Transcription:
Recovering From Endurance Sports Injuries

Scott Webb: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by the University of Maryland Rehabilitation Network. Offering a full range of physical rehabilitation services, the UM Rehab Network brings together a committed team of experts from across Maryland to help patients recover from illness or injury, such as stroke, joint replacement or traumatic injury. The University of Maryland Rehabilitation Network, bringing world-class comprehensive rehabilitation services directly to your neighborhood.

I'm Scott Webb and I'm joined today by Amol Bakre. He's a board certified orthopedic clinical specialist working as an outpatient physical therapist at University of Maryland Charles Regional Rehabilitation. And he's also an RRCA level one certified running coach. Amol, so great to have you on today. We're talking about endurance sports, so let's talk about that. Let's start here. What are endurance sports?

Amol Bakre: So basically when we look at any kind of exercise in sports training, we see the athletes in basically three types. One of them is power training, then we have strength training and then the third classification is endurance training.

So basically, any kind of training or sports conditioning is based on how much time we spend with that kind of a sport. In endurance sport, we spend a lot of time doing that activity with using your big muscles of your body. So like your buttock muscles or your calves when you're running, your shoulder muscles and your quadriceps like your knee muscles when you're biking and stuff like that.

So endurance sports are any activities which are done for a longer period of time and they utilize a lot of oxygen. So there's a lot of cardiovascular impact on it and there's a lot of muscles working at the same time. So basically, we see all that as a positive impact on the athlete.

Scott Webb: Yeah. I hear what you're saying. I like the way you put that, the big muscles. I can picture what you're saying, you know, the big muscles doing it for a long time. And so when we talk about injuries, how do these injuries happen in these particular sports?

Amol Bakre: There are multiple ways. Athletes can actually get injured. A lot of times, it's very high rate of injuries based on what time of the recovery the athlete is in. But if I would try to keep it simplified, we generally look at internal reasons and external reasons.

The internal reasons are generally something that the athlete cannot modify. So that could be age like if an athlete is a kid, so adolescent age group, like 12 to 14. And they're going out there, they're starting their new running program or they're doing the track and field and all that stuff, they’re not really knowing how that is done. So if the coaching is not done correct or there are errors in the form or training and those become the external factors for injuries.

So basically when we look at the injuries, whether the athlete is able to do it, like genetically he's able to do it, whether he is inherently capable of trying to do that sport. If not, then that's gonna lead to injuries. And the other reason being, is he trained enough or is he trying to do something out of his capacity or if he has any history of previous injuries? Those things will, you know, lead to injuries in these sports.

Scott Webb: As you say, there are things that we can control and things that we can't. So we can't control our age, like I'm 52 and I'm more likely to get injured if I go out and try to do endurance sports then maybe my 17-year-old son would. And I think you're so right, I think coaching matters so much and probably has more to do with injuries in young athletes than probably parents and people just even realize, right?

Amol Bakre: That is absolutely right. Yep. But let me tell you that, at the age of 52, we've had marathoners finishing the Boston Marathon at the age of 52. So I think you can still start, Scott.

Scott Webb: Yeah. There's still time. But I'm going to need to work up to that a little bit. Definitely, during the pandemic, I've fallen off my regimen just a little bit and led to some minor injuries. And when we talk about the common injuries, what are the types of injuries that you see in athletes doing endurance sports?

Amol Bakre: For example in runners, we see a lot of ankle strains and sprains. Shin splints are very common. We have something we call it as runner's knees, which is basically the inflammation right beside the kneecap area. And a lot of times these injuries are happening not first time, but they are recurrent. And it all basically could be like the foot not landing correctly on the curb or leading to the ankle twisting or the hill, which was not expected in that race, and they ended up injuring their knees. So that an example for running.

For bikers, we have a lot of low back pain, which is common because of that slouched posture. They are in that for long periods of time. They do have some knee issues as well. We do see in swimmers, we see a lot of swimming shoulder issues, because if they try to change the form, like from freestyle to backstroke, the shoulder muscles are not ready yet and that's when they are most susceptible to injuries.

Scott Webb: So Amol, is there a difference between rehabilitation and returning to sports training?

Amol Bakre: Yes. There's a slight difference between those two. So basically rehab comes in as a first step before heading back to sports-related conditioning. So if you look at it from patients' perspective, when he or she comes to the therapy, mostly what they're looking for is pain relief because that's their major complaint. They're hurting somewhere. Then they're either tight or they're weak in that muscle area pertaining to that kind of a sport.

And most of all of these things, most important one is the fear, fear of movement, like they don't want to do that activity again. They feel that they might buckle their knee again if they try to run a little extra with a little faster pace or something. So I think it is very important for us to address this fear or that apprehension, what we call it as, from day one, sticking to the basic facts and they need to be backed up with a solid research and making sure that we are not giving them any false hopes. And kind of build up that confidence throughout the rehab process.

And, once their confidence is back, once they're mentally ready and physically also getting stronger, that's when we move them along the line and, you know, push them into conditioning. And that is that sports specific conditioning, which comes into play.

Scott Webb: And can you tell us some important things that we need to take into consideration or that you would need to take into consideration when it comes to sending your patient back to the sport that he or she was in before?

Amol Bakre: Like we discussed about returning him, you know, back to the conditioning program, we look at two types of measures I would say, you know, in order to keep it easy, we call it a subjective measures, which is nothing but what patients tell us, that he or she is feeling fine and he's able to do that now. And then there is an objective measure. That is what we as clinicians, as therapists, as physicians and all the coaches like we observed, is he really able to do it?

So basically, when we look at the objective measures, we try to test the patient through what we call it as sports-specific drills. Now, these drills are different depending upon the sports. Like for example, for running is a single leg activity, right? I know it looks like we are running with both legs. But as a matter of fact, when you are increasing your speed, you are at one point in your gait or that cycle, you're on your one leg. So it's important for us to build up that single leg strength, like your calf strength, making sure that you're able to balance yourself on a single leg, you're able to hop and jump some distance or even able to test your speed or pace, testing it like for one mile.

So I'm not like looking very specifically if he's able to build up that speed during the rehab or conditioning, but at least he should be pain-free and it's going to take some time so we can gradually observe that patient getting better in the process.

Scott Webb: And what if during the conditioning part, the athlete injures themself again, and what can we do to prevent that?

Amol Bakre: That's a very good question. And that's what we were discussing like a minute ago. That's going to put that athlete back again into the line of this recovery, and he's going to be more mentally feeling that challenge right, as compared to physically being hurt. So all of that vulnerability starts piping again. And that's when it's very important for us to start adding that into the prevention tactics from day one in the recovery and especially after he is done after the rehab.

And it's not just the therapist to patient, but it's going to be a comprehensive approach between the family, because a lot of times they have a family pressure that they want to compete in a sport, it's going to be a selection for the college. Sometimes it's a coach and, if it is a team sport, then it's the entire peers. They all come in together to make sure that the athlete is physically and mentally equipped to not injure himself again.

So I think understanding that sport and correcting the form, which is required and knowing your limitations, that what you can or cannot do after the injury that it helps you prevent the injuries from happening again.

Scott Webb: Yeah, I see what you mean. And I love that approach, this sort of team approach that it's the athlete, it's the family, it's the peers, it's the coach, it's really is a total sort of team effort, including people like yourself, physical therapists, in helping an athlete get back out there and get back on the track, on the field, whatever it might be and working to eliminate the possibility as much as possible of reinjury.

That's really great stuff. Amol, as we wrap up here today, anything else you want to tell people about endurance sports, rehabbing, returning to sports, preventing injuries? What else can we tell people?

Amol Bakre: I would generally say is if you are feeling that you are not able to do your best in your sport, I would say give it a time and be confident on yourself because it's a healing process. It's not going to happen overnight, like this pandemic is going to take time to get over. Similarly, we've got to make sure that we are giving that much time in respect to the body to recover.

Scott Webb: Yeah, I think you're so right. And that's a great way to end. It really is a process and one that we all need to be aware of and understand that things take time, rehab takes time. We work with physical therapists, we work with the team as we talked about that team approach to get ourselves back out there. Thank you so much for your time today. Your energy was great and you stay well.

Amol Bakre: All right. Thanks, Scott. I appreciate that.

Scott Webb: Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.