Injuries (updated); trying to prevent them and what to do when you get them

 

Runners get injured. If they don’t then they are either lucky, don’t work hard enough or are biomechanically perfect. It’s as it is with everything in life; far from ideal but what’s a man to do?

The four years I’ve spent trying to become a runner have been littered with injuries – all of which have contributed to inconsistent training and thus inconsistent performances. In the vain of writing what I wish I’d known back then..........

this post is about the processes I go through to avoid injury and then what I do when inevitability strikes.

Eat and drink sensibly

Water is vital to our survival. So are nutrients and vitamins. I will write a more detailed post on this in future but for now one must surely realise that keeping the body nutritionally healthy will only help matters.

 

To expand slightly; if you unbalance your hormones as often happens during extreme exertion you are practically asking for trouble. Sometimes we seek this and on other occassions it cannot be avoided but doing it every time you go for a long run is foolish. You must eat and drink whilst training and you must focus on recovery to avoid the issues associated. Here's a few things I do;

1. never train on an empty stomach

2. ensure my last meal/snack pre-training has carbs in it - slow release only

3. avoid comfort foods as much as possible - think foods with a high fat content

4. try to only have sweet foods either just before I train (within 15mins), during training or within 4 hours of finishing my training

5. have carbs during my training runs - all over 90mins

6. always take a gel with me on every run - just in case of a sugar crash

7. have a post training snack consisting of 1gram of carb for every kilo I weigh e.g. 70kg equals the need for 70g carbs within 30mins of completing a key session. This roughly equates to a couple of medium sized banana's and a nesquick milkshake.

8. have a high quality meal within 2hrs of completing a key session i.e. good quality protein, low fat content with slow release carbs in the form of vegetables e.g. a roasted chicken breast with savoy cabbage and mashed sweet potato.

9. I eat between 5 and 6 times per day and try to avoid hunger.

10. some supplements; glucoseamine sulphate and Omega 3 for natural anti-inflammitories and also Neovite for repair and recovery. Cherry juice is exceptional in terms of speeding up the recovery process. Some supplement with this for 7 days leading up to an event to mitigate muscle damage.

Train smart

This means I only do what I need to do to achieve my goals and nothing more. It means I avoid overtraining and becoming fatigued more than I need to be. However, the last 4 years has left me incredibly frustrated with this part – so I contacted Olga King and begged her to help me. I now leave the thinking to her. The Heart Rate Monitor is an essential piece of kit for this.
 

Strength training

Part of my weekly routine is to work on my whole body strength; upper body, lower body and core. And this shouldn’t just be the big compound moves and large muscles – it’s equally important to focus on all the little muscles – the ones that provide support and stability for everything.

Olga gave me some routines to do but as I only have free weights at home I’ve adapted the routines to suit me. Essentially I will do 3 sets of 12 with a weight that I struggle to lift 15 times. Actually I do something a little different but from experience it’s difficult to explain in writing – you get the jist; do some strength training.

I will expand on this with specific types of workouts at some point in the future.

 

I also do some basic plyometric exercises and some bosu ball work. The plyo’s are usually done after a quality speed session and my gut feeling is that this technique really improves strength and efficiency.

The bosu ball is a tremendous piece of kit, especially for the lower limbs. The more you can do on one leg the better for your running efficiency.

Stretching

I have another routine which I try to do most evenings. It only takes about 10-15mins. I don’t go for the stretching each area 3 times for 30 seconds each way. Instead I just do each area once and for about 20-25seconds each way. I got this tip from the Men’s health book ‘Beat Any Injury’. Apparently, the body gets just as much benefit from one stretch as it does three; Bonus – some time saved there!

Wear compression socks

One of the injuries I suffer with is tenderness and pain in my Achilles. I’ve found that calf raises helps to prevent this but so too does wearing compression socks – especially when running on hard monotonous surfaces like roads. I don’t have to wear these type of socks when out on uneven terrain though.

some extra's
it's a really good idea to warm up properly prior to going for a long run. You should do some dynamic stretches and if you've just got out of the car to go trail running it might also be a good idea to pre-empt that warm up by using heat packs over areas prone to injury and niggles. For example, the hip flexors are prone to problems due to the amount of time many of us spend sitting.

when you finish your run you should do some stretches and if possible should ice the legs. This speeds up the recovery process - especially important if you're set for another long run the day after. You can either find a small stream near your car and sit in it for between 5-10mins or you can have some ice packs in a cool box (in your car - along with your banana's and milkshake) and get these on your legs as soon as you get back to the car. Once home and after your shower get some emu oil on those legs (thanks to Ali Bryan Jones for this one) alternatively you could try magnesium oil.

 

Now I’ll explain what I do when I get minor aches and pains…..

Ice

If I’m near home, I’ll try to get some ice on the affected area – for about 10-15mins. And I’ll repeat this throughout the day, maybe another once or twice if I have the time. If the pain persists (unusual for minor stuff) then I might continue to do this for another day or two. Then it’s time to reintroduce blood.

Compression gear

This stuff gets the blood circulating i.e. delivers nutrients and oxygen whilst retracting the bad stuff. It’s good to get some heat applied to stubborn areas too.

Self massage
I have a foam roller, a little sports ball and a little massage tool. All are used for different areas of the body and have a unique way of dealing with certain tweaks.

I was side-lined for 4 months after my WHW challenge. Why? Because I did it with an ITB strain. Ok so I had done little training in the 3 weeks prior to it in the hope that it would clear up. And to a certain extent it did except for the absolute pure agony I endured for the last quarter of that challenge. How did I eventually rid myself of this problem? A big part of it was using the foam roller. But if you think it’s going to be easy, think again. The pain one goes through using this bar-steward
is full-on!

I also have a TENS machine and an ultrasound machine. I also believe that the ultrasound machine is an invaluable piece of kit. I bought it from some beauty website but it still does the same thing whether you apply it to your face or your affected area. The ultrasound might come with two settings; low and high. The low should be used for deep tissue injuries and high for those nearer the skin surface. For acute injuries, you can use every day once or twice.

And now for what I do when things go from bad to worse….

Continue to do all of the things above
To save from repeating myself, all of the above is continued where it can be i.e. when it’s not painful to do so.

Ignore the pain and continue to train

Not intended as advice, more just the first thing I usually do – like many of us.

Stop doing the type of training that results in the pain

Notice I didn’t say ‘causes the pain’? There’s a reason for that and I’ll come to it in a bit. Yes unfortunately this is the bit that most runners have a problem with. It halts progression in running gains and by the time the runner is able to resume specific training often takes him/her back a few stages in that progression. 

Psychologically, this is made worse for the athlete who has ambitions to do well in a forthcoming competition/event. Time stops for no-man!

Fortunately you can still train if you can find an activity which doesn’t hurt you. But why would you when it’s running you love? Well, there are whole books written about this but for me one of the stand out things is the need to keep the cardiovascular system active. 

Yes you’re going to lose some running gains but if you simply stop training then it’s going to take you a lot longer to get your running fitness backonce you get over your injury.

 

At home (during the week), I’ll get on my turbo trainer and replicate whatever session I was down for that day. On a Saturday, I’ll try to get down the local municipal gym (sweat factory) and cross train for around 3hrs and follow with maybe a couple on Sunday.

What I would like to add here is that you should really focus on your leg strength work during this phase. Ohterwise, as soon as you resume running you will notice that your legs are  unusually unconditioned i.e. you will fatigue quicker than you remember beforehand.

If the injury is really bad, perhaps you can do some aqua running. I used to do this after big sessions in the Lake District as it was a great way to flush the toxins out of the legs. It’s also good for when you have DOMS.

Email and speak to other runners

With my most recent injury, I emailed Olga. She has a vast amount of experience and straight away offered two suggestions as to what she thought it might be. She also told me to continue with the training albeit substituting the running with something else that didn’t hurt.

Add a query to a runners forum
I actually did this with runnersworld but got no repsonses. I think this may have been for two reasons; 1. the time of the week that I posted - very late on a mid week evening, and 2. the post was very technical.

Start reading up about the injury

The sports injury clinic website is a great starting point. It’s not too technical and gives you just about the right level of information to get you going. This will often hone me in on some key words which I take note of then google afterwards.

 

So for example, with my latest injury I knew the area. After looking though this website I had more of an idea what was going on but my search was expanding on the basis of options offered to me.

 

I googled each diagnosis separately and like a mind map found that two or three theme’s kept being repeated. I now had a better idea of what was going on.

 

You tube is also very good in terms of watching how some physiotherapy exercises are supposed to be done correctly.

Re-read your books

For many runners (me included) the head needs to be in the right place prior to undertaking big challenges; doubt within regarding previous injuries can manifest itself in failure. Therefore this process is a great to reinforce your understanding of the injury.

Ch14 of Noakes is superb. Here you are told to prioritise treatment of what causes the injury rather than just the symptoms. Put simply, if what you have is as a result of overuse – you have a problem. If on the other hand, it is as a result of some external trauma e.g. a sprain, then you know what you need to do.

 

‘Running anatomy’ and ‘beat any injury’ are brilliant books in that they help to refine what you think you know and also offer physiotherapy exercises specific to each problem i.e. they explain how to address the cause of your problem. I haven’t got round to reading ‘brain training…’ yet.

Arrange an appointment with a sports injury specialist

This should be done in tandem with your self understanding of the injury. After all, hardly any of us have the time available to spend whole swathes of time reading up. For my most recent injury, I spent an hour here and half an hour there over the course of 3 weeks trying to get to grips with what was going on.

My appointment helped in terms of the physio giving me some specific exercises which isolated a certain area. It’s not the panacea though and as I still had some doubt I had to continue to pursue a more definitive answer.

Arrange an appointment with a masseuse

As part of my injury prevention processes I have been visiting Linda Curry, a registered masseuse, once a month for some maintenance work. With a bit more understanding of this injury I explained all to her at my most recent visit and she set to work on the area.

There are many techniques a masseuse can use as therapy; Linda specialises in Myofascial release. After the last session I began to feel slightly better about my predicament.

In terms of timing; a deep tissue massage should only be done 3-5days pre-race, 3-5days post race or 1-2days pre or post a long training run depending on your own recovery ability.

Arrange an appointment with an osteopath

The spine is the most important component of the body. Anyone who suffers with chronic back pain will testify to this. A huge tip is to always take care of your spine. Why do you think we runners care about our core so much?

One of the things I read about my injury was that a tilting of the hips could cause the problem. My visit to Vince Matthews was a big help as he confirmed that there were no major issues with my hips and spine.

Get your gait analysed

I haven’t done this on the basis that I believe my most recent injury was caused by trauma – as opposed to overuse. Once you have this done, I dare say you will be offered some cure – usually in the form of an expensive pair of trainers or shoe inserts.

 

If I sound negative about that - its because I am. Orthotics might work for some but they didn't for me. The 4 months I spent in rehab earlier this year was possibly 2 months longer than they needed to be - because of an orthotic I had been prescribed. Recurring back injuries finally woke me up!

As a slight side issue, I have spent the last 12 months making minor adjustments to my own running gait. There are two reasons for this; one in the hope that I reduce my chances of getting injured more often in the future and two in the hope that my running becomes more efficient – especially important for ultra running. Whether or not this works only time will tell. From what I’ve read, research into this process is inconclusive i.e. actively changing your natural gait.

If after 3-5 weeks you’ve still got some problems then you will have to seek a more permanent solution.

The NHS

We are quite fortunate in the UK. But any responsible person understands that things like an MRI scan cost the tax payer a heck of a lot. This is one of the reasons I try to deal with the injuries myself. There’s also the issue of time as it can take months to finally see a specialist.

My most recent injury

It’s exactly 5 weeks since I first felt this one and whilst I’m not completely out of the woods, at least now I can see through them. I went for a run today (6.5miles) and felt some minor pain but the key thing is that I have been able to walk freely afterwards.

I have followed all of my own advice and according to today’s run have lost between 15-20seconds per mile from my running at base pace. I’ve seemingly not suffered with fatigue from yesterdays sweat session either, so that’s quite promising too.

If anyone has any idea about this injury I’d be relieved to hear from you;

 

Pain over my left trochanter felt at first by a tendon flicking up and down over it. When I stop running the whole of the left of my hip was quite sore and tender and was making it very difficult for me to walk. I also have sciatic nerve pain deep in my upper left buttock – almost constant.

I believe I have knocked my piriformis out of its usual alignment. This has caused it to become strained under tension on the left side and coupled with other small muscles such as the iliacus and tensor fascia latae has manifested as pain over the trochanter and has also trapped or impinged on the sciatic nerve.

 

The single best form of therapy for this injury (whether I’m right or not) has been the Myofascial release and I intend to re-visit Linda soon. The down side to this is clearly financial as after the next visit I’ll have no money left until the next pay day – mid January!

Nevertheless, my coach has told me that I can just about manage to achieve my goals for 2013 if I am able to resume proper training by January. Fingers crossed.

In summary my weekly routine is self-reffered to as a 'sprinkling of several ingrediants' which are geared to keep me free from injury.  And although I don't have all the answers I'm somewhat comforted when I do suffer a set back that I have some means of trying to get over it.