Runners, especially those who train for long distance races, sustain injuries. It is bound to happen at some point. If you've been running regularly for more than a year, you've probably experienced some type of injury whether it was as severe as a fracture, or as basic as a twisted ankle. At the very least, you've likely encountered DOMS (delayed onset muscle soreness) from the exertion of a fast or long run, or an intense strength workout. While I can't diagnose your injuries, I can share the experience of my own injuries, and provide some things for you to think about and to possibly discuss with you doctor.
|Actual MRI image of my left foot|
So, you think you have an injury?
How do you know that what you're feeling is more than the typical post-workout muscle soreness or DOMS? Does it feel different? Is the pain sharp instead of the usual dull ache? Does it last more than a day or so? Does it affect your running/walking form and daily activities? If so, it's probably an injury. Sometimes you'll know right away that things aren't right. Other times you'll realize this when the pain doesn't go away. As soon as you think you have a real running injury, my advice is to seek medical guidance. Go to a sports medicine doctor if possible. In the internet age, it's very easy to find doctors who specialize in working with athletes. And yes, even if you're not an elite runner, if you're out there pounding the pavement, you are an athlete.
Here's what the doctor will do:
- Ask for the specifics of when and how you sustained the injury, as well as your weekly mileage and training routine. Try to remember as many details as possible.
- Palpate (touch and move) your injured area to see what hurts, what doesn't, and assess your range of motion.
- Take images. This may or may not be necessary. X-rays are typically the first step, but don't show all problems. For more dubious injuries, an MRI or a Bone Scan may be required in order to get a proper diagnosis. These are expensive tests, so should be done only if necessary.
- Send you to a specialist. Again, this may or may not be necessary. But sometimes it's necessary to see an orthopedist, for example.
- Diagnose your injury and provide a treatment plan. This may include any of the following: a switch to non-impact activities, medication (for pain or inflammation), advice to "RICE" (rest, ice, use compression, elevate the injured area), referrals to physical therapy, wearing a cast or a brace, or other treatments. In severe cases, steroid injections or surgery may be prescribed.
Once you have a proper diagnosis, you can begin the road to recovery. Your path my be short or long, depending on the type and severity of your injury. Bone injuries tend to heal faster than soft tissue injuries, but they require you to immobilize and minimize impact. Sometimes, you can still exercise while you heal, but you should heed the doctor's advice regarding what kinds of exercise you are allowed to do, and when you can return to normal activity. Part of your recovery will depend on you "listening to your body" and noticing how your recovery is going.
My Generic Recovery Advice
Having had several types of running injuries (I detail the specifics of those later in this post), I can speak from experience. Whatever your situation, here is some advice for you from me:
- Listen to the doctor, but if things don't seem right, don't hesitate to get a second opinion. You are the master of your own health, and you know your body better than anyone. Every medical practitioner has a slightly different perspective. If I felt like my diagnosis or recovery plan was somehow "off", I would question it.
- Don't stop your treatment early, even if you're starting to feel better. That's a good way to re-injure yourself.
- Find every way possible to stay active, while still following doctor's orders. Ask your doctor what exercise is approved for you, and do it. You'll heal faster and return to running more easily if you stay in shape as much as possible.
- Research home remedies. This is not to take the place of medical advice, but to complement it. Your doctor may not know of or think to tell you about everything you can do at home. For example, I purchased a home ultrasound machine and used it on my plantar fasciitis and my stress fracture. It's a non-invasive treatment that did not conflict with my doctor's treatment plan.
- Remember what caused the injury and try to prevent it in the future. Was it because you increased your mileage too rapidly? Then next time add weekly mileage a little at a time. Don't jump from a 20 mile week to a 40 mile week...get there gradually.
- Once your injury is healed, add cross-training into your schedule. If you only run, you may have great running muscles, but you'll do better to balance yourself out by adding some different activities. Cycling, light strength training, swimming and yoga are all great for runners on non-running days.
- Make stretching a priority. Tight muscles can lead to injury. Regular stretching and foam rolling are a great way to help prevent injury. Links to stretching for runners and foam rolling.
Tendinitis - What I Did
My first injury came when I was training for my first marathon. I followed a structured training program that included run/walk intervals, and didn't add mileage too fast. Still...I got injured. I question whether the injury came from running or from the gym workouts I was doing. My trainer had us do a lot of lunges, and I've since learned that my knees don't like lunges.
My diagnosis was tendinitis behind my knee. The pain was only on the back, and it was both above and below the knee. It was too close to marathon time to heal completely. I ran my first marathon with pain, especially after Mile 20. After that, I was determined to heal the injury.
What worked: Rest was key. I had to stop running so much. I also did some physical therapy, including specific stretches and exercises. But I think the number one thing that helped was ultrasound therapy. The therapist used an ultrasound machine on the back of my knee area a couple times a week for several weeks, and gradually I healed. Now, I have a small ultrasound machine at home, so I can use it as needed.
|My ultrasound machine looks something like this; you can buy online from Amazon|
Plantar Fasciitis - What I Did
I've had plantar fasciitis twice now, so I'm a pro. It can range from a dull ache on the heel to excruciating pain the length of the bottom of the foot. It's a ligament injury, and takes a long time to heal properly. When first diagnosed, I was training for a marathon in memory of my father, who had recently died of cancer. Dropping out of the marathon was not an option for me. My podiatrist prescribed lots of icing, specific stretches, running with cork heel inserts in my shoes (custom-made by the podiatrist), and wearing a boot at night to keep the foot flexed. I also got medical massage for the calf and the foot. But I was going to need more help if I wanted to finish that marathon.
So, I got steroid (cortisone) injections in the foot. Let me tell you - that stuff hurts! The injections themselves were among the most painful I've ever had, anywhere on my body. And immediately after the injection the foot hurt worse. This lasted for several days. Then, miraculously, the inflammation and pain went down just in time for my race. I ran it and earned a PR. But don't be fooled, steroid injections are a "band aid" treatment. They mask the injury, but don't really heal it. After my race I had to take a break from running to allow it to fully heal. I had to keep up my icing and stretching. It took a while, and I hated it, but eventually I healed. Everyone's case is different. I would have healed faster if I'd stopped running as soon as I was diagnosed. Also, for years after this injury I wore orthotics in my running shoes. You can have these custom made, but I was fine with standard ones. There are many brands of shoe inserts, but what worked for me were the Dr. Scholl's sports inserts. They're not expensive, and have great arch support.
Tibia Stress Fracture - What I Did
This injury did come about by increasing my mileage too quickly. I really should have known better. After my bad case of plantar fasciitis, I stopped doing races longer than a 5K or a rare 10 Miler. I didn't run as much for a few years. Then I jumped back into marathon training without a good base. And, I fractured my tibia (the larger bone in the lower leg). It was a sharp pain, and I felt it upon any impact (walking or running). I went to my podiatrist because he is a marathoner, and was great in helping me through my previous injuries. It was important for him to know whether he was dealing with a bone or a tissue injury. But x-rays don't always show minor stress fractures, so he sent me for a Bone Scan, which confirmed his suspicion. I had to stop running for 10 weeks. I could walk to get around, but not for exercise. Bones just need time to heal, and I had to respect that.
While recovering from the stress fracture, I tried Water Running (overview and training plan). This is a great form of cross-training that has no impact, because you're suspended in a pool, wearing a floatation waist belt. Water running uses the same muscles as running on land, so it's the next best thing. I watched some videos to learn the technique and found a training plan online. Rather than just "winging it", I followed an interval plan to get those muscles moving, and it really was a good workout.
Slowly, I started running on land again. Even though I was healed, my leg felt a little unstable. So I began wearing compression socks for every run (and still do...they're quite stylish!). I also learned how to use KT Tape to tape my calf (link to various taping techniques based on your injury location; mine was the posterior shin splint taping). I could run again, but had to be careful. Downhill running didn't feel good on my bad leg, and I worried about re-injuring it, so I had to walk down the steeper hills to minimize impact. I also didn't feel confident with any workout involving jumping, as I felt that impact. So, I modified workouts according to how I felt. I was able to run a half marathon a couple weeks after my 10 week rest, but it took months to get to the point where I felt normal. I still minimize jumping.
IT Band Injury - What I Did
This was not a bad injury, thank goodness. I know that some people have nagging IT band issues. I was lucky. I was still recovering from my tibia stress fracture while I was running a marathon, and all of a sudden I felt a strange pull in my hip. It was toward the end of the race, so I slowed down but kept going. I'd never had an issue with my IT band. I didn't think it was bad enough to see the doctor, so instead I saw my massage therapist. She was really good at working with runners and sports injuries. I scheduled three appointments in a two-week period and had her focus exclusively on the IT band and areas surrounding it. And it worked! After those two weeks, I never had another problem with it. This was luck. But I also know my own body well enough to know that my injury wasn't severe. I would have seen the doctor if the massage didn't help.
Plantar Fasciitis II - What I Did
Lucky me, I got plantar fasciitis a second time. It's no surprise really, as I started running a lot of marathons in 2012 and 2013. As a Marathon Maniac, I had a goal to run 30 marathons in different states in a 1 year period. I was also working on running a marathon in all 50 states. In order to minimize travel expenses, some of my marathons were in neighboring states on the same weekend (e.g. Georgia on Saturday and Alabama on Sunday). My feet weren't ready for all of this, even if my muscles were. I got plantar fasciitis again.
This time I knew what I was getting into. I also knew that the injections were not an option (I had a second round of injections after my first occurrence of plantar fasciitis, and they did NOTHING to help). I was also stubborn enough to keep up my marathon schedule, against better judgement. Most of my races required air travel and hotels, and were already booked and paid for. I would be out a LOT of money if I canceled. I also knew I would never again be in a position to do the 30 states in a year. If I wanted to cut my losses and achieve my ambitious goal, I had to keep running.
I pretty much cut out all training activities. I was already "trained up" to marathon distance, and I was running them frequently enough. Short training runs in between races would only make the injury worse.
Here's what I did do. I bought cushy shoes, and wore them on Day 2 of my double marathon weekends. I also walked a lot during the marathons, as it hurt less than running. I kept up stretching. I should have iced more too. After my marathon schedule wound down, I finally healed by taking a break, of course. And I also learned how to tape my foot (here's the taping technique). Taping the foot while I ran was one of the biggest things I did to alleviate the pain. Even though I'm currently injury-free, I still tape my feet for long runs and races. It can't hurt, and it can only help.
I hope I've provided some ideas for other runners who are battling injury. It can be painful, both physically and emotionally, to deal with these set-backs. But it is possible to come out of an injury and keep on running, maybe even stronger than ever. Use your doctor. Do your research. Put in the time and effort to heal.