Thursday, November 28, 2013
Advice on Injuries
Okay, after a careful review of the advice below, it might be prudent to get a second opinion. Once that is done, by all means follow this advice:
Just the other day I was thinking that there are not a lot of comprehensive resources for running injuries. Then I thought “Hey! I’ve been injured for 30 years now – I must be an expert”! Unfortunately, being chronically injured probably indicates that I am not an expert on injury prevention or optimal healing practices…
I once wrote an article entitled Advice on Running. It included this quote, which sums up my attitude towards injuries:
Injuries can be divided into 2 categories. Those you can “run through” and still heal, and those that take a hell of a long time to heal, when you continue running.
There are some aspects of injury management that I could impart to other runners, along with a long list of “Do the opposite of what I do”. For example, Ibuprofen. I actually got this tip from my doctor: Take half dosage (one 200 mg tab) 3 times per day for 3 days. This will help with inflammation, yet avoid developing a tolerance to the pain killer. The concept is that it will help reduce swelling which speeds up the healing. Take the low dosage for 3 days about 5 days before a race. Take no Ibuprofen 2 days before the race, so that you lose the tolerance to the painkiller component. Hence the Ibuprofen will be more affective during the race.
Once you develop PF in one of your feet, try to develop PF in the other foot. If you are successful, it will force you to change your running style so that both feet heal faster. I’m full of these great healing tips that you will never find in medical journals!
Back to Ibuprofen
If your injury suddenly becomes more painful, stop taking Ibuprofen. You will then limp more (if you have a leg injury) and heal faster. If you take Ibuprofen while in significant pain, it will mask the pain and you will cause more damage to the injured area. Pain is your friend! It helps you to figure out what actions aggravate the injury.
Strains and sprains
Ignore mild sprains completely. Your ankle / knee / hip did it on purpose and if you don’t punish the area by forcing it to run, it will do it again next week. It’s the PRINCIPLE of the thing. I have never been sure what that means, but I’ve heard it all my life, so it must be some altruism. Severe sprains are a different story. You probably did something stupid and should not blame it on the injured area. Take 2 days off running and use ICE (Ice Compression Elevation) 2 – 3 times per day, but never for more than 10 minutes at a time. Some football player put his foot in a bucket of ice for 4 hours and it was black when he removed it from the bucket… If it is too painful to run, use a bike or one of those weird parabolic machines. It might be apparent that I don’t take this advice to heart. I find that hobble-runs on a trail where no one else can see your pathetic gait are much more enjoyable. Don’t look up the definition of “enjoyable” in the dictionary. Even severe sprains will eventually heal, blah blah blah blah.
Pulled / Torn Muscles
I like these! A sharp no-nonsense pain. Your body is telling you “Yup! You are injured”! The best part of a torn muscle is that you can completely ignore them. You’ve scheduled a speed session for tonight? Go for it! It’s just a tear. Even if it gets worse, it just means recovery will take longer. Possibly years longer. Torn muscles also give you an excellent excuse to run slowly or cut the run short altogether. You have way more running options with a torn muscle. I recommend not doing any recovery activity. You want to savor this injury!
For the sake of brevity, I’ll lump these together. Pulled IT band, torn ACL, patella, cartilage or broken knee cap: Get surgery. You can easily perform the surgery yourself. A torn cartilage is simple with an old phone camera, scalpel and forceps, but trained surgeons will get you some time off work. More time for running directly before and after surgery. Think about it! When running with a knee injury, do not compensate your running style to accommodate the injury. See above for mild strain. You are in control, not the knee. If you don’t subscribe to the “firm machine gun hand” approach, consider this. Changing your running style by limping will put undue stress on other parts of your body. You are asking for another injury. Don’t believe me? Try deliberately limping for 3 hours during your next run. You will develop a back injury.
Tricky subject. Back injuries fall into 2 categories. Minor (torn muscles, strains) and major (bulging disc, fractures, major contusions and skeletal degeneration). Treat minor back injuries as you would any other torn muscle or sprain. The only downside is that even something as innocuous as a torn muscle in your back can make it painful to breath. Breathing is high on the list of mandatory items for running. It can be frustrating when trying to run through a torn back muscle and you keep passing out from the lack of breathing. I have a strict rule about running along cliffs when suffering from a torn back muscle.
Major back injuries are the trickiest. Don’t assume that you can run, when you can’t walk. I think there is a progression issue here, but I’ve already lost interest, so let’s move on. During one of the years when I ran one of the Toronto marathons, I fell down. It was at about the 30K mark, so I got back up and continued to run. Some chap caught up to me and asked why I had fallen. I explained that I have a bulge in my disk that puts pressure on my sciatic nerve. The injury had flared recently and due to shooting pains that travelled down my leg to my ankle, I had lost all feeling in my right leg and fell over (duh!). We ran for a bit and then he asked me a question I could not readily answer. “Why the hell are you still running”? It took me only seconds to misinterpret his question as “running today, in this marathon, after falling due to a lack of all feeling and control in your right leg”. I had to think about that for a while. I had never DNF’d in a race as short as a marathon before, but I kind of saw his point. Perhaps continuing for another 12K wasn’t such a grand idea. At 32K I stopped. I boarded a street car (although I had no desire to do so) and explained to the driver that I had no money. I had just dropped from a race due to injury and could not run back to the finish line. I got a free ride! Note: The free ride was not worth the DNF.
I don’t like going to see doctors. They are typically full of bad news and make irrational decisions that curtail my running. And my attitude has nothing to do with it. I will politely and patiently (get it?) tell the doctor my symptoms and even more patiently describe my lifestyle, which includes a modicum of running. It is usually at this point (new doctors are the worst) when they are giving me that long stare – almost a glare, that it dawns on me they will soon proscribe a hiatus from my sporting lifestyle. I’ll give you an example.
I played rugby back when the earth was cooling. I developed severe pain in my upper spine. Do recall I’ve had my share of injuries. Severe pain is when your vision goes black. Got the picture? You are still standing, but you can’t see anything. X-rays showed nothing at the time. Years later, I decided to start playing rugby again. I also contracted a cold that would simply not go away. Thinking it might be the flu, I went to see my doctor. I explained about the flu and also that I was experiencing tingling in my arms. I mentioned that years ago, while playing rugby, I had severe neck pain and that I had recently starting playing rugby again. My doctor scheduled x-rays. She called me at work 3 days later and told me to get to her office as soon as I could. I told her I could fit her in on Thursday of next week. She wasn’t very polite, she simply said over the phone “Get down here directly after work. You have a broken neck”. To make a long story short, I had to stop playing rugby, again. The good news is that I should continue to run. Supposedly, “short” runs are good for the neck! Short is relative, isn’t it?
If you break your neck, keep running. If it causes pain during the run, wear a neck brace. No one will bother you while running with a neck brace, trust me.
Flu and Colds
Although not technically an injury, running while sick is no fun at all. I don’t know about you, but that sums up how it can feel to run while injured. Rule of thumb: If the cold is above your bronchial tubes, continue to run. I once went for a run and still had a hacking cough. Running with a cough can be very healthy, as the run helps to clear your lungs. This was not one of those runs. I realized it was apparent that I was still sick when the fellow behind me asked if he should go back and pick up my lung…
Death is nature’s way of telling you to slow down a little. This is one injury I have not yet experienced, so the advice is hypothetical. Cut back on your tempo runs. In fact, cut back on all of your runs. Breathing will be a major issue, as I understand that breathing while dead is problematic. This may sound very morose, but I see no reason why you can’t continue to enjoy running, just not at the same intensity as when you where alive. Puts a different meaning on my sign-off: