Training Around Injury Is Different Than Training Through Injury

by Kevin Purcell, D.C.

During my time as an athlete I have experienced a few injuries. My personal experience reminds me that pain tolerance cannot be trusted when a physician or coach is evaluating an injured athlete’s ability to safely train.

As a coach and chiropractor who gives advice professionally to super motivated athletes I always recommend training around an injury. I get very uncomfortable (some might say emotional) when an athlete tries to train through an injury.

I am very willing to explore a healthy, motivated athlete’s limits. Likewise, I am willing to explore his or her limits as we safely train around injury. What follows is an ongoing case study.

Amy Larson, San Diego, is at the pointy end of the 40-44 age group. She's won her age group at Cali 70.3 and raced well at Ironman Hawaii. On March 5, Amy went down on her bike and suffered a badly broken clavicle. When I picked Amy up at the trauma center she was understandably upset about a number of things. I let her know that when she was ready to start an aggressive program to preserve fitness that I would make it happen, quickly. She let me know that was exactly what she wanted, ASAP.

Always, the first order of business is to get an accurate diagnosis and plan for recovery. Planning recovery is done before planning to preserve fitness. The sooner we get the best treatment plan the sooner we can plan training around that. I put her in touch with local legend and orthopedic surgeon Roger Freeman, M.D.

On March 7, Dr. Freeman determined the broken clavicle had numerous small pieces and that surgery to fix a plate and several screws was mandatory. As well, he found four full rib fractures behind the scapula. The next day, Amy’s surgery was complete. I conferred with Dr. Freeman and asked for specific limitations as I laid out my training plan ideas for Amy. I had spent hours reading about professional cyclists who had suffered similar injuries and how they preserved physical fitness during early recovery. Particularly helpful was Hans Kellner’s experience and Dr. Max Testa’s early training guidelines to Hans. Amy’s plan was designed to specifically avoid pain.

The Plan
Four days after surgery I scheduled Amy for a 15-minute morning trainer spin and a 15-minute afternoon trainer spin. The front wheel was to be raised to reduce forward lean as well as reduce pressure on her good arm and wrist. The next day the spin was 30 minutes. Six days after surgery we added brisk walking and the next day 30 minutes of Stairmaster. At the end of two weeks Amy was riding 90 minutes, inserting strict cadence changes, steady and mod-hard intervals via her power meter with daily Stairmaster sessions of 30 minutes. In total, there were seven rides and seven “runs.”

By week three she was doing 60-minute Stairmaster sessions with some mod-hard efforts and 90-minute rides. By week four Amy did seven rides, the last two hours long, and six runs, mixing elliptical and the Stairmaster. To start week five we planned focused freshening Monday through Friday. On April 21, she did her first 20-minute swim and first ride outdoors: three hours, followed by a 30-minute run on the road.

The last outdoor ride today was impressive. Normalized power was 74% pre-injury threshold power (very steady) with heart rates that were in line, all with a tight VI of about 1.04 -- a positive testimony to the preservation of fitness over the past five weeks. As well, I am certain a 60-minute Stairmaster session at 96-102 steps a minute is a good measure of fitness! Amy will pass on Couer d’ Alene and focus on a later summer Ironman. I can’t say enough about the way she has handled the adversity; it makes me misty eyed. I have a similar shout out to Julie Dunkle’s current recovery from distal fibular fracture, Mark Corely’s fractured hand, surgery and shoulder separation, as well as Sharon Underwood’s facial and shoulder separation injuries. I also want to add a special thanks to my good friend Jeff Shilt, MD, who has always made himself available to me and the athletes I work worth.

The level of focus to recover quickly and maintain fitness that I am by the athletes mentioned above and others like them makes them tough to compete against.

Kevin Purcell, D.C., works with long course triathletes; from elite to those new to endurance sport. Coach KP has guided dozens of athletes to qualification to the Ironman World Championships in Kona, including over 15 IM age group championships. Dr. Purcell is certified in Active Release Technique (ART) and has completed a medical rotation at the Olympic Training Center in Chula Vista. Coach KP retired from competition in 2006.