Cross training when injured

[Michelle Lowry]

I've been injured with an SI joint inflammation, upper hamstring injury.  I've dabbled with rest, but ran about once a week to test it, it started to get better, so I started running some, and it flared up.  So I haven't run since last Monday.  I was told by Dr. Brady its ok to cross train, just so long it doesn't aggravate the injury, and he didn't expect biking, the elliptical, stair stepping, or pool running to aggravate it.  I've gotten serious about the cross training now that I have been 7 days without any running and will likely have at least two more weeks at least.  I want to cross train my heart out, but I biked Saturday for 2 hours (longest ride before that was just over one hour) and today I pool ran 90 minutes (longest pool run before was 50 minutes I think, but that was after 45 minutes on elliptical/bike).  After both of these workouts I am getting mild but troubling soreness in my SI joint.  So are there times when your body needs total rest to heal, or is this just a case of me ramping up the cross training too quickly.  Leave it to me to exacerbate my injury with CROSSTRAINING.  I feel like I am in a catch 22.  Must I lose ALL of my fitness to heal?  I'm getting steroids tomorrow and seeing another doctor, Dr. McLaine, so perhaps I should take a total veg while the drugs do their magic?  Is there another way?  Hand cycling?  Running on my hands?

[Sasha Pachev]

Swimming?

[Dallen]

I'm with Sasha. Try swimming.

I would steer very far away from any cross training that causes any related soreness. I my opinion 2 weeks with no exercise is better than a 4 week recovery with cross training.

Alternatively you could try cutting way down on the volume. You may not lose that much fitness doing 30 minute workouts for a little while.

[David S]

My first question is what caused the SI joint inflamation?  I suggest seeing a sports injury Dr. and/or Physical Therapist who deals with sport's injuries, esp. running.  You want to find out what is going on and correct it so that it does not repeat itself.  This is a great time to do some specific strenghting exercises, stretching, foam roller, etc.  I almost gave up running last year because of some unbearable pain around my lower knee. I had to get a ride back on a long run once, and had to walk back on several other occasions. I tried running through it for about 6 months but finally went to a running specialist PT.  With some unbelivably simple streching exercise the pain went away and has never returned. Turns out that there was a nerve acting up - I would have never been able to "run" through this pain or corrected it by time off, etc.  It would have just come back. 

Any time you have an injury that makes you stop running you need to find out why the injury occurred if the cause is not obvious, such as overuse, etc.

Swimming is great for cross training - just go easy and say 20 - 30 minutes or so.  Dallen is right - do you want to be doing this 4 weeks from now or just take it really easy for 2 weeks?  Just because it is cross-training does not mean that you should go out and hit it as hard as you can.  The purpose is to get the blood flowing to the injured area to help in recovery and to keep some aerobic fitness while you are away from running.

[Paul Petersen]

A few thoughts...

For one thing, you have to ramp up cross training just like you would running: slowly and deliberately. Doing 2 hrs biking or 90 minutes elliptical may have been overzealous. Try starting a 30 minutes, and adding 10 minutes every other day until you hit 60 minutes. Or progress even slower. But you definitely cannot dive in head-first (as you've experienced). Like anything else, you can overuse muscles while cross training.

Regarding being "forced" to take time off: yes, it could happen. Sometimes you must lose it all in order to gain the world. Back in '05 and again in '06 I was having SI and knee problems, same boat as you. I tried to elliptical my way through it, but it did not get any better; it probably got worse. I had to quit most aerobic training for about 5 months before I was completely better. When I started back up, it was after months of core work and physical therapy, and I was pretty much starting from scratch. But within 9 months I had set huge P.R.'s in the half marathon and the full marathon...so it certainly wasn't a deal-killer. Staying injured is the only true deal-killer.

Thirdly, the drugs should probably help, but they are almost never a panacea. I've had multiple cortisone shots, taken prednisone, and enough NSAIDs give a buffalo an ulcer, but they never solved a muscle weakness or a biomechanical issue. However, I've taken multi-week physical therapy sessions on four different occasions for different problems, and PT is 4-for-4. I absolutely HATED every minute of it (so tedious), but the slow fix seems to be the best fix, at least for me. Faster-acting treatments, such as drugs, chiropractic, and massage work very well in tandem with PT: a great complement and they make each other better. Consider PT, if your insurance will cover it.

Finally, I like what Dallen says. Swimming is great, especially with back/SI issues. Time off can be better. You should be able to find the amount of X-training you can do without aggravating things. Maybe it is 20 minutes, maybe 30 minutes. Also, it's great to work on core strength during times of injury. For me, it's never aggravated anything, and it's actually really good for SI problems. Plus, even if you lose fitness, you'll have great abs. A new and improved core will help with your running once you come back too.

[Michelle Lowry]

Paul, I did ramp up but not as gradually as I should have.  I've definitely learned a lesson there.  Most of my ab workouts rely on my stabilizing on an exercise ball, and Dr. Brady said my SI joint is unstable, so that stresses it.  He said crunches are ok.  I guess I could do those.  BTW, I also plan on going to a trainer to get running-specific core and strengthening routines once I'm a bit more recovered.

So is physical therapy where you do repetitive motions prescribed by a PT to strengthen what is weak?  I looked up the definition of physical therapy and it seems to include a lot of different types of treatments.

http://physicaltherapy.about.com/od/typesofphysicaltherapy/a/whatistherapy.htm

David, I have gone to a couple of doctors.  They have said no strength training for the problem area yet, but that will come I am sure.  I have gotten PT, but the advice to go to a running specialist PT is good, and I am in the process of finding one.

[Paul Petersen]

I could see how that would be with a stability ball. My favorite ab workouts are just variations of the plank. They really get deep, and would not bother the SI. You can do variations of this facing down, up, and to the side. You can also lift up one leg or arm for additional discomfort challenge.

http://bodyweightworkout.wordpress.com/2007/04/14/the-plank-a-core-exercise/

My experiences with PT all came at the IHC sports medicine facility. In all cases, I was given a prescription for it by a doctor. A typical one-hour session would begin with application of heat to the injured area, followed by ultrasound. Then I would warm up my muscles on a stationary bike for about 10 minutes. Then a series strengthening exercises that involve anything from therabands, to traditional weight machines, to rolling office chairs. A lot of PT's can also do chiropractic manipulation, massage, or taping, depending on their expertise. But I would say it focuses on 1) strengthening; and 2) stretching through various methods. In all cases, during the first visit the PT would give me about a 30 minute evaluation to "diagnose" my exact weakness(es) and imbalances by a lot of poking and prodding. Then they would devise a program to directly address those issues. There is always a lot of homework every night (stretching, theraband, etc.), but it gave me something to do when not running. It was also nice having someone overseeing my recovery program besides...me. Outside accountability to a professional is good.

[seesuerun]

I wouldn't call pilates cross training but they sure helped me when I got hurt in the same area. I started with very basic pilates and stopped any time there was a sharp pain. I would recommend a DVD like pilates for dummies from the library instead of a class where you don't feel like you have to follow along with the more advanced and painful moves. Our injury might have been caused for different reasons though so discard all of this if you feel any pain whatsoever while doing them.

[Dan Dickey]

Michelle
Any update on your injury....what helped ? what didn't ?

I am coming through the same problem......hyper-mobile SI joint, although with Hamstring issues.
MY PT prrscribed an SI Belt....seems to have helped a bunch.....and as was mentioned before...a lot of Plank oriented exercises.
Dan