Not long ago, I put a poll on Twitter asking if injuries were always preventable or if, at some point, no matter how much caution and how many interventions are in place, injuries will occur in competitive athletes. The overwhelming opinion appeared to be that as a competitive sportsperson, injuries are likely par for the course and at some point, you have to accept you will probably have to deal with an injury of some magnitude. That being said, I believe we, as coaches and athletes, need to take a large degree of responsibility for mitigating the risk of injury with sensible programming and sound mechanics.
Due to the volume of injuries I have had to manage throughout my time as a competitive athlete, I have likely never been able to realize my full potential. While some of those injuries were less avoidable than others, for the most part, a large degree of the responsibility rested on my shoulders. I am sure there are other athletes and coaches that share the same frustration that I do with regards to injuries disrupting progress.
There is a saying that the best ability is availability, which is something that has resonated with me on a deeper level as I have gotten older and gained experience. Phillip Bennett, a master’s athlete from North Carolina, recently tweeted that he received the advice that it is better to go into a competition 70% “ready” but 100% healthy. This led me to consider programming decisions and the concept that if you cannot remain healthy on the ‘perfect program’ then it is not the perfect program.
More recently, I have come around to the idea that performance and injury are two sides of the same coin. Vern Gambetta often speaks about the misguided concept of having a separate rehabilitation and prehabilitation program, and that any well-rounded training set up should have these features built in; this is something I agree with. I am fairly vocal on social media about the need for a holistic approach when developing sprinters. This is another example where I see the need for an integrated approach, with all stakeholders working together in unison to prepare the athlete for the demands of the competition.
With all of the above in mind, if you want to maximize your athletic potential, it is likely that you will face an injury at some point or another. I will share my experiences regarding some of the injuries I have faced, what I was doing at the time they occurred, some of my ideas as to the cause, some of the strategies I used to get back to full training, and how long that took.If you want to maximize your athletic potential, it is likely that you will face an injury at some point or another, says @davidmaris958. Click To Tweet
I have a better understanding of some injuries more than others, so the degree of detail I am able to provide will vary greatly from injury to injury. This writing is by no means intended to be exhaustive, and there are subtle variations in the types of injuries that can occur in similar parts of the body, as well as different approaches in returning to play that may be more or less appropriate for different individuals and their circumstances.
Finally, as a disclaimer, I am not a medical professional, and anything I have written is not intended to be specific advice for somebody who believes they are experiencing a similar issue. It is merely a recount of some of the injury issues I have had and how I have gone about managing them, and in some cases, some of the things I would do differently should the issue arise again.
I’ll start with my Achilles, as this is something that in recent years has caused the most disruption to my training—coaches such as Dan Pfaff and Brendan Thompson have probably gotten tired of hearing me whine about it. In early 2012, I completed a block session with no problem, but when I was cooling down by completing some easy strides, I became aware of a discomfort in my right Achilles tendon.
I discontinued the strides and went home without thinking too much about it, as the pain was minimal. However, I returned to the track a couple of days later with some mild discomfort still present and at my first attempt of performing a stride, the tendon felt weak, like I was unable to apply much force through it. I continued to rest off the track and looked into strategies to manage the issue so that I could hopefully return to sprinting as soon as possible.
I noticed that the pain and discomfort improved in the presence of heat therapy. I had a pack that could be heated in the microwave, which I would apply a couple of times a day, and in the shower each morning I would place the shower head directly over my Achilles whilst running the water as hot as I could tolerate. The theory behind this is that tendons themselves have low capillary density. This means that the blood supply to the area is poor, and therefore it takes longer and is more challenging to remove waste products and supply fresh, nutrient-rich blood to the area, both of which can promote healing.Heating an area causes blood vessels to dilate, increasing them in diameter, which allows a greater volume of blood to pass through, says @davidmaris958. Click To Tweet
Heating an area causes blood vessels to dilate, increasing them in diameter, which allows a greater volume of blood to pass through. Therefore, by heating my Achilles I could promote blood flow to the area, hopefully stimulating the healing process. Additionally, one of the reasons we warm up is to encourage the tissues to become more pliable for the stress we are about to place on it. Heating the Achilles could potentially acutely increase the suppleness of the tissues, improving sensations of discomfort for the short term.Heating the Achilles could potentially acutely increase the suppleness of the tissues, improving sensations of discomfort for the short term, says @davidmaris958. Click To Tweet
I also saw a therapist, Liam George, based in Luton, England, who performed a cross friction technique which seemed to significantly help the issue. It has been suggested to me that this may have helped in reducing tendon thickness by stimulating the nerves in and around the area.
I was initially able to return to full training within about two months, but it is an issue I have had to manage ever since, and I have had to be careful regarding exercise selection in order to minimize the risk of subsequent flare ups. I found that activities that promoted repetitive or slow foot contacts aggravated my Achilles, therefore I opted against things such as jogging or slow tempo, and even short accelerations (my basis being the ground contacts were longer than they were in upright running).
My main choice of exercise, once able to return to running, was fly runs with an adjusted gait during early acceleration to decrease ground contact time whilst I transitioned into a more upright posture. With these, I gave myself ample recovery, so I was able to maintain good mechanics and crisp contacts whilst progressing in rep distances and volumes. Adjusting acceleration mechanics in this way may not be ideal in the long term, but in my opinion, it served its purpose by allowing me to perform sprints in some capacity and conditioning it by placing specific stress upon the tissue.
In May 2019, my Achilles issue returned, by which point I was living in the U.S. and had access to the U.S. healthcare system, and therefore sought the advice of a doctor who suggested that dry needling, in combination with prolotherapy, may be a viable strategy to get me back on the track. Hindsight is 20/20, as they say, and this is not an approach I would use again.
By the time I had the procedure, the tendon had already begun to improve slightly, but having already gotten the wheels in motion for the injection and needling, and with the hope it could prevent a return of future Achilles issues, I went ahead with the intervention. After the injection and needling, I was told not to jog for three weeks and by the time those three weeks had passed, there was no chance I would have been able to jog.
Four months post-procedure, I tried to jog but the discomfort was considerable and by the summer of 2020, having tried various anti-inflammatories, collagen, cold laser therapy, self-massage, rolling, and isometrics, I was able to return to the track. I am far from certain as to how much benefit any of these interventions provided and it is still an issue I need to be cognizant of, as I certainly do not want to have to take another year off from running to nurse another Achilles tendon issue.
Very possibly related to my Achilles, over the past few years I have had some issues with my calves. I use the term “calves” to encompass my gastrocnemius, soleus, and tibialis posterior. In mid-2015, I was running a 150-meter run at high intensity, and without warning I felt a sharp pain in the lower part of my left leg, forcing me to end the session early. The pain began to subside fairly quickly, and through some dry needling, which was extremely painful as the time, with a lot of twitching, the issue was resolved quickly and I was back into full training in about four weeks.
The most debilitating of these issues has been with the medial head of my right gastrocnemius. In late 2017, I was running a relatively fast 250-meter run, and after about 150 meters I felt a sudden sharp pain, again forcing me to stop and end the training session there. After resting for a couple of weeks and a session of dry needling, it felt like it had returned close to normal with just a little residual tightness. However, during a session of easy strides, I again felt a sudden pain and was forced to stop.
The aspect that I found most challenging with this issue is that I would not feel any real sensation to suggest there was a problem, yet running or drills would cause a reaction, so it required me to exercise more caution than had been necessary for most of my prior injuries. Through therapy, massage, and the way the tissue reacted to needling, it appeared the area was chronically tight, which took a while (four to five months) to dissipate to a point where I was able to return to consistent, high-intensity running.
Throughout returning to play I was extremely patient (not something I found easy as it is not a strength of mine) and progressive. Initially, I tried to get on the grass whenever possible, though because I was living in Dubai at the time, often I was not allowed to use it, so I substituted in artificial turf and performed short, sub-maximal accelerations in training flats.
An example would be two sets of four 30-meter runs with a walk back recovery between repetitions and four to five minutes between sets. I gradually increased the intensity of these and then the distance and volume of the runs, before moving to the track and performing similar sessions, then finally transitioning back into spikes as the distances stretched out far enough to be considered maximum velocity work.
One of the things I noticed since the onset of this issue was that it took a long time (several weeks of regular sprint training) before my calves appeared to be conditioned and resilient to the stress placed upon them—which could potentially be related to my age, as I was 35 at the time. During this period, each morning, particularly after I had run, I had a lot of soreness in my calves and for the first few minutes after waking. I would walk very flat footed, which really emphasized to me the concept of “use it or lose it.” With respect to managing and rehabbing these issues, I had to pay close attention to how my Achilles felt, as some activities recommended to prepare my calves for high intensity stress (such as jogging, skipping, and calf raises) had irritated that area in the past.
It’s very likely that, when speaking to a sprinter about injuries, hamstrings will come up in the conversation. Throughout my twenties, if I had an injury it was usually related to my hamstrings. There was more than one occasion where I had felt in good shape and was performing at close to personal-best levels, when a hamstring issue would arise in training or in competition which would prevent me from running for a few weeks.It’s very likely that, when speaking to a sprinter about injuries, hamstrings will come up in the conversation, says @davidmaris958. Click To Tweet
Typically, any hamstring issue would occur during a maximum velocity or speed maintenance phase of running, as opposed to early acceleration. The occasion that stands out was in 2006 when I was 80 meters into a 200-meter race, having run personal best times over 100 and 200 meters three weeks earlier. Hamstring injuries are perhaps more likely to occur in maximum velocity mechanics due to the more compromising positions the hamstring can be placed in throughout this cycle.
The hamstring muscle group serves two purposes: operating as hip extensors and as knee flexors. At a point in the cycle of a stride, the hamstring is required to both extend the hip and to eccentrically control the opening of the knee, placing it under large magnitudes of stress with both these actions occurring nearly simultaneously with high forces and velocities.The hamstring muscle group serves two purposes: operating as hip extensors and as knee flexors, says @davidmaris958. Click To Tweet
It is worth considering that pain in hamstring issues, as often discussed and perhaps bastardised, may originate elsewhere in some cases. Therefore, ensuring that the tissue is moving freely elsewhere in the chain may help relieve some of the tension, and in my experience, manual therapy or use of a lacrosse ball around the lower back and gluteal muscles has offset some of the discomfort in my hamstrings, occasionally with an immediate and noticeable benefit.
For example, there are some suggestions that in most of the population the sciatic nerve passes underneath the piriformis muscle, but that in a small percentage of the population, the nerve passes through the muscle. If this were the case, then should the piriformis become excessively tight, then it could theoretically impinge upon the nerve causing a referred sensation further down the leg, and by releasing the piriformis, hamstring pain or tightness could be relieved.
A typical recovery timeline from this kind of issue was about six to eight weeks, but again it is imperative to avoid too much stress too early as I found the risk of re-injury to be significant. This meant that it could take up to twelve weeks before I was able to return to consistent, full sprinting. When returning to play I followed some of the protocols outlined in the Charlie Francis literature, with a very progressive ‘short to long’ approach to acceleration and speed work, starting with runs as short as five meters while also integrating some bike work and jogging as tolerated to help retain some of the more general fitness qualities.
My feelings are that when training, mitigating the risk of hamstring issues can generally be tackled from two perspectives. Firstly, sound mechanics can reduce the magnitude of undue stress placed upon the muscle group. By landing close to a point under the center of mass, the degree of ‘pulling’ throughout initial ground contact can be reduced, offsetting the load placed upon the hip extensors. To assist in making contact with the ground at a suitable location with respect to the hips, avoiding an excessively plantarflexed ankle and landing flat can reduce the extent of what may be termed a “pawing” action.
Secondly, as mentioned briefly in the introduction, appropriate management of the volumes, intensities, and densities of training, with sensible programming decisions, can help to offset the risk of hamstring issues (as it does with most or all other issues). Excessive volumes and frequencies of high intensity sprinting serve to increase the risk of injury and while there are guidelines of what is appropriate in terms of dosage, learning to understand your body or the bodies of your athletes can allow for a more targeted approach to managing these variables.Appropriate management of the volumes, intensities, and densities of training, with sensible programming decisions, can help to offset the risk of hamstring issues, says @davidmaris958. Click To Tweet
In the summer of 2005, I was performing some relatively light cleans when I felt a strange popping sensation in my lower back. At the time, my father lived in Western Australia and I was flying out to visit him, and I remember that the movement in my back had become so restricted that I had to crawl out of the car on all fours when my mother dropped me at the airport. I was not looking forward to the next 20 hours sitting on a plane!
After returning from Australia (using heat patches throughout the flights) I had a couple of sessions of sports massage which did not seem to provide too much benefit, but I got back into training and was introduced to the concept of a chiropractic adjustment, which brought about an immediate and noticeable benefit. In the subsequent, similar issues in either the lumbar or thoracic regions, I have found that waiting a few days after the onset of the issue before seeing a chiropractor or osteopath has led to better results—perhaps because it allows the muscles in the area that may have spasmed to relax.
If a positive thing about an injury exists, it may be that in this case, the fix is relatively quick and easy, and a return to full training can be within a week or so. Chiropractic care is surrounded by some controversy as there is little evidence to suggest that an adjustment can move bones, and I have heard theories ranging from adjustments releasing pain-relieving hormones to a placebo effect explaining the mechanisms behind this kind of treatment. However, as an athlete, I am personally less interested in the reasons why we feel better than I am in the fact that we simply do feel better.I am personally less interested in the reasons *why* we feel better than I am in the fact that we simply *do* feel better, says @davidmaris958. Click To Tweet
There have been several occasions where I felt this type of treatment has benefitted me, so it is therefore something I have continued to use despite some of the negative perceptions surrounding it. Those with the negative opinions of adjustments can easily make the claim that, if they were that beneficial, I would not have repeat issues nor would I have to continue with this type of treatment. However, this is where I accept some of the responsibility for my injuries and appreciate that I may need to change some of my habits to avoid recurring injuries to the same area.
In order to reduce the incidence of these issues, I have modified and vastly reduced the volume of lifting I do, as I alluded to in my last article, “Training Volume, Intensity, and Density in a Masters Sprinter”, and I have noticed a significant improvement in how my back feels on a daily basis. As with anything, a risk versus reward analysis is required when deciding upon how to approach a resistance training program, and staying healthy and consistent in my training outweighs the potential performance increase I may get from performing regular heavy lifting.
In addition, I have increased my focus on simple back mobility exercises, rolling my back regularly, and have paid more attention to my sleeping position. In the past I often slept on my stomach and found that this seemed to compound any tightness in my back, while making a concerted effort to sleep on my side has left me waking up feeling more mobile early in the mornings.In the past I often slept on my stomach and found that this seemed to compound any tightness in my back, says @davidmaris958. Click To Tweet
In early 2003, I was very new to resistance training and was using a Pec Deck machine when the weights returned to the stack with enough violence it caused the pad of the machine to forcefully return to its resting position, partially dislocating my right shoulder. The ball felt like it was out of the socket for a split second before relocating itself and was painful for a week or two before I was able to stress the joint again in training.
Over the next few years, similar incidents would occur: once when squatting; once when performing punches whilst doing some boxing pad drills in a circuit training session; and most recently during a fall when doing hurdle hops. With each subsequent occasion, it appeared to take longer for the shoulder to relocate and the pain would last longer afterwards. For example, the most recent incident in 2015 (after the hurdle hop fail), the shoulder was dislocated for around 45 minutes and I was not comfortable maximally stressing the joint for five to six weeks afterwards.
In 2005, I had a shoulder arthroscopy which I was told found no abnormalities within the shoulder joint, but I have been aware for a long time that my shoulder strength and mobility appears to be poor—but perhaps within acceptable ranges. Fortunate for sprinters, there is little requirement to stress the shoulder joint with high loads, which perhaps raises an entirely different question about the need to perform certain actions in the weight room that are often staple exercises in many sprinters’ training programs. (Including my own! Perhaps a case of “we’ve always done it this way”?) Regardless, it meant that while I could not directly load the shoulder joint, I was able to run at fairly high intensities within a couple of weeks of hurting my shoulder.
My approach to overcoming and trying to prevent these events from recurring was to use light loads and perform movements whereby the shoulder joint would travel through a full range of motion. Rotation exercises using a TheraBand and dumbbell exercises that targeted the deltoids were my starting point in the progression, before building up to dips and heavier presses, always ensuring full ranges of movement.
When injuries arise, my advice would be to seek professional help if you are in any way uncertain about how to approach returning to play. I am by no means qualified to advise you, nor am I attempting to, on what you should and should not do in the event that you do become injured. My own personal experience has taught me that injuries need to be respected and adequate time is required before starting on a progression, and adequate time is required throughout each stage of a progression.When injuries arise, my advice would be to seek professional help if you are in any way uncertain about how to approach returning to play, says @davidmaris958. Click To Tweet
In Ryan Banta’s new podcast, he interviewed Dan Pfaff in the first episode and something that resonated with me was a comment Dan made about the “rule of ten days,” essentially pointing out that time heals most ailments and things will start to feel better given adequate rest. This fell in line with a thought process I have had in the past regarding healing and the fact that perhaps it’s an arrogant mindset to believe that we know better than Mother Nature and can shortcut recovery processes that have been put in place over the course of thousands of years of evolution.Time heals most ailments and things will start to feel better given adequate rest, says @davidmaris958. Click To Tweet
Therefore, despite the fact that some injuries may be unpreventable, perhaps the most meaningful impact we can have, with regards to injury management, is having sound practices that help prevent their onset in the first place. Despite injuries being part and parcel of competitive sport, through appropriate loading and programming, and via optimizing mechanics, the risk can be mitigated.
Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF