well, and went on to compete in an Ironman, multiple half Ironmans (IM 70.3), and even qualified for IM 70.3 championship World for her age category in 2007. After recurring injuries suffered during Ironman training and cyclocross, she decided to shift her focus from running and triathlons, to cycling instead. The lessons she learned after those injuries are 1. Seek out good medical care early so as to avoid any unwanted complications, and 2. Try to be flexible, sometimes it may be a “blessing in disguise.”

As Mike says in the podcast, “Sometimes it’s actually a good thing to get injured.” It can be beneficial as the recovery period can “Refocus yourself. Maybe that’s taking on a new hobby, taking on a new sport, or focusing on weaknesses, and focusing on things you wouldn’t otherwise necessarily have time to do…A lot of people get better from the physical therapy that comes after a significant injury. We’re often creatures of habit and the people who get these sorts of injuries are often overuse injuries…you need periodization in your life, and in some ways injuries I think almost force periodization to some degree. There’s potential benefit here.”

Anne agrees and thinks back to her own experiences doing Ironman training. “In a lot of ways, injury gives you forced recovery.” The “forced recovery” can be a great time to optimize weight, nutrition, and strength training. As well working on any weaknesses or imbalances you may have in other parts of your body that aren’t injured.

When it comes to coaching an athlete coming back from an injury and working with them on managing expectations, Anne says the first thing to do is work with their medical provider and get them good physical therapy, if it’s an orthopedic injury. The second thing is trying to refocus them, and see what other things they can work on. For some it is as simple as working on doing nothing. For some athletes she will add mindfulness meditation to their training plan so they can see that is something they need to be doing. Erring on the conservative side, Anne says from there, it’s a gradual progression. She draws a lot from her experience and trying to bounce back too quickly, and adds that she is mostly working with athletes “not in their twenties.” Sometimes just talking to people, and being there as a supportive person can be a big help through someone’s recovery. Suffering from an injury can feel like the end of the world for some people, and in those cases, a good therapist is recommended.

Noting the importance of seeking out therapy or counseling, Mike adds that when such a giant aspect of your life is activity, whether it’s your sport, your hobby, or just exercise and going to the gym, it’s very much a way of getting relief from the day, and that can be as important as daily meditation. It can be tough when all of a sudden, you’re thrown off, when you’ve been doing well, and then thrown this curve-ball and have to shift and change the way you get relief.

Strategies during recovery:

  • Diet/Nutrition
    • Focus on a cleaner diet, try to avoid processed and high sugar foods.
    • Fresh fruits and vegetables.
    • Whole grains.
    • High quality protein –stimulates anabolic muscle synthesis to heal bones.
    • If you can tolerate it, eat and drink a lot of dairy, especially if you have a fracture.
  • Supplements
    • Optimize vitamin D levels, if someone is deficient –have your vitamin levels checked before starting a supplement
    • Collagen, especially with tendon injuries –Mark says the data is mixed, but believes risks are low. Anne says collagen is great, and puts it in her coffee every morning.
  • Movement
    • A more recent frame shift in recovery from concussions specifically, is implementing low intensity exercises earlier on in the recovery period.
    • Studies show people have a shorter duration of symptoms, and better cognitive function if they start moving a little bit sooner.
    • Light walking on a treadmill or cycling on a stationary bike.
    • When exercising, looks at heart rate zones and stay in the recovery heart rate zone.
    • The Medicine of Cycling Group has guidelines for cyclists to return to training and racing after head injury, which can be found on USACycling.com
  • Meditate
    • The blood flow you used to use for performing your sport is now going to your injured area, which can be a great meditation to work on.
    • Meditate and visualize sending your blood flow going to heal that injured area.
  • Rest
    • Get a lot of rest and sleep more –don’t fight it! Let yourself sleep.
    • If you have a head injury, give yourself mental rest.
  • On Preventing/Avoiding Injury
    • Always have a gradual increase in duration and intensity of exercise.
    • Work on skills, especially for mountain biking and cyclocross, before competing.
    • Improve balance by increasing functional strength work. You don’t need a lot of equipment. You can use just your bodyweight, low resistance bands, and lightweight dumbbells and kettlebells.
  • Bodyweight Exercises
    • “Tippy bird” aka single straight leg deadlift, start with just your body weight, focus on form and where in the body you are bending and bend at the right places: hips, knees, and shoulders. Anne and Mike agree this is one of the best movements you can do for improving stability, strength, etc.
    • For people with weak shoulders Anne recommends using resistance bands to do internal and external rotations.
    • Start with no weight, or light weight, to prevent overloading the knees.
  • Core work
    • “Not just your six pack abs!” Work on everything between your chest to your hips, get that whole area stabilized.
    • Planks
    • Alternating lifting opposite arms and legs, known to some as “bird dog”
  • Muscle-Brain connection
    • Mark says, you have those muscles there, it’s just getting the brain connected to them and firing in a pattern that is beneficial, activating the core muscles in a way so that when you are in your sport or in training, you can use them effectively.
  • Genetics matter
    • Wild Health talks a lot about genetics and the human genome
    • There are different genetic markers that may be used to tell what someone’s risk of injury is, what their recovery may be, and how the body responds to different training programs.
    • Some genetic markers that are looked at, and “high-risk snips” can determine how the body encodes collagen, if you’re more prone to an ACL injury, etc.
      • COL5A1
      • COL1A1
        • There are different alleles or “snips” can show an increased risk of tendinopathy
      • If we look at these genetic markers, and identify someone who is at a higher risk, we can avoid a training program that can predispose them to injury or overload overtime

Top take home points:

  • Avoiding injuries
    • To start with avoiding injury, use proper strength training, core strength, whole body strength, nutrition, and looking into genetics. Focus on a gradual increase in your training load both with endurance and strength training.
    • Use proper technique in your sport, make sure you’re biomechanically stable and solid. If you’re doing a technique-intensive sport such as cyclocross or mountain biking, take some lessons and focus on skills training.
    • Focus on good form in training. So much of sports performance is good training, proper form, and better technique.
    • Have a good overall physical foundation.
    • Have consistency in your training and exercise.
    • Ask for help! If you’re not sure if you’re doing an exercise properly, or performing with good technique/form, ask for advice to improve technique.
  • Optimizing the recovery period after an injury.
    • Nutrition is the key!
    • Refocus on other activities and movements that don’t use the injured area.
    • Use talk therapy if needed. Talk to a friend, talk to a therapist. Acceptance of an injury is one of the harder parts of recovery.
    • Recognize that injury is a good time to focus on other areas that can be optimized. This change in thinking can provide a more positive outlook on injury that can help in recovery, and even “catch up on life.”

Find more informative podcasts from Wild Health on their website https://www.wildhealthpodcast.com/podcast