Running Injury - I'm
Injured, Now What? by Claudia Piepenburg - editor of
Peak Run Performance
Since 2 out of 3 runners are
injured at any time, there's a very good chance you're injured right now. And
the probability is high that you're suffering from one of the common running
injuries listed below:
Runner's knee (the
medical name is patellofemoral pain syndrome or chondromalacia
- Iliotibial band
- Achilles tendonitis
- Plantar fasciitis
These are the four most common
injuries runners sustain, and although each one affects a different area of the
leg or foot, the causes are the same.
How Did I Get
When you're injured
the first thing you must do is treat the running injury. But equally as
important is learning why you got injured so you can prevent another running
injury in the future. Runners typically get injured because:
- They make training errors. These
errors include (but aren't limited to) increasing mileage too quickly; doing
speed-work too often or too soon in the training cycle; not getting enough
rest; running on surfaces that are too hard; or running hills too often.
- They're wearing the wrong shoes.
This means either wearing shoes that are inappropriate for their foot type, or
wearing shoes that are worn out.
- They haven't dealt with muscle
imbalances or weaknesses by engaging in a regular stretching and strengthening
Do you recognize yourself? 95% or
more of you will, and you'll probably realize that more than one of these
errors contributed to your injury.
How do I Get Out of
Once you know why
you're injured you're halfway down the road to recovery! As soon as you're able
to run again, you're going to make changes in your training, start running in
the right shoes, and begin a stretching and strengthening regimen
By doing so you should be able to avoid future injuries. But what do you do in
the meantime, while the injury you have now is healing? First, you need to
determine if you have to stop running completely. How do you know? Take the
- Is the injured area swollen, a
different color than the surrounding skin, and warm to the touch?
- Do you have difficulty walking
without discomfort or a limp?
- Do you have such pain when you
run that your gait changes?
- Do you have an injury to your
If you answered "yes" to any of
these questions, you MUST STOP RUNNING until you've seen a medical professional
and the injury is healed enough that you no longer experience pain. But if your
injury isn't quite so serious, you may be able to continue a limited running
schedule and fill-in your non-running days with cross training.
Staying on the Road to Recovery If you're going to "run through" your injury,
try the following:
- Start getting massages on a
regular basis. Initially, you may have to get a massage as often as once a
week. Sometimes 2 or 3 one-hour massages can produce excellent results, but if
your injury has been festering for many months (or years) you may need 20 or 30
to see results. Make sure the massage therapist is trained to work on
- Reduce the number of miles you
run per week. If you usually run 20 miles a week, run 10 for several weeks
until you feel that your injury is healed. Also try doing shorter runs more
often, but run the same number of miles weekly. For instance, instead of doing
a 8 mile long run on the weekend, do a 4 mile run on Saturday and another 4
miles on Sunday.
- Run on a treadmill rather than
the road. Treadmills provide good cushioning, which softens the impact to your
joints. Also, you tend to run a little differently on a treadmill because the
belt is moving underneath you.
Cross Train your way back
If you can't run
for several weeks, you can keep yourself fit by cross training. The secret is
choosing an activity that will give you a good aerobic workout so your VO2 max
won't drop too much. Biking, swimming, aqua jogging, cross-country skiing and
roller-blading are excellent cross training activities. The one you choose
depends on your physical capabilities, access to the right environment, and the
type of injury you have.
Biking is an excellent cross training
activity if you're suffering from knee pain. Cycling builds up muscle mass in
the muscle that's just above and inside the knee. When you cycle you also build
up the muscles in your hamstrings and glutes, which are often weak in runners.
Biking also stresses your cardiovascular system. It's important to use the
right gears when you bike. A cadence of 90-100rpm will create good
cardiovascular benefits without tiring out your muscles. The downside to biking
is that it can destroy your posture by flattening your lower back and rounding
your upper back. If you already have poor posture, biking would not be a good
choice for cross training. Also, people often don't get properly fit for their
bike. If your bike isn't set up properly, your posture will suffer even
Swimming is an excellent exercise for
stressing the cardiovascular system that doesn't stress the legs. If you have
Achilles tendonitis, swimming is a good choice. The biggest downside to
swimming is that you need to be a fairly decent swimmer to reap any of the
benefits of the activity. If you can't swim well, thrashing around in the pool
will only make you tired, won't create the appropriate aerobic training
stimulus, and may cause shoulder and neck pain. Also, swimming doesn't
strengthen the legs.
You'll lose virtually no
cardiovascular fitness aqua jogging, primarily because running in the water
mimics the actions of running on the ground. Because the legs receive virtually
no stress, aqua jogging is an excellent choice for runners suffering from lower
leg and foot injuries. (Note: if you have had recent knee surgery you may find
that running in the water will cause pain. In that case, you'll have to wait a
few weeks until the tissues heal, then you can begin aqua jogging again.)
Another benefit to running in the water is that you'll "feel" like you're
running, which is good for morale. However, like swimming, aqua jogging doesn't
strengthen the legs, and you need to "run" with good form (don't slump over in
the water) or you'll experience low back pain and limited lung
This is one of the best
exercises you can do for cardiovascular fitness and leg strength. The skating
style will develop your glutes, hamstrings, and muscles around your knee a
little better than the classic style. If you have access to snow, and are a
good skier, cross-country skiing is the best cross training exercise you can
do. As with swimming, you'll have to possess some skill at the sport to reap
the benefits. Unfortunately the cross-country skiing machines you see in gyms
and health clubs don't replicate actual skiing outdoors, so they won't be of
much use if you don't have access to real snow.
Roller-blading (inline skating)
cross-country skiing, roller-blading is an excellent cardiovascular exercise
that also strengthens the legs. Performed properly, with low technique,
roller-blading will also improve range of motion in the hips. However,
roller-blading does require a significant amount of skill, and must be
performed correctly (with a low torso and an arch in the lower
Don't Forget the
you initially manage your injury will make a big difference in how quickly you
recover. At the first sign of pain or discomfort use the RICE treatment:
Rest: How long you rest depends on the severity of the injury, and
how long you've ignored warning signs that something was wrong. By taking off
for 24-72 hours you may be able to get back to your regular schedule without
Ice: Ice the injured area several times a day for
up to 7 days. During the first 3 days it's advisable to ice even more, as often
as every 30-45 minutes. Hold the ice in one area for no more than 20 minutes at
a time. The iced area should initially feel cold, then "burn", followed by an
aching feeling, and then numb.
Compression: Compression helps
reduce swelling, so it's important that you do it very soon after you feel
pain. Apply compression using an elastic bandage, which you should start below
the injury, away from your heart. Wrap the bandage toward your heart, tighter
below the injury and looser once you're above it. Check your skin color
regularly to make sure that the bandage isn't wrapped too tightly, the skin
above and below the bandage should be the same color as the surrounding
Elevation: If possible, the injured area should be raised
above the level of your heart. This is easy to do when you have a leg or foot
injury; simply lie on your bed or sofa with a pillow under the affected limb.
During the first 2-3 days elevate the area as much as possible.
and One More Thing! It's important
that you become familiar with your own body, and how you handle pain and
stress. You'll save a lot of grief if you learn when an injury is so serious
that you need medical attention, and when you can manage it yourself. By using
good common sense, you may be able to avoid unnecessary trips to the doctor.
How often have you heard running friends complain (maybe you've said it
yourself): "The doctor told me to stop running!" Of course that's what the
doctor recommended, rest is a crucial first step in treating an injury. You
know that, you don't need the doctor to remind you.
Get in tune with
your body! When you feel a little nagging ache in your Achilles tendon, ice it
before and after you run, and make sure you're stretching out your calves well.
Replace your shoes if they're worn out. If you're a woman, stop wearing
high-heeled shoes to work. Chances are the ache will go away and won't blow up
into a full-fledged case of Achilles tendonitis. Listen, listen, listenyour
body will tell you what's going on. Don't ignore it!
Words to Live By
Many years ago, shortly after
I had started running, I received an excellent piece of advice from my family
physician. At the time he was in his early 50s, running over 80 miles a week
regularly, and had a marathon PR in the mid 2:20s. Because he was such an
excellent runner, he had gradually built up his practice to the point where the
majority of his patients were also runners. Since I was relatively new to the
sport and knew virtually nothing about it, I would make an appointment with him
whenever I felt the slightest twinge or ache in my legs.
One day at
the end of my appointment, the good doctor said to me, "Claudia, I have to tell
you something important. I enjoy visiting with you when you come in, and I
certainly love taking your $20.00 (my, how times have changed!) but sooner or
later you're going to need to learn when you really need to see me, and when
you can treat an injury on your own." I was flabbergasted that he would be
suggesting such a thing. Then he said, "Anyone who's running more than 10-15
miles a week is going to have an ache now and then. It's important to learn how
to treat that ache before it becomes a big, giant pain that stops you from
From that day on I started listening to my body.
I admit I haven't always been as attentive as I should be, and my body has let
me know it! Your body is talking to you too, pay attention, you'll be glad you
(I'd like to acknowledge Chris Maund, B. Sc. (Hons) for the
cross-training material that appeared in the July/August 2002 issue of Peak
Running Performance, published by Road Runner Sports.)
About the Author: Claudia Piepenburg
has been running for 21 years and is the current editor for Peak Run
Performance. She holds or has held state age-group records in Michigan, North
Carolina, Florida, Tennessee and Virginia. In 1990, she was ranked 18th fastest
masters woman in the world and 8th fastest masters woman in the U.S. in 1990
and 1991. She competed in the 1988 Olympic Marathon Trials, was 20th woman
overall in the 1987 Boston Marathon and women's winner of the 1986 Virginia
Beach Marathon. If you have questions or comments for Claudia, she can be
reached at firstname.lastname@example.org.