Injury Management

There probably are some people who run for years without any kind of injury, but I haven't met them yet. Of course, a lot of things depend on how you define injury, but I am going to call any noticeable pain or discomfort that lasts more than a couple of runs an injury.

I started running about a year and a half or two years ago with a major injury. In fact, it would not be an exaggeration to say that, in the first months, a big part of my motivation to run at all was curiosity to see if I could work through my injury.

I had run a bit ever since high school. By a bit, I mean that I would jog for two, three or four kilometers once or twice a week when I was really feeling motivated (which is to say a few months out of any given two or three year period). Sometimes I notice a bit on pain in my knee. In my early thirties, I started getting a lot more pain. (I guess I was running more at the time. We were living in Paris and had a baby, and I had a job with long, irregular hours. I needed the stress relieving benefits of exercise like a diabetic needs insulin.) The pain was always in my left knee, and in time it got so bad that I would just have to stop after a kilometer or less.

I saw a sports doctor, who told me that my knee was just wearing out. I could either stop running now, or tape it and stop running  in a couple of years. By that point, he said, I would probably have permanently lost the ability to climb stairs without pain.

So I stopped. I took up rollerblading and cycled more. Fast forward fifteen years and I am in Vancouver, where I found I could run on steep mountain trails with no knee problems, but when I tried running on the flat, the thing swelled up to the size of a small football (yes, I know, footballs only come in one size). With a little research on the Net, I found that the issue was the difference in my foot strike on trails and flat land. So I switched to barefoot running. I'll save the details of my conversion for another post, but I will say that things weren't perfect as soon as I took my shoes off. It was better, but I still had quite a bit of swelling and some pain when running with bare feet. At that point, I didn't care. I just wanted to run, and if all I could manage was 5K, and if it meant a bit of pain, that was OK.

I did talk to my doctor about it. He sent me for an x-ray and, finding no big visible damage, told me that I shouldn't quit running, but rather run a bit less when I had a lot of pain. So I kept going, running in bare feet, icing my knee after each run, and taking ibuprofen. And as I did, things got better. Within weeks, or maybe a month at the outside, I was running my 5K without pain and I no longer needed ice or pills.

Since then, I've run a few half marathons and I am now training for my fist full, and along the way I've had a few other injuries. The biggest was iliotibial band syndrome (IT band). When that came, I followed the stern commandments to REST, REST, REST that one encounters everywhere  on the Net, and spent a few weeks on the couch. Then I tried a short run. I was OK. So I tried a longer one and limped home like a pirate with a peg leg. I tried more rest and then, for some reason, I decided to risk going up the Grouse Grind. This is a very steep 850 m climb up the side of a local mountain. By the time I got to the top I felt great. So I did it again a couple of days later. Then I tried a run. Problem fixed. This lead me to think that what I needed was the right kind of movement to stretch and strengthen my legs. With a little googling I found a series of exercises that solved the problem permanently. Once again, it was activity, not rest that worked.

So, for me, the key to injury management is to identify the problem as soon as it starts (by which I mean, as soon as there is any discomfort that shows in a couple of runs) and do something about it. For example, I have a little mild discomfort in my Achilles at the moment. It started about a month ago. It doesn't hurt during the run, but sometimes there is an ache or a bit of soreness in some positions after a run. So I pay a lot of attention to how the area feels when I am running, and I'm mindful of landing and rolling forward without strain on that leg. I started a stretching routine for the Achilles. I started a progressive strengthening routine, and worked up to 3 set of 15 reps of two-legged heel lifts on the stairs, three times a day, then switched to one-legged lifts. So far, I'm up to 3 sets of 10 reps, one each leg, three times a day. I'll  keep going until I can do all 270 lifts per day with perfect form and without discomfort. Then I'll keep a reduced number in my routine.

I also do yoga twice a week and visit my chiropractor when something feel out of balance or doesn't respond to changes in stride. In other words, rather than waiting until injuries become so bad that I can't run, and then waiting again for them to go away, I think of injuries as a natural part of my progression. As my body adapts and moves faster and further, it needs support to help it become stronger and more flexible. Injuries are trail markers on the path to the physical adaptations that are needed to reach the next level. When you see a trail marker, you don't stop, you adjust course and keep going.