Coach Tip Tuesday: Don’t Underestimate an Under-Rehabbed Injury

It’s every athlete's nightmare: An injury.  Injuries are frustrating, to say the least.  Depending on what is going on, they can be tricky to diagnose, treat, and/or resolve.  The patience that it takes to properly rehabilitate an injury is very real…and it’s also a very real challenge.  However, it is worth it if it gets you back to doing what you love to do.

The Endurance Athlete’s Injury Progression

Over the years, I’ve observed a common sequence of events:

• An athlete indicates that they are injured.
• If it is not an acute, severe injury (such as a clearly broken bone or the result of acute trauma), the athlete exists in a state of denial for a period of time.  (Denial is probably the most predictable of human responses.)
• Once things are worse, the athlete accepts that they may, in fact, be injured.
• The athlete seeks a diagnosis and treatment.  Often, because they are now in a significant amount of pain, they settle in terms of who or what kind of provider they see; they often end up at an urgent care facility instead of at a specialist’s office.
• The athlete starts a rehabilitation protocol that may include some or all of the following: rest from activity, reduced activity, physical therapy, at-home exercises and stretches.
• Once the athlete starts feeling better, they start back up with their activity of choice and also decrease their rehabilitation protocols.
• The injury lingers.

Does any of this sound familiar?  This week’s Coach Tip Tuesday is yet another example of something that is “easy to say, harder to put into practice:”

Don’t underestimate an under-rehabbed injury.

Injuries Suck; There’s No Other Way to Say It

Believe me, I get it.  As an athlete I’ve sustained several severe injuries (including one that almost cost me my arm…literally).  As a coach, I’ve watched athletes go through the (emotional and physical) pain of an injury.  It sucks…and that’s being nice about it.

Because it sucks so much, it’s incredibly tempting to do any or all of the things in the sequence I outlined above.  Denial feels better in the short-term.  Accepting that things are out of your control is hard.  Properly rehabilitating an injury can take a long time, be very un-fun, and is usually a lot of work.  And once you start to feel better, an overdose of optimism kicks in, and it’s super tempting to go back to what you were doing before.

Resist the Urge to Rush Through The Healing Process

However tempting this may be, it's a flawed approach.  The first issue with this approach is that many athletes want to start back up where they were when they got injured, and that’s just not possible.  Even if you only take a short amount of time off (such as 1-2 weeks), it’s necessary to regress a bit in order to reduce the probability of another injury or to keep the current injury from lingering longer than it needs to.  The amount of regression does correlate with the amount of time spent rehabbing an injury; if you have been reducing your training or eliminating something from your training for a longer period of time, it is going to take a longer time to build you back up to a similar level of fitness that you had when you got injured and you’ll need to adjust where you’re starting from accordingly.

The second issue with this approach is that it makes the assumption that everything is better and you don’t need what you were doing rehabilitation-wise anymore.  However, if you’re feeling better, you’re feeling better because of your rehabilitation protocols, not in spite of them.  This means that you need to keep doing what you were/are doing in order to keep your healing coming along.  

Just Because Something Feels Healed Doesn’t Mean it Is Healed

I’ve seen it enough to know it to be true: An under-rehabilitated injury is going to be like what happens to Bill Murray in Groundhog Day.  It’s going to keep nagging you…over and over and over and over again.  As paradoxical as it may seem, just because something feels better doesn’t automatically mean that it is truly healed and better.  

In my humble opinion, this stage of recovery is the toughest because of the level of patience and restraint that it requires.  Because pain is generally no longer a limiting factor, it requires athletes to limit themselves and to do less when they feel like they might be able to do more.  However, an absence of pain does not always indicate that something is fully healed or resolved, and this can be a very hard truth to embrace.  If you are tempted to do more, remember to ask yourself this: What is so bad about feeling great?‍

This stage of recovery also requires athletes to forecast out further than they might usually look when it comes to their training.  In my experience, athletes are very granular; they see what they are doing today and maybe what they are doing this week.  However, it is much more challenging for athletes to see how what they do today and this week impacts 14 weeks or even 30 weeks from now - whether that impact is positive or negative.  This is where coaches usually come in; athletes often seek the services of a coach precisely because of that long-range, third-party perspective that an experienced coach can offer.

The Bottom Line

Band-aids and temporary fixes can make things feel better in the short-term, but they can ultimately be harmful in the long-term.  What makes us feel better and what makes us better are often two different things.  Mishandling and/or underestimating an under-rehabilitated injury can be the beginning of a long, winding, and frustrating road.

Instead, seek to do the tough thing and fully, completely resolve any injury you experience.  Do less so you can do more later…and for longer.  This discipline may not seem pleasant while you’re going through it - at all.  However, in the end, it will result in a better, more sustainable, and longer-term positive outcome for you.