How to plan ahead and stay injury free.

Endurance athletes will be all too familiar with the enjoyment that training brings when it is done right. Unfortunately, many of us also know that anguish of sitting out whilst a stress fracture heals or the feeling that you have less and less energy with every training session.

We may not all be champions, yet we can all get the same satisfaction from exceeding our personal expectations. To do this we need to enjoy our sport, and we need to stay healthy.

Here are Dr. André La Gerche’s (sports cardiologist, ironman athlete, marathon runner) tips for devising a training schema to minimize injuries:

Firstly, divide your training schedule according to the relative stress of each session on differing parts of the body. I do this in three simple columns with the following headings:

1. Skeletal stress. This refers to the stress that training puts on the bones. The greatest load occurs whilst weight-bearing. Thus running > cycling > swimming. The impact on skeletal structures is predominantly determined by the session duration and is also influenced by the surface and type of terrain. Eg. running 40km on the road places a very large load on your bones. Do this every day for a week, as an extreme example, and you will guarantee yourself a stress fracture.

2. Muscular stress. Referring not only to muscular load but also all of the tendinous insertions and ligaments that are put under strain during intense exercise sessions. Sprinting will place a great load on the muscles which helps provide strength and power but, once again, if you do not find a balance then it can easily lead to an Achilles, back or shoulder strain.

3. Cardiovascular stress. This is the least easy to “put a finger on” and is probably more contentious. My profession involves assessing the impact of sport on heart function. I am convinced that like the bones and muscles, the heart can be over-trained. The type of exercise that places the greatest load on the heart, lungs and blood vessels is sustained maximal efforts like time-triathlonaling and racing. Your heart is pushed close to its maximum performance during such efforts and it requires significant training to develop a cardiovascular system which can maintain very high cardiac outputs (large amounts of blood pumped by the heart) over a sustained period. This is a positive thing. As we train, the heart gets bigger and stronger, quite literally. This adaption process is also what is mostly measured when we do a VO2max. A VO2max measures how much oxygen can be used by the body’s muscles and 85% of that equation is explained by the ability of the heart and lungs to get the blood to the muscles. Thus, better heart conditioning, higher VO2max.

It is (probably) also possible to do too much and provide a setting whereby the heart ceases to improve its function or even becomes weaker. It is hotly debated as to what causes the over-training syndrome but I believe that the heart has not been adequately considered as an explanation for the lack of improvement and general fatigue that comes when you are ‘cooked’. Regardless of whether I am right, it makes sense to include it as a potential source of injury in the examples on the next page.

Now having considered these basic elements of the athlete’s make-up (the heart, the muscles and the bones) let’s consider them in an over-simplified but very useful schema. Here is an example of some training sessions to paint the picture.

SESSION SKELETAL STRESS MUSCULAR STRESS CARDIOVASCULAR STRESS
Long easy run (2.5 hours) *** * *
Swim session including: 20 x 50m at max effort with 2 mins recovery * *** *
60km time triathlonal on the bike * ** ***
12km run including 12 x 100m hill sprints ** *** **
Easy 3 hour ride on the flat chatting to mates * * *
Swim 10 x 400m at race pace with 1 min rest * ** ***
90 minute fast run in the hills *** *** ***
Cycle 8 x 4 min time triathlonal on wind-trainer with 5 mins rest between * ** **

 

These sessions provide some examples but every session can be considered in this fashion. It may not be an exact science but it gets you thinking.

THEN, the important bit! You look at the weeks and the months training schedule and you look (or even count) the number of ticks in every column. If you do all of your sessions long and slow then you will wind up with a stress fracture well before getting the most out of yourself. If you do all of your training like a race then you will put undue stress on your “motor” and will wind up tired and will cease to improve.

If you sit down before training starts for next season and try to develop a balanced program with ticks in every column then you might find greater success and fewer ice packs and illness. Obviously, it needs to be tailored to the type of sport and racing required (no point doing too many sprints in training for an Ironman) but no matter what the sport, balance is an important ingredient.

Other KEY points:

1. It is not about the load but how you get there. You may have wondered how the marathon runners can manage 240km/ week or the tour riders manage 700km +/ week. For injury prevention, it is more often not about how much training you do but how much CHANGE you take on. Increasing your running from 110km to 120km in one week is less of a risk than increasing from 30km to 70km in a week. I am sure that many of you have been frustrated by the injury that occurs whilst you are rapidly trying to increase your training back to ‘baseline’ amounts. Treat training with respect, especially when getting back into it after a break. As a rule of thumb, do not increase any session in distance or intensity by more than 10%/ week and avoid increases in duration and intensity at the same time.

2. Consider what type of recovery you get. I never get injured on holidays but I frequently get injured during the busy times at work. Why? It is all about recovery. There is a massive difference between finishing a tough session, gulping down some breakfast and screaming at the other motorists whilst running late for work vs. sitting quietly over a newspaper and slowly having breakfast. It is hard to put the finger on why, but it is a big, big difference. I find that I can measure performance improvements more by what I was doing outside sessions than during them. Obviously, we can’t make everyday a holiday but don’t try to be an Olympic athlete with the timetable of Obama – you will fail at the outset.

Anyway, there are some thoughts as we head into a cold Euro winter and we think about next season. Start a successful season with careful, thoughtful planning now…..and stay warm.

Dr André La Gerche
Cardiologist and post-doctoral research fellow in sports cardiology
Marathon runner, previous Ironman triathlonathlete
University Hospital, Leuven, Belgium
St Vincent’s Hospital Melbourne, Australia

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