It’s odd really it’s taken me around 8 posts before I got round to a general advice article. The reason for that is that there are so many out there. I wanted some specific stuff first.
That said, a lot of people may benefit from some more general advice…so here goes…in no particular order
- Train Smart and include rest – learning when to rest is a key part of running, especially when training for an event. Sometimes it’s harder to rest than to run but it’s essential for your body to repair. A lot of conditions, especially tendon problems, require around 24 hours post run to strengthen the tissue. The body is in a constant balance of tissue breakdown and tissue strengthening, if you run without allowing adequate rest it tips this balance towards breakdown. Remember we train to race, not the other way round, there are no prizes for the quickest time in training. Think about the bigger picture, sure running your long run 30 seconds per minute faster may be a better workout at the time, but how will it affect the remaining runs that week? Have one focus for each run, working speed, endurance etc individually , not together. A long slow run is just that, don’t be tempted to run it fast, you should be able to chat comfortably the whole way. Add new workouts gradually, especially hills and speed work where the risk of injury is higher.
- Find the cause of your injury – most websites are excellent at helping you settle symptoms and giving you generic advice on rehab. The idea on RunningPhysio is to help you identify the cause and deal with it appropriately. This helps to stop problems returning again and again.
- Settle the symptoms – the old acronym of RICE often proves useful here. Rest. Ice. Compression. Elevation. It has become PRICE, with the P standing for protect and more recently it’s been suggested to change it to POLICE. The R from rest is replaced by OL for Optimal Loading. More on this here, we also have details on what to avoid, sub-acute injuries and the use of anti-inflammatories. Other things can also be used to settle symptoms like offload taping and self massage. Once symptoms are settled and you’ve identified the cause of your problem then you can start rehabbing it.
- Strengthen – the most effective way of strengthening is to identify specific weaknesses and work on them. Common areas are calf, glutes and quads. Strong muscles will absorb impact more effectively and help improve running economy (how efficiently a runner uses oxygen while running at a certain pace). Strength and movement control are intimately linked. It is difficult to control movement without adequate strength. After injury it’s important to strengthen weak areas before returning to running. A classic with this is a calf tear, lots of people post on the RW forums about “recurrent calf tears”. When you probe a little deeper you discover they didn’t do enough rehab and returned to running with a weak calf leaving them vulnerable to reinjury.
- Stabilise – control and stability of movement is very important for runners. If you have poor control then you are likely to have excessive movement during the impact part of running. This can place a lot of stress on certain structures (like the ITB, Achilles tendon etc.) and lead to inflammation and pain. Assess your single leg balance and single knee dip. Is your balance good? Can you maintain balance without movement of the pelvis, ankle or knee? When you do a single knee dip can you do so without the hip adducting (which makes the knee move inward)? If you find one side is worse than the other or you struggle to control a movement practice it regularly and it will improve. Details on control and stability work here, including videos of tests and exercises, but you have to promise not to laugh at my skinny legs!
- Stretch – runners often complain of muscle tightness or joint stiffness. We tend to use generic stretches but it’s best to identity specific tight areas and work on those. Common problem muscles include calf, quads, hip flexors, ITB and hamstrings.
- Modify – in many situations you may be able to run pain free by modifying your running. This is a short term strategy but can be very effective in helping something settle. It’s a case of seeing what you can change that allows you to run pain free. It can simply be reducing distance or speed, or avoiding hills or interval training. It might be decreasing your stride length, regularly changing your running surface or starting slower and building up. Changing footwear, trying taping or a gel heel insert can all be ways of modifying your running to keep it pain free. Then when symptoms settle you can gradually return to your normal running.
- Plan a gradual return to running – so many people expect a rapid return to where they left off as soon as symptoms have settled. Unfortunately the body needs time to adapt to running again and any long break from running requires a gradual return. One way to do this is to plan it like you might a race. Set your goal as your normal weekly mileage and plan your running building up to this. Start by finding where your new level is – the maximum distance you can run without causing pain (during or after). Build up from there and but don’t increase your weekly mileage by more than 10% per week.
- Footwear – having appropriate footwear is an important part of your running. Old, worn out shoes will offer little support and it’s recommended you change your running shoes after approx. 350-500 miles. Choose the right shoe for your foot shape, generally this means a stability or motion control shoe for over pronators and a well cushioned shoe for people with high arches. A growing number of runners are now moving away from supportive footwear towards minimalist shoes. The theory is that with a gradual introduction to these shoes the muscles in the foot and ankle will strengthen and provide the support. The key though is to make the change gradually. If you are unsure about what footwear is best then arranging gait analysis can be very helpful or take advice from a podiatrist who can make custom built insoles.
- Ask for help – runners often seem reluctant to ask for help from their GP, Physio or Health Professional. There are several reasons for this, one is they worry they will be told not to run, the other is that some health professionals seem to know very little about running or have a very negative attitude towards it. That said sometimes you need help, injury management isn’t simple are can’t all be managed through advice online. Find a Physio or GP who understands running and has experience of managing runners and use them whenever you can’t manage an injury yourself. The better they get to know you and your training, the easier it will be for them to help you manage any injuries.
A simple diagram showing the balance between doing too much and overloading the tissues and doing too little and not improving strength and fitness. Some tissue overload is needed to improve strength but keep working too hard, for too long with too little rest and it’s likely you’ll pick up an injury.