No one likes to get shut down. The entrepreneur trying to run a hospitality sector business in a pandemic, the reveler at the bar at the end of the night, the child wrenched away from play to partake in something as dull as bathing and the athlete with an overuse injury all share this distaste for the dreaded ‘shutdown.’ My brother, a preventive care physician, reveres the complete shutdown as the most aggressive prescription a physician could give for an injury. “He shut me down!” carries the same emphasis in his storytelling as this line might: “He punched me in the face!” Fortunately, most chronic injuries do not require a total shutdown. Acute injuries, on the other hand, often do. When one tears an anterior cruciate ligament (ACL), it’s appropriate to shut down soccer in the immediate post-injury period. When someone breaks their femur, that person is shut down. But what about the more common, less dramatic, nagging aches, pains and overuse injuries that are all too familiar to endurance athletes and fitness enthusiasts?
Unfortunately, if the athlete brings this injury to a physician, even a sports medicine physician, the prescription will be a shutdown and an Advil. ‘It hurts when you run? Ok, stop running.’ I’ve met approximately zero runners who want to hear advice like that. They also don’t need the input of a medical professional to come up with that treatment plan. They can think of that themselves. After thinking of it, of course, their conclusion is often to ignore that thought and keep running until the injury gets worse to the point at which they become hobbled.
There is a middle way though. There is some nuance to how the athlete can approach these injuries. The approach can be dichotomized as follows: are you working with or working through the injury? Working through the injury involves titrating your training load to what you can handle without getting worse. You keep doing the same sport, the same training and layer on the home remedies and recovery modalities. Signs you might be working through an injury include frequent or habitual use of non-steroidal anti-inflammatory drugs (NSAIDs) and waxing and waning symptoms that never go to zero. Working through an injury might get you through a particular competition or even a season, but it doesn’t get rid of the pain and doesn’t address the reason it’s there in the first place. Pain is a signal from the body. Yes, it can be conquered by the mind on our way to performance greatness. But do you know the fine line between your body screaming in protest from effort and it screaming in protest because you’re inflicting damage that will last beyond the workout? Well, once the adrenaline wears off, you should have an idea.
Working with an injury, on the other hand, is a much healthier approach. Sometimes, you do have to stop the activity, but that doesn’t mean you have to stop moving. For the vast majority of overuse injuries, there is some way to engage in movement that will accommodate the injury. This approach is founded on the notion of acceptance, which is a key for any challenge or unpalatable reality that life presents to you. Even if you desire the future to be different, you’ll make yourself miserable if you wish the present to be different. The present simply IS. No amount of wishing it otherwise will change the fact that your toddler is currently, at this moment, throwing a tantrum or that your flight was canceled. As Byron Katie says in Loving What Is,
“When I argue with reality, I lose – but only 100% of the time.”
Working with the injury may require some creativity. It may require trying new training modalities. Guess what – there’s a chance to grow your brain with some neuroplasticity! What are some weaknesses that you can turn into strengths? Can’t run full-court? How is your free-throw percentage looking? When I finished the Philadelphia marathon last month, I wanted nothing more than to get after it with some more running. But when I tried to run a week later, then again two weeks later, my lace bite and iliotibial band (ITB) flared up each time. I thought of Ryan Holiday’s book, The Obstacle is the Way. How is this problem a solution? I have been toying with the idea of triathlon for years. I’ve done a lot of running and cycling during those years but never got around to swimming. So I took the opportunity to join the YMCA and get in the pool. The obstacle is the way.
The other key aspect of working with the injury is identifying what led to it in the first place. Most of the time, the genesis of the problem involved inappropriately high training volume, or inappropriate scaling up of intensity without periodization (periods of progressively loaded training stress followed by rest). If we’re honest with ourselves, most of us can acknowledge how our bull-headedness led us to injury. Other contributing factors might require a second set of eyes from a fellow athlete, a coach, a trainer, a therapist or a doc.
If you listen to your body, it will tell you the problem. If you listen to your mind, it will tell you the solution. Stop hurting yourself. But don’t stop moving. The obstacle is the way. I’ll see you in the pool!