‘After every run I have been experiencing pain in my knee. It’s been gradually getting worse for three weeks….. ….. ……’
‘My Achilles is niggling. It’s really sore and tight in the mornings but eases off when I run then get worse again…… …… ……’
‘I have a pain on the front of my foot. A little hot spot. It’s not stopping me running but it’s there all the time and I think I can feel it more …… ……. …….’
‘What should I do?’
Me, You, Everyone
From the novice beginner to the experienced professional I’m confident many of us runners have asked ourselves and others these questions or similar more often than we would like to admit as we struggle to balance the demands of finely tuning the body for competition with the stresses of everyday life. Equally there isn’t a murmuring in the pre-race hustle and bustle or thread of one of the ultra running communities where people are not discussing what they are carrying or dealt with that has hampered training. Do an internet search on planter fasciitis, metatarsal stress fractures or Achilles tendonitis and you will be gifted with pages of advice, diagnosis, treatment and patient chat. With all this information available and the commonality of these injuries why is there such conflicting advice out there and while one person is able to get back to training within a week of symptoms while another is struggling six months on?
Reading the daily rag about my other sporting passion I am openly infuriated every time I hear of another indulged superstar footballer swiped down with injury but at the same time given, nearly exact to the day, timescale of when they will return action and almost always the prediction is accurate with the said superstar back to the field running round chasing the pigs bladder with no care in the world.
With the commonality of runners injuries out there, the plethora of advice and information, and our own personal experience (how many of us have been struck down multiple times by the same injury?), how is that from the stage of first pain to our return to training as arbitrary as the length of a piece of string? Why is our treatment table different to footballers? Why is our path back to the trail or road so unknown?
Although it doesn’t dismiss my green eyed envy, firstly we are not under the close scrutiny of those footballers who are watched with beady eyes by all with a vest interest and subsequently bubble wrapped at the first twinge of pain. However, how many of us ‘tough’ runners have keep going if it doesn’t hurt when running or keep going if it’s not getting worse or even worse, pretend it not there until we cannot even walk without a wince let alone jog. I’m guilty as charged with all three and more. Footballers on the other hand will be stopped immediately. Treated. Loved. Nurtured and cared for until being unleased back onto the pitch on the final day of the ‘six week’ scale.
One of the key frustrations at being injured for me is the ‘when’. When will I be able to run again? When will I be able to race again? I can deal with the injury itself and the disappointment and throw myself and my energies into cross training if I had some security in the knowledge of an accurate prognosis and time frame. For me this is part of the anxiety and mood swings that being injured causes. While I cannot offer you medical advice to help you get back on track I have learnt and am learning from past mistakes. I have been guilty not listening at crucial times to others and my body but am getting better as the years pass and run with more intelligence than my youthful gung ho impervious approach of yesteryear hitting hard till I broke literally and figuratively.
Having just contended with a 5 week period of injury frustration and come out the other side returning back to full training I offer you my 6 point approach to injury prevention, management, and rehabilitation. Over the years I have sorted my own wheat from the chaff and while my approach is not perfect things it works for me and some may work for you. If someone learns from one of my past mistakes or finds a little nugget of information which helps them it’s a winner in my book.
- Get yourself a good physical therapist or physio you can trust. Trust is so much more important than cost. Word of mouth is a great source and the best advertisement for a physio. Without my trusted physio Rob King I would have missed many more months of training and racing and I can confidently say wouldn’t be half the athlete. Regular sessions are vital to stay on top of things and iron out any creases (every three to four weeks if cost and time suffice). Do not expect to walk to into your physio and find out exactly what is wrong and how long it will take either. They are not blessed with X-rays, MRI’s and CT scanners so it is inevitable uncertainty will exist. However, follow any advice given meticulously. How can you complain things are not improving if you do not take the professional advice given? Flexibility, strength training, heat or cold treatment. They are not miracle workers but if you find someone you can trust they will do their upmost to get you back on your feet but you need to take some responsibility and help yourself.
- Do not ignore it. If you are feel a niggle do something about it before it progressively gets worse. Treat. Stop. Rest. Recuperate. RICE. Source what might be causing the issue and try and resolve it. Inevitably, if it is getting worse it will eventually debilitate you if you continue, increasing the rehab time two, three or even four fold. Sometimes something as simple as changing worn trainers, a couple of days rest, a deep tissue massage, some good nutritious food and sleep can be all you need.
- Incorporate conditioning training into your training. These sessions don’t have long. They can be fit into your daily routine, replace a shorter run or tapped onto the end of a middle distance run. While group circuit sessions are great for motivation these require time. If like me you haven’t got time to squeeze in a group 90 minute to 2 hour session (including the travel) in an already loaded week you need to be creative. I complete one circuit session a week focusing on specific exercises which improve muscular endurance of the key running and core muscles to improve my form, efficiency and condition neglected and stabilizing muscles. Progression in intensity, load or time is important. Change the circuits according to periods of training. Some of my sessions take as little as 16nminutes which I fit into a break time at work others extend to 50 minutes at the end of a shorter run. Each one meticulously planned and utilizing time resourcefully. Additionally, I do daily conditioning exercises for my core which take no longer than ten minutes either immediately as I crawl out of bed in the morning to wake me up or last thing at night before I brush the gnashers.
- Incorporate flexibility training into your training. Don’t be a slave to routine but try and do some flexibility exercises on at least 80% of your training days. I stretch using key exercises adapted over the years and constantly keep my eyes out for improved and deeper stretches and exercises. Proprioceptive neuromuscular facilitation (PNF) is great and simple stood or led in front of the goggle-box. Additionally, get a foam roller and a ‘stick’. When I received the latter as a Christmas present from my brother I was skeptical. I’m not going to lie. It stayed in its packet for sixth months. However, since using it when rehabbing from serious car accident its benefits was miraculous and I’m confident it has helped me manage some long term issues I have. It is great around the calf muscles, inside and outside of the shin muscles, feet, hamstrings, quads and the glutes.
- When injured find another activity to maintain your cardio-vascular fitness and conditioning. My circuit training tends to focus on my core in this period. Additionally, I follow this order: Cross trainer, aqua jogging, turbo trainer / road bike, swimming, pull buoy swimming. If I can’t do the first I move onto the next. Add variety to your training. Try and mimic the neuromuscular pathways of running as much as possible but if you can’t because of the specific injury get your endorphins from another. You must ensure you’re not inhibiting your recover by battering yourself cross training and wasting the energy needed for recover and of course if it aggravates it do not do it!
- Return to training slowly and with caution. Depending on long I’ve been injured for I follow a systematic pathway to return to running. I can confidently say it has helped me return to good fitness smoothly and without short term recurrence. If the injury has been less than 4 weeks I tend to follow a week to two weeks of 1 minute running 1 minute walking for 30 minutes total in replacement of that time frame in a cross training session. I then double each period of running every one to two days but still maintain the 30 minute session total until you are able to run for 30minutes straight, pain free and without any additional niggles. It is surprising how strong this makes you and confidence grows each day as your fitness improves and signs of keeping the injury improve. You know you are not building too quickly and gradually introducing the body back to the form and weight bearing running specifically requires. If at any point you feel a niggle return back to a time period when It was clear. If the period of injury was longer extend this build up over a longer period. When I was finally allowed to run after the car accident I did this over an eight week period doubling the running time segment every one to two weeks.
This is by no means a one size fits all advice but something which works for me as I try and balance my mind and body with the demands of training and pushing myself towards the next level amongst the demands of daily life. Rest and recovery is a key training principle. It is on the GCSE syllabus. It is something which I drill into my students daily but for some reason one of the most common neglected principles in our training. I am learning to become an athlete who not only trains hard but rests hard too. Remember training adaptations only occur when you rest. When you sleep and feed the machine with the right fuel.
I am out the other side of a tiny window of discomfort and after blasting round a charity 15km trail run for the Stroke Association, a charity close to my heart, I am looking forward to my first ultra of the year in a great local 40 miler at the end of all a full training week to test my fitness. The next stop will be either blasting along the West highland way in Scotland, in the Highland Fling, or a week later the Anglo-Celtic Plate 100km in Wales for England. I’m currently first reserve for the team in this home international and either race will be my first key ultra of the year and the reward at the end of this block of training. Either way I will be also spending some, if not all of the weekend at XNRG’s Pony Express race round the New Forest supporting or hammering the trails at that great event. The Compton Downland Challenge 40 may not be the Sahara where many of you are venturing this weekend but it is these events that are the bread and butter of my ultra-running. And I am a simple man. The simple pleasures are often the best and I am looking forward excitedly to my first proper challenge of the year for the legs and see what answers they provide before the bigger challenges ahead. Good luck desert devils and everyone out there venturing out over the coming weeks approaching your own key challenges, be it managing your bodies or your first major ultra of the year.
Nathan Montague Team XNRG runner