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Workload, Fatigue Management, and Pain - Part 2
If you haven’t read part one of the series, click the hyperlink here. If you’re caught up, let's dive into the specifics of what we last discussed.
The Balancing Act
Throwing and Training
One thing is for certain, you’re not going to throw harder if you don’t actually try to throw harder. Sometimes for an athlete, this means building a better engine in the weight room in order for them to produce more force and sometimes they are physically well trained and need to spend more time cleaning things up on the throwing side.
Throwing hard is stressful. Getting big, strong, and powerful in the weight room is stressful. And one has to take precedent over the other. Trying to turn the dial up on both sides will more than likely send that acute workload beyond the threshold.
In best practice, you want to have a system in place that allows you to balance the throwing and the training program in a way that as one side demands more of an athlete’s training economy, the other reduces demand.
However, pain isn’t predictable and no matter how much we would like to have it down to a science, we can’t currently measure what an athlete’s threshold is or how close they are to crossing it. Which is why having a comprehensive strategy is necessary in order to mitigate and navigate any bumps in the road.
Consolidating Stressors and Recovery
A primary strategy for attempting to manage workload is by consolidating stressors and respecting recovery days. Athletes in-gym often work off a 3-Day training plan where their primary throwing and training stresses are consolidated into the same days with the remaining 4 days being strictly recovery days. We need high levels of stress to drive adaptation, and we need adequate time for the body to recover in order to balance out their acute workload over the course of a given week and keep them at a recoverable volume. We often see that athletes who like to get in “extra work” these days, are the ones who end up having issues down the line.
Volume, Intensity, Order and Fatigue
Additionally, there are several other variables to manipulate when managing the training economy. First and foremost is the order of stressors. A general rule of thumb is to place highly coordinated tasks first in the session, which in our environment is throwing and hitting. These tasks are significantly impaired in the state of fatigue and should always precede the weightroom if performed consecutively. After that you want to follow up with high CNS demand tasks such as jumps, sprints, or max effort lifting followed by less demanding accessory lifts and energy systems development.
Volume and Intensity are the other big variables we monitor. You simply cannot train hard every day. Even when consolidating stress and providing plenty of recovery, some training days have to be less demanding while others are designed to send it. This is particularly important on the throwing side, which is where utilizing Pulse allows us to keep an eye on an athlete's throwing intensity and ensure they are sticking to the prescribed intensity levels.
Oftentimes we will find a loss of range of motion, a nerve irritation, or weakness in an inflamed tissue as the outcome of any workload spikes that needs to be addressed first. If pain persists, adjusting volume and intensity is where we try to live as PT’s and modification of either variable, whether overall or in a specific movement pattern, usually allows us to reduce the acute workload enough to allow the body’s recovery process to do its job. But sometimes, we find the athlete has nothing demonstrably wrong with them on assessment, and that the mental thought processes around their pain are playing a large role. Addressing that then becomes our intervention strategy.
Bouncing Back
In the cases of acute injury to the degree the training plan is significantly modified, we take a few steps in order to get an athlete back as soon as possible. First, modifying their program to remove aggravating activities. This is where we will work with throwing trainers and the strength staff to modify the training plan accordingly. Examples of this may mean shifting an athlete to a low-intensity throwing schedule for a brief period if the shoulder is irritated, removing spinal loading and promoting stability for a painful back, or decreasing sets on their accessory work if they have consistently been dragging and they aren’t recovering well. Once we see some baseline indicators like pain-free range of motion come back online, we move on to re-introducing those stresses at low intensities and lower volumes. Depending on the severity, this may mean long-duration isometrics or using lighter weight and reteaching any faulty movement patterns. Once an athlete can tolerate those activities, volume is layered on first before we turn the intensity dial up again, all the while monitoring their response.
When to Shut Down
Surprisingly, athletes aren’t here to see us amazing PTs, they’re here to train. So, finely tuning the right variables in order to help them still train as much as possible plays a big factor in keeping the ball rolling for athletes. However, we occasionally have to shut an athlete down if they aren’t responding to our modifications. If after several adjustments in workload an athlete isn’t getting better and hasn’t returned to their normal training program, it’s likely best to refer out for full medical evaluation.
Conclusion
There is some finesse associated with managing your athlete’s health and performance. Pain and injuries often happen due to a lack of looking at the full picture, especially in younger populations who are often being managed by several independent coaches. That’s why having a multi-disciplined team with shared understanding is a huge advantage in our facility. In the case you have less access to PT or other medical services, we hope these guidelines are helpful in appropriately responding to the complaints your athletes might approach you with. Of course, if you feel that an issue is beyond your scope or understanding, don’t hesitate to refer out.