5 Minute Facts - Return From Injury

This is episode 219 of the Empowered Team podcast. Happy, happy New year. Welcome to 2023. And we know you are people who take a lot of action. We do too. We're achievers, we're leaders. We love to serve other people. However, sometimes the actions that we're taking are not quite getting us where we want to go. They're really just keeping us busy. So join us for our Empowered Action Challenge. This is a free seven day challenge. Join us so that we can support you in taking the actions that are really going to make a difference in your life. And maybe they are inactions, maybe there are things you don't want to do and you need a little bit of accountability. Well, this challenge, Empowered Action Challenge, is accountability for leaders. So join us. It's free, it's seven days. It's going to be a whole lot of fun. We'll keep you accountable and get you really into that momentum so that you can stick with the actions that you really want, the ones that really matter. Join us. Welcome to the Empowered Team Podcast where we explore how to optimize your performance in career, sport and life. And now your host, executive coach and life strategist, Kari Schneider. Welcome to Performance Power. We love to do this once a month, just once a month only so that we can dive into the nutrition, the training, the recovery, the health, the performance. Because we know that you want your absolute best performance. So this month our topic is return to play. That is what we call it in sport, we call it return to play, but it is really return from injury. And hands up if you have had an injury before or currently struggling with one. Most of us have. Amazing. Yay for injuries. Not did we learn something about ourselves? Absolutely, I think so. So injuries happen just like life stuff happens. And our five minute facts are going to deal specifically with injuries and then we'll dive into the questions that you have and you might have some specific questions about your injuries or your training or your performance and we'll go into that. So our fact number one, we're going to go with the acute injuries. Fact number one, your acute injuries is, is up to 48 hours. It's usually a 48 to 72 hours. I should say that's the acute zone, but this is where we're dealing with a lot of pain, spasm, inflammation. So that's the acute injury. Something happened. You bashed your knee on the cement, you stubbed your toe and broke it, you sprained your ankle. That's the acute injury. And that's when all that thing, it balloons up. What do we do with the acute injury? If you're in that stage between that 48 and 72 hours, you do what we call peer. The old method would be rice. Rice was rest, ice, compression, elevation. Peer is the same thing, but it allows you to do it in the order that needs to happen. If you have an acute injury, if you tripped and fell or sprained your ankle, it goes like this. P is for pressure, I is for ice, E is for elevation and R is for rest. So it's the more current rice. It's pier, pressure, ice, elevation, rest. So that's fact number one. Fact number two, we're going to take you into the subacute phase. Our subacute phase is four days to six weeks, a very long span of time because it is our repair span of time. This is where our body goes and takes all this inflammation. It settles down and it is starting to put all sorts of collagen towards repair. But it is done in a very disorganized fashion. So when your body's sending all that inflammation and sending more collagen, this is kind of how it starts to repair. So when you think of that area, this is how it's laid it all down. Pretty miserable. Ok. But that is what is happening in the four days to six week mark. It is really easy in this phase to return too soon. How many of us have done that return too soon? Because it feels like it is better. I can do so much more. It is not as painful, but it's still all jumbled up and it's not ready for full function. Might be ready for partial function, but it's not ready for full function. So that's fact number two or stage number two, three is remodeling. And this can be from that six week mark plus or minus to three months. So this is where all of that cellular disorganization starts to become a little more organized and it might need some help. So sometimes there needs to be transverse massage, sometimes there might need to be ultrasound, other sorts of flushing, massage. You probably need some help during the zone to get to back to optimal. So that's the remodeling stage number four, we've got ongoing repair and remodeling and this can happen from three months to 12 months. And if there's been some other little injuries along the way, guess what? That 12 months can turn into up to three years. So the actual remodeling people think, I had my injury, it's been three weeks, it should be repaired and done but some injuries, especially a second degree, especially ruptures, they can be remodeling and repairing for up to three years, sometimes more if it's been re injured along the way. So that is fact number four. But fact number five, we are going to get you right into the rehabilitation. I can give you a few points here that are really important. So rehabilitation. And this is coming from. So some of you know my background, some of you don't. I come from the highest level of training in sports. So I was a head strength and conditioning coach for multiple national and Olympic level athletes and teams. I have a background in athletic therapy and exercise physiology. So what that means is that when dealing with an athlete or an individual who has to get back as soon as possible, guess what that means? That means it's not going to be that classic timeline that the doctor gives you. If the doctor says to you, all right, you're going to have six months off to deal with this injury, what do we do? We do nothing. Many people do nothing. Or those of us who are go getters, we do too much too soon. We usually fall into those two categories. But this is what we do at the highest performing level. When somebody has an injury and they cannot function on that ankle, let's say then what that means is that we're doing all of the other things that can be done at that time. We're working the hamstring, the glute. The glute means the adductors, the core, the upper body. We're doing everything else at the same time. So when we go with that original peer pressure ice elevation rest, the rest is only really for the body part that needs the rest because the rest of the body can still do what it needs to do. And in fact, for the injured part of the body, that blood flow is fantastic to bring new cells to that area, flush out the waste product from the injury healing. So that blood flow is phenomenal for helping the healing process. So when we say rest, it doesn't mean bed rest because that can be one of the worst things for an injury. It means rest the body part that is injured. And that I'm being very general right now, but rest the body part that's injured and still work on the areas that we can work on. So what that means is, is that if somebody who was at a high, high performing level, there's often areas of the body that are neglected because they're working so hard at a high performing level and their hamstrings are really tight, or that one shoulder never really got rested. And finally with that injury, they've got more flexibility through the hamstrings because they worked on it or they repaired that shoulder as well. All of the things can be dealt with at that time when there's more rest that is happening. Rest starts with A protection and offloading and rest to only that area B protected and progressed, reloading and reconditioning. So protected and progressed, reloading and reconditioning. That doesn't mean that if you were a runner and you sprained your ankle, that once the ankle is at that, say six week mark, that suddenly you start running your 5K again, that that's what do is a 5K every Monday? No, it means starting with trying out a minute, trying out half a kilometer, trying out something that is a really low level, just to test it out and then progressing. And here's the rule of thumb. In athletic therapy, in physiotherapy, in strength and conditioning, the rule of thumb is to progress by 10%. Very few people progress by 10%. What happens is that if someone wants to get back faster, it might be appropriate for 20%. However, most of us either go too much, it's 50%, 80% more of a progression, and it's simply too much. Then we wonder why we have two steps back, protected and progressed, reloading and reconditioning. The rule of thumb is 10% plus or minus. Then only then do you get to sports or life specific conditioning, going back to the actual skill, which would be the run in the example I just gave. Then you integrate the sport and life activities. Then finally, when you've integrated everything back, you've progressed, you've protected, you're integrating back, you feel like you're probably at 90% on that injured area, hamstring, ankle, whatever it is, then you do what we would call preventative care. We call this prehab in the sport world. At the high performance end, prehab exercises are done all of the time. If you have a volleyball player, guess what we're doing? Prehab shoulder exercises, ankle exercises, back exercises, hand exercises. Even though that area is not injured. The same can be done if you know that you love to kayak and you know that your shoulders tend to get a little imbalanced from doing the same movement pattern over and over. Then prehab exercises are appropriate to prevent the injuries that can happen from that, whether they are acute or chronic. So whatever your life or your sport. So for instance, I had a client who was a surgeon, a back surgeon, go figure. So he could spend if somebody came in with a car accident, he could spend as much as 10 hours in a surgery that meant that his back was awful. This would be a chronic scenario. So what we would do is we would create prehab, all the exercises to prevent what his life was doing to him. That was very powerful for him to be able to function not only for his profession, but also in life without as much back pain as he would have had had he not done those preventative exercises. Those were five minute facts that took a little bit longer. And now we love to open it up for your questions that are specific to your injuries, your training, your nutrition, your health. So pop a question in the chat or unmute yourself and we'll dive into those specific questions. So what do you got? We've got. All right, so Alex, Caroline, Kira, nada. Bert, what do you have for questions? Somebody's got their hand up and mute here. If you could. Is it Caroline? Go ahead. Oh, you're muted.

There we go. Yes. Hi. Okay, so I have come off of two years of frozen shoulder, at which point I did what you had said, which is do nothing for two years other than running. Kept that up. So when, when it's the matter of getting back to the gym, I don't like, I can easily do things with my shoulder and it. I can feel the pain so that I back right off a little bit timid. So when you're going back in the gym, like, how, how much is too much when you're doing the 10% as far as the gym, like, the running is easy, you do 10% of the run. But when you're going back into the gym, what does that 10% look like?

Okay, great question. Can I back up just a little bit and ask what, what precipitated the frozen shoulder? How. How was, what was the original injury?

So combination of things. Triathlons, probably over whatever, with swimming, like crossing over. And then the nail in the coffin was gardening for four hours.

Do you know what it was that happened in that? It was just where was the pain specifically?

Initially, they thought initially it was an impingement, so they treated me for impingement. And then whatever that muscle is that's right under your armpit, that's my biggest. Like the supraspinatus, I believe it was. Yeah.

Yeah. Okay. So what it's called is supraspinatus impingement. And what happens is there's your acromion, which is that bone on the top of your shoulder, and that little tendon runs underneath it. And if you do a lot of swimming, a lot of upper body movement, then that can get a little inflamed and it can get kind of pinched underneath that bone. If it's inflamed, it just gets more and more painful. Is that what it sounds. Is that accurate?

Yeah, pretty much. And then, yeah, there was like, the mixture because then everything sort of shifted because I kept doing things when I should have rested.

Okay, so what Caroline is describing, thank you so much for sharing this, because this sounds like it's been a really long process. So what she's describing is that there's an initial injury or a chronic, what we would call acute on chronic. And so what that means is that she probably had an initial, maybe little tear, maybe little aggravation, and then she kept going. And so she kept a chronic situation. There's chronic inflammation, chronic inflammation. Then she might do a little thing and. And then bother it more and it might be somewhere else and it's chronically bothering her until finally she can't do the things. Am I describing it fairly well?

Yep, perfectly.

Okay. And then this is the big thing that's really problematic. Finally, she can't. It's so painful and so problematic that she does nothing in order to let it heal. But shoulders don't do well with nothing because then they do. They freeze up. And you can get what's called frozen shoulder. So if you're in a physio's office or a therapist's office, physical therapist office, then they will have you move that shoulder very carefully even if it's injured, because nobody wants to get frozen shoulder. That means that almost anything is bothersome. She can't move it at all. So what I would suggest is really getting conjunction with someone who is really good with shoulders. So a physio, I don't know where you're located, if you're in the US Or Canada, and someone who's really good with shoulders. And the reason I say that is because when you go to the gym to progress your gym movements, the shoulder is in a joint that's not a ball and socket like the hip. It is not like this. It is more like a third of it sitting in a socket. And what makes up the socket is soft tissue. It's really, really easy for the shoulder or the arm bone to be moved forward too much or internally rotated too much or externally rotated, usually internally rotated too much or dropped down a little bit because it's so influenced by the soft tissue instead of an actual solid ball and joint. That's why it's really great. To have some therapist help you with the postural positioning, the external rotations, and make sure that that positioning is fantastic. Or maybe it's a really good personal trainer, but that positioning is fantastic. Before you do any push exercises, before you do any pull exercises, that's what I would suggest. First and foremost, if you're at a stage where you're going to the gym and you feel like you can do a few things, but you notice that it's painful, the easiest place to start for shoulders are going to be pull exercises, not push exercises. The easiest place to start is going to be having those shoulders down and back. So that's your set position, meaning your shoulder blades are not squeezed together, nor are they relaxed forward. They have been brought down and just have a little tension to hold this postural position. So it's not like this and it's not like this, but it's down and held so you've got this tall postural position as though there's a plumb line from your chest. When you have that position, chances are you'll be able to do something like a row, especially if it's close to your body. And your shoulder will typically respond well to that. That is a great starting point so that you can create more strength, more blood flow before you get into some of the more precarious positions for the shoulder, which might be arm away from your body or push positions. Because it's sometimes really hard to hold the postural position. When you're in a push position after a shoulder injury, you'll find that the shoulders are doing all sorts of things and they need to be well managed in the position and the stabilization before diving into some of those more risky positions, like arm away from the body or as much of a push position. I would say pull first if those are pain free and next to the body. So arm is close to the body. So maybe a single arm row, maybe a seated row, those first. If those go well, then you're going to try something like maybe a very easily controlled dumbbell press where your shoulders can stay stable. Stay away from barbells initially doesn't mean barbells are bad. They are fine. It's just that when you have a shoulder injury and your hands are fixed, then the next point of movement ends up being your shoulder. And if that shoulder isn't ready for it, you risk bothering it or re aggravating it so that your starting point is stabilize those blades. The dumbbells allow a free path of movement. I would prefer the dumbbell over the machine over the barbell. And another great choice to start with would be elastic as well. If you're going to get into a push exercise, the pull is going to be first, the push is going to be next and then if you are going to get to eventually overhead, that's going to be the last thing that will come. And you're going to need to be doing a lot of stabilizing exercises like small external rotation exercises for that supraspinatus infraspinatus, teres minor and teres major. Those little rotator cuff muscles are going to need some of that external rotation. Now I just verbally vomited information. All of you. You might have lost you there for a second, but tell me where that lands for you.

No, that was great. Yeah. And I have been with a physio so I do have my exercises which are done not on the daily like they're supposed to be, but. But yeah. So I'm at the point where I think I'm good. So then I, you know, was looking at options and stuff. So that was, it was great because I like knowing that I need to pull before push. That's, that's the. A big, big little piece of information. Yeah. So that's basically my 10%, right, is knowing that.

Yeah.

Start with that. Start with one set. Try one set of a single armed row. Really controlled, really careful. Try a seated row with a cable. Just start with those and then you've got something that you can. The weight can be your 10% or the, or the number of reps and sets can be your 10%. But just start with one of those and start to control those numbers and then you'll be able to see that progress really carefully and have far less likelihood for setback.

Perfect, thank you.

Awesome. No problem. Ok, so there's another question here and it is nada. How often rest? And adding the 10% to get back to normal training. How often rest? OK, so that's awesome. And nada is a runner by identity, I would say, and so many other things by identity too. A beautiful soul who derives so much from running, not just exercise, but so many other things. So I would say what I often do in high performance realms and it works very well for the rest of us because we all want to perform at our best and highest level. What I typically do is do a two week build and then a recovery week or sometimes a three week build in recovery week. So what that would look like on a micro cycle, meaning one week, that would look like one day try something and if it went really, really well. You might even be able to do a second day of something and then you must do a day off. And that day off might still be activity, but not the thing that can be aggravated by your activity. For instance, if running is the thing that you want to be doing, then you might look at one day is 1km. If there were no problems with that, none at all. As in zero inflammation, zero pain, zero anything you might do even a second day back to back, you might do a kilometer and a little bit a kilometer 0.1 and then a day off. Even if there was no pain, no setback, no swelling, no nothing, you'd still take that day off. So I would go either a 1 to 1 or a 2 to 1 in terms of a work rest cycle in a week. And then when it comes to your weak suh, I would be doing something, especially post injury, trying to build a little bit in one week and then build a little bit in the second week. Meaning progress that 10%, progress that 10% and then pull back for a week. Doesn't mean you don't run at all, doesn't mean you are not doing activity, it just means you decrease. So you go back to maybe even where you were in the first week, you drop everything down. Now psychologically that is hard because on the third week you feel like, well, what the heck, I am going backwards. No, you are not. You are doing planned recovery, planned rest. And then on the third week you go in and you start to build a little more from where you left off on the second week. Right. So sorry, on the fourth week, I should say so, you built on the first, you built on the second, you recovered and rested on the third and, and then on the fourth week you're going to do the volume you did on week two follow. And so on week four, you're doing week two's volume, but you're building it a little bit. And then on week five, you've built it a little more. And then by week six, you can do another recovery week, but you might go back to what you were doing at week four, which was actually your overall week two. And then you build and build and build like that. And that would be a really easy way to do it, a two week to one week build to recover and you do it that way so that you're progressing really carefully and slowly. Now if I had somebody who wasn't injured, I'm typically doing a three, three week build, a one week recovery and then a three week build again anyway. Because that is how our body responds best. Our body does not respond best linearly. It does not want to keep growing, growing, growing, progressing. It responds in waves. It responds in dips and dives. So even if somebody was perfectly healthy, I would still be doing some sort of build, build progress, progress and then drop it down. Drop down the. Typically I'm dropping volume and not dropping intensity. I'll usually keep the intensity but drop the overall volume. And that's how I will build and frequency too. So on a recovery week, if running is the example, I might have kept the same intensity but reduced the number of kilometers or distance and even cut out a workout or two. That's how I would make the recovery week. So maybe that recovery week there was only one or two short runs, whereas on another week there might have been three or four more long runs, depending on the week. Okay, does that make sense? Okay, awesome. I think we have time for one more question. Bring in another question. If someone has another one. Could be related to injury, could be related to nutrition. Whatever is there for you? Training, wellness, health, you name it. Could be unrelated to what our topic is today. And that's all good. Go ahead.

Yeah, Kari. So if like in my situation I ended up missing two weeks of training because of life. Now I did the workout today that I was supposed to do for today and I did that workout. But what should, like when that. Because sometimes it's unavoidable, like I'm really consistent. But if I'm away a week with my three grandchildren, pretty much forget working out.

Okay. So what I would do in a situation like that is go into. I'm about to head into this. I've got a week of travel next week and I'll be in a very intensive program, a business mastery program. But it will be very, very long days. So kind of like the grandkids or being with them intensely, I would go into, in my head, I go into maintenance mode. I basically go, ok, what do I need to do to maintain what I've developed and what I've built? And it's probably going to be, I might not have access to a gym. I might not be able to do the things I would ordinarily do. But I'm going to scout out and see what I do have available. So what that might look like is that if I'm in a hotel, I might have to run a few stairs. If I couldn't get out for a run or if I didn't have a gym, I would end up getting up early before all the craziness so hear my language. Before all the craziness of the grandkids, I would get up just a little bit early and I would do my, I might do for me, I would do some single leg squats, I would do some push ups, I would do some core work for my back. I would do the things I need to maintain my ankles and my feet. Because if I stop all workouts, that means that I have stopped all my prehab, all my mobility work, all my stretching work. And then I know that between all the old injuries that I have, I, I will have a major setback with how I feel physically, with how I feel mentally. Old injuries will flare up, my back will flare up. So I'm going to do, I'm going to go into maintenance mode. I'm going to get stuff done on the floor. I'm going to do bare minimum things. I'm going to bring a roller with me. Traveling, I'm going to. But guaranteed every day I'm doing something so that my mobility doesn't go backwards. Mobility at as soon as you are over 40 years old, mobility is number one. I am going to say, then I am going to say cardiovascular strength is number one for women or whatever, but they are all so important. But I know that when I am traveling or something like that happens, that the mobility becomes paramount. So those little exercises, anything that you can fit in, you are maintaining, maintaining. And if you have done that for a week, guess what? You won't have lost as much ground as you think. So that when you start back, you're going to start back, say at the early stages of your program where you might have done, say one or two sets of your lifting program instead of your three or four sets, and you would start back with one of your early conditioning or your run workouts where you did lower volume. So you're going to start back with that lower volume again to reintroduce and you are not going to start back with every one of those workouts. So if you had five workouts in the week planned, you are going to do about three of them. There is one last question here. Does that help, Burt?

That does help. The one week though, that I was away, it was hiking and I did try, I did do a weight workout one afternoon, but the day that I did that, because I had done a strenuous hike in the morning and then I did one of the strenuous weight workouts and then the next day on the hike, you know, my legs were really fatigued. So one week I was Being active and I mean, and then with the grandkids I'm active in a different way. Like we were paddle boarding and stuff. But yeah, I'm going to be away one more week with them. So I will get up really early.

So notice that there's lots of activity. But it's the specific mobility that's probably missing and it's going to be in key parts because with that activity with grandkids she might be down and up certain ways, but it might be say a core thing that she needs or a shoulder thing that she needs more than an ankle or hip thing because she might be down low with grandkids. That's awesome. Thank you so much. Then there's last question here. There's never a resting day. Is there ever a resting day, not doing any exercise? That's very individual. But what I would say on that, I'm going to leave that to the individual. However, here's how I approach it and approach it with most of the people that I work with. It's that most of the people that work with me want high performance. Not just physically, but also mentally either for their businesses, what they deliver to other people, maybe their families as well. And what often happens if nothing is done at all physically, nothing at all. They feel a shift both mentally, intellectually and emotionally. So what I often I do myself and I advocate for other people is that there's at least one day in the week. Usually for me it's one day a week. Sundays I don't lift and I don't run and I don't do intense workout. But I might walk, I might hike, I might do some stretches. But there's one day a week that's completely unprogrammed. I might have a second day that's non impact but still has some kayaking or some other activity. But I would differentiate. The main distinguisher there is the difference between exercise and activity. Exercise is that performed prescriptive, very intentional work that's trying to get a specific result. Whereas the activity might be a little more freeing. It might be exercise too, as in there might be exercise involved like hiking or walking. However, it's less doing and more being if that makes sense. Okay, beautiful everyone have a fantastic rest of your day. Thank you for joining us and thank you for the questions because it really goes a long way to helping other people with what they are experiencing as well. And stay healthy, stay mobile, stay active, keep going with the things that you are doing because it is how you deliver you to the rest of the world. So thank you for that. Have a wonderful rest of your week as well. If you enjoy listening to the amazing Empowered Team Podcast, you'll love being on the Empowered Team. The Empowered Team runs year round. It is our group coaching and accountability program where we take mindset and physical performance concepts and break them down to usable action steps that optimize results. To learn more about our Empowered Leadership coaching for business, our customer online physical training plans, and of course, the Empowered Team Group coaching, head to www.theempowered.ca empowered learn more. That's www.theempowered.ca. empowered learn more.