Level 4 Injury Protocol

The BC Injury Protocol (Part 1). You can’t train effectively if you are injured, meaning you experience pain at the twinging level or higher on the following scale: tender, twinge, ache, sore, severe. Use the following protocol every time you feel the sudden onset of unusual pain.

• Whenever you feel a sharp twinge of pain, back off on exertion immediately. Slow down untilthepaingoesaway,whetherinthatworkoutoroveraperiodofseveralweeks. Better to lose a few weeks of training than be saddled with interminable debilitating injury.
• Whenever you experience pain, your highest priority should be to get rid of it through a concerted injury-freeing process. First, until the injury goes away, see about changing your mindset from training to rehabilitation. Train under pain, never through it. Tender only.
• Remember, all injuries go away if they are treated properly. The most important thing is to slow down so you experience the pain at no more than the tender level. The pain will go away gradually as long as you don’t continue hurting yourself with painful exercise.

The BC Injury Protocol (Part 2). Never train with soreness that causes limping (even minor limping). Limping means you’re going too fast for rehabilitation purposes. Whatever your training purpose, it’s not as important as getting rid of the injury so you can train enjoyably and sustainably.

• The Don’ts of Injury. Don’t try shoe inserts or pain pills. Don’t stretch, unless you do it gently. Stretching feels good but often exacerbates an injury, as do strengthening and therapy exercises meant to work a damaged area that needs active rehab more than work.
• Begin with a regimen of active exercise at the gentle level. Use excruciatingly slow walk- ing to keep the pain at bay. Do very-short, 5-minute workouts to warm and loosen the area, relieving stiffness and poor circulation. Afterwards, cool it with 10 minutes of icing.
• The pain should go away from day to day, enabling you to go a little faster. Consult with a coach before going to a doctor. It’s a coach’s job to get you out of the injury. Medical consultation will be recommended if this protocol doesn’t result in rapid rehabilitation.

Solving the Injury Problem. Every pain has an antecedent problem, which must be uncovered and solved by active intervention. Most athletes can reflect on their circumstances and come up with several plausible hunches about causal factors. An expert, by contrast, ferrets the answer.

• It helps, therefore, to have the input of someone more experienced than yourself. Hunches can be straw dogs. Dead ends that lead nowhere. Plausible, but in the end they don’t reveal the real problem. Find someone who can strike through to comprehension.
• Someone who can reflect, for instance, on the circumstances surrounding the onset of a pain. Most injuries are caused by too much exertion and too little rest. If that’s been true for you, then resolve to do better. Build new habits that lower the risk of future injury.
• Otherwise, you’re doomed to cast about for solutions to non-existent problems, while an injury festers long enough to be wrongly accepted as normal. An injury is never normal. There is always a way to more natural forms of exercise. But can you accept the solution?
  

Changing Injury-related Attitudes. Thinking: I’m a bad person; this is the end of my running career; I’m so depressed; I have to train through this injury. These are all unnecessary and counter-productive mental/emotional aspects of the injury phenomenon.

• You must nurture a positive mental attitude because that will lead to the positive emotions that should drive your decision-making. The first step is to become aware of your injury- related mental conversation. What are you telling yourself about it and how does that feel?
• You are ultimately responsible for dealing with the injury in such a way that you return to enjoyable, injury-free training—your natural way of being in the world. Everything else should be rooted out, along with unbridled ambition.
• My wife used to wag a finger at my injured athletes and say, “All injuries are rooted in ambition.” She was right, of course, but only the bravest athletes are willing to examine their deep-seated motivations and the compulsions that drive excessive, injurious effort.

Insensitivity to your body can easily lead to injury. Pain is one way your body signals some- thing’s wrong. Yet many people will deny the pain is there, or simply overlook it as necessary or inevitable. Becoming aware of pain is the primary prerequisite for effective injury rehabilitation.

• You may think you are in charge of your body and that what you say goes. But your body operates according to rules and processes that can be foreign to your mind, which is thrown to intuitive, habitual, and often incorrect decisions, without thorough assessment.
• Your physical self doesn’t think with words or concepts, but with pain and other physical sensations. Your body governs these sensations with forces beyond your direct control. It has at least equal claim to agency with your thoughts, emotions, and perspectives.
• Thus, the most you can hope for during a workout is to control your body indirectly through scrupulously correct exertion, such as a proper warm-up. And by never over training. Our goal is to enjoy year-round, pain-free, and sustainable fitness exercise.

The Transition and the Warm-up. The “warm-up” doesn’t actually begin until about 10-15 minutes into a running workout. That’s how long it takes for the metabolic “transition” force to run its course. The transition decreases energy and increases the risk of injury.

• The “transition” phase of the workout energy cycle occurs between standing around before the workout and the warm-up phase, which begins once you’ve walked or jogged for 10 minutes, or so. The transition takes the form of a physical shock to your body.
• As such, the transition is a tricky part of the workout. If you go too fast—especially if you can hear your breathing—you can easily injure yourself or become prematurely fatigued. The transition can reverberate throughout the workout, so it must be handled carefully.
• Your transition pace should be excruciatingly slow. Some have said “painfully” slow, but that is an incorrect term. If anything, it should be painlessly slow, meaning you feel no pain at all. Thus, your first training goal is to minimize the shock of each workout transition.

Body Scanning (Part 1). Soccer champion, Lionel Messi, runs less during a match than his peers. But he scans the field 50 times a minute, far more than most. Similarly, great runners scan their body constantly and habitually for signs of distress—warnings that require their attention.

• Weird or unusual sharp-darting pain is the easiest to acknowledge, but not always the easiest to accept. The mind resists the obvious solution: to slow down and let the pain subside, especially when your energy is good and you want to go as fast as it will let you.
• Nonetheless, your highest priority is to run injury-free. Injury precludes joyful running and is ultimately unsustainable. To be injury-free requires freedom from whatever is driving you. Even novice athletes can be ambitious, about burning calories, if nothing else.
• Thus, body scanning is the prerequisite of injury-free running. Notice pain that lingers at such a low level that it hardly warrants consciousness. Tolerable pain is pain. And unsus- tainability develops from pain that isn’t treated seriously and expeditiously. So scan often.

Body Scanning (Part 2). A full body scan only takes a moment, as you have broad and imme- diate access to your entire body from head to heels and from the skin to your deepest innards. All your bones and joints, but especially the working parts, should be regularly scrutinized.

• Think first in terms of your body’s painful messages? Does a pain require immediate adjustment to your pace or stride? How about your footfall? Are you compensating with limping or poor posture for some barely acknowledged discomfort?
• Where are the sensations coming from? And is location, pace, or posture the main precipitating factor of an incipient pain? Remember, pain-free exercise is our highest priority. Abundant energy is nice to have, but high-level exercise is not always advisable.
• The physical body is only one aspect of the body and how it communicates with the thinking, observing mind. Pay attention to the affective side of your experience: the feelings that give rise to tension, anxiety, and fear. Strive always to augment relaxation.

Shoes and Injury. Training-related issues, such as warming-up incorrectly, can cause injuries. But there could be other problems. Shoes, for instance, can be a major cause of recurring injury. It’s often good to cover the new-shoe base as one of your first steps in the rehabilitation process.

• Find expert advice before you invest in a new pair of shoes. Go to a reputable running shoe store where the sales people know how to match your bone-and-muscle structure needs with a shoe’s intended function and features. And where they’ll let you jog in them.
• Running shoes wear out and compress much more quickly than street shoes. Often the uppers can look brand new, but the compression is hidden in the mid-sole. Even minor wear and compression can cause significant injury. So inspect your shoes frequently.
• A new shoe is as good as it will ever be the first time you take it out for a run. Once it starts to compress, it may feel broken in and comfortable, but it’s less capable of protecting you from pounding-related injuries because the platform is no longer supple or level.

Level 4 Injury Protocol

Base-building. The goal is to establish a base of three workouts a week, without increasing pain during or between workouts. Rather, as you repeat base-regimen workouts, there should be a gradual but noticeable diminishing of pain from workout to workout, or week to week.

• • At this base level, workout frequency, pace, and duration should depend entirely on what the injury allows, without returning to your full training load. That might be from daily 5- minute walks at a very-slow pace to several 30-minute workouts per week at a slow pace.
  • The key is to never allow the pain to rise above the tender level during a workout and, similarly, never allow the pain between workouts to increase as a result of the workouts you are doing. This can be a trial-and-error process; it’s best to smooth peaks and valleys.
  • The sole purpose of base workouts is to increase warmth, circulation, and flexibility in the injured area, and thereby eventually restore its normal function and pain-free condition. A week at this basic level is barely long enough to confirm sustainability.

Transitioning to Normal Fitness Training. Starting with the recently established rehabilitation regimen, there should be a gradual, incremental increase in workout pace and/or duration, as injury pain subsides. Beware, however. Increased effort is not the same as a return to training.

• • You are still in rehabilitation mode until you have completed phase three: return to fitness. Meanwhile, phase two is a transition between building a sustainable base (in phase 1) and progressing to a normal, injury-free training load (in phase three).
  • Phase two is still part of the gradual, incremental rehabilitation process as opposed to actual “training.” And pain—not THE schedule—is the final arbiter of when and how to increase pace or duration. Pain is in the body’s realm of control; your role is listener.
  • The key is to never increase the workout load unless you are 80-90% sure the current rehab regimen isn’t threatened by a sudden return to debilitating injury. Remember, your energy will probably run ahead of your ability to ward off renewed injury.

Return to Fitness. In phases one and two, you established a normal training regimen at the passable level of proficiency. In phase three, the goal is to feel progressively more injury-free and able to train at your usual fitness level, rising from passable, to effective, and then fully-able.

• • Throughout this process, there is a constant risk of slipping back to injury—the ineffective or unable proficiency levels—due to excessive effort. You must be aware of whatever is driving you: the emotion, the ambition, and the anxiety. All important Tells.
  • It’s important, therefore, to linger a while at the effectively-able level in order to allow the body time to adapt to your new training load—but more importantly—to continue reducing the underlying feeling of vulnerability to renewed injury.
  • In other words, resist the urgent desire to get back to the way training was before the injury. It could be that it was too hard, anyway, and objective reassessment of the training load is necessary. In this context, it’s always best to consider enjoyment and sustainability.