How to go from injured to injury-free.

I consider myself a very resilient athlete. I also don't consider myself injury-prone. Although my recent injury lasted around 4 months, I was able to complete two Ironmans, I experienced huge improvements in my swim and bike fitness and I am now back running injury free. This was my first  athletic setback in over 6 years.

Having said this, I know I am susceptible to injury. Whether it's my swimming (non-weight bearing) background or bad motor patterns or maybe my endurance and strength allows me to muscle my way through fatigue, me and running have a rocky relationship. I've never had a stress fracture or broken bone and no foot, ankle or knee issues. It's all been glute/hip/lower back related. I've learned that my body needs a certain amount of running frequency + strength based runs to keep my body happy. 

Injuries are extremely frustrating to athletes. They force "us" to modify our lifestyle and remove us from doing what we love to do with our body. However, there's always a risk to getting injured when you are learning new skills, exercising at a high intensity, stretching your comfort zone, pushing your physical limits or training through fatigue.

So much of the rehab process requires time, patience and assistance from a medical profession (doctor, PT, strength coach, dietitian). However, it's important to get your mind in the right head space throughout the healing process.

Because many athletes fall victim to a vicious cycle of injury→rehab→return to sport→re-injury, here are my tips for how to help you go from injured to injury-free.

1. Don't give yourself a deadline - There's never a "right" time for an injury. Most of the time, injuries come when you least expect it and in the mind of an athlete - at the worst time: close to a race or when you are feeling like you are in the best shape ever. Feeling like you need to be healed by a certain date can bring a lot of mental stress, anxiety and frustration. You can't predict the future so make peace with the situation and just focus on one day at a time.
   
2. The race is not as important as you think - It may feel like your upcoming race is the most important race ever. You feel a tremendous amount of pressure to perform, you worry that you are letting others down, you've invested so much time, energy and money and you may never ever have this experience to race this race ever again. If you find yourself expending a lot of mental anguish on your upcoming race, remind yourself that it's just a race. And race day is when you get to showcase the best version of yourself. Be smart. Instead of wanting to make it to the start line of your next race, being able to live a healthy and active lifestyle in the long-term is more of a priority.
   
3. Focus on what you can do - A setback doesn't mean that you have to throw in the towel. The worst thing you can do during an injury is be all or nothing. To expedite the injury healing process, keep yourself healthy, strong and active - within the confines of your physical limitation. While it's normal to feel frustrated, sad and dissapointed, you have a choice. You can wallow in self-pity or you can accept your new normal and be positive about what you can do. Above all, an injury doesn't mean that you have to give up your sport, be sedentary or that all of your hard work is now lost or was all for nothing. The body works in amazing ways. To see your body do something amazing, you can't give up on it.
   
4. Don't take it out on your body - Athletes have a very unique relationship with their body. An injury can be a traumatic event for any athlete, particularly the body conscious athlete. During this stressful time, the incidence of disordered eating or eating disorder behaviors may increase. When you put so much into your sport, it can easily become your identity. When your normal daily activity level is diminished due to injury, you may find yourself wanting to cut out food groups, avoid carbs and significantly reduce your calorie intake. Remind yourself that the body needs nutrients to heal. Depending on the type of injury, you may actually need more nutrients than normal. While adjustements in your diet may be needed, an extreme change in your diet is not necessary. Understanding that the body may change, this doesn't mean that you are becoming any less of an athlete. Be kind to your body. The body that you are starving or poorly nourishing is the same body that you also want to heal so that it can perform well in training and on race day.
   
5. Turn rehab into prehab - Throughout the injury healing process, you should surround yourself with a team of professionals. ART, chiro, PT, massage therapist. While some of these professionals will do the work for you, others will give you homework to improve muscle weaknesses, imbalances and to strengthen or mobilize an injured body part. It's a common mistake that athletes will forgo specific rehab exercises once training has resumed. To prevent a re-injury and to get more in-tune with your body, your rehab routine should turn into a consistent and evolving prehab regime. Don't wait until an injury occurs to address your limitations, niggles or imbalances.
   
6. Don't get greedy - It feels great to get back to a structured training routine. The first rush of endorphins after a time away from sport can feel amazing. You may find yourself craving more of it, more often. As you ease yourself back into structured training, do so gradually and patiently. Avoid the tendency to get greedy and to load yourself up with intensity and volume too quickly. Depending on your current fitness level, time away from sport and the severity of your injury, give yourself more time than you think to return to normal training and racing. And avoid the tendency to try to pick back up with your training where you left off before you got injured or to sign up for a race before you've given your body a chance to absorb a good amount of training stress.
   
7. A niggle doesn't mean another setback - Celebrate the small victories. Just because your injured has healed or you've been given the ok to resume physical activity, this doesn't mean that it will be smooth sailing. Understand that you may experience niggles, soreness and pain. This can also be a scary time as you fear re-injury. Learn to trust your body, understand what's normal vs. not normal and constantly listen to your body. During the return to training/exercise, it's better to be a little safe than very sorry.
   
8. Avoid panic training - If you have a big event coming up, you may be tempted to make up missed workouts or cram in as much training as possible before the big day. Because this approach is for your ego and not your physiology, it regularly fails. Instead, be grateful for where you are now. Thank your body for the injury that you were able to overcome. Recognize your current fitness level. With these things in mind, you can approach your race with a smart mindset. Having no expectations is a lot better than low expectations. See this upcoming event as a stepping stone to future events.
   
9. Tomorrow is just as important as today - Consistency is key to fitness improvements. If you put all of your energy into today's workout, you may compromise your ability to perform well tomorrow. After an injury, be realistic with your current level of fitness. A well designed plan has a mix of recovery and stress. While you may feel like you can do more or work harder, resist the urge. The continued goal is to always save a little something for tomorrow. There's no point celebrating an epic workout or leaving it all out there if you can't be consistent with training.
   
10. Time heals - No two athletes are the same. Every athlete is on his/her own healing path. Knowing that most injuries are not career-ending, you must have confidence in yourself that you will heal. The sooner you accept the injury, get a diagnosis, take action and start resting (or recovering) from the injury, the quicker you will start healing. Training through pain, racing with an injury or returning to training too hard or too soon simply delays the process and increases your risk for a more devestating diagnosis - which may be career ending. Instead of fearing what you will lose when you are injured, stay focused on what you will gain when you return back to the sport that you love. 

A few weeks ago I wrote about lessons learned through injury. I hope this blog post will come in handy for anyone who is struggling with an injury or is in the rehab process.

Making hard decisions when dealing with an injury

Imagine if you could train and race without a single risk for injury? 

If it seems to good to be true, well, that's because it is.

Injuries are part of sport. If you call yourself an athlete, accept that you are always at risk for an injury.

When you train for an athletic event, you are placing a tremendous amount of stress on the body to improve your skills, fitness and preparation. And for any athlete who wants to get more out of his/her body, there are risks to be taken to push a little harder and go a little longer. Certainly, every coach has his/her intentions to design a smart training plan/training environment to reduce the risk for injury but sometimes things are just out of your control. While many injuries (niggles) are managed conservatively with little break in structured training or activities of daily living, other injuries are very disruptive to life, often causing physical and mental stress due to a complete stop in physical activity. 

For any athlete who has been injured, it's normal to be pissed off, frustrated, sad, mad, angry, disengaged and irritated. This may cause isolation and lack of motivation and may lead into more serious issues such as depression, anxiety, disordered eating and substance abuse. 

Realizing that some injuries come randomly (without a known trigger or warning) and some injuries are accidents (crash, rolling an ankle, slipping on a wet floor), it's important to note that athletes are not injury proof. Whether an injury happens randomly or because you are always pushing your limits and ignoring pain, injuries happen in sport and each athlete will have his/her own mental and physical response. 

Certainly, for any outsider (friend, family member, training partner, coach, teammate), it's easy to give advice like "hang in there" or "stay positive" or "don't give up". But athletes don't just deal with the physical pain of a torn muscle, strained tendon or broken bone but also the mental pain associated with the temporary or permanent loss of sport (which also brings purpose and self-identity)

As an athlete, although there is no good time to be injured, one of the most difficult times to be diagnosed with an injury is right before an important event. While athletes will often get injured due to a ramp in training volume/intensity, athletes can often be a bit too dedicated (stubborn) to training in the 4-6 weeks out from a race and will often feel the need do go a little harder or do a little more to validate race day readiness - thus the risk for injury increases.

I get it.

It's very tough to make that decision "to race or not to race."

With your athlete brain, you are often only capable of thinking in the current moment. It's nearly impossible to think beyond your next race. 

For example, in 2015, Karel tore his plantar fascia in early June while training for Ironman Lake Placid. This was his first real injury and he didn't want to accept it. When he finally received the MRI results that it was a tear (as we were driving to Lake Placid a few days before the race), Karel still wanted to race. He thought he could just tough it up and race and then he could recover from the tear. His thinking was - well it's already torn, what worse could happen?

He was obviously thinking in the present moment and could not see beyond Lake Placid. He could not think about his health or anything beyond this injury. I don't blame him. This is normal and he was not doing anything wrong. He could not see that in 3 months, he would have the opportunity to participate in his first Ironman World Championship (with me) IF he didn't run in Lake Placid. It seems like logical thinking (don't race Lake Placid and heal up for IMKona) but as an athlete, it's extremely difficult to think logically, let along see beyond your next finish line. 

As athletes, we often struggle to recognize and accept long-term consequences of our immediate actions. 

There are many common reasons why athletes feel they need to complete a race, even though they are faced with an injury. For example.....

But I told everyone I was doing it and all my training buddies are doing the race.

I don't want to be left out. 

But I trained so hard for this race. 

But I spent so much money on this race and trip.

I don't want to gain weight.

But I invested so much time for this race and I don't want to let my family down. 

I'll just take it easy on race day. 

I want the finisher medal.

I just really want to do it.

I remember telling Karel over and over that his reasons for "racing" with a torn plantar were not smart. Come Kona, he would be sitting on the sidelines, regretting the decision of hobbling his way through IM Lake Placid - that is, if he could even finish the marathon. He would just be suffering and surviving until he could not tolerate the pain any longer. It was very difficult for him to see long-term but I kept reminding him that if he only competes in the swim and the bike, he will still have the opportunity to compete in Kona as he can kick-start the rehab as soon as he returns home from Placid.

Although we had many discussions during the 72 hours before the race (and Karel desperately hoping a miracle would heal his foot before the race), he finally made the right decision to DNF after the bike......after he packed his running shoes in his T2 bag and finally recognized that running was not a smart option.

Karel learned a lot from not racing with an injury. Karel is much better at thinking long-term and now he has the experience of a serious injury (with a positive ending) to help him make good future decisions with his body. I always believe that injuries teach us lessons - in sport and in life.

Well, here we are again....but with NO INJURY.

Instead, here we are, just a few weeks away from traveling back up to Ironman Lake Placid for Karel to race on the same race course as his first Ironman in 2013 (our first IM together) and on the same course that he did not finish on due to an injury back in 2015.

As an athlete, remember that the entire goal of training is to compete at your best. If you can not race at your best due to an injury, then your immediate goal is to heal yourself so that you can return to sport with a healthy and strong body.

It's always a tough call but be sure to think long-term. No race is "worth it."

And in case you were wondering, yes, Karel did end up racing in his first Ironman World Championship and he finished the race with no pain and a great marathon with minimal run training. He was diligent with his rehab therapy and was very patient in the process of letting his foot "heal" from July - October. After his torn plantar finally healed (it took about 11 months until it fully healed), he went on to have a phenomenal 2016 racing season by completing 3 Ironman's (and qualifying and racing Kona again), while running his fastest ever marathon off the bike (3:06 at IM Mont Tremblant - fastest male amateur run split).

An injury is a great teacher. Pay attention because it can teach you a lot if you listen! 

The injured athlete - take it from me

Year after year, season after season, I was defined, destroyed and strengthened by injuries. 

I remember the very first injury I had as a triathlete. It was 2007. 

 Karel was racing a cycling road race in GA and I decided to do a training run on the rolling hills while he was racing. Somewhere during the run, my entire hip/back tightened up and it was extremely uncomfortable. A few days later after returning home from GA, I felt a stabbing pain somewhere in my hip area during a run and that was it. 

And to make matters worse, I was just about 4 weeks away from my very first Ironman World Championship and my 2nd Ironman. 

I was devastated. 

I felt embarrassed, anxious, stressed and uncomfortable and simply put, my life just sucked for 4 weeks. 

Every morning I would wake up wondering if I could walk pain free. I went to bed hoping that tomorrow I would be in less pain. I wished for the day that I could take a hop without pain, let alone jog. 

I was no fun to be around and my boyfriend Karel was still racing bikes and I was envious of his freedom to use is body however he wanted.
I didn't want to be around anyone who was an athlete and I cried a lot. 

I did everything wrong for 4 weeks. 

I stopped almost all training to "rest" my hips. I got a MRI, X-ray (diagnostic tests showed nothing), saw massage therapists, constantly stretched and rolled, got a few cortisone injections, did ART, goggled, searched Slowtwitch for answers. 

I was desperate and I didn't know any better but to try to quickly fix myself as soon as possible. 

For several years after I finished the 2007 IM World Championship (yep - I still raced as a stubborn athlete and hobbled my way across the finish line with an excruciatingly painful marathon where I refused to walk), I told myself that I didn't regret my decision to race Kona. I earned my finisher medal, I was proud of my determination and I became an IM World Championship finisher. 

But fast forward to 7 more Ironman finishes, a PR of 10:17 in the Ironman and 3 more opportunities to race Kona, I wish I would have approached the race differently for my decision to race Kona as an injured athlete severely affected my health and body for 6 more years. 

If only I could have given myself better advice. 

I should have walked the marathon. Maybe I should have turned in my chip after the bike. Perhaps I just shouldn't have put myself in a tough situation to be in the race environment in the first place. 

After 6 consecutive years of dealing with hip/back/glute issues (from 2007-2013), often times not running for up to 3 months year after year, I've learned a lot about myself. When you are a chronically injured athlete (despite doing everything that you are told to do to keep yourself healthy and to overcome the injury), you hit some very low moments but also you can begin to have a better outlook on training and racing. 

Never is a workout taken for granted. 

You can give better advice to others than you were once able to give to yourself. 

It's much easier to modify workouts for a "fear" of getting injured again.

Looking back, I have had many scenarios where I have had to make tough decisions. As an athlete, some of my hardest decisions to make where not which races to register for in a season but instead, how to approach the season when an injury arises. 

Every athlete handles an injury differently and sadly, injuries are bound to happen. The human body is not as resilient as we think/want it should be. 

Some see an injury as an opportunity to focus on weaknesses. Others are frustrated with the situation but deal with the circumstances. And some refuse to change their lifestyle or goals and push through pain and discomfort. It's clear that there is nothing to gain when training or racing through an injury but it can be incredibly difficult for some athletes to think clear enough about the current situation and what's the best approach. 

Regardless of the physical pain, it's really the mental and emotional pain that is the most difficult part of being injured. Not only do you experience a loss of your sport but there is a dramatic change in your lifestyle. Workouts are removed, there is more time spent at doctor appointments and physical therapy treatments and there can be many days when it feels like the day is just a waste without a workout, just like old times. 

When you are the athlete who is injured, it is hard to think long term. It's hard to make good decisions that will benefit the future rather than what feels "right" at the moment.  Every effort is focused on quick healing and patience is an extremely hard trait if a race is on the horizon. For coaches, loved ones and friend's of an injured athlete, it is really difficult to say the right thing. As an athlete, you see that time is running out before a key race but the injury is just taking longer than anticipated to heal and that can be extremely frustrating.

Not racing or not completing the entire race is certainly one of the toughest decisions for an athlete to make. 

Out of frustration that months turned into weeks which turned into days, there is a tremendous sadness and a loss of identity as an athlete, and this anxiety and stress often causes athletes to make decisions that they eventually regret during the healing process. 

I often say that dealing with an injury comes with a roller coaster of emotions. Acceptance, denial, frustration content. Certainly a hard working athlete should be hard working in the rehab process but it's not easy to be all smiles and rainbows when you can no longer do what you love to do. 

As I head up to IM Lake Placid this week to spectate Karel and our athletes on Sunday, I am reminded of my last injury. 

Five months prior to 2013 IM Lake Placid, I suffered my last injury. For 3 months I did not run and I returned to run training in late May of 2013 with only about 8 weeks to prepare for the IM. 

Amazingly, I had a great race. Although it was not easy during my 3 month hiatus from running (and limited cycling and swimming), I refused to let my injury define me or destroy me. 

I had enough of being injured!

I told myself that this was going to be my last injury - enough already! 

 I was committed to the recovery from my injury to ensure that I didn't cause any more setbacks.  I was determined to get myself back to a healthy place and I would not rush the process even if it meant going into the race severely undertrained. 

Gloria was a big help and I wanted nothing more than to be able to race with my mind focused on pushing hard and not have my mind focused on tolerating pain or how I was going to overcome another setback. I was focused on taking care of my health and even though time did run out as I was progressing with my long run fitness before Placid, I did not let it affect my mental game on race day. 

2 years ago I crossed the finish line with a huge IM PR of 10:43. I ran a PR run of 3:48 after a 5:46 bike and a 1:01:02 swim. 

I was 5th AG which earned me a roll down slot to Kona (11 weeks later) and I finished 12 amateur female and 21st overall female. 

So what's my advice to you if you are an injured athlete with a race on the horizon? 

Don't let this injury define you. No one is taking away your athlete status. You do not have to prove that you are tough as nails by pushing through pain. Do what you need to do to get yourself healthy again. That is all that matters. Every day that you let your ego get the best of you, is a day that you could have made progress with healing. Be patient. You may not feel it now, but you will heal. And if you are proactive during your recovery/rehab, you will not only heal but you will be stronger than before. If you got injured because you made a poor decision in training/racing, admit it, own up to it and move on vowing that you won't make the same mistake twice. If you can't figure out why you got injured, explore the situation so that you can take the steps when you are healed (which you will be) to reduce the risk of a future injury.

Don't let this injury destroy you. There's no need to throw in the towel. We can all think about the many age group, elite and professional athletes who have had incredible comeback stories after overcoming an injury. There are athletes who have been injured and then beat the odds and other athletes who struggled for a long time and provided an extreme dose of motivation with their initial comeback to the sport.
When you get injured, you have to be 2x as motivated to put in the work to heal yourself than when you were an injury-free athlete. Come back too soon and you may experience more time lost. Keep yourself as fit as possible by focusing on what you can do, pain free, so that you do not cause any more setbacks. When you are ready to make your return back to full training again, you will be so happy that you did not give up when the going got tough. You will not be injured forever - don't forget this. 

Do let the injury strengthen you.
I believe that we can learn a lot from injuries. We learn a new side of being mentally strong. We become better in areas that we were neglecting to focus on before and we don't take for granted what we once thought was simple and easy.
Be your own comeback story. 

How will your story end? After a few days, weeks, months or even a year or more of an injury- what do you see as your happy ending?
What's motivating you to get better? What's keeping you focused and determined to not give up?
Who's helping you make smart decisions so you don't back track? And what will this injury teach you about yourself?
Are you going to be weak, lazy, unmotivated, angry or bitter or are you going to be determined, focused, hard working and diligent that there WILL be a positive outcome when you DO return to the sport that you love. 

From a former injured athlete...take it from me. 

You will be healthy and injury free again. 

Just do the right thing, make the right decisions and be smart.
It won't be easy, but it will be worth it. 

Never give up

In two days, I will be racing my 9th half ironman distance triathlon. 

In 5 months, I will be racing my 10th Ironman distance triathlon and 4th Ironman World Championship. 

In 9 years, I have covered 1827.8 miles with my body. 

That's like swimming, biking and running from Miami, FL to Maine!!!
INCREDIBLE!!

One thing I have learned throughout the past 7 years since starting endurance racing, is that patience, hard work and commitment help me accomplish a lot with my athletic goals but life isn't fair or simple when you are an athlete. 

Throughout every training and racing season, I found myself experiencing great highs and lows. With the highs, I have won races, qualified for Kona, set PR's and have traveled to really cool places in order to race. Most notable with the lows, I always found myself with yearly chronic hip/glute/back injuries (that would keep my from running for several months at a time), regardless if I felt I was taking risks to push my body to get to that next fitness level or being smart with my approach to training. 

But the past two years have been very different than the previous 6. After my first season of endurance training without an injury, I had nearly 6 years of chronic injuries But there is a happy ending to my struggles -  I have remained injury free for over 730 days! 

After years of visiting doctors, having multiple exams and expensive tests performed and visiting many PT's and massage therapists, I no longer have to work hard just to come back from an injury. Instead, I am able to train consistently without setbacks. And it feels amazing!!

My point is not to brag about where I am now because let me tell you, it has not been an easy 9 years. There have been many tears, painful days and worries for much of my triathlon career as an age grouper.  Out of 9 years of racing, only 3 of them have been injury free. I spent 6 years emotionally frustrated with my body, unable to understand why I couldn't stay injury free. 

For so many years, I always wondered what it would be like to just train and let my mind be my only limiter. To be able to just push on race day and not have to think about the training that I missed because of an injury.  

I envied those who could go to bed and wake up excited to train whereas I was going to be hoping to be in less pain the next day, hoping to be a day closer to a possible unknown date of returning to running and training injury free. 

But through all the frustration, time lost from training and money spent on healing, I never wanted an injury to stop me from reaching my full potential. Giving up was just not an option for me.....even though I did mention the words to Karel and Gloria several times about "quitting" triathlons. 

I battled between wanting to continue something that I love because it teaches me so many life lessons, let's me connect with other like-minded individuals, that makes me feel so healthy and happy versus when I was injured, understanding why I should continue something that often does not make me happy or feel healthy and instead, makes me feel like I am not living my life to the fullest because I can not move and use my body and explore nature.  

But year after year, I focused on what I could do....instead of putting energy into what I could not do. 

Life requires hard work, patience and commitment. If you have a goal, you just can't give up on it because of the time it will take to achieve it or because it will be a hard, difficult and tough journey.
Or because a setback comes into your smooth-sailing path. 

Through all the highs and lows that we encounter in life and in training, there is absolutely no reason to dwell on the past because well, that can not be changed. Every day, you have to wake up excited to give your best and be willing to work for the best possible outcome. When it's time to use your body for something amazing, you do not want to look back and wish you would have done things differently. Sometimes we can't predict the outcome and sometimes we feel we do things right and well, things don't go as planned but as long as you never ever give up, you will get to where you want to be. 

You can give yourself a thousand reasons why something won't work but if you can think of the one reason why it will work, you will find yourself doing what the mind believes...and the body will follow. 

Sunday will be a special day because at Challenge Knoxville, I get to officially start my 2nd consecutive season of racing injury free. 

I'm incredibly grateful to my body for staying healthy, strong and resilient for the past two years but more so, for being strong enough over 9 years to let me discover how strong I can be - through all the highs and lows of training and racing in endurance sports. 

If you are currently struggling with an injury, health issue or perhaps dealing with a life change in your personal life, please never give up. 

Take it from me and all that my body has not allowed me to do over 6 years and now what is allowing me to do for the past two years. 
Life will continue on and I want you to choose to be an active member in your amazing life journey.