Friday, April 26, 2013

Don't Want to Lose Conditioning While You Heal Up? -- " Go Off the Deep End!"

The biggest fear most athletes face when they get injured is the loss of hard earned conditioning levels. The biggest reason that most "Type A" athletes don't appropriately recover from overuse injuries is inappropriate rest for recovery due to these overwhelming fears.  There are as many recommendations for conditioning while injured as there are experts in the field.  Particularly if an athlete is heading into their competitive season, the methods of conditioning used while rehabilitating injury should have three major considerations (1) picking an activity that will not exacerbate the injury (2) find an activity that utilizes the same major muscle groups used that mimics the athlete's sport activity and (3) provides cardiovascular fitness levels equal to that experienced during the athletes land based sport activity.

In the previous blog, I covered necessary means and guidelines for using aquatic therapy to adjust varying amounts of stress on the body while healing from injury.  One of the great aspects of using water during rehabilitation is the ability to perform functional activities that mimic the activities performed on land.  Obviously, running in the water will mimic the muscles used on land, only in a reduced weight bearing environment (see the previous blog).  Additionally, adding multidirectional movements in the water can help strengthen key areas of the athletes body including the "core".  Jumping activities, strength activities, and other resistance activities can be performed in the water under the direction of an appropriate licensed athletic health care professional to enhance athletic performance even while recovering from injury.

Maintaining appropriate conditioning levels in the water, however, requires special considerations to maintain high cardiovascular performance.  It is readily recognized in scientific sports medicine journals that maintaining maximal oxygen capacity is achievable at levels in water equal to land based training as long as the intensity of the cardiovascular exercise in the water is at a level that matches that land based training.  What most athletes don't realize is heart rate on land does not equal heart weight when submerged in water.  Due to the pressure of the water on the submerged body, there is an approximate 35% increase in heart mean stroke volume, a decrease in blood pressure, and an increase in cardiac output that provides more oxygenated blood to the working muscles (another reason to use water to help the healing process).  Due to these effects, target heart rates in water should be 17-20 beats per minute lower than on land to produce equivalent cardiovascular effects.  Athletes not aware of this nugget of information end up trying to exercise at heart rate values equal to land and become frustrated with water conditioning, finding they cannot get their heart rate up to land based levels in water without going anaerobic and fatigue out much too quickly.  Likwise, an athlete conditioning in water that does not monitor their heart rate values will fall into a "comfort zone" in the water at levels not sufficient enough to stimulate the desired cardiovascular effects and aerobic conditioning will suffer.

As an example of appropriate conditioning in the water, an athlete wanting to perform a long run at 155 beats per minute should run at an intensity level in water that is135-138 beats per minute for the same amount of time they would run on land and will have the same cardiovascular effect without traumatizing their injury.  Scientific studies have shown athletes can maintain their V02max values through water running as long as appropriate levels are achieved.  The literature is full of examples of athletes that have rehabilitated common overuse injuries of the lower extremities, conditioning only in deep water running for up to eight weeks without running on land and returned to championship levels of performance within days of being released to run on land.  It seems almost too easy to be true, but armed with the right information, training, and rehabilitation plan, it is more than possible.

As always, if you are going to train hard, you might as well train smart!  If not, injuries will occur or goals will never be achieved.  This is never more true than trying to train while injured.

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