Swimmers

REHABING A BROKEN PHYSIO

If you've ever wondered how a physio goes about rehabing their injuries, this is your chance. Here’s a glimpse into my recovery process after busting my ankle at the start of the climbing season:

Week 1 (May 17th)

I busted my ankle on Super Dyke. For those of you familiar with the climb, you'll guess exactly where: between the boulder and the tree. My foot blew off the slab quite unexpectedly (I was feeling invincible that night!) and went crashing down onto the tree root below me. My left foot landed flat and my knee proceeded to continue moving forward. For you anatomy buffs, I hyperdorsiflexed my ankle. I did a couple of quick tests which told me I should get an x-ray to rule out a fracture…

 

No fractures!

 

The next day I woke up with a very swollen ankle, unable to put very much weight through my foot. It was clear this wouldn't exactly be a quick recovery.

Swollen ankle

At this point most people would think about RICE. Ever hear of it?

REST.

ICE.

COMPRESS.

ELEVATE.

DID I REST?  

I sure did! I avoided anything that was painful. In fact it's the only thing I could do. That's the beauty of pain and inflammation - it stops you from causing further harm when the system is weak and trying to repair itself.

DID I ICE?

I did NOT. Here's why:

Ice is thought to help slow or even prevent the effects of inflammation. It turns out the inflammatory process plays a very important role in healing. In fact this is exactly what HEALS your injuries, so why would you want to take it away? You shouldn’t take it away. Trust your body to heal itself - it does a great job!

To add insult to injury, when we look at the research, it turns out ice probably doesn’t even penetrate deep enough to have an effect on the inflammatory process. There is no strong evidence to suggest that icing an injury will accelerate your healing time.

Some will say we should use ice to help manage pain. While ice may help reduce your pain, I would argue that pain is very useful and a natural part of the healing process, especially in the acute phase. It tells you to back off! I chose not to use ice for pain management mostly because I could adequately control my pain by resting and protecting my ankle. If you push through the pain and use ice as a management strategy you’re not doing yourself or your injury a favour. In fact pushing through your injury at an early stage may in fact prolong your recovery period.

DID I COMPRESS?

This one isn't as clear cut as icing. Some studies have shown positive results on healing time and pain, while others have shown it to be ineffective. So what did I do? I wore tight ski socks and wrapped it with a tensor for a couple of hours here and there. I could visibly see a decrease in swelling with aggressive wrapping but it's questionable as to whether it had an effect. Just because the swelling is temporarily reduced, doesn't mean this accelerates healing time.

As far as pain goes, I experienced more pain immediately after removing the dressing. This would lead me to think that compression is helpful in controlling pain. What's more likely is that I experienced a temporary increase in pain as the ankle returned to its more natural swollen state. In other words, the ankle wants to be swollen because of damaged blood vessels and permeable cell membranes. The body will repair this over time and swelling will come down naturally with a little help from specific exercises.

DID I ELEVATE?

Surprisingly, this is the least studied of the RICE recommendations. Intuitively, it makes sense to elevate for swelling control, especially if it helps with pain.

Did I elevate it? Yes! I elevated it whenever it was throbbing or aching. Having it high above my heart was the most comfortable position. If it wasn't bothering me, I had it resting on the coffee table or planted on the ground. This is arguably the equivalent of resting my ankle.

What did I do?

If I didn't ice, or do much compressing, and wasn't religious about elevating it, it doesn't sound like I did much, does it? To the contrary, I did quite a bit.

 

Protection and Optimal Loading

I moved my ankle and toes as much as I could through it's available pain free range. I did so in non-weight bearing positions, but also with my foot planted on the ground. I used the help of a belt to move it around, but also did so actively with my ankle and foot muscles. I let pain be my guide. I would avoid anything that brought on an increase in pain, trusting that when I felt pain it was more so a warning sign as opposed to an indication that I was causing more harm (see video below).

I practiced walking as normally as I could using crutches. I also started moving my left knee, hip and back to help avoid the effects of disuse. I used my physio stool to load my left hip, which helped a lot with work! I was even able to get into the pool and tread water lightly. In essence, I tried to be as active as possible without aggravating my ankle.

 

WEEK 2:

 

It turns out my ankle was in fact broken... and I needed surgery.

 


 

To be continued...

 

Warming-Up for Swimmers

Warming-up is an often neglected task despite it's apparent benefits. I had the pleasure of preparing a warm-up schedule for the Squamish Titans this past week. Here's a bit of a summary for those of you who are swimmers, and a refresher for the Titans. 

1. All training should be goal-oriented, whether you're prepping for a triathlon or looking to maintain or improve your fitness. 

2. Goal-oriented training provides a good platform to understand your weak-links. 

3. Weak-links are best understood by doing a baseline test that encompasses all aspects of swimming, including your mobility and stability issues. 

4. An effective warm-up helps prime your system by addressing your mobility and stability issues. It also helps by getting your heart, muscles, joints, and tissues ready for high intensity activity. In essence, it can be a great tool to help you avoid injury. 

5. Work through the exercises bellow to understand your weak links. If one side feels stiffer than the other, focus on that side. If you know you have a hard time breathing to the left, make sure to work on the exercises that help with left rotation. If you know you have poor shoulder blade control, make sure to exercise your stabilizers. 

Mobility: 

1. Neck rotation 



 

2. Mid-back rotation


IMG_20151130_093437.jpg

 

3. Shoulder mobility 

 

 

 

4. Hip mobility 




 

Stability: 

 

1. WTYs




 

2. Swimmers

 

 

 

3. Breathers



 

4. Lunges



 

Sets and reps for each of these exercises will depend on what your body will take. Here are a couple of rules to follow when you're trying to figure out how far you should go: 

1. When you're working on mobility, your breath can really help to get you where you need to be. If you find yourself holding your breath it's your cue to back away - you're no longer getting any benefit.

2. Quality over quantity! If you lose form after 5 reps stop the exercise and take a rest. Try it again once you've recovered and do your very best to stay in good form.

3. The old adage "No pain, no gain!" is completely false. Exercising should NEVER be a painful experience. If you get pain give it up and move on to the next exercise. Seek the help of a professional if you haven't already.

 

These exercises should give you an idea of where to start with your warm-up. They were chosen for their applicability to most swimmers. You may already have exercises that are currently addressing your weak links. For example, you may know to work on hamstring mobility before hopping into the pool. Keep doing it! Find what works for you. 

Once you've completed the basics get into the pool and start warming-up your whole system. The first 10 minutes should be focused on technique! Go slow and focus on your weak links. If you have a hard time reaching in freestyle, focus on your reach. If your breathing is sloppy to the right, focus on breathing to the right. Your warm-up has to be purposeful with a lot of brain power dedicated to the process. Enjoy it and find your rhythm. 

Finally, ease into your session and get ready to enjoy the feeling of your body ready to train!