Case Study: Rehabbing an injured Para-Triathlete
Rhys Jones has been working with Optimize Fitness for several years in a journey leading, hopefully, to selection for the Commonwealth and Olympic Games in para-triathlon. He has an eyesight condition called cone dystrophy which means he is a visually impaired athlete and competes with a guide, on a tandem in the bike stage and tethered during the swim and run sections. He was tapering for a selection race in August 2019 when he completely snapped the patella tendon in his left knee with surgery the following week.
The surgeon stated that few ever get back into running after such an injury and there was no chance of getting back to elite performance levels. Never say never. On the 8th March 2020, 7 months later, Rhys came 2nd in the ETU Para Duathlon Championships in Punta Umbria in Spain.
This is the story of how he did it.
Immediately after being released by the Surgeon, a few weeks after surgery, Rhys started weight training to build muscle mass, strength and movement back into the injured leg using partial ranges of movement, adapted exercises and soft tissue work in a partnership between Optimize Fitness and Elite Physio (http://www.elitephysio.co.uk/ ). The advantages for Rhys of having a support team focussed on his recovery included that he worked to a personalised programme and could move from one stage of the rehab process to the next as soon as he achieved an outcome, he didn’t have to wait weeks for appointments. Weeks later, Rhys had gained sufficient strength in his injured leg to start walking on trails and be able to ramp up cycling and swim training.
By early winter, Rhys was running and starting to look forward to competing but there were some significant milestones to achieve. His injured leg had still much less muscle mass than the other, was weaker and less functional. S&C sessions were focussed on hypertrophy (building muscle mass) to reduce asymmetry but still with reduced range of movement and loads. Exercises included major lower body strength lifts like Back Squats, Hex Bar Deadlifts from blocks, eccentric hamstring work and a range of push and pull for the upper body such as pull ups and TRX.
Once minimum levels of movement and strength were achieved, monitoring started using the Push Band and Jump Mat to identify strength and power characteristics, some of the parameters used to test and monitor performance included jump height, flight time, ground contact time, reactive strength index, stiffness and power in Watts and were linked to gait characteristics like stride length on the treadmill and force and power on the Watt bike. As Rhys was in the system before the injury, we had pre-injury data and video footage to compare to.
In January, Rhys was running regularly and in full training in the swim and bike. The decision was made to take running up to the next level and he started reps, gradually building up pace and targeting VO2 and Lactate Threshold. By late winter, the Push Band was now used to monitor performance lifts in the Gym, Rhys had to reach a minimum velocity in every lift and sessions were cut when speed slowed, keeping fatigue to a minimum.
The injured leg was now functioning well, and full-scale training started. But monitoring of right and left legs started to reveal that asymmetry has started to reverse, the injured leg was out-performing the non-injured leg in many metrics including RSI, stiffness, ground contact time, jump height and flight time. However, statistical analysis of the results also showed that the injured leg had more variability than the other, so we knew that movement patterns were inconsistent still and had to be monitored carefully. S&C was ramped up towards max strength and light power, squat and deadlift loads were increased, and reps reduced with low level plyos being introduced but with a focus on reduced eccentric load.
Rhys had a brilliant race in the ETU event and came 2nd but then lockdown happened. Rhys decided to step back on the intense work and build a bigger base, experimenting with the 80: 20 approach. To monitor these bigger volumes, remote monitoring was brought in using App technology with Rhys using his smartphone to video the tests and email the results over for analysis on a weekly basis. The tests produced data on RSI, jump height, flight time, ground contact time, stiffness, drive index and step index and these showed continued asymmetry with the ‘injured’ left being a better performer than the right. Working with Elite Physio identified functional weakness and stiff movement in the right, and this has been improved by changing the S&C plan to include targeted isometric work. Loaded Hex Bar jumps were reintroduced as they are a great way of developing power in the jump and eccentric control in the landing, using the Power Band to ensure that all lifts were above the 1m/s benchmark.