Recovery and injury case study – Scott’s sacrum

Throughout this recovery series we’ve talked about the importance of balancing training load with adequate recovery to optimise performance and reduce risk of injury. Today we’ll look a case study of what can happen if you’re ‘under-recovered’ from top runner Scott Newton. Now Scott isn’t just an athlete he’s also an excellent physio with a wealth of experience treating runners and one of our recommended clinicians. His injury demonstrates how, even with detailed knowledge of running injury it’s easy to miss something and pick up an injury, I know I’ve certainly done it! For more from Scott follow him on Twitter via @scottnewton1981 and check out his website – londonrunningphysio.com.

Scott Newton: Top physio and 2:40 marathon runner

In April of last year, I sustained a stress fracture of my sacral ala;

My repeat MRI scan with the healing fracture line circled in red

It seemed to come out of the blue, but looking back at why this had happened, there were some key contributing factors.

Firstly, they weren’t the usual suspects (such as spikes in training, a crazy-calorie restricted diet, or the addition of HIT class). Instead, the reasons were more subtle, and I had to check back carefully to see where I had gone wrong.

One way to do this is to measure your ‘acute:chronic’ workload ratio. The international Olympic Committee recon we should be doing this. It’s a way of recording your ‘training load’ – which is made up of external training (mileage/runs per week) and internal training (things like heart rate and perceived exertion). An overtrained runner is likely to report a higher perceived exertion for a particular run, compared with when they are not overtrained. It’s a useful way of spotting early trends in how your body responds to the training. If you want to geek out on stats, have a go at using these tools for athlete monitoring from @adam89sullivan at progressiveathleticperformance.com.

Studies show that monitoring your training in this way can tell you where the sweet spot is, and helps to avoid injury. This is illustrated very nicely in the graph below taken from Tim Gabbetts’ work which suggests that a ‘sweet spot’ for reduced injury risk exists for acute:chronic workload ratio (ACWR) and is 0.8 to 1.3;

To find out more read our blog on athlete monitoring or download our free athlete monitoring tool by clicking the image below;

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My ACWR was around 1.2, within this so called ‘sweet spot’. Delving into my training data showed I hadn’t really over-trained, if anything I’d under-recovered…

…I realise now the big issue was that I was sleep deprived, having just become a Dad for the first time. I was trying to keep up with my ‘usual’ schedule on about 4 hours sleep per night! Being a parent is stressful, and the addition of a heavy cortisol load, didn’t do my physiology any favours.

In short, I broke.

You may have read in Tom’s recent blog on the importance of sleep for recovery that lack of sleep has been found to increase injury risk and may be a factor in bone stress injuries such as my sacral stress fracture. Finestone and Milgrom (2008) found that sleep deprivation influenced bone reabsorption in military recruits. They recommended a minimum of 6 hours sleep per night which, alongside reducing training load, lead to a 60% reduction in stress fracture incidence.

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What changes have I made after my injury?

I recognise the importance of getting enough sleep, simply if my baby daughter sleeps better, I sleep better, so if she’s having a fractious week, I will sleep in the spare room.

I also compress my working hours to make them more efficient, this allows me to fit my training into my day, and not having to trudge out tired at 10pm at night. For example, I can get my track session done in an hour and fifteen minutes by Boris Biking to the track at Mile End and not take a huge amount of work time out. Rescheduling late night or early morning runs to prevent them from effecting sleep is a simple method to improve recovery.

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I’ve learned to ‘let go’ more at the weekends in terms of checking in on work, and I’m being ‘selfish’ with my all-important long runs and hill sessions. They get booking priority. If I find myself very tired, I’m giving myself permission to back off on the intensity, and add an extra rest day, where needed. In addition, I’m focusing more on strength training, making sure I’m putting in a couple of decent sessions of barbell squats, deadlifts, lifting heavy plates, and abs and core work. I sneak in some ‘Dlux’ (a vitamin D easy to use spray), and Floradix (a tummy-friendly iron supplement), which I think most runners should consider using.

I’m hoping this combination of improving recovery through increasing sleep alongside monitoring external and internal training load will help me strike a better balance to reduce risk of injury in future. Adding strength training and appropriate supplements should further improve my bone health and capacity to manage the demands of my training.

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