Principles of Recovery
The annual incidence of injury in steadily 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 a complex 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 becomes 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.
There is some indication
that those who are naturally extremely flat footed, have high
arches, have a difference in leg length, are bow legged or knock
kneed are more susceptible to injury. The mechanics of
the skeletal system may limit the amount of training tolerated. Some
of these conditions may be improved with the use of a good running
shoe, orthotics (custom foot supports), strengthening exercises,
braces, or in extreme cases surgery. Chi Running puts together an excellent program to help improve running form and fluidity of motion.
- 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. 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 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.
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.
- 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.
- 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. See Return to
Running.
- 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. See Return to Running
- 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. 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. 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 choose from.
- Strengthening. Several studies have been published over the past five years that
have demonstrated the benefits of strengthening for treating running injuries. Unfortunately, the emphasis in treating runner's has 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, abdominals, calves and quadriceps. Gluteal strengthening appears to be especially beneficial for runner's knee and IT band syndrome. Research has shown that performing as few as ten repetitions (at a maximal level) one time per week can result in significant strength gains. 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.
Massage: he 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 controlled 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. However, I
do realize that sometimes they can be helpful in the earlier phase
if symptoms are more severe. An anti-inflammatory cream
may help reduce the pain and inflammation without the complication
of gastro-intestinal problems . ProZ is a new product
that contains ibuprofen as well as a blend of homeopathic remedies.
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 sane 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 and competition check out Peak Perfomance's publications below.
Sleep: Sleep may be your body's
best opportunity to rebuild itself. Ensure you are getting
sufficient sleep for your needs.
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