Training: How to Avoid Overuse Injuries
Guest: Dr. David Geier – Orthopedic Surgery
Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. David Geier who
is Director of the MUSC Sports Medicine Center.
Dr. Geier, there is a small but important group of athletes, the really
elite athletes, who participate in triathlons and I would bet that they have
unique concerns and issues. What are
some of their special questions and issues?
David Geier: This is a unique group of
athletes that really pose challenges to a sports medicine physician. These are athletes that run many miles. They cycle many miles. They swim.
They put their bodies through very unique demands that the average
population doesn’t. So, they’re at risk
for a lot of different injuries, more overuse injuries than, say, your average
Linda Austin: In your opinion, are there
optimal training schedules, for example, numbers of rest days per week?
David Geier: I think it’s a little
tricky because people have different body shapes and abilities to recover from
injury, but I think there are some general principles that are good. I think, maybe not for the ultra elite
athlete, but, in general, maybe for the, so to speak, weekend warrior, a heavy
day of activity followed by a long day of rest is certainly appropriate. So, you alternate your routine one day with a
day off. I think cross training is very
important to prevent injury. So, instead
of, maybe, running six or seven days a week, you run three or four days a
week. But then you throw in a day of
cycling or swimming, or some other event, to make up for it. I think the longer distances you run, the
longer lengths of cycling you do, to a certain extent, you need longer periods
of rest for your body to recuperate.
Linda Austin: How about just the
cardiovascular aspect of exercise? You
mentioned doing cross training. That, I
would assume, allows your heart to continue to have a workout everyday but not
necessarily so much strain on your joints.
Is it optimal to workout your heart everyday?
David Geier: I think it is. What we recommend, as a minimum, to keep
people in shape, about three times a week for about 30 minutes. But if you can get up to five times a week, I
think that’s what’s thought to be doing really well and beneficial for the
patient. I don’t see much downside in
getting a good cardiovascular workout, an endurance workout, every day of the
week. My caution against that is some of
the wear and tear on the muscles and the joints. I think from the standpoint of injury prevention,
cross training is beneficial.
other advantage of cross training is somewhat less related to the medicine
side. It’s the interest side. I think it prevents burnout of training
programs. I think there are a lot of
runners that, after five or six years, finally give it up because that’s all
they’ve done five, six, seven days a week for many years. They just get tired. So, I think if you can throw in some
variation, not necessarily even different activities, like cycling or swimming,
but if you’re a runner, just vary what you do, maybe do a hill day one day,
maybe do a long day, maybe do a sprint session on the track. Try to vary your routine. I think it lessens the likelihood of overuse
injury, but it also keeps it fresh and exciting.
Linda Austin: You know, I am probably
reflecting my background as a psychiatrist, but also someone who has friends
who are very committed to their programs.
It can sometimes be hard to be on the receiving end of those programs
and to hear, too many times, well, gee, I
would love to get together with you for the weekend but that’s a training
weekend, or, that’s my skiing weekend. And, I would imagine, for family members,
that it can take a toll when you start feeling like you’re always playing
second fiddle to somebody’s training schedule.
David Geier: There’s, absolutely, a
concern, especially among the high level athletes, of exercise almost being an
addiction, that it consumes their life, that it’s the most important thing to
them. They work their schedules around
it with work and family, but then it takes precedence over everything else,
including injury, and that’s where I come in.
It becomes such a big deal that even if they’re hurt, they’re going to
keep working through it because they just cannot see the bigger picture and
cannot get away from it. And that creates
a whole host of issues, from an injury issue, to a relationship issue, like you
mentioned, to work issues. Sometimes
it’s difficult to identify those people until it’s really gotten to be a
Linda Austin: I’m thinking of the model
of alcoholism, that if a person starts to pay a price, whether it’s in work
productivity, social life, emotional life, then you start to think, gee, maybe there’s an addiction of some sort
going on here. Now, obviously, it’s
not an addiction in the way alcohol is an addiction, but it certainly can be
very detrimental to life, beyond a certain point.
David Geier: Yes. And I think there are probably other factors
involved. I think, especially with
runners, the endorphins that are released, the chemicals that make your body
really get an energized feeling, after a long run, if not addictive, may be
something potentially very pleasurable, very satisfying, to the runner that
keeps them doing it. Certainly, you have
to have someone with an objective view of things to maybe take a look at
it. I don’t know if I’d call it an
addiction, but it’s certainly a worrisome proposition.
Linda Austin: Is it going too far to say
that, if you’re asking yourself the question, am I exercising too much, the answer is probably yes?
David Geier: Yeah, if you have to worry
that you’re exercising too much, maybe so.
There are certainly questions, at least from an injury standpoint, if
you’re not having any injury, can you really be training too much? I think if you keep the principles we talked
about, cross training, varying your routine, you can do many hours of training
and be completely healthy. But, no,
absolutely, when in doubt, you certainly need to be careful about overtraining.
Linda Austin: What is the level of
exercise for which we actually have evidence, good data, to suggest that it
helps promote health throughout the lifespan?
David Geier: I think the accepted
guidelines of what’s really supposed to help keep you in good shape, medically,
with regards to your weight and everything else, is thought to be 30 minutes of
cardiovascular, aerobic, exercise three to five days per week. I don’t see, within reason, any real problem
in increasing past that, but I think, certainly, three days a week is probably
Linda Austin: And, I gather, we don’t
really have any evidence that doing a whole lot more than that necessarily
helps. We just don’t know.
David Geier: I think there’s still a lot
of research to be done. But I think
there are other types of physical activity that are thought to be beneficial as
well, namely, strength training. I think
there’s certainly a role for that, that doesn’t really fit in the 30 minutes,
three to five days a week model.
Strength training is thought to be very beneficial even for older
patients, for women after menopause, for example. I think there’s a role for strength
training. I think there’s a very
significant role for flexibility training and stretching. I think they’re all important components of a
big exercise picture.
Linda Austin: Dr. Geier, thank you very
David Geier: Thank you.
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