The Next Steps

So now that the spasm was settling down, I was able to start to sit down for controlled periods of time, in order to get some spinal flexion back. I could also progress my rehab on to much more challenging exercises, and for the second and third weeks I was doing up to four hours of these exercises every day. This really wasn’t fun, but I was pretty motivated to achieve my goal of beating the doctor’s timescale of comeback. There were times where I didn’t want to do the rehab (it was insanely boring), but I forced myself to do it.

Exactly two weeks after my injury, I was allowed to do three very slow jogs over 30m. This might not seem like anything, but for me it felt like a huge breakthrough! Week three I was allowed to do some form of gym work, although not much at all. I also started to do slightly more structured running sessions, although no spikes as of yet. I was allowed to do 50% of my reps in spikes 4 weeks post-injury, and again this felt like a big breakthrough. Five weeks post-injury I was able to start doing some runs from a four-point start without blocks. Blocks were the last thing to be added in, coming 8 weeks post-injury. Nine weeks post injury; I competed in my race, running 10.39 seconds. To put this in perspective, it is only 0.01 seconds slower than I ran last year. In addition to this, it was in a very small competition, and I usually run my best times in big competitions when the adrenaline is flowing. So, all in all, I am fairly happy with how things have progressed.

So that is where I am now. I still cant do power cleans or squats, the two mainstays of my lifting programme. Instead, I have had to get creative with how I set up my lifting sessions. I can’t lift any weights off the floor, or take any large loads on my shoulders in order to protect my spine. One day I might be able to do these again, but for now I just have to accept my limitations!

The First Week

The first week post-injury was also fairly difficult. The first couple of days were focused on helping the disc settle down as much as we could. To achieve this, I wasn’t able to flex my spine at all (i.e. no sitting down), and couldn’t do any real exercise. I was able to do some very slight rehabilitation exercises, with the focus being at regaining control of the muscles in and around my core I also managed to get hold of some prescription painkillers which helped it all settle down.

Three days post-injury I went for an MRI scan, and I got the results the next day. The injury was diagnosed as a disc protrusion between the L4 and L5 vertebrae. This was the sight of my existing protrusion – however, it had got significantly worse. I was given a time frame of around 8-10 weeks until I was back to full fitness. Immediately, I formulated a goal to beat that timescale, and to facilitate this goal I entered myself in a competition nine weeks down the line.

The rest of the week was just treatment to get rid of the spasm, and rehabilitation exercises four times per day. Finally, at the end of the week, I had an epidural injection to settle down some of the spasm that myself and the physiotherapists couldn’t get rid of. For those of you that don’t know, an epidural is an injection into the dura that runs alongside the spinal column. It’s certainly an interesting experience, but it did really help settle down the muscle spasm, and I awoke the next day feeling much better.

I - Day

If you follow me on twitter, I am sure you are aware by now that I have suffered some sort of injury, as I have spent most of my time moaning about rehab. Some of you might be wondering what has happened to me; others wondering what I am doing to get better, and some of you might be thinking about how this might affect my training and competition performance. Well, over the course of a series of blogs, I will answer these questions.

Injuries are a part of sport, and a large number of athletes suffer one big injury at least (and hopefully only) once in their career. These injuries are career and possibly life-changing. They alter what you can do on a day-to-day basis both in training and life. I fully believe what happened to me is my “big” injury, so hopefully now that is out of the way. Ready? Here we go:

Background

In 2005, aged 18, I suffered a spinal injury which was diagnosed as a left sided SI joint strain. There was no x-ray or MRI to confirm this, it was just a working analysis. It is highly likely at this point that I also suffered some sort of lower spine disc bulge, but at a very low level. In 2007, I was suffering from intense muscle spasms in my back, which at some points got so bad I couldn’t get my hands to my knees. This was happening mid-season, and so to stop it I had a couple of injections, and had to stop doing blocks, which was a part of my race that needed work – as Imp sure you can believe, this was very frustrating for me. I had two MRIs that year – one before and one after the season. They showed a couple if disc bulges, at a fairly low level. So, due to this, I modified my training slightly, added in a whole host of back and abdominal strength exercises, took good care of my back, and, over time, suffered no symptoms at all. As far as I was concerned, that was the end of my back problems.

Day 0 – Injury

So now we move forward to March 4^th 2011, the first day of the European Indoor Championships, for which I hadn’t been selected. So, I was back into my first week of training, and I was in the gym. I had already done some push-press and hang cleans, and was feeling good. I was doing some deadlifts, at a very light weight of 140kgs, and as I was preparing for the third rep of my set. I locked in my back position, and prepared to begin my pull. As lifted the weight off the floor, I was aware of my back rounding ever so slightly. Straight away, I then had a really weird feeling, like something was moving backwards out of my spine, followed by a strong pain either side of my lower back, which immediately became a shooting pain across the whole of my back. I yelled out a few choice words, dropped the weight, and stood up, and which point my back completely locked up. Every muscle from my hamstring to the top of my ribcage had spasmed, in order to protect my spine. I made my way (slowly) to the physio room, and they set me up with an appointment for later in the day, gave me painkillers, and sent me to get a warm shower. The idea here s that the warm water would help my muscles to relax.

The shower was very hard work. Because my back had spasmed, I couldn’t get my shorts off, and it took me fully 5 minutes of hard work to get my socks off. As I stood in the shower, I was about 75% sure that my career was over, the pain was that bad. Getting out o the shower wasn’t much fun either, as I had to stand still to allow my shorts to dry, and spend another 5 minutes getting my socks back on.

The physio appointment didn’t go much better! This was about 3 hours post-injury now, and there really wasn’t much the physio could do for me. As I got off the physio bed, I then went into shock, because the pain was so bad. That was a weird feeling, as I went dizzy, lost my hearing, and couldn’t stop shaking. Anyway, my girlfriend came up to look after me, which was necessary as at this point I couldn’t even dress myself, and I tried to get some sleep that night, but I slept terribly as every time I dosed off I jolted awake because my back seemed to spasm.

Before I went to bed, I looked at myself in the mirror. I was in an horrific state. My stomach was distended as my core musculature had completely shut down. I had a very significant lurch in my spine (which I common in disc injuries), which caused my pelvis to be significantly outside of my body’s centreline.

Next time, we will look at my first week of rehab, and what I did during that time period.

mTOR, Muscle Growth and Supplements

In my time off from training, I like to spend a bit of time researching things that I hear little snippets of information here and there about. Driving home from a race once, I was listening to a podcast from Keith Baar, a molecular biologist. The podcast was primarily about mTOR and AMPK, what they do within the body, and how we can maximise their benefits. This got me interested, so I thought I would pull some papers off the internet, and see what else I could find. Suffice to say a lot of the technical details were well over my head, but hopefully I can simplify the basics of the mTOR pathway in this article, and how to get the most out of it.

Firstly, we should probably introduce the star of the show, the aforementioned mTOR pathway. mTOR stands for mammalian target of rapamycin, and it is the pathway through which muscle protein synthesis is activated. During and immediately after resistance training, various target proteins in the mTOR pathway are activated through a series of complex chemical reactions, the end effect of which is an increase of muscle protein synthesis for a period of up to 72 hours post-workout. This is the driving force behind muscular hypertrophy.

A large number of papers on this subject look at nutritional interventions, and their effects on this signalling pathway. In a 2009 paper, Hulmi et al. examined the effect on a whey protein supplement on muscle hypertrophy, with a specific eye on the mTOR signalling pathway. They had three groups – the whey protein group, placebo and control take part in a single resistance-training bout, followed by a further 21-week resistance exercise-training programme. They found that the ingestion of 15g of whey protein before and 15g after a resistance training session significantly increased signalling in the mTOR pathway, as well as prolonging this signalling relative to both placebo and control.

A second study by Dreyer et al. (2007) looked at the effect of an Essential Amino Acid (EAA) and carbohydrate (CHO) containing supplement on protein synthesis post exercise. Again, in this study there was a control group. The main finding from the study was that EAA+CHO ingestion enhanced mTOR signalling and increased muscle protein synthesis post-resistance exercise. There was a 41% increase in muscle protein synthesis in subjects not taking the EAA-CHO supplement, compared to a 145% increase in the supplement group. Possible mechanisms for thee results included that EAAs (and, in particular, Leucine) activate the mTOR pathway, and that activation of this pathway may also be through insulin stimulation (the result of CHO ingestion).

A review article by Blomstrand et al. (2006) looked into the effect of branched-chain amino acids (BCAAs) and their effect on protein synthesis following resistance exercise. They stated that although resistance exercise increased protein synthesis, it also increased protein degradation, and hence protein intake was important in order to provide a net protein gain. They speculated that the use of BCAAs post-exercise might increase protein synthesis via two pathways. The first was that an increase in amino-acid (AA) availability leads to an increase of AA uptake into muscle, which stimulates the rate of protein synthesis. The second theory was that a specific AA, or group of AAs, had a stimulatory effect on protein synthesis.

The final paper I read was one by Norton & Layman (2006) on Leucine and protein synthesis. They stated that Leucine had many important functions within the body, including being a constituent of protein, a regulator of protein synthesis, a modulator of the insulin signal cascade, and a stimulator of mTOR. The most interesting part of the review article was with regard to AMPK, which is activated when energy levels in the cell are low. AMPK appears to inhibit mTOR activity, so resistance training with low glycogen levels, or long, exhausting training sessions, appear to be negative.

So, what are the practical aspects of this? Well, to keep AMPK in check, it might not be a good idea to do heavy cardio work post-weights, or to have excessively long workouts. If you want to mix both, it might be a good idea to do a morning/evening split, with one session in the morning, and the other in evening. From a nutritional standpoint, it seems apparent that some sort of protein-carbohydrate mixture immediately after weight training work out is necessary. For me, I use Myprotein true whey (35g) along with somewhere between 15-30g of a simple carbohydrate, like dextrose. The amount differs according to how hard the session is. I also go one step further and add some Leucine to my protein shakes, as that seems to have special effects on its own, possibly by increasing insulin in a similar fashion to carbohydrates. An alternative to this might be to use MP’s EAA powder or tablets, or maybe even BCAA powder or tablets. Why not give it a go and see if you get any further benefits.

You can listen to Keith Baar’s podcast at:

http://coaching.uka.org.uk/audio/keith-baar-mtor-vs-ampk/

The articles I referenced are all available for free in full-text format. They are:

Blomstrand, E., Eliasson, J., Karlsson, H. & Kohnke, R. (2006) Branched chain amino acids activate key enzymes in protein synthesis after physical exercise. J Nutr. 136 269S-273S.

Dreyer, H., Drummond, M., Pennings, B., Fuijita, S., Glynn, E., Chinkes, D., Dhanani, S., Volpi, E. & Rasmussen, E. (2007) Leucine-Enriched essential amino acid and carbohydrate ingestion following resistance exercise enhances mTOR signalling and protein synthesis in human muscle. Am J Physiol Endocrinol Metab 294 E392-E400

Hulmi, J., Tannerstedt, J., Selanne, H., Kainulainen, H., Kovanen, V. & Mero, A. (2009) Resistance exercise with whey protein ingestion affects mTOR signalling pathway and myostatin in men. J Appl Physiol 106 1720- 1729.

Norton, N. & Layman, D. (2006) Leucine regulates translation initiation of protein synthesis in skeletal muscle after exercise. J Nutr. 136 533S-537S 

Dealing with Injury

If you play sport to any sort of competitive level, or do a decent amount of training, it is highly likely that at some point you are going to get injured. Whilst this is especially frustrating, it is part of sport. What is important is how you react to the injury, what you do about it, and how you come back. Below are some of my top tips.

1)    Being depressed doesn’t help.

The natural reaction to the frustrating nature of injury is to want to lock yourself in a room and just be depressed. But doing this does not achieve anything. Recognise now that you need to do something about it, and be proactive. In 2008, I tore my hamstring 6 weeks before the Trials. I could have accepted that my Olympic dream was over, or do something about it. I chose the later, and made the team.

2)    Knowledge is power

Learn everything about your injury. The key to getting better is improving recovery and doing corrective exercise – know how to do this. The key to not losing too much fitness is to exercise that don’t aggravate your injury but provide stimulus for fitness maintenance – find out what these are. The key to not getting injured again is to find out why the injury happened, and what you can do to correct this – find out what these factors are.

3)    Do ALL your rehab

Rehab is very boring, and very long. No one enjoys it. But it has to be done. Find some distraction techniques (music, TV) to take your mind off it. But whatever you do, make sure you get it done, as it is what is required to get better.

4)    Understand pain

Things are going to hurt. Depending on where your injury is depends on how much pain you are allowed to experience before you can stop. With a spinal disc injury, pain is generally avoided. With a hamstring injury, you are allowed a greater level of pain. It is important to recognise what I term “injury pain”, and pain that is allowed. When I was coming back from my 2008 hamstring tear, for my first race my hamstring really hurt. However, I knew that it was allowed to hurt at this level, so I could just ignore it and carry on.

5)    Be mentally strong

There are going to more set backs, and you are not going to achieve all your goals on your comeback. Staying positive and bouncing back is important.

6)    Make whatever sacrifices you need to in order to get back.

I don’t like needles, but to come back from injury I have had 12 injections into my hamstring. I’ve had an injection into my spine. I have had 36 acupuncture needles into my back. I did this because I knew that is what it took to make myself better. When I injured my spinal disc, I wasn’t allowed to sit down for two weeks – so I didn’t. Imagine what impact this has on your day-to-day life – but I made that sacrifice to get better.

7)    Injury Nutrition

As you wont be training quite as much, you might need to consume slightly less calories. Upping your fish oil intake may also be a good idea in order to reduce inflammation. MSM, glucosamine and chrondritin may help with degenerative joint and disc injury repair. Creatine may help attenuate muscle loss associated with injury. Higher protein levels may be required to help repair. Vitamins and minerals may also improve injury recovery. Attempting to boost testosterone and HGH through nutritional means should also improve recovery time.

So there you go. As I alluded to earlier, you are going to get injured. That’s a fact of sport. But how you deal with this injury, what you do to get back, and how you stop getting re-injured, all matter. It is important to do the right things, and hopefully this article will give you a better idea of what you can do.

Recovery - Too Much Of A Good Thing?

There is a lot of literature on various forms of recovery, and a great number of different modalities that can be used to recover. Perhaps most well known are the dreaded ice-baths, where athletes submerge themselves in very cold water (usually about 5 degrees Celsius) for a certain time period, in order to dampen inflammation post-training. Then there are also the new compression garments, which are supposed to help recovery. Recovery nutrition is also a big field, with the discussion of antioxidants (substances which “mop-up” free-radicals, preventing muscle damage) playing a large role.

I am very interested in recovery. But some emerging research has got me thinking. Can we be too recovered? Adaptation to training requires the body to put under a great deal of stress – how the body deals with this stress then causes adaptation. By prematurely removing or reducing this stress, do we alter the adaptation response? Recently, I have been encouraged by my support staff to avoid antioxidants around training, and to reduce the number of ice baths that I have during a heavy training cycle, in order to hopefully increase adaptation.

Don’t get me wrong; there is a time and a place for maximal recovery. During the competition, and pre-competition period, I will have a great number of post-training ice baths, increase my antioxidant consumption, and wear compression garments. But in general training, I am taking a step away from this. What are your thoughts on this, and what are your optimal recovery tips?

End Of The Indoors

So, its all over. In the end I was 0.01 seconds away from making the European Indoor team. The concept of that is difficult - 0.01 seconds is such a minute period of time! But there you go, sometimes things don't always go as planned!

There are plenty of positives to take from the indoors - my technique held up under the pressure of big races. Now I just have to add more speed onto that technique. I also feel like I got some of my killer instinct back, which was missing in 2010 - I feel much more race confident. I also feel like my top speed was very, very good.

I feel like I need to work on 0-30m, which again I guess is a positive, because without doing the indoor season, I wouldn't have known that.

Overall, I feel pretty good. On the face of it, it may seem silly that after my slowest 60m season for 5 years I should feel happy, but I feel like my top speed is better than ever, and 100m is about who has the best top speed, not who gets to top speed first (which the 60m is). So if I have to be 0.1 seconds to 60m to be 0.1 seconds quicker to 100m, I am happy to do that!