Principles of Recovery

The annual incidence of injury in regularly training recreational runners is estimated to range between 37 and 56%. Unfortunately, for those of us who enjoy running, the likelihood of getting injured is quite high. Running injuries are often an interaction of several factors; however, an understanding of a few principles can help you more effectively manage an injury and prevent future injury.

 

 

Self Evaluation: It is essential to have an understanding of why runners get injured. If you don’t know why you developed an injury it is more difficult to treat it and also more difficult to prevent an injury in the future. The following are common reasons runners get injured:

  • Too much, too fast. The human body has an amazing capacity to adapt to increased loads (whether that is distance or intensity), this is what allows us to improve. Unfortunately, each person has a limit as to how much training the body can adapt to and how quickly it can adapt to that higher level. When we exceed the level that our body is able to adapt to then each training session can become destructive and injury follows.
  • Cumulative stress. Just as increasing the volume or intensity of training can exceed the limit of the body to recover; prolonged training, without distinct periods of rest, can also lead to injury.
  • Biomechanics. You don’t have to watch many runners to realize there is a lot of variability in running styles and the way our bodies are formed. Some of you may recall when men with flat feet were not allowed to join the military. Flat feet where thought to be a deformity that would lead to injury. Further research conducted by the military actually found that those with high arches were more apt to develop injuries. Runners who are naturally extremely flat footed, have high arches, have a difference in leg length, are bow legged or knock kneed may be more susceptible to injury. Your body mechanics may limit the amount of training your body will tolerate. Some of these conditions may be improved with the use of strengthening exercises, good running shoes, Save Up To 56% OFF & Get FREE Shipping Today! braces, orthotics (custom foot supports) or in extreme cases surgery. Running form can be improved with practice. For a simple but effective approach try LARS.
  • Training surface. The terrain you train on may contribute to an injury. Running downhill tends to cause more strain on the knees and lower back. Running uphill may overstress the Achilles tendon. Angled roads substantially alter running mechanics. Reapeated laps on a track place uneven strain on the legs. Trail running decreases impact but may result in unanticipated twists or sprains. Sidewalks are safe and level but the stiffness is far greater than asphalt, meaning your body gets to absorb that extra force.
  • Shoes. In a recent study of runners in British Columbia, shoe age was significantly related to injury. The optimal time to retire a running shoe is unknown. However, the older the shoe the higher the risk of injury. Your shoe is the mediator for all of the above factors. If you have great biomechanics and running form you may not need new shoes as frequently. If you have to run on sidewalks or have high arches you may want to consider replacing shoes more frequently. Specialty running stores are an invaluable resource for finding the right shoe. Chain stores will not have staff that can fit you appropriately. If you do not have a specialty running store close by, a helpful website that can take some of the confusion out of selecting a shoe is roadrunnersports.com.
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PRICES: Apply the principles of sports medicine that create this acronym.

  • Protection. The area that is injured may need protection or support. Plantar fasciitis, or heel pain, heals more quickly when supported. This can be from an over the counter arch support or an orthotic (custom foot support).
  • Rest. Rest is a word that makes many runners cringe. Rest does not necessarily mean that you have to stop exercising. Often, you will be better off continuing to exercise. However, you may need to supplement with cross training. Different grades of injuries require a different degree of rest.
    1. Grade 1 Symptoms are experienced primarily while running and you can run with only mild to moderate discomfort.Your symptoms are not severe enough that you limp or anyone else would think that you are limping. The pain is no worse after your run. This type of injury is usually best treated by continuing to run and perhaps decrease distance or intensity slightly. You may want to consider cross training for more vigorous workouts (as long as you do not feel the symptoms during or after training). Initiate treatment that is specific to your condition. Injury Identifier
    2. Grade 2 Pain is moderate and may ease after you are warmed up, or pain begins after a certain amount or intensity of running (symptoms may worsen after two miles or when running at six minute per mile pace). Your pain is usually worse after the run and you may have a slight limp. Limit your running distance or intensity to what you can do without hurting after the exercise session and supplement your running with a type of cross training that is pain free. Initiate treatment that is specific to your condition. Injury Identifier See Return to Running.
    3. Grade 3 The pain is getting worse, it is moderate to severe and others can tell that you are limping before, during or after a run. You need to be off of your feet if you want to train! Get in the pool or on a bike so you can stay in shape and let your body heal. Initiate treatment that is specific to your condition. Injury Identifier See Return to Running
    4. Grade 4 You are now wearing a cast and probably in need of an anti-depressant (I've been there). Someone in town has an arm cycle or Upper Body Ergometer, work out a deal to be able to train on their machine a few days per week. You could also do upper body and core strengthening circuit training - but it has to be pain free and non weight bearing. See Return to Running
  • Ice. A runner's best friend! A patient once told me if you're not icing, you're not training. I would rather not have to ice at all but I appreciate his zeal to keep the aches and pains under control. Ice can help stop the inflammation process (similar to an anti-inflammatory medication) and also numbs the nerves, which blocks the pain (temporarily). Ice application should last around fifteen minutes. I recommend a thin wet towel as the only barrier between the ice and skin. Several applications can be applied throughout the day depending on how sore you are. Ice massage is another great form of icing. Take an ice cube, or frozen cube from a paper cup and rub it back and forth over the injured area. At first it will feel insanely cold, then it begins to burn and finally after about five minutes you are good and numb at which point you are done.
  • Compression. This principle works great for a swollen ankle. See Horse Shoe Compression for a picture of this technique.   A compression strap is also helpful for patellar tendonitis.   A patellar tendon” strap applies pressure to the tendon and often improves symptoms.   Compressive knee sleeves or braces may be helpful in cases of Runner’s knee.
  • Elevation. A swollen joint (sprained knee or ankle) will recover more quickly if it is elevated. Elevation helps to reduce swelling which inhibits muscle function.
  • Stretching. There is some recent evidence that stretching an injured hamstring in the traditional approach may not be the best approach to recovery. A diagnol stretch improved healing time and reoccurence. See hamstring strain. Another review of studies conducted on stretching as a method to prevent injuries concluded that there is not good evidence to endorse or to discontinue stretching to prevent injury.Although the effects of stretching are not fully known, you don't have to talk to many runners to find out that gently stretching an injured area, as well as other tight muscles, can accelerate your recovery. You will probably get the best results by stretching after you exercise. If you are injured, try to get two stretching sessions in each day. To improve the flexibility of a tight muscle, hold the stretch for thirty seconds or more and repeat three times. If you are using stretching as a general warm up or to gently stretch the tender area, then a shorter stretch perhaps five to ten seconds repeated five times will work better for you. The DVD The Injured Runner - A Balanced Solution contains a stretching section with 26 different stretches you can select from for your target areas. If you prefer a specifically designed routine Vinyasa Yoga for runners is your best bet. Balanced Solution DVD
  • Strengthening. Recent research has made substantial breakthroughs in the understanding of strength and running injuries. Unfortunately, the emphasis in treating runners has primarily been flexibility. While flexibility is important, much more can be done to speed recovery and prevent future injury. Strengthening exercises for runners should emphasize movements that are similar to running and target the muscles involved in running: the hamstrings, hip abductors, lumbar extensors, gluteals, abominals, calves and quadriceps. Gluteal strengthening appears to be especially beneficial for runner's knee and IT band syndrome. The DVD The Injured Runner – A Balanced Solution presents the most specific program available for runners and is based on the most recent research available. Kettlebell Training for runners is also an excellent program specifically designed for runners with the unique benefit of using kettlebells to increase the dynamic nature of strength training. Kettlebell training is best if you are on the recovering side of an injury, want to prevent injury or improve performance.

Massage: The benefits of massage are gaining wider acceptance. I prefer to hold off on massage for the first three days following a specific injury, unless you want to go for a light massage. After three days, a deeper massage, working the area around the injury vigorously and the direct area moderately is the approach I use. If you are working with general tightness, stiffness or a chronic issue then go deep.

 

Anti-inflammatory: I prefer to avoid the use of anti-inflammatory medications. Runner's are often highly motivated and may over stress an injury if symptoms are masked by the use of these medications. Additionally, risk of serious gastro-intestinal problems is estimated at 1 in 1,000. Given the common use of these medications I prefer to be cautious.

For joint swelling a few days of anti-inflammatories could give you a boost toward recovery as long as you are not continuing to train. If you have an injury effecting a bone (like a stress fracture) there is some evidence that anti-inflammatories may delay healing.

 

sports nutrition guidebook

Nutrition: Some runners have gotten away with horrendous diets for a while. In the long run (no pun intended), a disciplined adherence to a balanced diet is probably the most healthful approach. There will always be trends in nutrition advocating particular vitamins, minerals or enzymes. A more sensible approach would be to take a high quality multi-vitamin with minerals and eat a balanced diet. Ladies may want to consider a product with iron (if this is an issue for you, discuss it with your physician). For an excellent guide to nutrition check out Nancy Clark's Sports Nutrition Guidebook.

 

Sleep: Sleep may be your body's best opportunity to rebuild itself. Ensure you are getting sufficient sleep for your needs.