When Canada's Olympic athletes prepare to dig in their oars, power down the track or execute a gravity-defying manoeuvre on the uneven bars, many may start with a silent prayer: "Please, God, don't let me get injured."
Pushing their bodies to the limits of physical endurance, competitors are all too aware they could pull a hamstring, sprain an ankle or worse — no matter how finely tuned their bodies have become in the months of training leading up to the Games.
"Injuries are unfortunately an inevitable part of physical performance," concedes Dr. Penny Werthner, a sports psychologist at the University of Ottawa who works with the national canoe-kayak team and diver Emilie Heymans.
And while most athletes gunning for Olympic medals are reluctant to speak about it publicly, many are likely nursing sore muscles and joints and keeping tabs on other not-quite-perfectly healed injuries as they prepare for the London Games.
"I think every athlete who reaches any kind of high-performance role at the World and Olympic level has probably had several serious injuries as a result of hard training, breaking something or pulling muscles," says Werthner.
"I think if you talk to any athlete they would talk about the year they missed or that half a year they missed or struggled back."
Kyle Shewfelt is a case in point.
The Calgary gymnast captured the gold medal in floor exercises at the 2004 Olympics, but 11 months before the 2008 Games, he broke both upper tibias after a mistimed landing on the vault at a World Cup event.
Surgery and months of intense rehab, followed by hard training, allowed Shewfelt to compete at Beijing, though his performance couldn't match pre-injury levels. But even before shattering those shin bones, he was no stranger to serious injury.
In spring 2004, he severely bruised the main bone in his ankle and wasn't able to resume practising his tumbling routines until about a month before the Athens Games.
"Advil was my best friend," Shewfelt quips about one of the brands of ibuprofen, an over-the-counter anti-inflammatory and painkiller commonly used by athletes to ease sore muscles, joints and tendons.
"When you're a gymnast, you really are dealing with an injury every day, that's kind of the reality of it. There's always something that hurts," he says. "And I think many that are competing at the Olympic Games are on a heavy dose of anti-inflammatories. But it's just par for the course."
Dr. Linda Thyer, team physician for Canada's track and field squad, says the goal before London is to deal with potential performance-limiting injuries as quickly and effectively as possible.
"When they're training hard, they're always pushing that limit, going to the edge of too much, where you get into that area of getting injured," says Thyer, a former world-class distance runner who practises family medicine in Vancouver.
"So there are a lot of techniques that many people use around the world that athletes will use to try to improve their recovery between training (sessions) and also reduce the chance of injury."
Those include massages to ease tight muscles and regular assessments by a chiropractor and physiotherapist to prevent muscle and joint imbalances that can result in harm. Immersing a painful limb or joint in an ice tub can bring down inflammation and speed recovery; taping a sprained ankle, for instance, can limit range of motion to prevent a more debilitating injury.
How athletes fuel their bodies also plays a key role in preventing injury, says Trent Stellingwerff, a Victoria exercise physiologist and sports nutritionist who works with Canada's rowers and triathletes.
"There's a lot that nutrition can do, where you think about the number of training bouts throughout the whole year, in allowing that muscle and that human to recover better and therefore not be as predisposed to injury," says Stellingwerff, whose wife Hilary will run the 1,500-metre event in London.
He says athletes should focus on fresh foods like fruits and vegetables — especially vitamin- and polyphenol-rich berries and leafy greens — that can help reduce oxidative stress and inflammation.
"It's very interesting to look at the nutritional habits of, say, Kenyan and Ethiopian runners and Jamaican runners, because they eat so much from the salt of the earth," he says. "And the more we learn about nutrition, the more we realize that Mother Nature has a lot of things figured out and the anti-oxidant components of whole foods are way better than we could ever get with supplements."
Indeed, Thyer says competitors as a rule should avoid supplements because the industry is unregulated and "we're never sure what's on the label is what's in the bottle." Some supplements could contain banned substances that might leave athletes unwittingly running afoul of anti-doping rules.
Once competition begins, the heady excitement of participating in the world's premier sports extravaganza and intense pressure to perform can ratchet up the risk of injury.
Athletes who do suffer strains, sprains or any other musculoskeletal damage between heats, bouts or matches will have a roster of doctors and therapists ready with tape, icing devices and anti-inflammatory drugs to try to get them back on track.
"I hope that most of my work has been done and that I will have very little to do, as hopefully we'll have a very healthy team coming in," Thyer says of the track and field competitors she will oversee in London. "And it looks like that will be the case."
Yet there are a number of athletes in a variety of disciplines who are coming off injuries, which could affect their medal chances during the July 27-Aug. 12 Games.
Diver Alexandre Despatie of Laval, Que., struck his head on the springboard during training a month ago, opening up a 10-centimetre gash in his head and sustaining a concussion. The two-time silver medallist has resumed training and will compete in London. He's done it before: in April 2008, he broke a foot, yet finished second in the three-metre springboard in Beijing.
Cyclist Ryder Hesjedal of Victoria had to withdraw from the Tour de France earlier this month after suffering massive bruising on his hip and knee in a huge pile-up. He is back training and should be ready for the Olympics, his coach has said.
Edmonton triathlete Paula Findlay is still recovering from a nasty hip injury last summer that shut down her world No. 1-ranked 2011 season. While babying her hip with intensive physiotherapy, Findlay is training for London, but hasn't raced in 2012.
Still, dealing with injuries isn't just about physical recovery, but also about staying mentally strong, says Werthner, who teaches athletes to overcome stress using controlled breathing, biofeedback and other cognitive techniques.
"The reality is an athlete can be sitting in an ice bath or getting a massage and their brain can still be spinning about a million things," says the psychologist, adding that many competitors have trouble turning down energy-sapping thoughts so they can go into recovery mode.
The trick is knowing when to flip the switch, she says. "They've got to learn to turn it up and be ready to go and be very focused on the right things at the right time."
Given the pounding that elite athletes put their bodies through, it's not uncommon for them to end up competing while in pain, says Shewfelt. But he believes "going into warrior mode" and focusing on their overriding purpose can help them block out all but the worst physical distress.
"When you have a reason and when you feel the Olympics is pulling you and you have this goal to be your absolute best, and you can visualize what that looks like and you can feel it and you can just see it, then pain really does subside.
"There's nothing more powerful than a goal to push an athlete beyond their point of comfort."