Mounting A Comeback
We have all heard the tale of the comeback kid; sometimes it’s a success, but other times it’s a bust. The difference? Strategy. Every great comeback is predicated on a lesson learned while away from the sport or activity, we have come to identify with. A comeback from an injury is no different.
The death of any training progress is an injury. It will simply break momentum and requires significant healing time as well as even more time just to get you back to your pre-injury level. This is the mecca of training adversity and we need to have strategies in place to minimize downtime, sustain mindsets, and put us back on track with our goals.
Unfortunately, it’s not always a simple process. All injuries leave a footprint in our brains. We store memories on the how, when, and where of an injury and postulate the why, based on previous experiences. Most acute injuries occur for two reasons: mechanical failure or discoordination during a task. Recognize this and don’t assume we can prevent injuries because we can’t. All we can do is learn from our failures (injuries) in an attempt to best prepare ourselves for similar scenarios in the future.
KEY POINT 1: An injury isn’t just the disruption of mechanical homeostasis, it also disrupts our psychological homeostasis.
Many of us who have endured an injury know it isn’t just a physical experience but is often mentally agonizing too. Not only is there an inability to participate in one or more of our passions, but simple everyday tasks become increasingly difficult potentially leading to fear avoidance, or illness behaviors. Fear will activate our hypothalamus-pituitary-adrenal (HPA) axis, which is responsible for increasing our sympathetic (fight-flight) response: elevated heart rate, blood pressure, respiratory rate, pain signalling, and even sweating. Additionally, illness behaviors will create a delayed secondary neuroendocrine response where the anterior pituitary gland facilitates the eventual release of cortisol, an anti-inflammatory stress hormone. However, if cortisol becomes chronically elevated our stress response becomes dysregulated and our perception of threat is negatively skewed. We will always be on high alert. In an attempt to protect ourselves, our bodies will distort their abilities causing a lack of awareness of our physical boundaries.
Initially, overcoming an injury is then very cognitive based and we must learn to become aware of our boundaries. In other words, we have to begin performing exercises that are going to help redefine the internal map of how we move. This is represented by the little man in our head, the homunculus. When injured, the homunculus becomes distorted and we often lose our mind-body connection and develop a high level of uncertainty. By going after some low hanging fruit, we can ease the uncertainty and improve movement awareness.
KEY POINT 2: An injury doesn’t just reduce local tissue tolerance, but systemic tolerance.
Now, I don’t want to downplay what happens physically/mechanically because it will, in part, determine how successful we are with rebuilding our movement awareness. Physical and/or mechanical disruption also drives the ability to rebuild both tissue and system tolerances. When a tissue is physically injured it undergoes several changes locally that reduce load tolerance; from the inflammatory response, to the loss of joint degrees of freedom, to physical shape changes. Systemically, the body inherently looks to move towards a safer attractor state, seeking efficiency for survival purposes. Thus, these changes among others can derail us from the health and performance continuum and move us to a survival continuum.
An injury, as previously established, is an internal threat. When seeking efficiency for survival purposes, respiration is prioritized. By prioritizing a survival state over both health and performance, an injury state increases a system’s rigidity, minimizes force production, and ultimately disrupts mechanical homeostasis.
To downregulate this survival mode and restore mechanical homeostasis we must first improve our movement options. In reality we only have two options: expansion and compression, or rather inhalation and exhalation mechanics. There are only these two options because of our heterarchial organization. When we inhale, we expand at the mirco-level, capillaries expand to take on oxygen. At the macro level all bones move into a relative externally rotated position to create space. When we exhale, we can assume the opposite is true. Now, because we express movement in such a connected manner, if we are not proficient with one of these strategies, movement becomes compromised and we will lose the relative motion between moving parts. This is the body’s attempt to simplify, but recognize everything comes at a cost. So to comeback from an injury, it's logical to think we must get better at what we cannot do.
Any exercise sequenced with respiration
KEY POINT 3: An injury creates fewer solutions to the problem.
As mentioned, an injury causes our body to simplify its movement strategies. The outcome of this strategy is a loss of movement options. Although this is a good strategy to reduce cognitive dissonance in the short term, it’s not a good solution for the long term. We need to maximize our movement options to provide multiple solutions to a problem. This is critical because as a self-organizing system movement is an emergent outcome based on the context of a situation. The more options we can make available increases the probability of a successful comeback from an injury.
In a nutshell, this is movement literacy and can be analogous with literacy in terms of reading and writing. Think about it this way, the fewer letters that are known, the fewer words that can be spelled, and fewer words mean a shorter book. Thus, to write a bigger book it requires practice, learning, and a supportive environment. In order to improve our movement literacy, we need to practice specific movement patterns as well as learn new patterns in various contexts. Thus, to become proficient in our movement literacy we can utilize:
Positional exercise iterations
Manipulation of task constraints
Change the environment.
If we get this right, the solution will emerge on its own.
KEY POINT 4: By an injury disrupting the coordination of movement we are significantly impacted in our ability to produce output.
Having these movement solutions is one thing, but using them is another. We can constrain a task to cause the correct movement behavior to occur, but we need to have confidence in our abilities to do so without the use of any constraints and without pain. This relies on our ability to know how to properly coordinate and sequence movements to function at a high level. For most of us reading this article, this means producing power and strength in our training. Neither of these are possible if we cannot appropriately coordinate muscle interactions during a task. This holds true in all movement patterns: bilateral, unilateral, offset, upper, lower, you name it! Coordination is the regulator of your power and strength output.
Coordination training reflects efficiency. Remember the old phrase, “muscles that fire together wire together?” This makes it easier to recall specific movements when sufficiently practiced. It also stands to reason when “isolated muscle” rehab tends to fail so often. In order to strengthen and protect a structure we have to consider training and coordinating all components so that they learn how to best balance each other and distribute a workload. Doing so reduces the threat perception and improves the health of a system. We can address coordination training with:
Proximal strategies (top-down influences)
Distal strategies (bottom-up influences)
KEY POINT 5: An injury empties the reserve tank leaving little room for error.
The final aspect of an injury comeback reflects a system’s resilience. How quickly can you come back from a stressor or load? To develop load resilience we must pay respect to the laws of forces. The first law being we cannot produce what we cannot absorb. In other words there is a fundamental need to still bias sensorimotor work, but it needs to become more dynamic and tempo-regulated. In this case, consideration should be given to eccentrics and statodynamic movements as they not only build tolerance at both the local and systemic levels, but support the development of movement literacy and coordination.
After we can absorb a force, we can work to turn this potential energy into useful mechanical energy and begin creating force. There are three different ways we need to be able to create force, each relying on muscular coordination:
Simply create force.
Quickly create force
Quickly and repeatedly create force
Thus, the ability to create these overcoming forces relies on the ability to accept a yielding force and redirect it through the elastic elements of the movement system: muscles, tendon, etc. It is then continued practice and graded exposure that allows us to logically and efficiently learn how to create force for a given task.
If you encounter an injury, don’t let it consume you and prevent you from training. Rather seek the opportunity to learn how you can become better and more resilient in the future.
Now the question becomes how much of this “good stuff” do we need for a comeback? Only you can decide. Ask yourself, where do you want to be on the health and performance continuum?