Thursday, December 1, 2011

Coaches' Corner: Learning the Difference between Pain and Injury

In all sports, and especially in endurance sports, it is important for coaches and athletes alike to be able to differentiate, as much as possible, between pain and injury. The higher the level of training and the heavier the training load, the more difficult it becomes to walk this fine line. In rowing, as in other endurance sports, success is largely determined by mental and physical toughness, in both training and racing.

No matter how healthy or injury-free you may be as an athlete, achieving to your maximum capability on race day comes down to the ability to push through pain and discomfort. Rowing, like any racing sport, requires pushing up against one’s physical and mental limits (for a related article from The New York Times, click here). However, in addition pushing through manageable barriers, there are often instances in which the athlete, doctor/trainer, and coach must determine whether it is 'normal' pain or an actual injury that could detract from training and performance if not properly handled.

What is the best thing to do? Stop? Keep pushing through and hope the pain goes away?We’ve all been there, during a heavy training cycle, in the middle of a long, hard workout in which we experience a slight twinge, or even sharp pain somewhere in the body. What is the best thing to do? Stop? Keep pushing through and hope the pain goes away? Sometimes these moments are just minor pains that go away with normal rest following a workout, or work themselves out after a few days of subsequent/differentiated training. Other times, they are the beginning of a significant injury that only gets worse. It is an important part of athletic maturation to be aware of these differences, and be able to take part in the decision-making process.

Ideally, there will be a symbiotic/cooperative relationship between athlete, medical professional, and coach with a mutual understanding between all three parties despite their different priorities. The athlete will naturally be biased toward continuing to train through injury, as he/she will not want to lose any hard-earned edge in training or in competition. The medical professional will likely lean the other direction–now, more than ever, given the litigious nature of modern society, doctors are conservative with their recommendations. The coach, then, often takes on the position of fulcrum in this delicate balance, taking into account both his/her knowledge of the sport and the particular athlete (with which/whom the doctor may not have direct experience) as well as the information presented by the medical side.

The most important part of all this is that each figure in the triumvirate described above must play an active role. The athlete must learn to take on some level of personal responsibility in terms of identifying, to the greatest extent possible, the difference between pain and injury. Obviously, no athlete is going to be able to train or compete at a high level without pain, discomfort, soreness, and varying degrees of injuries. The key is to be active in identifying and treating them, and to be intelligent in dealing with them. It is up to the individual to know his/her own body, and discover the difference between pain and injury, which may take trial and error over time. The medical professional must be available to provide the data necessary to make a rational decision regarding continuing to train or altering the training plan, and the coach must understand both sides well enough to advise the athlete in either circumstance. For this reason, it is often most useful for a coach in any given sport to have a general background in exercise physiology.

Nicholas Purnell and Drew Ginn (right) in Bled (Photo: B. Kitch)
These questions arise at every level of competition, and affect every level of athlete. A prime example of this is Australia's Drew Ginn, who has battled injury throughout his career, winning multiple Olympic gold medals along the way, and who is likely to bring home more hardware from London next year (he recently took home the bronze in the M4- at the 2011 world championships–for a video interview with the Aussie M4- following their race in Bled, click here). Coincidentally, Ginn was also the World Rowing 'Athlete of the Month' for November, 2011, and his interview for the FISA website (quite comprehensive and very well done) covers a great deal of his training through injury over the years. During the Olympic regatta in Beijing, Drew and pair partner Duncan Free were unable to practice due to the condition of Ginn's back, but had done enough work leading up to the racing that they were able to put it together when it mattered most (more on this from The Canberra Times). Ironically enough, it's now Ginn who is awaiting the return of Duncan Free, as Free suffered a broken leg in a bike accident prior to the international racing season last summer (fortunately, he is recovering quite well).

Muscle imbalances and strength deficiencies can also lead to injury.To be sure, the goal is to be preventative and avoid injury as much as possible. The important keys for doing this include rowing with good technique, not increasing volume too rapidly, not doing hard sessions day after day, paying attention to core strength, getting enough sleep and proper nutrition so that the body can repair itself, etc. Most injuries occur either after a long break, or when an athlete or coach revs up the volume and/or intensity too rapidly for the body to handle, or in the middle of heavy volume training cycles when the body is fatigued and in a weakened state. All it takes is one bad stroke in the middle of a long, hard workout in a heavy volume week, one heavyweight squat with poor stability/core strength, or repeated strokes with deteriorating form in the middle of a workout to lead to injuries that require time away from training. Muscle imbalances and strength deficiencies can also lead to injury. Injuries, outside of freak accidents, typically don’t just happen–more often, they are often a result of or a response to something that could have been altered in hindsight. By keeping this in mind and staying smart, injuries can be avoided.

While it is important not to generalize, given that every athlete is different, and every athlete's body will respond in different ways, it can be said that, if you are suffering from a sport-specific injury, then there are nearly always ways to train around that injury, which will maintain overall fitness through periods of altered training. As Ginn describes in his interview, he suffered a rib injury early on in the 2011 season, limiting his ability to row, but, in his case, not limiting his ability to utilize the watt bike. Cross-training becomes extremely important to maintain base fitness, and, as long as it can be done without affecting the existing injury, can often be done at a higher volume to compensate for the loss of sport-specificity. This will not only help with performance upon making the transition back to rowing training–it may help the healing/recovery process as well.

-Justin and The RR Team

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