Injuries- Preventing and Dealing with them in a nutshell!
I think it’s pretty realistic to say that as runners we fall into one of these categories at all times:
1. Trying to prevent injury
2. Recovering/ coming back after an injury
3. Currently dealing with an injury
If you claim to never deal with any of these phases then you are either not a regular runner or you are probably not being honest. I do not say this to discourage anyone- it’s just a reality of running.
In this post I will list the main things I do to try to prevent injuries. I will also share some of my own personal injuries and how I’ve dealt with them through the years. Quick Disclaimer— I am not a doctor so please take this for whatever its worth. If you’ve been struggling with an injury my advice would be to see a doctor and/or physical therapist.
Obviously the best scenario is to not get injured in the first place. So… how can you prevent it? Most of us know what we should be doing. Do we follow all the rules? Probably not. The following are some guidelines I found from a Runner’s World article (RW). I modified it a little and here’s the gist of it:
We need to let our body rest in order to recover and rebuild. This will mean the occasional day off running. It can get very easy to get caught up in mileage and not missing a workout. I try not to look at it like I’m skipping a workout. I prefer the term “re-arranging my running schedule” to accommodate what my body needs. I think rest also applies to easy running days and recovery runs. We need those miles too. Every run can’t be further and faster. I love my easy run days and more of my runs fall into this category than any other.
|my daughter giving me a leg massage- her idea I promise!|
|Just some R and R with my favorite kiddos|
“Include rest days into your training plan by taking a complete break from training both physically and mentally. Get off your feet, rest your mind, rest your body for the day. I recommend training no more than two weeks consecutively without resting. Novice and/or masters athletes may require “off” days more frequently. Recovery weeks, typically less hours spent exercising or less miles trained, should be included every third to fifth week. Recovery days, easy non-intense training, should follow hard training days.” RW
2. Incorporate Recovery Techniques.
For me this includes massage (sometimes active release technique), foam rolling and occasional ice baths, as well as warm Epsom salt baths.
|compression socks are a must!|
“There are a number of ways to incorporate recovery into your routine. Biofoam rollers and massage sticks help sore, achy or stiff muscles recover from exercise. Watching movies, spending time with family, reading, listening to music or socializing with friends can all be effective relaxation strategies that allow you to disassociate from physical exercise and reduce tension while developing positive mood states of happiness and calmness.” RW
Enough said. Get your sleep! We need it. Plan ahead at night so you don’t have 2 hours worth of stuff to do once the kids go to bed.
“Essential for physiological growth and repair, routinely physically active individuals are encouraged to aspire for 8 to 9.5 hours of sleep each night. Cardiovascular performance can be compromised by up to 20 percent with sleep deprivation while reducing reaction time, the ability to process information and emotional stability. Naps are always icing on the cake.” RW
4. Consume Post-Exercise Fuel.
- Typically I walk in the door after a run and make my go-to protein smoothie. This is my routine at least 4-5 mornings a week. My recipe: 1 banana, 5-6 partially frozen strawberries, 1/2 cup blueberries, almost 1/2 cup almond or coconut milk, 1 Tablespoon chia seeds, 1 scoop protein powder- vanilla or chocolate. Blend and enjoy! I usually have enough for a big glass for me and a small cup for my oldest son. He loves it!
- If I am in a hurry and don’t have time for a smoothie I grab a banana but make plans for something else to eat within an hour. I cannot skip breakfast. I just can’t.
“The goal of post-exercise nutrition is to restore muscle and liver glycogen stores, improve hydration and repair muscle tissue. You should eat 15 to 30 minutes after exercise, preferably as soon as possible, when the muscles are most receptive to fuel. Muscle replenishment and tissue repair can be accelerated if you combine carbohydrates and protein together in a ratio of 4 to 1. Weigh yourself before and after exhaustive exercise to determine how much water you lost. Stay hydrated by consuming at least 24 ounces per pound of body weight lost within six hours after exercise. Performance begins to decrease after only a two percent loss in body water. Include electrolytes to eliminate the risk of hyponatremia if engaging in activity for more than four hours.” RW
5. Warm-up and Cool-down.
When I first started training to qualify for Boston during the summer and fall of 2009 I can honestly say I did not warmup or cool-down. If my Hal Higdon schedule called for 6 marathon pace miles I hit start on my watch and I took off… at my goal marathon pace. I knew I probably should warm up a little but who has time for that? At least that was my mentality. I looked at warming up or cooling down as optional. I couldn’t have been more wrong. Now I factor it into every single workout. My warm-up/ cool-down is never optional. It is a key ingredient in a successful workout. I know a good warm-up will help my body get ready to run the pace I need to run. I also know the cool-down will help me recover and let’s face it- these are easy miles! It’s my reward for going all out in my workout. Typically I run 2 easy miles before any hard effort workout session. (These warm-up miles range from 1.5-2.5 minutes per mile slower than my marathon pace.) I like to cool-down with 1.5-2 miles. These are as slow or slower than my warm-up miles.
|cooling down after a race with my son|
“A proper warmup is a key component to preparing the body for the demands of any training session or competition. Developing a pre-race warmup is unique to each individual. Performing a warmup will elevate heart rate, VO2, and increase blood flow to the connective tissue and local muscles to be trained. This in turn will raise muscle temperature and help decrease joint and muscle stiffness, therefore improving range of motion. Warm-up periods of five to 15 minutes are recommended with the effects lasting up to 45 minutes. After 45 minutes of inactivity, re-warming may be needed. On the other side of the coin, the recovery process and preparation for the next day’s training begins with a proper cooldown. Low-intensity aerobic exercise, such as aquatic-based training, light jogging or cycling, are effective cooldown activities for clearing lactic acid and lessening the severity of muscle soreness.” RW
6. Integrate Strength Training.
|Yes, unfortunately this was my attitude for a long time…|
In high school I was really into strength training but somewhere after college and after having kids I stopped. When I started getting into running again I did not make any time for strength training. (It was hard enough it seemed to even find the time to run.) After my stress fracture injury in 2011 I was reminded how important core strength is so that summer I started a very short and simple basic core routine . At the time my youngest was about 6 months old. It’s been three years now and I am still staying with it. I have modified it and changed it up a little over the years. I started with simple knee planks, girl push-ups, leg raises and some other ab exercises. Now I am doing various types of planks and change up the time. It took a while but I am now up to 100 (boy) push-ups and I vary the ab exercises. I do this about 5 days a week. Recently I’ve added in some low weight arm and shoulder exercises as well. Sometimes I need reminded that getting in a little strength training is better than a few extra junk miles.
|watching Netflix while planking makes it a little more bearable|
“Strength training is essential for preparing the body for the rigors of training and racing. It facilitates bone health and enhances injury resistance, including factors that contribute to overuse injuries. It can help bridge the metabolic power gap between swimming, biking and running by boosting lactate tolerance, as well as assist with delaying fatigue.” RW
7. Use Proper Equipment.
Wear the right shoes! Know what your feet need. I wear neutral shoes but I also need a little support so the Brooks Ravenna are perfect for me. I also wear Brooks Cadence for racing and speed work because it is a little more minimal but still has the support I need. If you aren’t sure what type of running shoe you need go to a running store with workers who know what they’re doing.
“Correct equipment minimizes unwanted stress. Running shoes should fit your gait pattern. The road will wear your shoes faster than running on trails. How to know if it’s time for a new pair? New shoes may be in order if the grooves on the outsoles are worn smooth, or the upper appears stretched causing the foot to slide off the midsole.” RW
8. Increase Mileage Slowly.
This is one lesson I learned the hard way. There were several things that may have contributed to my stress fracture in the spring of 2011 but rapid mileage increase was the number one problem! I was following a very aggressive plan so that I could run the Boston Marathon 3 months after giving birth (via c-section) and I increased mileage much too quickly. This led to a sacral stress fracture. Before my stress fracture I thought things like that only happened to other runners.
Note that January (2011) has zero mileage. I took off this month when I had my baby. I started up again mid February and went CRAZY in March. Do you know what happens when your mileage sky rockets (like mine did in March)? You get a stress fracture. I was diagnosed with a sacral stress fracture the week before the Boston Marathon.
“Increase annual training hours, or training volume, by ten percent or less. For example, if you ran 20 miles this week, your total mileage next week should not exceed 22 miles. If you are training according to time, for example, and your triathlon program called for 15 hours of training this week, it’s recommended training hours not exceed 16.5 hours the next week.” RW
9. Interval Train.
Change up your training. Don’t run the same pace for all your workouts. If you are trying to break 2 hours in a half marathon you shouldn’t do all your runs at a 9:00 minute pace. You will want some to be easy and much slower. You will want some to be faster so you can improve your VO2 Max. You need to run some race pace workouts but not every week and certainly not every day.
“Proper interval training can improve VO2 and anaerobic threshold. Intervals allow your body to adapt to and eventually race at greater speeds.” RW
DEALING WITH AN INJURY
So what do you do if you are dealing with an annoying pain that just won’t go away? It might be time to accept that yes, you are injured and it’s time to do something about it. Sometimes an injury is very obvious. With my stress fracture I knew I couldn’t run. There was not a doubt in my mind- I knew something was wrong. I’ve had other injuries that I have continued to run through. Some went away on their own while others lingered and I eventually took some time off running so they could heal.
Below is a little list of the main injuries I’ve had over the past several years. Maybe you’ve dealt with one of these before or maybe you are working through one of them right now. I am putting this out there because I want you to know that when you run may get injured at some point. It doesn’t need to be the end of the world. You can come back stronger than before the injury. I have continued to race and have run my best times- after these injuries.
- IT Band Syndrome– Dec. 1999. This was actually my first running injury ever. It happened in college my junior year after cross country season. I had decided along with some of my friends on my team to run a marathon as a bucket-list type of race. I had never run more than 12 miles at one time and although I was in great 5K shape I was NOT at all properly trained to run 26.2. (I finished in 3:45 but the last 10K was full of walking and 10+ minute miles.) Recovery Process: I spent a lot of time in the training room for massages and stim treatments from the physical trainers. Time: All in all it lasted about two-three months. This injury took place long before I had a running blog so I do not have a post to share about it.
- Sacral Stress Fracture– Mar. 2011. This is my most serious running injury to date and was caused to rapid increased mileage. I had also had a baby recently and was nursing- all of which could have contributed to the fracture. (Increased mileage was the biggest factor.) Recovery Process: Rest! 2 weeks of no physical activity. Then I tried swimming. Swimming actually aggravated my stress fracture area so I decided not to do that. I also tried biking which was even worse than swimming. The best cross training method I found was the elliptical. I built up from 30-60 minutes and the whole time envisioned my big comeback BQ marathon. About 6 weeks later I started walking. Once I could walk for 60 minutes without any pain I started to jog a little. It took a few weeks but I finally got to jogging more than walking and eventually to 100% jogging. A brief comeback blog post is here. Time: All in all 8-12 weeks (from starting to jog to fully jogging). I ran a half marathon 7 months after the injury and a marathon 9 months after the injury. It was closer to a year though before I really went a day without thinking about it. Often little things I did would make me feel the injured area.
- Patellar Tendonitis/ Bursitis- Mar. 2012. My knee pain started during the Little Rock Marathon. I love this race but LRM is not the easiest marathon course. I took off a full week after the marathon but then continued to train and run through the annoying pain for about six more weeks before I decided it was not going away unless I did something about it. Recovery Process: First, I went to physical therapist for the diagnosis. He also worked on the bursitis and tried to massage that area. I did the usual icing but I eventually decided to take a complete break from running. I took two weeks off and cross trained during this time. Then I ran again and still felt a lot of discomfort so I took another two weeks off running. During this time I did a lot of swimming and (stationary) biking. I built up to swimming two miles at the pool but mostly I did one mile. I did this about four days a week. At first it took me about 40 minutes to swim a mile but I started to improve. (Yes, I got really into timing my pool mileage. Hard to break some habits!) Time: All in all this injury lasted about 5 months. Only 5 weeks total were complete rest though. After my last two week stint off I slowly started running again and the annoying pain eventually just went away.
- Hip Pain- Mar. 2013. I picked up this little injury during the Little Rock Marathon in ’13. About halfway through the marathon my right hip started to hurt with every step down. It was bearable and I was not about to drop out of a marathon when I was in fourth place. Recovery Process: I knew as soon as I finished I was going to need to take at least a week off. When I did come back after that my hip hurt for another two weeks. During this time I had a few massages. I also got new training shoes (Brooks Ravennas) which I immediately loved. Time: All in all about 3 weeks.
- Leg Tendonitis– this is actually a reoccurring injury. It tends to pop up around peak mileage training week of almost every marathon training cycle. Then it goes away when I cut back my mileage days before the marathon. The worst it has ever been was before the Boston Marathon in 2013. Recovery Process: During the high mileage weeks I would ice almost daily, along with contrast therapy (rotate between hot and cold water). I also used KT tape. It really just went away with decreased mileage during the final taper week. Time: Typically lasts about a month.
Contrast therapy- rotate between hot and cold water
- Calf Strain– Oct. 2013. This injury came out of nowhere about two weeks before my fall marathon. After an easy run one morning I was doing some strides and suddenly my right calf cramped up and the tightness would not go away. Recovery Process: Fortunately I had a very mild strain. For a few days it hurt to even walk. I had a few massages, iced it, rested my leg and wore compression socks like it was going out of style. I tried running 3 days after the pull and I could still feel it so I started biking at the gym to continue some cardio. Biking did not hurt so I did this a few more days. One week after the first symptom I ran pain free. However the next day I felt it again. At this point my mileage was decreasing a lot anyway (final taper week) and I was able to run pain-free in Springfield.
stim treatment therapy (desperate times call for desperate measures) good old fashioned icing
- Plantar Fasciitis- Mar. 2014. This is actually a current issue I am dealing with and apparently I am going to have to be a little more aggressive with my treatment. I noticed the first signs a few days before the Germantown Half Marathon. My right heel actually hurt the last half of the race but after a day off felt much better. My main goal was getting through the Poconos Marathon in May. My heel really only hurt first thing in the morning and after a long run. It was very manageable so I didn’t see a reason to stop training all together. It did not bother me at all during my marathon. For the past few weeks the heel pain has returned and is a little stronger. I’ve cut down my mileage but it is not enough. I am planning to race the Fast Firecracker in 10 days and after that I’m taking a little break for a few weeks. I still plan to swim and bike but I know I can’t continue to run through this forever. So that’s the plan! For now I’m rolling it on an ice bottle a few times a day, stretching, and massaging it.
COMING BACK AFTER AN INJURY
So you have been injured and are wondering if you are ready to come back? My best advice is to take it slow and LISTEN TO YOUR BODY. This is harder to do than you think because after an injury we are at our weakest mentally. Our confidence as an athlete has been crushed and we are very uncertain about our future and our ability. Every little ache or twinge immediately puts us in a dark downward spiral of depression. Sometimes it’s hard to know whether to push through the pain to get back in shape or to listen to every ache and play it safe. I can’t give you an answer. It depends on the extent of the injury. If the injury that caused you to stop running still hurts when you try to come back then you probably need to take a little more time off. You want to feel pain-free before you start back again. It’s also a good idea to ease back into it slowly. Try running every 2-3 days for a week or two (or more) before adding in back to back days. It may take months to build up to the mileage you were at before the injury. That’s ok. It’s hard but try not to compare yourself to others or even your past non-injured self. I remember a 10K I ran one summer after having taken off over a month of running (when I was trying to recover from patellar tendonitis). My time was much slower than the time I’d run just 3 months earlier. I just had to remind myself to be glad I was at least running again. Months later I ran an even faster 10K than my PR but it just took patience and some hard training. Hang in there!
16 thoughts on “Injuries- Preventing and Dealing with them in a nutshell!”
Great post! I know that I’m really really bad about proper warm up and cool downs. I am a firm believer in strength training and also training for imbalances. I think runners have a few additional issues that they need to focus on with resistance training. ITB was my first. I’ve dealt with “runners” knee, plantar fasciitis (switched feet even, oh and tore my left one during one LR half), most recent was posterior tibial tendonitis. Good times! As for PF – what really started to help mine was stretching and strengthening calves and rolling the holy crap out of them! Also, a golf ball became my BFF for really getting in deep to the feet. I keep one in my purse 😉
Thanks for the PF tips! I am looking forward to the day that I actually do not think about it!!
I’ve never worn compression socks but I want to try them. I’ve noticed you don’t always where them when you are running. How do you decide when to wear them?
I wear them in colder weather running- usually 40’s and below. Over 50 degrees and I know I will get way too hot in them!
Great post!!!! Holy cow…100 push ups…superwoman!!!! I am totally that I ain’t got time for strength training person, but I am trying to change. I have added planks and push ups (I am no where near where you are…I am at 1:40 plank, and 2-3 sets of 15 push ups) to my routine and also form drills and some strength drills.
I have been really fotunate as far as injuries go! I had runners knee several years ago but was able to rehab it with a week or so off and drills. I think I got that one from increasing mileage to quickly and going from doing most of my runs inside to doing them outside. Right now I feel like I am flirting with the line of IT band. I have been trying to rehab this little niggle without taking much time off. Just when I think it is totally gone, then I feel a little something again. I have never had a real sports massage (just the ones that my husband gives me), but would LOVE one! These are some great tips Tia!
Thanks Jen! It’s taken me a long time to build up to 100 and even that is about 5 days per week. I need a day off every 3 days or so. It sounds like you are doing great with your routine so stick with what works and when you feel ready to move up you’ll know. My big thing is making it manageable. I knew that if I tried to do too much it would get overwhelming and I would never want to stick with it.
I hope your IT band starts to feel better soon. I am so over this PF!
Thanks for posting this. I’ve been pretty discouraged with my injury lately and getting back to where I was… not that I was very fast before. I guess I’ve been fortunate that this is the first thing that’s taken me out for more than a couple days since 2010 (I had severe anemia), so 4 years injury free is a good little streak. Still, I’m cross training and looking forward to getting back out there.
While I was cross training before and trying to prevent injuries… I guess the thought of it never really crossed my mind so much. Now, I’m going to be a lot more paranoid. I think it’s hard when you’re injured, to know where to draw the line, to know what’s “discomfort” and what’s “pain”. I’m sure I will err way on the side of caution for awhile now, but I also think it’ll make me a lot more thankful for every run, even the ones that are easy, slow, recovery, etc… just because I know what it’s like to not be able to run for so long!
4 years is a great streak! 🙂 I tend to race a lot and in 2012-2013 did 8 marathons. None were casual or to have fun. They were all out which is pretty demanding on my body. I am definitely cutting back marathons- only 1-2 a year from now on I think!
Injuries definitely add a sense of paranoia and you are smart to ere on the side of caution. I hope you start feeling recovered soon! 🙂
This is such a good post. Injuries get all of us at some stage of our running life and once you’ve had one you’ll do anything not to have to go through that again. I’m a big believer in rest. Rest is when all the improvements that you’re training for happen. It’s as important as the hard work.
You’ve go that right Char. I tend to go non-stoop and race like CRAZY so I know I need to switch things up soon. Only one more race I promise! Lol!
Such a timely post…I’ve had some pain in my toe for a few weeks. My PT thinks it’s not a stress fracture but it still hurts and I’m so depressed. Thinking it’s time to take a few weeks off.
On another note..I ran a 1 mile race this weekend and was chatting with a girl at the start who said she had run the Go! Mile. I said that I had read about it on your blog and she said she knew you! Small world (I did not run my mile as fast as you though)!
Yes, it is! 🙂 Where was your 1 mi race? They are not nearly as common as other racing distances but I think they are starting to get a little more popular. The summer is definitely a great time to have them since it is so HOT!
It was in San Antonio. They are not easy to find at all, but I’m glad I did it. It’s nice to have a mile time to set my longer distance paces off of!
I’ve had PF twice. The first time it lasted about a year, and the second almost that long. The first time I stopped running for about 6 weeks, and then started back. I found that it didn’t really matter whether I ran or didn’t run as to whether it would feel better, but I did have to stop marathon training during my second time around with it. It is frustrating. I agree with Heather’s comment above about the golf ball. I have done everything under the sun for PF, and I think the golf ball and a night splint are what helped me the most. Now that my symptoms are gone, I am very vigilant about stretching, rolling, and rolling my foot on that golf ball for preventative maintenance. Hope it gets better soon!
For some reason I had the impression that you never get injured! It seems like you race so much without major problems. I guess the secret is just that you manage and recover from injuries like a pro. Thanks for taking the time to write this one up
Great post Tia! Very informative and its refreshing to read how you and those who have commented have dealt with injuries both physically and mentally. I am going to share this post for sure!
I have had PF twice. The second time was so severe I thought I had a calcaneal stress fracture and even paid a visit to Dr. Nix at Ortho Arkansas. I have since learned that chiropractic adjustments to the feet help cure and prevent PF. Now I get my feet adjusted along with my weekly chiropractic adjustment.
Speaking from personal experience, if any of your readers are struggling with constant injuries one after another then it’s time for them to take a serious look at their diet. As you know this was my own struggle: my poor diet was not sufficient to support the demands my training was putting on my body and as a result I stayed either sick or injured. I ended up taking off almost 3 months from running and didn’t even add elliptical until after 8 weeks. During this time I focused on getting healthy while making small changes to my diet and didn’t even think about running goals. I also switched to high quality pharmaceutical grade supplements to help fill any nutritional gaps. It’s taken longer than I thought to come back and I have had to just be really patient and forgiving of myself. While I still have a long way to go in getting my running back where it used to be, I feel better than I have in years!