by Eric Oliver, PT, Founder
During the average training cycle running injuries begin to pop up during the later stages of training more so than at any other point. By this time in the training program, your body has already endured through hundreds of thousands of steps, and if you have any movement faults, strength deficits, motor sequencing issues, running pattern faults, or issues in your training program your body is likely to react to them.
Common symptoms of these deficiencies (small or large) include gradual build-up of aches and pains. These symptoms do not feel the same as general post-workout fatigue or discomfort resulting from the activity. These are the “this doesn’t feel right” kind of soreness, achiness, burning, jolts, zings, and sharp pains. Many times these pains don’t gradually build-up, though. Rather they can come out of nowhere, piercing at your muscle or joint like a hot knife. In either case, both scenarios will bring your training to a halt or at the least a snails pace.
So what do you do when this happens with just four weeks left in your training?
1. Get a proper diagnosis for your symptoms and the root cause of it, and not from Dr. Google. For example if you search “pain on the outside of my knee when running” five of the top six search results talk about IT band syndrome which then prescribes a healthy dosage of foam rolling, massage, stretching, icing, heating, and strengthening exercises. This is fine if you truly have IT band syndrome. What you don’t get as options with that Google search, though, is that outer knee pain can also come from an LCL sprain, meniscus irritation, patellofemoral stress, proximal tibiofibular sprain, and outer hamstring irritation to name a few. Suppose you identify the correct diagnosis, though. Unless you have a skilled understanding of the mechanics of running, endurance training principles, and the physiology of injury, healing, and sports science you will have a hard time identifying the root cause of your symptoms and difficulty formulating an effective and efficient plan of action that will guide you for the remaining training period.
In the case of an IT band irritation this root cause could be any one or combination of issues including your: running cadence, step length, muscle strength, muscle firing pattern, motor coordination, core and back strength, posture, hip flexibility, thigh flexibility, your training schedule, improper cross-training, and MAYBE your shoes.
(Unfortunately, shoes get a bad rap for the cause of many injuries. Check yourself before you blame your shoes. Look for an upcoming post on shoe prescription and how to easily determine what shoe is best for your foot.)
If a skilled clinician can put you on the path of treatment, adjust your training program, and instruct you on effective home treatments you will spend less time dilly-dallying with internet cures that may just waste your time.
2. Don’t over-react. Your race aspirations are not over yet. Once you know the source of your pain, you can put a plan together. With four weeks remaining in the training schedule, you have one more big workout left to perform. If you have already performed at least a 10-mile run (half-marathoner) or a 18-20 mile run (marathoner), you are prepared enough to finish your race, but only IF your injury isn’t too serious AND it has enough time to heal. There’s a saying I like to tell runners on the mend: It’s better to go into a race healthy and under-prepared rather than going into a race injured and hurting. You’ll be guaranteed to have a bad race if you go into a race actively injured. If you’re under-prepared you can always adjust your pace or if the going gets tough pull yourself out, but at least you’re giving yourself a fighting chance with a better healed body. Yes, you may have to adjust your expectations as to how fast you finish your race, but if your goal is purely to finish then giving yourself the opportunity to recover by race day should be your priority. If your goal is to PR or place in the top of your division, then some serious conversations regarding prognosis and strategy needs to happen between you, your coach, and your physical therapist to determine whether you’ll be ready enough to compete or if it will be more worth your time to wait for the next race. I have had several conversations in this scenario that literally come down to the wire, and regular open dialogue between the athlete, coach, and physical therapist is key in this situation.
3. Find ways to work around an injury for the remaining training cycle so that you can continue to work your aerobic and anaerobic energy systems without the weight-bearing stress of running. These strategies include (and are performed in concert with your rehab plan):
- Adjust your training schedule—
If you were running five to six days per week, reduce that workout frequency to 3-4 times per week. Your body needs time to heal. Unless the injury is really bad, soft tissue injuries can undergo significant healing within four weeks time. You should get approval from your rehab specialist to make sure it is okay to continue running, albeit at a reduced frequency.
If you’ve been given clearance to continue running, give yourself an extra week of healing and wait until April 16 or 17 to try your last big long-ish run workout. If you’re a half-marathoner aim for 8-10 miles (rather than 12 miles) which is an appropriate enough distance for you to recover over the following two weeks leading up to the race. If you are a marathoner aim for 16-18 miles (rather than 20-22) so as to not overly fatigue your body and deplete your energy systems beyond the ability to fully recover by race day. If you are still not able to run the full distance, then get creative with the workout:
You can split the workout between running, elliptical, and cycling so you’re not pounding your legs the whole time. The combined time of your workout should equal the same amount of time it would have taken to perform your long run.
Another way to split your workout is to divide your run into two sessions—do half in the morning and half in the afternoon. You can also do half on Saturday afternoon and half Sunday morning if you feel like you need extra time to recover. To get even more creative, throw in some cross-training machines to lessen the stress even more.
Your rehab specialist can better guide you on which option is best for you, depending on the severity of your injury. Keep him/her in the communication loop, and don’t run through pain.
- Cross-train with machines—
If you are either unable to run, or you’re restricted to running no more than one or two days a week then utilizing cross-training machines can be very effective in continuing your training. This includes using the elliptical machine, indoor bike, swimming, aqua jogging, or getting on an AlterG treadmill.
The fact that you can’t run outside or on a regular treadmill doesn’t mean you can’t work the exact same energy systems you’ll be utilizing during the race. Trust the science of physiology, elevate your heart rate on these machines, and at the worst you will lose a minimal amount of your aerobic and anaerobic fitness. Sometimes you can even improve your fitness through these other workout modalities.
You must find a cross-training tool that does not exacerbate your symptoms or cause new ones. This is especially true for swimming. Many runners who overdo it in the pool end up with rotator cuff inflammation.
When you implement a cross-training program to take the place of your running make sure to follow your run training schedule but instead of running, perform the cross-training workout for the same amount of time, intensity, and heart rate that you were supposed to do for your run. Don’t pay attention to the mileage displayed on the unit.
- Use as many strategies as you can that will promote tissue repair.
DO include warm water epsom salt baths, hot packs (as directed by your rehab specialist), pain-free movement exercises, good sleep, and good nutrition.
DO NOT aggressively stretch your muscles, overly ice the area (this can lead to local constriction of blood vessels, thus reducing the flow of blood that is necessary to heal the tissue), or aggressively foam roll or use The Stick. Runners who are dealing with an injury tend to stretch themselves too aggressively as a tactic to heal themselves faster. This may actually exacerbate the symptoms and delay the healing process.
When gently stretching do so in a pain-free range for 10-15 seconds. This will prevent your tissue from scarring down too much. If it reproduces your pain, don’t do it!
Following these tips is not guaranteed to get you ready in four weeks after sustaining an injury, but it may just give you a darn good fighting chance to toe that start line. We wish you the best of luck with the remainder of your training.
If you would like assistance in determining the nature of your symptoms and in formulating a plan to get you through the last few weeks of training you may schedule an appointment with one of our physical therapy specialists online or call the office at 513-533-9355.