Marion Moose Herring Advanced Orthopaedics Sports Medicine Center.
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Transcript of Marion Moose Herring Advanced Orthopaedics Sports Medicine Center.
Structured Return To
Endurance Sports Marion “ Moose” Herring
Advanced Orthopaedics Sports Medicine Center
Who has pain when they run , bike or swim?
Who has had to stop or alter training because of an injury or pain?
Who has continued to train despite an injury ---- knowing you were doing damage or digging a deeper hole to recover from?
Suppose you are having that magical day. You have trained months to get ready. You have sacrificed diet, family time, and rest to train. You had to buy a plane ticket and hotel. Your race fees and tribike transport was paid. You start having a pain you know is bad. You are on PR pace.
Do you stop?
Suppose you are racing and having that magical PR day. You suddenly feel chest pain. You know if you continue, the consequences could be really bad.
Would you continue?
Understand the mechanism of injury
Athlete Rationalization: A break from activity causes disorganization of the strength and flexibility of muscles
2-3 weeks off leads to significant losses of fitness especially the endurance components
Return takes twice as long as the down time
General Principals of Treatment
When can I run/ride/train again ?
Not
When will I be healed?
The Question Becomes:
Integration:Athlete-SportsMed-Chiro-PT-Coaching
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout
Very Individual
You can kill a career by going to fast
Make a Goal for the End of Each Phase
“You are lucky-You get to do this for fun“
Conrad Stoltz
Healthy Progression
Phase I (3-6 weeks)◦ Goal : to eliminate the pain or stimulus for pain
***Stopping the activity Get the correct diagnosis !!! NSAIDS ( oral or topical), injections ? Ice Active or inactive rest Gentle stretching or Range of motion Deep tissue massage
Chiropractic Treatment Set Your Phase 1 Goals: More time with family, Learn about nutrition, Swim technique or speed, read books, learn Spanish
Initial Treatment
Rest ----Ice------hydration
Initial TreatmentPhase I
Avoid Temptation to Not Rest
Initial TreatmentPhase I
Active Rest◦ Cross training, walking, swimming that does not
cause pain**If cross training causes pain, you need complete rest!
Chiropractor: Active Release and modalities Physical Therapy (with dry needling) Core Strengthening
◦ Yoga, pilates are great for flexibility and strengthening Hot yoga is incredible for flexibility, core, balance,
heat acclimatization Stretching
◦ ***All that does not cause pain*****
Initial TreatmentPhase I
Integration:Athlete-SportsMed-Chiro-PT-Coaching
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout
*Pain or injury is better
Phase II (? weeks): Assume pain is absent
◦ We are beginning our sports specific motion (train coordination of joint and muscle)
****be aware of the pain******
Set Your Phase 2 Goals: Time with family, continue nutrition , Yoga, Core strength, swim , better run or bike technique
Initial Treatment
Too much ◦ 4 x body weight each step
across your hip , knees and feet
Too little◦ Not enough nutritional
ability to train◦ Bone density decline
Just Right ?
Proper Weight
Form and Technique Mechanics of repetitive load Orthotics/Shoes Bike fit General and Specific Strengthening
Phase 2How do I avoid the abnormal stress that led to injury ?
Gait Analysis ◦ Crucial is determining repetitive stress ◦ Cadence (Metronome) ◦ Specific exercises to address these issues
Drill Work ◦ Striding ON
Fitness Goals Limited www.fitnessgoals.co.nz
Shoe Wear
General and Specific Training
Form and Technique
1. Deep Well running*Zero gravity *Good cardio with high cadence *Work hip flexion and careful of extension, straight back, arm swing*Use as a return from injury or supplement**Pete Pfitzinger 9 week plan
2. Under water treadmillUp to 30%
3. Alter G treadmill -50-90% weight bear
4. Running
Aquatic Based Return to Running
Bike Fit
◦ This must fit your flexibility and your race plans
◦ **Not everyone should be “nose down”
◦ Cleat Position
Form and Technique
Integration:Athlete-SportsMed-Chiro-PT-Coaching
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout
**understand mechanism**gait and bike fit **proper strength /balance
Use of a Coach
Develop a Long term and short term plan ◦ Training ◦ Racing ◦ Recovery◦ Journal
Develop An Aerobic Base to build volume and intensity
Phase 3 : Increased Volume
BALANCE
Run Progression in Phase 3
walking
jogging
running
Cutting
Track/grass
gravel
Hilly or uneven
Fitness Challenge to set zones
Use of Run/ Walk Program
***Rules of progression *Each stage should last 1 week.
You can obviously progress the total time by increasing the interval . In stages 1-8 do not increase the interval by more than one.
*If you have pain-skip a run ( 3 days ) and return to the previous stage. If you still have pain at that lower stage please notify your doctor
Phase 3: Increased Run Volume
Stage 4-7 are jogging steady or zone 2 ( no intensity); the walk is good form good arm swing . This should be done no more than 4 times per week.
Stage 4: 4 min run / 1min walk x ___ Stage 5: 6 min run/ 1 min walk x ____ Stage 6: 7 min run/ 1 min walk x _____ Stage 7: 8 min run/ 1 min walk x _______ Stage 8: 9 min run/ 1 min walk x______
Run Walk
Stages 8-10 : the run pace intensity can increase by adding strides focusing on perfect form and, terrain can vary. This should be 75-85 % of normal pace prior to injury. The walk is same as above. You may want to do a shorter steady run without breaks on other training days.
Stage 8 7 min run/ 45 sec walk x______ with ____ x strides @____________
Stage 9 8 min run/ 45 sec walk x _______ with ____ x strides @____________
Stage 10 9 min run / 45 sec. walk x _____ with ____ x strides @____________
Run WALK
Stages 11-14: This progression is meant to realize longer race pace with scheduled rest. This would be normal run walk training for, marathon, half marathon, Ironman or half iron man
Stage 11 7 min run/ 45 second walk x ____ Stage 12 8min run/ 45 sec walk x_____ Stage 13 9 min run / 45 sec walk x ______ Stages 14 and 15: the athlete should decide where they want their
nutrition and interval to match that plan. Build the time to match the event .
Example1 : I plan on running 730/ mile marathon pace and I want to walk for nutrition every 2 miles. That would give 15 min run/ 1 min walk.
Example 2: I plan on running 9 min/ mile for Ironman and walk 30 seconds through the aid stations. This would we 9 min run/ 30 second walk.
Stage 14 15 min run / 1 min walk x ______
Run -Walk
Recumbant
Bike Progression
Trainer
On the road or trails Fitness
ChallengeTo Set Zones
Integration:Athlete-SportsMed-Chiro-PT-Coaching
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout*increase run volume*increase bike volume*Strength/core/yoga*Test to set zones/aerobic base
Our favorite step!
Race Day
Suffer So Good !
Recover !!!!Enjoy What You Do !
Marion M. Herring, [email protected]
Injury phase
Normal prep for racing
Race
Build phase
Begin workoutModified
Increased Workout RECOVER
Thanks [email protected]