Injuries - Just Can't Avoid them!!
By Andrew Simpson
Posted March 2013
“OOOuuuchhhhhh!!!!” Then “$%#$%$@!# IT!!!!” Every endurance athlete knows that feeling you get when you realize you are in pain and have really hurt yourself. It could be an abrupt feeling that you get that forces you to stop your run, or a gradual pain that one day startles you when you get out of bed. It isn’t a question of if it is going to happen, but rather, when and how often. Preventing injury has become a very popular pastime these days, and it has in fact sparked a new industry, based on rolling, massaging, stretching, strengthening, and temperature therapy. As a coach I was instructed to be very careful in endorsing or recommending products or activities that do not have scientific basis. I’m always surprised at how many products laud some radical benefit but don’t offer any science to back it up. There still hasn’t been one study to prove any benefit to barefoot running yet people still cling to the theory although I have noticed a lot of “minimal” shoes on sale recently (totally unscientific observation).
To me the area that is totally neglected these days is the process to follow once you have an injury. Usually if you start asking your friends you get a variety of go see this person or do acupuncture or try ART or jump up and down three times and put a snowball in the toilet and flush it down...oh wait that’s the snow dance. As I have embarked on my coaching career after over 20 years of running I have come to the realization that a significant part of my job is counseling and advising runners on what to do when they are injured. Part of it is providing emotional support and reassuring them that the old adage is true “Time heals all wounds” and that they will get better. The more challenging part is what to tell them to do. I know you are dying to know so here it goes. And if you are experiencing an emergency medical situation stop reading now and dial 911!
1. STOP DOING IT IF IT HURTS!
And I am not casting a stone here. My last injury occurred in the first couple of miles of a run. I kept running until Mile 8 and I had to stop because the pain was too intense. Why did I keep running? Because I had made it a point to always finish my runs, regardless of any pain. What did my fellow coach Scott Baldwin ask me: “Why didn’t I stop?” Let’s face it; endurance athletes are driven and stubborn. If we weren’t we wouldn’t be endurance athletes, and we’d be batting a shuttlecock around a badminton court instead of losing toe nails running ultramarathons. So if you get hurt and specific activities make it hurt or are making it hurt worse, stop those activities. If you want to cross-train, fine, but don’t do anything that incurs pain (more on that later).
2. GO SEE THE DOCTOR.
I know, I know, I hate it too. Here is how my conversation with Doctors tend to go...
- Doc: “What hurts?”
Andrew: “My knee.”
Doc: “What were you doing when you hurt it?”
Doc: “How many miles per week were you running?”
Embarrassed Andrew: “Ummm, I dunno, 50-60 maybe (note: never reveal actual number or might be committed immediately)!”
Doc: “Well that explains it then!”
Andrew’s inner voice: “I wish I could get paid for “insight” like that!”
Seriously, go see the Doctor. They will do the necessary diagnostics to determine what your injury might be. MRIs aren’t so bad, they are just time consuming and expensive but you will know exactly what the problem is and be able to take the most appropriate, specific course of treatment. If you don’t know who to go see ask around. Ask your coach or fellow athletes. My guess is that if someone has been running or doing triathlons for at least five years they will have a name or two to offer. Make sure you understand what the injury and treatment is and question the doctor if you don’t. Your body is your own and no one else’s. If you aren’t comfortable with something, ask about it. Don’t be afraid to ask for a second opinion. I am amazed at how little information providers are willing to give about the why’s and how’s of treatments, medication, etc. I have heard several stories of the side-effects of medication or treatment leading to unplanned or unforeseen problems (see Read Your RX Labels and Ask Your Doctor
3. FOLLOW THE TREATMENT PLAN
Once you have your diagnoses and know what your treatment is FOLLOW THE TREATMENT PLAN. Everyone knows if you don’t run some long runs you will have a miserable marathon. How many times do you hear “Yeah the doctor told me not to run but I figured it wouldn’t hurt” or “I didn’t feel like taking the pills so they are still sitting in the cabinet.” Come on folks, you shelled out all that money for healthcare you might as well take advantage of it. OK, I am guilty as well but as a dad I am trying to do better and set a better example for my children and take my pills when told to.
4. DON’T GIVE UP ON THE TREATMENT
Check out this article: Navigating the Pain Trail. It says that even a minor sprain will take up to 6 weeks to heal. That’s a month and a half folks. I know I have gotten to the point at times where I was ready to forcibly remove an offending limb from my body and carry on due to an injury and then one day, miraculously about 4-5 weeks in I all of sudden realize that the pain is subsiding. Except it isn’t a miracle per se, just the miracle of the body healing itself, and you allowing time for it to heal. Also, if part of the treatment incorporates exercises and Physical Therapy, or any sort of active recovery, keep doing those as well. One complaint I hear is “I don’t have time to do these” or “I can’t make it to Physical Therapy.” Well get creative and ask for exercises you can do at your desk. Do your exercises at home, most are not strenuous and can be done while curling a lager. And don’t rush recovery or “test” the injury. I have a good friend who tore his Achilles. I asked him when he last ran, and he said “Oh last week I went for a ten mile test run.” A ten mile run is not a test run? He probably did more damage and set himself back another 8 weeks or so.
5. ESTABLISH A CROSS TRAINING PLAN
Once you have identified the injury, and started on a treatment plan, consult with your doctor and your coach to determine how you should cross-train and ultimately get back into whatever sport caused your injury. Although you can never replicate exactly the sport you can’t do, you can replicate the conditioning and endurance by using minutes or miles as a guide, depending on the injury. One time I took the miles I was supposed to run for my marathon plan, multiplied by my easy run pace and used the duration to dictate how much elliptical I had to do to maintain fitness. Another time I rowed the miles I was supposed to run on a Concept2 ergometer. Each time I got back into running, I found the transition astoundingly easy, much easier than if I had done nothing and had to build both my strength and my endurance.
6. REINTRODUCE YOUR TARGET ACTIVITY
Once you have established your treatment plan, you have kept up with your cross training, and you are not experiencing any more pain, it will finally be time to re-introduce your “prohibited” activity. Your healthcare provider may have a suggestion but one that is easy to do and easy to track is to start with 10% of your intended mileage every other day and build up gradually from there. So if you schedule run is for 3 miles, then do 10% of that running and 90% of it cross-training. The next week move to 20% running, 80% cross training. Usually once you have done this for a couple of weeks you will “break through” and get over the strange aches and pains associated with recovering and rebuilding from an injury, and pretty soon you will be ready to rock and roll!
7. EVALUATE YOUR RACE PLAN
Potentially the costliest part of an injury could be the race that you will miss. That being said, before cancelling or giving up on a race you should take a hard look at your training schedule and your cross-training plans, and see if it might be possible to still do the race. Particularly if it is a destination race or a race like Boston or Kona where you qualified and have a “lifetime” opportunity to run the race. Two of my Boston’s I ran post injury and had great days and credible times, so do not give up on a race just because you are hurt. However, the flip side of making the decision to do a race with an existing injury my also cause more permanent damage to your body, thereby increasing your recovery time and in turn, missing more races, and possibly an entire season. If you need to consult an experienced athlete or a coach on the best, most conservative approach, make sure that your Doctor agrees with the plan.
My parting thought to the wounded warrior is to execute your injury healing and recovery plan training as you would execute your training and racing plan. If your plan is followed properly, you will be rewarded with an even sweeter feeling the next time you cross the finish line.