This has been my worst year of running. I injured my ankle twice and have twice needed to take significant time off to recover. The first injury was a sprained ankle while hiking. The second was an overuse situation because I was hurrying to get back to marathon training, making up for lost time. How many times can I do this to myself before I start listening to my body? What am I doing wrong that is leading to these injuries? After losing seven weeks and a marathon entry fee to injury this year and learning some very difficult lessons, I think it’s time to share my experiences and knowledge regarding injury prevention and recovery from mild injuries. Before we begin, I want to make it clear that I am in no way a physician, and this information is simply my set of guidelines for my personal running life. If you have a major injury or emergency, obviously get medical help. And as I’ll discuss later in this post, a professional should always be consulted when it comes to preparation and recovery.
RICE: First things first, RICE. I’m not talking about organic brown rice for your diet (although, it is pretty great). I’m talking Rest, Ice, Compression, Elevation. Of these components, I don’t think anything is more important than rest. If you have an overuse injury, in particular, stay off your feet. As runners, we want to get back out there as soon as possible and work through injuries, if we can. It can be hard to determine when to stay put and when to get back to it. I prefer to err on the side of caution these days. Too many times I’ve gone out quickly after an injury, just to hobble home dejected and frustrated. Ice can work wonders for many injuries. Ice serves multiple purposes by helping to reduce swelling and numbing an injury. While inflammation can be good for injuries, too much inflammation can prevent nutrients from getting to the injured area. Use an ice pack or a frozen bag of peas for up to 15 minutes on an injury. Toss the ice back in the freezer for 45 minutes before using it again to prevent frostbite. Compression is the wild card here. There are those who advocate letting an injured area swell to brace the limb from movement to aid in healing. In my experience, I prefer to use compression to reduce swelling and encourage blood to flow to and from the area easily. I use an elastic bandage or wrap. Elevation is also important. Try to elevate the injury to the level of your heart, or slightly higher. This allows more blood to flow to the area and to remove any damaged tissue that could be lingering. I tend to stack pillows on my couch and recline as comfortably as possible. Use this as a good excuse to relax and catch up on Netflix.
If you don’t notice injury improvement in a week after you begin the RICE routine, seek a healthcare professional’s advice.
Time Off: It is difficult to take time off. We don’t want to stop. Whether we fear a loss of momentum or a reduction in fitness, cutting back on exercise is not something we runners do well. Perhaps we feel like ‘slackers’ for not moving. Maybe our inner voice is screaming that we’ll never be ready for that marathon now. Whatever the reason, it’s important to come to terms with time off from running. There are still things one can do to stay fit. During my time off, I focused on various exercises I had been neglecting. Upper body and core work became a daily routine. While I wasn’t trying to gain upper body mass or do anything to risk my recovery, I found it rewarding to move every day and retain fitness and confidence. I felt it important to address ‘time off’ separately from the ‘Rest’ in the RICE routine. Sometimes we need days to recover fully, sometimes weeks, even months. The important thing is that we do recover fully. Rushing back out the door to another injury will only land us back in the RICE routine all over again.
Physical Therapy: Some of you are rolling your eyes. I used to be just like you. But after three weeks of inaction and getting tired of sitting around waiting to heal, I got proactive. I scheduled an appointment with a physical therapist who is a runner. To me, it was important that my PT understand runners and what makes us tick. From the start, physical therapy was difficult. My PT put me through a battery of tests, pokes, and prods to determine my injury, the severity, my weaknesses and strengths. In addition, I provided my injury history, current running workload and race goals for the near future. In my first couple of visits, I was assigned homework: a workout routine aimed at strengthening and stretching to relieve my injury. In following weeks, I was assigned additional routines, based on my progress. I was also cleared for slow, short runs. Time went by, I received gait analysis on a treadmill and all sorts of other strength reviews. My progress in a short time astounded me. All this time, I had errors in my stride. One of my hips was dipping. I wasn’t extending my legs fully behind me. My hamstrings were weak. I never engaged my glutes. The laundry list went on and on. Not only were these issues causing lingering pains and injuries, they were making me an inefficient runner. Eventually, we came to discover that the crossover angle of my right ankle was overly aggressive and was putting extensive pressure on the ankle. I started extending my arms further behine me, engaging my glutes and stretching my legs out fully when I ran. This allowed my hips to rotate properly and straightened out my crossover angle. Problem solved! These days, I still regularly return to my PT for evaluation and improvements. We’ve moved on to posture and core strength as ways to improve my overall power and balance.
Oh, and foam rolling. I roll after every run now, before my post-run stretching and cool-down. My recovery time, especially after long runs and even tough hikes, has been reduced exponentially.
Core Strength: This might seem like a no-brainer to veteran athletes and anyone who has ever had a coach, but I feel like most runners I know avoid anything that isn’t running. Since I started working on my core, I’ve noticed that I have more balance and confidence, particularly on trails. Things like bridges, planks, mountain climbers and squats can strengthen muscles from the chest to the knees. While core strength can help prevent injuries in the long run by improving strength, flexibility, and form, a quick internet search can dig up a core routine that works safely to accommodate those who have already sustained an injury. For me, I was able to work around my ankle and still maintain fitness and gain strength without compromising my ankle recovery.
Know Your Limits: Overworking ourselves with mileage, hill repeats, interval sprints or any other aggressive activity is the easiest way to find ourselves injured. I was running five days per week before my injury. I have since recognized that four days is plenty for me. I cross-train twice per week and take a full rest day as well. Cross-training is imperative as it allows us to strengthen additional muscle sets. Whether you enjoy rock climbing, kayaking, cycling, swimming, or weight training, get out there and break up your routine a little bit. If you can run seven days a week with no problem, great. Good for you. Humans like me need recovery time and the sooner we realize it, the better our running lives will be. We all like to dream of bigger and better things. We all want to maintain our fitness into old age. If we don’t take the time to recover and enjoy other activities, we may as well say goodbye to running as we get older. Figure out what works for you and don’t lie to yourself. If your body is screaming after your fourth day of 10k hill repeats in a row, it’s time to rest. And don’t forget to follow the 10% rule when you’re building mileage. If you did 10 miles this week, do 11 miles next week, and so on. Building up mileage too quickly is a rookie mistake that leads to miserable injuries and setbacks.
This is a short list of what works for me and what doesn’t. So many other things factor in: foot strike, shoes, stride, illness, weather, and much, much more. I’ll try to address some of those items in future posts. But for now, I encourage all of you to find your limits. Test them, but understand the consequences if you push too far. Get healthy, stay healthy. Here’s to hitting all of our remaining race goals for 2015.