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Apr 16

Running Injuries – why????

So, you have an injury. Injuries fall into two main categories – an acute injury such as from a fall or specific incident like an ankle sprain, and over use injuries – usually a ‘niggle’ that grows into something more longstanding.

We tend to see see acute injuries in people playing sporting games – football, netball, basketball, or as mentioned before, after a fall. There is obvious bruising, swelling, pain, trouble walking if it is a lower limb injury. In broad terms, management for this type of injury will include following the RICER principle for the first 48 hours:
Rest the area, using crutches or a sling if you need to
Ice the area using frozen peas in a plastic bag and wrapped in a damp chux style cloth to protect your skin. You can use the ice for 20 minutes on and 20-40 minutes off, as many times as you can in that first 48 hours. It can make a huge difference.
Compress the area using a bandage or splint – it will need to be specific to the area injured.
Elevate the injured body part as much as possible so that there is less pooling of fluid near the injury. This can reduce swelling and therefore speed the total healing and recovery time.
Referral – see someone to diagnose the injury. An XRay is required if you can’t weight bear, or if there are other reasons to suspect a fractured bone. For most soft tissue injuries, your physio is probably the best placed referrer to diagnose and start a management plan. Your GP is of most use if you need a referral for XRay or other imaging, for medication or for referral to a specialist such as an orthopaedic surgeon. Your physio can tell you if you should see your GP, or a specialist.

Just as important in the first 48 hours is to do no HARM:
No Heat
No Alcohol
No Running or vigorous exercise
No Massage

All of these things will tend to promote bleeding in the area, and in those first 48 hours we are trying to give the blood vessels that have been damaged in the injury event a chance to heal and for bleeding to stop. After this time, the more significant job of healing and repair can get underway. This is where specific advice is important, as most injuries heal better (quicker, with less bulky scar tissue and less loss of range of motion, function and strength) with gentle, graded movement and exercise, balancing the activity with rest. This can’t be delivered in a generic blog post!

Overuse injuries are what we see more of with our population of runners. Many of the runners we see are no longer ‘young’, many have recently returned to running after many years not running (or any exercise), some are brand new to the sport, some have recently increased the distances they are training or planning to compete over. Over use injuries often come about when we have something just a little ‘off’ – it may be that there is a subtle muscle imbalance with one muscle tighter than it should be, or another that is weaker than it should be. It may be a glaring imbalance. It may be caused by an old injury that either wasn’t rehabilitated completely, or has left you with an stiffer joint in the long term. These small differences are usually of little consequence in a short period of time when we have sedentary lifestyles or exercise only very moderately or infrequently, but as we increase the volume of the loads that we are training, these small differences can make a big difference. Weak muscles cause joints to move unevenly, as do tight muscles. Poor balance or joint position sense will contribute to excessive movements, putting joints and support structures at risk.

‘Under recovery’ is a related phenomenon, whereby we don’t quite recover from one training session to the next, that fatigue building, causing movement patterns and coordination to deteriorate, and leaving us susceptible to injury, or even more chronic disease patterns like thyroid dysfunction.

Most of these overuse injuries – ITBS (Iliotibial band syndrome), Runner’s knee, Achilles tendinopathy (previously known as tendonitis), Plantar Fasciopathy (previously known as fasciitis), shin splints, stress fractures, hip pain, low back pain – have a few contributing factors to them. It has often taken quite a long time to get to the point that you are ‘injured’ and full rehabilitation will often take a while. But your physio can monitor your progress with you, getting you back to full strength, or even better than you were before!

It will start with a period of relative rest. If you have a major competition goal in mind, we can work closely with you – sometimes the treatment and training regime required to get you to the start and finish line will be different to the plan to get you to 100% recovered. It will depend on the timing. So long as you understand what you need to do, and what your goals are – discuss this with your physio regularly, ask for more or better explanation if you don’t understand, and try to be patient. All too often, we want a problem fixed right now, today, even though we have been carrying it for 6 months!

Every person presents with their own combination of weaknesses, tightness, strengths, training history, training load, training age, choice of shoes and running surfaces. And all of these things are taken into account when we are both diagnosing and managing your problem.

Somethings for you to be aware of in terms of managing your own training load and trying to avoid an overuse injury are:

Be aware of all the stressors in your life. Training causes physical stress. For many of us, it is an important mental health release. But that is the difference between an easy 5-10k run, maybe with some faster sections to feel the wind in your hair, and a 30k training run because that’s what the (generic) program says you need to do this weekend. Never mind that the dog has to go to the vet, one kid has to get to basketball, another to piano lessons, you have a major deadline at work to get finished off, and someone was sick during the night so you ended up with 3 hours of broken sleep. There is a *load* on your system. Your body releases cortisol and adrenaline in response to stress, whether physical or mental. Cortisol will delay healing, repair and recovery. Don’t make it worse – look to make it better. If you are training for a marathon (and you have done one before), 3x 30km runs in your 4 month lead up is enough long runs. Perhaps not if you are looking to win the race, but if you are not a professional athlete, and you have many other roles to juggle, then this is enough. When you are feeling the load under other stress factors, it is ok to skip a training session, or substitute it for a lower impact activity. Meditate, do yoga, go for a walk, do some deep breathing, listen to a short relaxation podcast. Get your head on top of some of the other factors, and that will give your body a chance to recover adequately, with a calmer hormonal profile.

Get enough rest! Sleep is critically important. We all need different amounts of total sleep, and some people claim to do well on very little sleep, but when you are training hard, you need the down time and the sleep time as well.

Eat well. Fuel your body with good, high nutrient food. If you eat a variety of real food with minimal processing (food that your grandma or great grandmother would recognise), you will have little need for supplements.

Your training age. This refers to how many years you have been training regularly for. I have been running for 3 years – my training age is 3. I am still relatively new to it, so I am still working out what works best for me with this sort of training. Having tried running 3 times per week for nearly 2 years, I then moved up to 5 times per week. At first, it seemed really good. I felt very strong. But I had a few more niggly sore spots, that over the course of that year, developed into a hip issue and then a foot issue. As part of my rehab (which will include little running for a while and no competing), I will aim to run only 3x per week in the longer term. I think, at this stage, that may be where my optimal program lies, as a busy working mother.

Your general health. We all recognise that as we get older. we don’t ‘bounce’ like we used to. A late night takes a bit more of a toll on our functioning for the next day or two, let alone those silly dance moves on the dance floor that seemed like a good idea at the time. A tight muscle that used to feel all stretched out and fine a few hours later takes longer, and doesn’t seem to just go away when you ignore it. If you have medical conditions such as diabetes or heart disease in some form, these will slow your healing time from each training session, so you will need to give yourself more time. Perhaps that 7 day program should be stretched out, so that you work on a 10 day cycle instead? If you are a woman, your cycle can effect how you respond to load, how you recover and how you react (no kidding, right?). The person who wrote the program you are following might not have factored it in, your coach might not have either, so it is up to you to pay attention – more on that in a post to come!

The aim of all of our training is to stress our body to stimulate it to change, to adapt to the loads we are placing on it. To create more mitochondria in muscle cells so we can run for longer, to burn more calories to create a leaner physique, to be more efficient in every movement, to run further, faster. We need to work closely with our own body, and your physio can work closely with you, and your coach and trainer if required, so you can achieve your goals.