You’re plagued by an overuse injury…How to break the cycle of overuse injuries: what is the missing component and why do I keep getting injured?!?!
We're rounding out our 4-part series on overuse injuries, and talking about what to do when you do in fact have an overuse injury. It is a very common scenario: you have just recovered from your overuse injury and you get back to hiking, only to be stopped short again because it comes back and rears its ugly head. Or you just can't ever seem to get it to go away or fully heal. What gives?!?!?
You’ve got an overuse injury…maybe it’s plantar fasciitis, maybe it’s Achilles tendonitis. Maybe it’s some nagging knee pain that won’t improve or even some back pain. Maybe you just got it or maybe you’ve had it for a while and just can’t seem to shake it.
We’re going to go over the TOP THREE things you need to do to break the cycle and get you back on the trail, happy, healthy, and enjoying your hikes again without pain!
First, you’ve got to STOP. Yes, STOP…what you are doing. Hear me out for a minute. I don’t necessarily mean stop entirely. A lot of people avoid getting help, because they believe they will have to fully stop their activity. Well, that’s not necessarily true. But you do have to stop what you are currently doing. Let’s face it, what you’re doing is NOT working…otherwise you wouldn’t be where you are currently…googling how to overcome your injury. So listen to someone who treats these issues all the time and has also had them myself. It is imperative that you stop your current level of activity. Notice that I didn’t actually fully stop your activity (though depending on how severe, this might be a possibility, so don't let it get to that point! Do something about it!). The key here is going back to the definition of an overuse injury, which we talked about in the first part of this series (check it out here if you missed it). To refresh your memory…An overuse injury means that whatever tissue that is injured, whether it’s bone, muscle, tendon, or ligament-you’ve basically exceeded that tissue’s capacity to withstand a certain amount of load. That tissue is just not strong enough to perform the task that you are asking it to do.
So the first key to really addressing your problem, is you HAVE to decrease the load…NOW!!! That does not necessarily mean you stop hiking altogether. When I’m seeing a client or a patient, I always try my best to keep them in their activity. In part, because that is what makes them happy. But also, if you think about it, well yes you are going to feel better if you completely stop your activity. You have completely taken away the load, so yes it will feel better. But that doesn’t solve your problem of going back to your activity. So when some physicians want to put a boot on your for 6 weeks and then that’s all they do…well they didn’t actually solve your problem. That decreased the load, but they haven’t addressed anything about improving the tendon’s (or bone or other tissue we’re talking about) ability to withstand a greater load (for the rest of this blog for simplicity, I'm going to refer to the tissue as a tendon but realize this applies to other types of tissues as listed above). That’s where a physio or physical therapist comes in. So yes, step one is to stop or decrease what you are doing. How do you know how much you should decrease? Well, it isn’t cookie-cutter; it may be different for everyone. But you’ve got to decrease significantly to where you have a noticeable improvement or reduction in your pain. Pain is a signal from your body that something is not right (except then when that’s not the case, but that’s a topic for a different day). So depending on how you are hiking, this may look a bit different…are you thru-hiking and in the midst of a LASH…even with this, sorry to be the bearer of bad news, but you’ve still got to stop. I’m not saying necessarily that you end your hike, but it is possible that you might need to. At the very least, you likely need to take a day or two off. And then when you go back, you can’t expect to do exactly what you did; you’re not going to be able to do the same speed/pace or mileage. Something has to give before it’s the tendon. Realize again also that with that rest, you’ve only offloaded temporarily. If you go back to the same level, then you’re going to get the same result. Unloading the tissue is the first step but that doesn't fully resolve the issue.
So that’s #1 and yes, it kinda sucks because yes it is slowing you down. But think of it this way. You’re stopping right now or slowing down for the time being, so that you can progress forward for your lifetime. If you don’t take the time to address this right, you will have a chronic problem that could possibly end your ability to hike at all, or you may just struggle with it indefinitely and never fully resolve the issue. This is a temporary issue that can be solved, but you have to take the time to address it right. If you don't it becomes a chronic nagging problem that you never can seem to shake.
Your ankle/foot or whatever better be fully trained and up for that incline! (and then decline to come back down!)
I think I’ve hammered that home enough, so let’s move on. Next up #2 just as big as number 1 is that you’ve got to train that tendon to be able to sustain the load that you are asking it to do. And so this most definitely means you’re needing to increase the strength of that tissue. Targeted strength training is imperative in your plan to kick this overuse injury to the curb for good. And really, you will save time, money, and heartache by seeking a consult from a professional…a physical therapist is the best person to help you with this. You can try to find some things on Youtube, or heck over time you’ll find more information on this blog as to how to address these issues yourself, but honestly you are guessing. You don’t fully know all the factors as to why you have this injury in the first place. Typically 99% of the time, there is more than one factor involved. You have to realize that what happens in one area of your body affects the other areas, so you may have plantar fasciitis in your feet due to poor ankle mobility, poor intrinsic foot strength, or hip muscle imbalances which is then affecting your gait. If you just do the stretches you saw on Youtube…first a stretch is NEVER going to address your problem, because that is not going to change that tendon’s ability to withstand a greater load. But let’s say you’ve figured out some appropriate strength exercises and how to do them correctly to address your plantar fasciitis. If you still have a hip muscle imbalance that you have not addressed, you’re still going to be prone to plantar fasciitis or some other related issue. Sometimes people think oh I’ve solved my problem of PF only to find 6 weeks later, their knee hurts. Well if you had saved time and heartache and money, by cutting to the chase and consulting a physical therapist, you’d likely be back to crushing your goals.
I realize not everyone can consult a PT in certain situations but honestly, you really need to make it a priority when you can. I will add to #2 is that with strengthening the tendon, in most cases this typically does involve eccentric strength training, which most people neglect. So if you’re still bound and determined to google your symptoms and solve it that way, google eccentric exercises for fill-in-the-blank. Quality of movement or your form matters (Can you hold it and own that position? I don't care if you're doing heel raises with 200 lbs (why?) if you can hold that position at the top and very slowly lower down, you're fooling yourself to think you can actually handle that 200 lbs). Or stay tuned here with me and at some point, I’ll give you some valuable info to help you on your journey. (In fact, comment below what your issue is and I’ll try to make it a priority to address it on one of my channels, so be sure to follow me all on social media… Instagram, Facebook, and YouTube).
View from the top of Mount Quandary
And I said 3 things to get you back on track. The last part is really so that you don’t end up dealing with this issue again. You have to realize that when you’ve solved your problem and you’ve done #1 and #2. Your pain is gone and you’ve done some great targeted and appropriate training to increase the ability to withstand greater loads. You do have to realize that you might still face this issue again. I’m not trying to be a Debbie Downer here, but you have to realize that when you seek a greater goal, let’s say your first goal was to do a 50-mile hike and then you got PF. You did the above and were able to accomplish your 50-mile hike with no issues with PF. Great job! You need to realize that you still could be prone to PF when you try to surpass that goal you just crushed. Now your next goal is a section hike of 200 miles (overachiever much? LOL…I see you). You strengthened everything to address that specific goal of 50 miles, again if you don’t continue to strengthen things to be able to achieve the next goal, then yes it could very well come back. It doesn't really come back in this instance as in you're back to square one; likely you can still function at a lower load but you have trouble progressing past that. Because again go back to the definition, it’s an inability for that tendon to sustain a certain load…so you now have a new load you’re asking it to do. So you need to be certain that you train it to meet (and surpass that load).
Along with this, you also need to realize that should your activity level change in the opposite direction (which it will for all of us at some point), you could also possibly suffer from it again when you go back to your activity, if you aren’t training smart. For example, let’s say you take the summer off from hiking or for whatever reason. You’re off for 3 months. You have to acknowledge and realize that you are NOT at the same level you were at when you last hiked. So you can’t go hard and heavy right back at it. You need to progressively train back to that level. If you’ve ever suffered from an overuse injury of any sort, this becomes even more important. However, it’s really important for everyone as we’re all prone to overuse injuries if we don’t train smart. So some people will tell me, well I did physical therapy for this like 5 years ago and I thought it was healed? Well, it may have been healed 5 years ago…but what have you done in the meantime? What activity level were you at 5 years ago and what are you asking it to do now? More than likely your activity level is way higher than when you last did physical therapy. Rarely does traditional physical therapy get you back to your full activity. When it’s time to discharge you from therapy, they will give you some exercises to do. You need to continue to do them! BUT it’s also very likely that you may surpass those exercises and need a progression to get you to your goal of hiking. This is where working with a physical therapist in wellness or also known as performance is vital to crushing your goals and fully kicking an overuse injury to the curb!
I had a very surreal experience with this mountain goat. (I did NOT approach him; he approached me!).
Are you struggling with an overuse injury that you just can’t seem to shake? Or maybe you are just now starting back to hiking after recovery from an injury…do you feel confident about what to do to reach your next summit without re-injury. Contact me for a free phone consultation to see how I can help you get to the summit without reinjury and enjoy your hike! You can schedule that here!
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Last comment below or feel free to message me if there’s a particular topic you’re wanting to know more about in regards to hiking/backpacking and preventing injury and training smart.