It is much more common for runners to pick up injuries that could be referred to as overload or overuse injuries. This is an umbrella term for pain or injury that occurs because a structure or structures become overloaded, irritated, and more sensitive as a result of too much mechanical or physical stress (training sessions or runs) without adequate recovery between bouts. This leads to a reduction in the ability or capacity of said structure to tolerate the demands being placed on and it becomes sensitive or irritable or painful. Examples of these types of injuries would include Runners Knee, Tendinopathy and Shin Splints.
The most common factor that leads to these types of injury is training error. Research has shown that training error accounts for up to 70% or injuries in runners. Training error incorporates a number of common errors made across all forms of sport and exercise. The most common themes among runners are increasing mileage, intensity or frequency of running too quickly and getting the recovery element wrong. I will discuss these factors in more detail in future blogs.
When it comes to managing overload injuries I really like the simple mantra ‘calm it down, build it back up’. This isn’t my mantra and is something I read a few years back by Greg Lehman, a fantastic physio, chiropractor and strength and conditioning coach.
I’ll explain how I apply this principle below, but remember, this does not represent medical advice, each injury is different and individual to you and I would always recommend seeking expert advice from an appropriate healthcare provider.
Calm it down
With overload type injuries, the pain is often gradual in onset and the severity will be directly linked to the amount of load or stress applied to the area during training. There is also often a warm up phenomenon, where the pain will be worse at the beginning of a run but will then warm up and feel better during the rest of the session, only for it then to feel a lot worse later that day and for up to a few days after. Because of these factors it is often not clear for the person suffering from the pain/injury as to whether they should persist with their training, back off to some extent, or completely stop running.
As a general guide I will usually try and find out the distance or time the individual can run for where the pain doesn’t impact how they run (i.e. cause them to limp) and, if the pain flares up afterwards, settles within a 24-hour period. This may mean reducing the running time or intensity, or both, but rarely does it mean completely stopping running. The goal in this phase is to find this level to allow the pain/injury time to settle down whilst maintaining as much fitness/conditioning as possible. It could mean that a large amount of the running must be stopped, and this may be replaced by something else such as swimming or cycling in the interim to help maintain fitness.
During this phase there is also opportunity to address underlying causes of the problem in the first place, this could be education on training and recovery, strength exercises, gait analysis and retraining, to name a few areas that may be targeted.
Build it back up
The point at which the goal switches from calming things down to building them back up is individual for everyone, but once the symptoms have reduced significantly and there are only mild or acceptable levels of discomfort during training and quick resolution of any pain flare after the running session then the focus can usually move towards building everything up. This includes fitness, running tolerance, strength etc.
During the ‘calm it down’ phase, a baseline of what can be tolerated within the general guidelines should have been established (how often and for how long each run can be or the total amount of running in a week). There are lots of possible guidelines on how fast running should be built back up but the two most common are using a simple 10% rule where distance or time on feet is increased by no more than 10% a week or using acute vs. chronic workload ratios (this is more complicated, and I will cover in another blog).
Whilst building up the same guidance around pain during the run and in the following 24 hours is applied. It can be a long and slow process building back up to the level of running you want to do but it is important to be patient and realistic. Using other forms of cardio and training can be useful during this stage.
Once you have returned to previous levels of running the same principles on progression of running and keeping up with any adaptations or strength exercises that were used to aid recovery will help to minimise the risk of future injury.
Thanks for reading, as always this blog is not medical advice and always get injuries checked out be an appropriate health care professional.
Any questions feel free to email me at email@example.com or message me on twitter @quinn_physio
Specialist Musculoskeletal Physiotherapist