Wednesday, July 22, 2009

Training Injured

...As human beings, athletes, and animals, we will undoubtedly encounter an injury at some point in our lives that will impede our performance in, or even hinder our participation altogether in, the sports we love, our work or daily activities. Kelly Starrett, Doctor of Physical Therapy, Coach and Owner of San Francisco CrossFit, stated that injury is often the result of an underdeveloped area or deficiency in our overall “ready-state”, and that staying active while injured will expedite our post-injury recovery back to a "ready-state". Injuries in life will occur whether or not we choose to be active competitive athletes or sedentary couch potatoes. (I consider regular participation in the daily CrossFit wods to be “competitive athletics”.) The difference is, those engaged in regular activity will often heal faster. Part of this difference in perseverance of recovery is certainly “Physical”, as “fit” people’s bodies mend more easily, thoroughly, and quickly, for many reasons, than do the “unfit”. However, part of this difference is also largely “Mental”. By having a strong Mind and Will, or “Mental” foundation, garnering the physical benefits that expedite healing come with greater fruition. Thus the likelihood of ascendance over our injuries is more assured.

As an athlete and long time CrossFit’er, I know full well what it’s like to be an athlete and obtain a bad injury, as I’ve had several. The worst being a ruptured L-5 disc, torn C-6 disc, separated carpal bones in my left wrist, as well as the occasional bad knee injury. I used to post lengthy comments on the message board years ago about training injured and persevering through ones injuries. Injuries to an athlete can be mentally and emotionally devastating, to the point of tears. ...I recall about 15 years ago (I hate to admit this) I broke down crying in Garth Taylor's office at Claudio Franca's Jiu-Jitsu due to the sheer frustration of my many injuries at the time that greatly limited the extent of my participation in the sports that I loved.

With a little help, I diligently and successfully rehabbed all of my past injuries. (Recent x-rays showed that I had the vertebral disc-spacing of a healthy 20 year old.--NO disc degeneration despite the severity of my original injury years ago.) Yet, many weeks ago I suffered another bad injury, greatly altering my ability to train in the manner for which I want and need, ...and it couldn’t have come at a worse time seeing whereas the 2009 CrossFit Games were only weeks away. I was revisited with the same frustrations of long ago as not only did I want to perform at the capacity that I would normally be capable of, but I didn’t want to let my team down. Since obtaining this injury, I’ve become aware that there are more than a few of our regulars who are also nursing some injuries and are struggling with how best to balance maintaining quality training without aggravating their injury or losing their mind. (Andy, how’s that shoulder doing? ...Kyle, your low back?) In light of all this, I thought it an opportune time to address the subject of training while injured.

Athletes at every competitive level suffer severe injuries either through sport, training, or non-related circumstances. Some of those athletes persevere and thrive and even dominate in their sport, while other’s competitive careers are cut short. There is no one determinant factor in distinguishing between the two, though I know for fact having a strong Mind and wielding a powerful Will can play a profound role in the athletes ability to persevere through their injuries and not only keep from having an emotional breakdown, but successfully rehab, recover, and stay fit while doing so, so as to “hit the ground running” once the injury has fully healed. Granted, for the competitive athlete, there may be no time for full recovery before the athlete is called upon to perform at a high level. Thus in these situations, possessing an iron will, unrelenting mental focus, and a lot of heart (as well as the occasional high pain tolerance) can prove our best weapons for success in achieving athletic dominance and victory.

Along with cultivating a strong Mind and powerful Will, ...having a great coach to work with to develop a solid game plan, the patience and diligence needed to stick with that game plan, as well as the support and motivation of great coaching and great community, all play a role in the athletes success.

Kelley Starrett teaches workshops on “Chasing Performance” and has spoke in great detail in regards to “Training The Injured”, outlining many of the reasons to “Train Acute”. (i.e.; Many of the reasons to continue training when you’re injured.) If you ever have the opportunity, I highly recommend you spend some time with Kelly and attend one of his workshops. Many of his lecture clips can be viewed in the CrossFit Journal.--(If you aren’t yet a subscriber to the CFJ, it is seriously one of the best fitness publications anywhere in the world.--Period.) Many of the reasons Kelly gives for training while injured are in regards to the significant physical benefits bestowed upon those of us who train while injured. Some of those reasons are;

1). Cross-Over Effect; Working out the body parts that are not injured will have a cross-over positive effect to heal the injured body part, though more so in the lower body.--Through training one side of the body, the other side gets stronger through Neural Facilitation, etc.

2). Promotes Healing; By producing a powerful endocrine response, hormones such as Testosterone, Growth-Hormone, and IGF-1 are released systemically and thus help the entire body, including injured areas.

3). Helps Keep Systems intact;

4). Reinforces Tissues; Reinforces and maintains the tissues that are working to support the injured body part.

5). Decreases Compensatory Patterning; Injuries can yield other “problems” in the body that training can greatly mitigate.--Thus training can minimize, or even fully eliminate, the “ghosting” of the injury.

6). Don’t “Rot”.--Lack of movement while injured means the body starts to degenerate and lose muscle mass.--Training will allow us to retain lean muscle, strength, and everything we’ve worked so hard to build before the injury was incurred. (i.e.; ...Think of Wolf’s Law; “Use it or Lose it.”)

7). Increased Blood Flow; Training increases blood flow to injured area which increases healing/circulation and minimizes development of chronic conditions such as Tendinosis.

8). Improved Insulin Sensitivity: Increased Intensity drives Insulin Sensitivity.--This keeps systems looking for anabolic enzymes and helps shuttle needed proteins and nutrients into cells.

9). Boosts Immune System; Training increases immune system response, reducing the likelihood of infection.--”Immune Up-Regulation.”

These are many of the “Physical” reasons why those engaged in regular activity heal faster than those who aren’t. Put simply, by staying active and training while injured, your post-injury recovery back to a "ready state" will be significantly shorter.

If you are injured, ...don’t stop coming into the gym. Between the skilled and knowledgeable coaches and the strong community that we have all helped forge, you have the best support team possible here to help you through. The CrossFit box is an amazing place to be and having the constant support of those you regularly train with can really stave off the depressing feelings that sometimes find their way into the injured athlete. Once in the box, you want to do anything you can as far as functional exercise that doesn’t directly aggravate the injured area. Train around the injury as much as possible so as to help maintain as high a level of fitness as possible.

...When I separated the carpal bones in my wrist, I couldn’t do underhand pull-ups or kipping pull-ups, but I could do dead-hang overhand pull-ups, and so I worked the heck out of them. At least I was able to fulfill the “pulling” function of the human body.

...If your wrist, hand or elbow only hurt on the “catch” during a clean, then just do clean-pulls so as you are still developing explosive power, such as was the case with Dwight Lowery after breaking his hand the first time.

...A friend and client, Craig Parks, broke his hand on a box-jump-gone-bad. After surgery, he had pins sticking out of his hand that drove deep into the bone to keep the hand stable while it healed. Despite only having one useable hand, he kept CrossFit'ing and was able to do many workouts along with the rest of the class, he would just do so one-handed. He would do One-Handed BarBell Push-Jerks, One-Armed KB-Swings, One-Armed DB-Snatch, One-Armed Rowing, One-Armed Jump-Assist Pull-Ups, Back-Squats, One-Armed Dead-Lifts, Run Sprints, Back-Extensions and GHD Sit-Ups, etc, etc. He even did Box-Jumps, the very movement for which he broke his hand on. Through this process he finally got the kinematics of the Snatch and it just "clicked". He went from an "arm-puller" to finally, JUMPing the object to overhead.

...When I first ruptured my L-5 disc 15 years ago, I was unable to do much of any weights, but I could air-squat and walking-lunge, so I became an air-squatting machine, doing 500 air-squats with a 20# vest like in the Ken Shamrock book, “Inside the Lion’s Den”, (though I did them for time, of course), and I would walking-lunge laps for time out at the local track with the 20# weighted vest. Anything I could do to work my legs aggressively, yet functionally, I would do.

...If you have a busted knee, try working the UBE (“Upper Body Exerciser”, or “hand-bike”) so as to build the localized muscular endurance in the upper body as well as jack up the heart rate, or do pull/push couplets for time as this will tax the met-con as well as generate a lot of blood-lactate systemically. The CrossFit storm, “Mary”, was practically built for those with knee injuries.

...A long-time CrossFitter and active duty serviceman, Grady M., tore his knee apart during Jiu-Jitsu, so he did everything he could to still train while his knee was in a Robo-Cop like brace. He would still use the rowing machine, just would do so one-legged. He hung a set of rings at his house and spent hours working various gymnastics skills on them; everything from Muscle-Ups, Hand-Stand Push-Ups and Ring Push-Ups, to Ring-Rows, Front-Levers and Back-Levers. Grady worked diligently to develop new skills and strength moves on the rings. Through doing so, he went from a slightly pudgy redhead (sorry, Grady) to looking like that of a viking warrior or typical gymnast, and from 22 pull-ups to 54, etc. ...Kelly Starrett says being injured is a perfectly opportune time for people to “Work on their GOAT”. What he means is, when you’re injured, work on the things you suck at, much like Grady McDonald did with the rings while his knee was busted.

...About 6 months ago I severely injured my lat (or so I think that’s what it was anyway) and was unable to do any pulling what-so-ever for well over a month. Even the pull on the rower was quite painful. I had to rest it completely and then gradually reintroduce pulling movements, starting first with the Concept-2 Rower, eventually graduating to the ring-rows, then a little steeper angle ring-rows, then finally jump-assist pull-ups. ...I recall doing a timed workout and being forced to do jumping pull-ups as though I was just starting CrossFit. While it was a bit depressing and humbling thinking to myself how I used to do 50 C2B kipping, and now I was reduced to doing jump-assist, I stuck to the game-plan and over the course of about four months was once again able to start doing aggressive, powerful, chest-to-bar pull-ups with a 20# weighted vest.

...Time, ...diligence, ...patience, ...and a plan. Those elements mixed with the support of your Coach and the community that you’ve helped forge will help you persevere through your injury. Work with your coach, (and Doctors if needed, depending on the severity of the injury), and you can develop a solid game-plan to not only work around the injury, but to slowly improve your functional mobility within the injured area, all while maintaining a very high level of fitness. As Kelly Starrett has said in regards to rehabbing injuries, “Doing nothing is like death.” You might need to rest the injured area briefly to give the healing process a head-start, but you want to incorporate movement as soon as you are able so as to help maintain functional mobility in the injured area. If you have an injured joint, it’s vital to maintain mobility in that joint.

Ice the heck out of your injury after every time you train, NOT just when it hurts. Ice it periodically throughout the day if you are able.--The standard 20 minutes “on”, 40 “off” if using the standard ice-pack method. ...For this method, icing 10-15 minutes is not enough and 30-40 minutes is too much. Using a frozen dixie-cup ice-cube for focused ice-massage works extremely well and is considered by many to be superior to simply icing with an ice-pack. Kelly Starrett says that 5 minutes of focused ice-massage with the frozen dixie cup is the equivalent of 20 minutes with an ice-pack. We can all make 5-minute investments throughout the day. Period. ...If you prefer a smoother, more rounded and "focused" ice-chunk, try filling small water balloons and freezing them. The result is a rounder object for which makes applying pressure to knotted areas of the back, for example, easier. The rubber from the ballon also yields a decent grip, as well as provides a bit of insulation for the fingers. Whatever the method you choose, the important things is to ICE!!! ...And do so several times a day. Period.

Sleep as much as you can and eat as well as you can, as these too play a significant role in facilitating the healing process. Continued training at your local affiliate, even when injured, will often increase your likelihood of maintaining both, adequate sleep and adequate nutrition.--Both vital to expediting your recovery.

Continued involvement in your local CrossFit affiliate will help you remain connected to the community you helped create. Injured or not, you still inspire others with your efforts and they will inspire you. Be around the athletes you train with regularly and train with them just as you always have done, just alter your training as needed and stick with the game-plan. Over time, given a solid and well thought out approach, the patience and diligence to stick with that approach, combined with the support of your Coaches and fellow CrossFit’ers, you’ll be “back in the saddle again” and tearing shit up just as you were doing before the injury.

That’s what I did. (And am still doing). During the six weeks before the CrossFit Games, I wasn’t able to do any weightlifting movements with anything other than negligible loads, (which is depressing for me), but I was eventually able to wear the weighted vest and air-squat and squat-jump and “pull” and “push” and drag the weighted sled and so I worked all of those elements and functions as much as I could in preparation for the Affiliate Cup Challenge at the 2009 CrossFit Games and I was ultimately able to compete. Recovery is somewhat slow, but with the excellent help of Dr. Aaron Hinde in Scotts Valley, recovery is also very steady. With the limited training that I am able to do, I’m still able to produce lots of blood lactate systemically, as well as maintain my metabolic conditioning, the localized muscular endurance in my legs, my strength and power in some of my pulling/pushing functions, and to some extent, my mental and emotional well-being. For this I am grateful. ...Being here in the gym at CFWSC regularly, working with all the great Coaches here, and being around all of you, the clients, our community, our family, is all playing a huge role in my continued success of getting through this injury.

Despite the severity of my injury and the significant disruption that it caused in my normal training protocol, through diligence, persistence, a solid game plan, and some excellent chiropractic care, I was still able to perform reasonably well come “game-time” at the 2009 CrossFit Games. I managed to hit 230 pounds for a Triple on OverHead-Squat for the first workout of the Affiliate Cup Challenge. Not a PR for me, but still a respectable load considering the injury kept me from doing ANY actual “weight-training” for eight weeks prior to the games.

...If you are injured, and you’re still a bit despondent at the current state of your injury and situation, then recall for a moment the stories of Laura Wilkinson and Rocky Bleier....

Laura Wilkinson is a US Olympian. 22 at the time, Laura represented the USA in the 10 Meter Platform (diving competition) at the 2000 Olympic Games in Sydney, Australia. (No American woman has even come close to winning this event since Leslie Bush won the Gold at Tokyo in 1964.)

In March 2000, just six months before the summer Olympics, Laura broke 3 bones in her foot during a land practice that involved somersaulting off a block onto a mat. She was unable to dive for two months during her recovery. During this time, Laura was reduced to using "mental imagery" of her dives as her only training tool. Prompted and guided by her coach, Ken Armstrong, Wilkinson embarked on a difficult training regiment that included standing in a cast for several hours a day on top of the platform to practice her push-offs. As soon as her cast was removed, Laura began practicing dives underwater to avoid putting pressure on her foot. She was only able to start diving again just weeks before the US Olympic Trials. Despite the significant disruption to her normal training and the physical pain she was constantly in, Wilkinson persevered and qualified for the Olympic games. The fact that she even qualified was an impressive feat in itself.

"The day I broke my foot, I thought my dreams were over," Wilkinson said. "But God works in mysterious ways."

Wilkinson never completely healed from the injury and was in constant pain. After earning her spot on the US Olympic Team in June, she decided to put off surgery till after the Olympics. To help manage the pain, Laura was forced to wear a special shoe to climb the ladder, though Olympic rules stated that upon reaching the top of the ladder, she had to remove the bootie before walking the platform to execute her dives. To observers, the pain seemed a sure distraction as there were a few times during the Olympics that she was clearly limping on her way to the platform, yet in interviews afterwards she claimed she didn’t even notice the pain.

After the first round of dives, Laura was in last place. Her medal hopes seemed fleeting. Laura kept her focus, continued onward and through the rounds, climbed in rankings. She was in fifth place after the second round and by the fourth round, Laura had absolutely no cushion for error. At 394 points, the two women right behind her had 393 points. Only 1 point separated the top three women. There was literally zero margin for error. The pressure was on Laura to perform with the others in pursuit, the hunter now hunted. Adding to the worry, Laura now had to perform the dive she was the least confident in, the inward 2 1/2 pike somersault; ...the same dive she was practicing when she broke her foot. With the greatest pressure, she had to perform her toughest dive.

As Laura herself put it in an interview, "That's my trouble dive. I got up there and prayed to God. I thought I had nothing to lose, and I didn't hold anything back." She had been unsure of that dive since breaking her foot in three places in March. "It became hard to push off, and I'm always nervous I'm too close to the tower," she explained. "But it was worth risking!"

Laura came through in the clutch and dived very well. Her strong score helped her maintain her narrow lead despite the fact that all four divers behind her bounced back with excellent scores.

Laura faced enormous pressure in the final round since she had to jump first and set the standard for the four women to shoot for. A weak score would certainly give the women behind her a huge incentive while a good score would put the pressure back on them. Laura was only 1 point ahead of the 2nd place woman and 6 points ahead of 3rd place. Again she had no margin for error.

Laura's dive was strong, averaging "8.5", but now she had to wait, ...watching the other divers to see if they could execute a perfect dive and overtake her. It didn't even have to be a "10". A couple women could average "9"s and catch Laura. A dive averaging a "9" for world class divers was certainly within their potential. The event was not even close to being over.

Li Na of China was the closest diver to Laura in the rankings and nailed her dive. The announcer said it was either a "9" or an "8.5". Sure enough, Li Na received 4 "9"s and 3 "8.5"s. ...Laura had edged her out by a point. One point!!! Just one single point separated first and second place.  Laura Wilkinson was the 2000 Olympic 10-Meter Platform Gold Medallist! ...As a result of her strong mind, relentless will, solid work ethic and tremendous poise under intense pressure, Laura had become the Champion of the World. Gold Medal.

After breaking her foot, the farthest thing from reality in most people's eyes would be for Laura to even make the US Olympic Team, much less win the Gold Medal. ...Yet, she did. ...And she wasn’t surprised.
"I knew I could do it," said Wilkinson, 22.

...What can we learn from Laura Wilkinson?

There are many great stories from Olympians that we can learn from, such as that of Japanese Gymnast, Shun Fujimoto, in the 1976 Olympics, or Kerri Strug, US Gymnast in the 1996 Olympics. (I’ll share both their stories another time as the timing of their injuries and nature of their perseverance is a bit different.)

...Does anyone remember Robert “Rocky” Bleier? He was a Football Running-Back/Full-Back who all his life dreamed of playing Football, from the time he was just a kid. He did very well in High-School but was told by most that he was too short to play in College. Bleier was determined to prove them wrong. He worked very hard despite what everyone told him and was accepted on Football Scholarship to Noter Dame (a powerhouse in Football) as a Business Administration major where he went on to have a very successful Football career, breaking several school records during his time there and winning a National Championship in 1966. Despite his great success in College, he was told by many, coaches, scouts, etc, that he was too small/short to play for a Pro team. Professional Football scouts would say things like; "Can't win in the NFL with this kid."; "Is not capable of playing professional Football."; and "I don't think this man can make a Pro club."

Bleier ignored them and continued to work hard at bringing his dreams to fruition. He ended up proving them all wrong as well. Rocky Bleier was selected by The Pittsburgh Stealers as their last pick of the 1968 draft in the 18th round. He was selected 417 out of 441 Football players drafted in the NFL in 1968. The steelers picked 18 players and Bleier was the 18’th. He was the only one of the 18 to make it in Pro Football.

But Bleier was also drafted into the Army that same year to fight in Vietnam where he served with the 196’th Light Infantry Brigade. On August 20’th, 1969, while on patrol in Heip Duc, Bleier had the bottom of his right foot ripped open by a grenade, his right leg shredded by shrapnel and his left thigh torn up by gunfire during an ambush on his Platoon. He was listed as 40 percent disabled when released from the service and was awarded the Purple Heart and Bronze Star medals for his service to his country. The doctors strongly urged amputation as his only option but he begged them to just “sow em up” the best they could and that he would deal with it. You see everyone, ...despite the grave severity of his injuries, ...Rocky Bleier was still intent on playing Football once again.

After returning from Vietnam, Bleier attended the Steelers' training camp. Despite the odds of his badly injured legs and all the time away from the game being stacked against him, Bleier was determined to play Football once again. Most everyone on the team, doctors, trainers and coaches alike told him that it was futile and he should consider giving up his dream of playing in the NFL.

...But still, Bleier was determined to play Football once again. He had tremendous heart, powerful will, unrelenting focus, and unparalleled work ethic. He would rise in the early hours of the morning and jog with the help of a special sole he designed for his shoe. It was all he could do. His injuries were so devastating that he would often times fall flat on his face, literally. ...Yet he would get back up and start jogging again. Bleier never gave up, and said that he worked hard so that "some time in the future you didn't have to ask yourself 'what if?'".

When Pittsburgh's training camp opened in 1970, Bleier was there, battling eight running backs for only five spots. "I didn't want to face the truth," Bleier said. "I have a certain self-discipline, an ability to persuade myself that reality is not what it seems.--During the training camp, I convinced myself that I actually had a chance to make the ball club. I forced myself to ignore the fact that I still had a noticeable limp, especially late in the day when I was tired. Years later, in better times, players told me how they collectively shook their heads in 1970."

It became evident to those at the Steeler’s camp that Bleier wouldn't quit, despite the advice of coaches, trainers, and doctors that he should give up Football rather than take a chance of suffering more permanent injury.

...Bleier almost made the team that year, but was the last player cut before the final roster was set. Yet still, ...Bleier’s resolve held as he was intent on playing Football again.

He underwent another operation on his foot and was put on the Steeler's injured reserve list. He scouted for Pittsburgh during this time and was then reactivated for the team's final game.

He worked diligently to get ready at taking another shot at the NFL. "I tried to rationalize the workout. Ten laps, two and a half miles. That's all I could do," Bleier remembered. "My right toes ached; I still couldn't push off them. I was still running cockeyed on the heel and side of my foot. My toes had no strength, no endurance, no flexibility. I couldn't do any more. Then I thought of the other running backs --- Bankston, Fuqua, Pearson, plus the rookies who would be coming in. Ten laps would be nothing for them. Then I imagined super shape, running the football, breaking tackles, the crowd roaring. I got up and ran some more."

At the next training camp, Bleier ripped a hamstring muscle in the leg that had been shot up in Vietnam. Again, he was strongly advised to just give up on ever playing Football again. But by that time, the doctors undoubtedly knew what the answer would be. Bleier taped up his leg and returned to the field.

By 1972, Rocky Bleier was playing every game with the Steelers on their specialty teams. (And here’s the kicker, everyone!); ...He was timed as being 2-tenths of a second FASTER in his 40 than he had been before he suffered his wounds!!! In 1974, Bleier moved into the starting backfield, and in 1976, he gained over one thousand yards. He became a KEY player in Pittsburgh's emergence as the dominant team of the 1970's, winning four Super-Bowl Rings in the process.

Rocky Bleier became a great Football player simply because he refused to quit.
“I’m a breathing example of what you can do if you want to,” said Bleier.

...He refused to listen to the oh-so-many who wrote him off as never being able to make it and all those who told him he should quit. He did so *despite* suffering the massive injuries that he did.

...Perhaps we may not have quite the same resolve, focus or determination that Rocky Bleier possessed, but this is where coming into the box regularly, regardless of the nature or severity of your injuries, can help facilitate your recovery. The sincere camaraderie, energy and support system in place at your local CrossFit affiliate can really help you through your darkest hours.

...People sometimes feel a disconnect with stories like Rocky’s or Laura’s, as they are professional athletes that we may have never met. But the fact is, they aren’t God’s or otherwise intangible references that we can’t empathize with or relate to. They are just human beings who, just like us, found themselves severely injured. Yet despite the severity of those injuries, they found a way to persevere and rise again to athletic dominance.

Thus ultimately my point, everyone, is that your injury, no matter how grave or frustrating it may seem, is a minor setback. You will bounce back from this and be tearing shit up again soon. Just don't let the inertia of your injury inhibit your forward progress, for that inertia, if not kept in check, can way on you heavily; ...physically, mentally and emotionally. Our injuries are small roadblocks put in our path for us to overcome. They test and develop our character. The only question is *how* will we deal with them and overcome them? How will we grow from it? ...How will your injuries, and your perseverance through them make you a stronger person? Will we rise up, and forge the same mindset, dedication, discipline and tenacity that Rocky Bleier possessed? Or will we let the weight of our injury bring us down and thwart our persistent progression? I think we can, and will, do as Laura Wilkinson and Rocky Bleier. Every one of you has that kind of heart and perseverance within you. It’s just a matter of summoning it up from within and applying it. ...Keeping yourself submersed in a supportive and positive environment, such as that of your local CrossFit affiliate, will only serve in facilitating this growth and perseverance.

Don’t lose hope. ...No room for negativity. ...No room for doubt. ...No room for despair. ...Only perseverance.

You will rise up again and dominate!

Jason “J-Dogg” Highbarger