Injuries and Motivation, a post from an online group that I wrote

"yyyy" is the anonymized name of another group member.  My responses are to him:

On Sat, Dec 17, 2011 at 6:06 PM, yyyyyyyyyy <yyyyyyyyyyy> wrote:

yyyy---FIRE (Frequent Injuries and Repeated Exacerbation), of shoulders, knees, elbows, etc..

Chronic athletes know all about them. The body isn't built for the wear and tear of swimming, running, rowing, biking or pretty much anything at the intensity needed to be competitive today.

Me--Hmm.  Not sure I agree, on a couple of points. 

I suppose it's to some extent a matter of definition--particularly of "competitive."   At what level?  Local? National? World? In one's own mind? And why do you care about competition?

Pushing through injuries will get you what you describe, but careful training, even with steadily increasing mileage, likely won't.  It's all in the approach.  Outside of a genuine life and death setting, there's nothing heroic about forcing oneself through injury.  It's just creating an unnecessary problem. 

Not that there isn't a genuine temptation to push for me: I love everything about the athletic lifestyle.  I revel in exertion, exhaustion, and endorphins.  I actually find competition a fun way to interact with peers, and a great way to get motivated.  I like the mind-boggling rush of pushing past my preconceived limits.  Sports push me into a gloriously, enjoyably primal, limbic brain mode, and I'd be in a real spot if I had to give it up.  It is the antithesis of all the polite, faux horseshit that I have to put up with in the human social world in order to fund Basecamp Quigley.  For a spaz like me, the white noise of exertion is my most effective form of meditation, free association, and what Nathan calls "Back-burnering." 

But like anything that gets the dopamine flowing in the Nucleus Accumbens, it requires caution.  The key to keeping the party going is effective cortical oversight--caution, sensibility, reason.  The temptation to overdo it is always there, and my past, athletic and otherwise, is littered with numerous failures of limbic guidance. 
 

yyyy-----Or even non-competitive, but for an extended duration, all the more pertinent if your expected lifespan is on the up-slide.Are we doomed to give up the sports we love, or restrict them to a couple of decades of fireworks? Can the party go on?

Me--I think xxxx 's point re body adaptation is key.  You don't see endurance athletes, even those who have been at it for awhile, walking around bowlegged like weightlifters, hidebound  from muscle fibrosis due to repeated stress.  Nor is breakdown inevitable.  Quite the contrary.  Slow, incremental (versus excremental?) increases in distance/effort will strengthen and limber both the muscle and the gristle, and prevent injury and breakdown.  Increasing the stress on the body by increasing training will expose weaknesses, whether they are structural, technical, training/strength related, or psychological.  If a weakness if found, it needs to be addressed properly in order to continue, and experience has shown me that it is unlikely that it will be best addressed by brute force.  Luckily, the body is constantly remaking itself, and the medical/dietary/health/coaching resources for dealing with injury are better than ever. 

My foremost concrete suggestion would be to make sure you stay mentally resourceful and flexible, explore and use any and all available resources, and be OK with doing less than you think you ought to.
 

yyyy---From more seasoned athletes, I would like to know what their standards for unreasonable cowardice are, with respect to pain of chronic injury keeping them off their chosen sport. How much do they tolerate before backing down. How much pain have they persisted through and seen the light at the end of the tunnel in spite of it, etc. Does having a sense for the consequences mean that they're more predisposed to being a bigger wimp, or is that just me?

Me--When I was a young competitive swimmer, I had the retrospective good fortune of closely pursuing accomplishment for three straight seasons and pushing myself into a career ending injury.  I had been on the brink of being national caliber, High School All-American, and recruitable by schools that would have paid for my education, but it was all gone in a matter of weeks because I couldn't make myself back off when my body first asked, then insisted, then demanded. 

How this was good fortune was far from obvious at the time, but it: 1) Taught me that COX-2 anti-inflammatories/painkillers BEFORE workouts were a one way ticket to disaster; 2) Taught me that my body had its limitations; 3) Taught me, after a fair interval of adjustment, that there was more to life than swimming backstroke; 4) Taught me that all experts ought to be demoted to advisory status (after one swim coach radically altered my backstroke technique to his liking and my shoulder's profound distress); 5) Taught me that nose-to-grindstone, brute force effort was neither the only nor the best way to achieve a goal, athletic or otherwise. 

My assumption in my mid 20s was that I'd only be able to run for a few more years before I fouled up my knees, and wound up permanently on the stationary bike watching soap operas and sipping Crystal Light.  After all, I was a 200-ish pounder, and there's only so much shock one can administer to the knees. . .  This was the conventional wisdom at the time; nobody was really aware of controlled stress as a stimulus for rebuilding and injury prevention.  After my swimming experience, I figured that I could milk it as long as possible as long as I was cautious, then bow to the inevitable need to switch to the bike.  But time wore on, and I continued with impunity, and at increasing mileage.  20 years and 30K+ miles later, I have no knee/hip/ankle pain whatsoever.  It likely won't go on forever, but that's another day's problem.

There may be some fortunate genes involved, but IMO, there's no real reason to think so.  There is some luck, as I went against a fair amount of the prevailing "wisdom" re running back in the late 80s to 90s.  Recovery time and reasonable surfaces were a large part of it.  It was probably fortunate that I preferred trail running and hill running 3-4x/week to daily flatland running on concrete.  More recently, a fair number of distance running coaches incorporate hill training as one of the centerpieces of injury prevention, and running on hills in Northern NM and the SF Bay area was, as luck would have it, my preferred form of exercise from ages 20-40.  "Heel striking" was also the preferred technique of running back then, but I fell more naturally into a forward-leaning, midfoot striking, Neanderthal style run, which felt more natural to me.

This gets to probably the most important point: I listen to my body far more than I listen to what others' idealized methods and techniques ought to be.  Nobody knows me better than me.

Even as I've recently remade my technique into a more efficient, chi-running/pose running style, I constantly play with technique to see what feels not only most efficient speedwise, but most natural in terms of effort.  Muscle exhaustion is inevitable; joint pain is a 100% indication to back off until it goes away.  If this is what top triathletes and coaches say and do, it's likely a good idea.  If my body agrees, then it's unanimous.  

Part of why I can't really anticipate the limits of my triathlon performance trajectory is that I don't quite know what they are.  Our bodies have limitations, and pretending they aren't there is the best way to invoke them.  If they are encountered abruptly, they push back hard.  But if they are approached gradually and cautiously, over a longer time period, they flex/bend.  Given the nature of adaptation, I will not likely run into the limits of my triathlon abilities, particularly cycling, for a few years. 

I'd like to qualify for and participate in the Ironman world championships in Kona, HI.  It's a great daydream, and a heck of a motivator.  But I can't bring myself there by sheer force of will.  Every time I run, bike, or swim, or do all three consecutively in a race, I'm "going to war with the army I have, not the army I want."   I cannot push myself farther along the imagined path towards a goal than I actually am.  I'll drive  myself into injury, guaranteed.  Further, I'll make myself, and those around me, miserable.  And there's no real way to anticipate the path anyway: It's always different than my internal model.

On the whole, I think that if you argue for your physical limitations, they're yours.  Approach them cautiously and introspectively, and you may very well be on the other side of them before you know it.

Taking a step back, though, I think that perspective is perhaps the most important point.  If this is as far as I get, as fit as I get, as fast as I get, then it's OK.  Better than that, it's been a blessing to be able to live so fully in this arena.  I have the paradoxical good fortune of working amidst ongoing tragedy, which makes the everyday blessings of my life that much more obvious.  If it all ended tomorrow and I never took another stroke, stride, or pedal, it would still have been amazing, and far more than others have had.

Best of luck. 

--Tom.

--
Thomas W. Quigley, MD FAAP
Assistant Professor of Anesthesiology
Division Chief, Pediatric Anesthesiology
University of Arizona Health Sciences Center

“You will always find those who think they know what is your duty better than you know it. It is easy in the world to live after the world's opinion; it is easy in solitude to live after our own; but the great man is he who in the midst of the crowd keeps with perfect sweetness the independence of solitude.”  -Ralph Waldo Emerson