If any of the warning signs for impending injury appear, take action immediately to minimize the damage, and begin self-treatment right away. Here’s where most runners mess up—they wait for the injury to heal on its own by stopping training and hoping things will work out ok. The injury usually settles down with complete rest, but there is a 50% chance it will recur again. Leaving an injury to heal itself can result in a mass of scar tissue building up in the affected area, causing problems later. Follow this recovery plan instead.
Self-Management of Your Running Injury
1. Rest! DO NOT RACE.
2. Ice the area for 10–15 minutes, several times per day (minimum 2–3 times) for the first 3 days. Never apply heat to a new injury.
3. Compress the area firmly with a bandage (but not tight enough to stop blood flow to the area).
4. Elevate the area when you sleep, above the level of your heart. Reducing the blood flow to the area minimizes inflammation and swelling.
5. Stretch the affected area gently if there is no pain.
Even if the injury is not severe enough for you to stop running, you still must modify your training. Here’s how:
By doing these steps, there’s a good chance your injury will turn around within a week or two, so you can gradually begin to increase your runs. This is where you must develop a sense for your limits by listening closely to what your body is telling you. If your injury starts getting sore around 3 miles, then keep your run to 2 miles, for example. You alone can determine how much running is safely within your limits.
A good indicator that you’re recovering from your injury is how the affected area feels in the morning. If there is no pain then or during your training efforts, you can slowly build your running back to where you were. However, if it’s stiff and sore, you may have to take the next step.
Still Not Getting Better?
If, after a few days or a week, your pain and swelling have still not receded with these therapeutic measures, it’s time to visit your sports medicine physician. The doctor will diagnose your injury, and advise you on whether you need to stop running and take anti-inflammatory medications. Your physician may also determine whether you need physiotherapy treatment.
Physiotherapists have seen your injury before in hundreds of other limping runners, so listen closely to their advice, and when they prescribe home exercises for you, do them. Following an in-home program will help turn your injury around very quickly. Your physio will also perform some other magic on your injury with various modalities including ice, heat, electric stimulation, ultrasound, massage, and mobilization exercises.
Another specialist to consider visiting is a podiatrist, just in case you need an orthotic for foot support and to address any biomechanical idiosyncrasies in your gait.
You also need to be aware that feelings of hopelessness and frustration may overcome you with enforced time off from running. Often runners will completely stop all exercise. This practice is highly counterproductive—stopping training completely causes a dramatic reduction in VO2 max. (your ability to process oxygen) and will therefore cost you many weeks of slogging to regain lost fitness.
But take heart, because many research studies have found that reducing training shows almost no reduction in fitness for periods of 1–15 weeks, if your training is done the right way. One study found that when intensity of training remains unchanged, VO2 max is maintained for 15 weeks, even when frequency and duration of training are reduced by as much as 2/3.
Other studies show that when frequency and duration of training are kept constant and intensity is reduced by 1/3 or 2/3, VO2 max is significantly reduced. What this all means is that you can train fewer days per week, with shorter sessions—and as long as you train hard—you won’t lose any fitness.
Clearly if you’ve been instructed not to run you’re going to have to make some choices about other types of cardio-respiratory exercise you can do. This is a good time to do some cross training. Try swimming or walking, or some of the non-impact equipment in your local fitness club, such as the elliptical trainer, stationary bike, or rowing machine. While trying these other exercises, monitor your pain levels to make sure they are not aggravating the injury. If you feel pain, try a different activity.
Remember, to maintain your fitness you need to exercise at a high intensity, so aim to get your heart rate above 80% of your estimated maximal heart rate. This is difficult with stationary cycling as you’ll most likely suffer from localized muscle fatigue in your legs before you can get your heart rate up close to your normal running heart rate. This is ok, and to be expected. You’ll still get a great workout from cycling.
You can continue with your strength-training program while injured as long as you avoid exercising the affected area. And if you haven’t done any resistance training previously, this would be a great time to start strengthening the rest of your body. If you don’t use your muscles, they will get weaker and resist repair.
Mistakes to Avoid When Returning to Running
A common mistake is rushing back to your training program and trying to make up for missed runs. Never try to catch up on lost training days, as it is likely to aggravate the injury again.
Something important to remember when back on the comeback trail is that your body is composed of many different systems, all integrated at different levels. Ideally they act as a smoothly functioning unit, but when you are deconditioned or injured, and starting up again, some systems are more out of condition than others.
For example, you may notice your respiratory system (breathing) returns to condition faster than your muscular system (leg muscles). Here, you need to be patient and wait until the slowest adapting systems catch up with the faster adjusting ones.
Rehab is an important part of coming back from an injury. But one mistake and you’re back on the injury list, chomping at the bit to get back out on the roads. Listen to your body and adjust workouts accordingly. Pain sends a clear message that our tissue has temporarily reached its limit. Ignoring this message inevitably ends in re-injury, so heed the messages your body is sending and take it slow.
Bingham, J, 2003. Marathoning for Mortals. St. Martin’s Press.
Glover, B and S. 1999. The Competitive Runner’s Handbook. Penguin Books.
Neitz, K. 2008. Runner’s World Guide to Road Racing. Macmillan Paperbacks.
Tiidus, P. (Editor), 2008. Skeletal Muscle Damage and Repair. Human Kinetics Publishers, Champaign, Illinois.
Roy Stevenson has a master’s degree in exercise physiology and coaching from Ohio University. He teaches exercise science at Seattle University in Washington State and has coached hundreds of serious and recreational runners and triathletes in the Seattle area.