Our series continues with Question 3. This question is about coming back to the sport of triathlon after a back related injury.
Q: When I think of therapy, I think of coming back from an injury. How about coming back from a back injury?
A: It really depends on the extent of the injury, what structures/areas were affected, and did the area require a surgical repair? I have worked with an athlete who progressed very well after a spinal fusion. Before surgery this individual worked with physical therapists at Specialized Physical Therapy to enhance gait, strength, and mobility. Post surgery it was time for healing and recovery. Additionally, they consulted with their physician about progression in the sport and contraindications.
The anti-gravity (AlterG) treadmill is a great option for returning to running after back injury. The AlterG would allow a patient/athlete to start running and walking at a lower percentage of body weight (ie, 20%) and progress over time to near full body weight. Pool running can also be used but running mechanics in the AlterG will be closer to normal than in the water. With the AlterG we can progressively increase loads and speeds with near normal running mechanics and this cannot be done in the pool. Road bike cycling is also effective at building back to the sport of triathlon.
The client I coached used their road bike to eliminate excessive flexion of the spine, contrary to what we see in the aerodynamic position on a triathlon bike. Freestyle and backstroke were the only strokes performed when swimming. For the first couple months, I eliminated use of a kickboard which could promote excessive lower back extension. At first, pull sets were the focus in order to eliminate significant motion in the lower body and assist in keeping it afloat. Aerobic conditioning and strength were the
key concepts for the first three months.
This individual raced 6 months after their surgery completing a sprint and Olympic distance triathlon. Since healing depends on a variety of factors day to day feedback became extremely important in their return to racing. In any injury situation holding back rather than pushing forward is the best approach. As a coach, my overall goal was to progress her safely based on her feedback and the specialists associated with getting her back to competition. We succeeded!