The Injured Runner
Running shouldn’t define you, they say. It’s not your identity. There’s more to life than running. One hundred percent, you nod in agreement. You’re a family person, you work a day job, you enjoy other activities like cycling, fishing and birding. Of course running doesn’t define you. You don’t have to run, you simply like to run. Nod, nod. Running isn’t your identity. You can live without running...
The injured runner can be a miserable sod - unpleasant to be around at best, impossible on the bad days. It’s similar to the tapering runner, just several degrees worse. The number of degrees is generally directly proportional to the severity of the injury, the number of running-free days to date, the expected number of weeks for a full recovery and the number of races likely to be missed in the process. Other factors which often add insult to injury (excuse the pun) include an active partner who continues to enjoy their daily 5am trot, racking up the miles without you; friends who still invite you for beer and pizza after their Saturday marathons to discuss PBs; and those relatives who relish in the opportunity to substantiate their life-long claims that running is bad for the knees (almost regardless of the location of your afflicting ailment) with frequent exclamations of “I told you so!” while serving you generous helpings of ice-cream with extra chocolate sauce. Some people just don’t get it.
The injured runner is usually very quick to identify as such. How are you? How’s life? General question. Man, I’m injured. Not running at the moment. Identity crisis... This raises the question then, if running didn’t define you before injury, why is it that injury and a lack of running suddenly does define you? Well, some might argue otherwise, but I believe in a certain degree of addiction to running for most athletes. And runners, like most addicts, prefer to deny their dependency habits. In fact, they’re worse, because unlike with many other addictions it is quite feasible to declare running a “healthy addiction.” But, as with many smokers and alcoholics, that “I could quit if I really wanted” mentality only holds when things are going well and you’re getting your daily dose of endorphins. Take away the “drug” and suddenly it can seem as though your world is falling apart.
So, as you may have already guessed – two things. One, I am a running “addict,” and two, I am currently that injured runner. Of course I am. Healthy, pain-free athletes don’t have time to write articles about issues they don’t have. They’re out happily cruising the trails, tagging peaks for the new year and scheduling an epic race line up for 2021, including their first hundred miler. Don’t worry, I’m not jealous, just a little envious. Okay, maybe a little more than a little. But that’s okay. I’ll be back on track again soon. Hopefully.
But while I’m not back yet, I wanted to take the opportunity to share my own experience and opinions on the injury management process. Because you can be sure that the minute I’m free of this persistent knee pain I won’t be sitting at my laptop typing out thoughts on injury analysis. Oh no. This running-less start to 2021 will soon be relegated to a far corner of my mind and I’ll be out there sweating up passes and bombing down ridge lines to my heart and head’s content. Hopefully!
Hopefully. Let’s start, or stop, right there. Most runners experience a niggle from time to time and usually just push though the discomfort, hoping that it’ll pass. Fortunately, it often does. But what are the indicators that a niggle is threatening to become something more serious? When is it time to hold off on the “hammer and hope” approach and pay attention to what your body is trying to tell you? Recognising and acting on these indicators can be crucial in preventing you from becoming that injured runner.
Although pain perception is highly subjective and individualized, there are three factors I take into account when a niggle begins to plague me. The first is persistence. Something that bothers me persistently for three consecutive runs warrants more attention and I’ll take a few days off from running, alternating between rest and cross-training, before testing it again. A red flag here is having the same issue present during cross-training as during running, or no improvement by the next run after the recovery period. This is a warning that more time and effort may be required to resolve the issue and simply ignoring it is probably not your answer.
The second factor I consider is specificity, or localisation. If the discomfort or pain is very localised (limited to a small, unchanging area or specific muscle, tendon or ligament) then it is more likely to be something sinister. A localised injury often correlates closely to acute onset – a sudden and notable starting point to the pain, possibly associated with a traumatic event. I would take this sort of incident very seriously and refrain from running through the discomfort. In contrast, a generalised, shifting discomfort stands a better chance of being rectified by resting, stretching and foam rolling. Chronic pain often presents in this way and sometimes a modicum of running can be continued while simultaneously working to strengthen weaknesses or release tightness in a broader region. It is important to remember that the location of your pain is not necessarily the origin of your pain, even with more localised injuries. The body is a complex web of interdependent bones, muscles, ligaments, tendons, nerves and fascia, and having an open mind in trying to identify the source of your pain generally yields more accurate results.
The third factor is making the distinction between discomfort and pain. This is rather a grey area since runners who have been training and racing for many years often have a high pain threshold. In order to continue running they prefer to classify anything painful as mere discomfort with the end result being a debilitating injury. A good way to manage this is to grade the discomfort or pain of an injury each day in your training log or journal. This will allow you to track changes and give you a more objective indication of an intensifying problem. Ultimately, something that is worsening is cause for concern, regardless of the current degree of pain.
So let’s assume you’re in my position now – that injured runner. You’ve finally acknowledged your injury and ungraciously adopted your new identity, so what’s the next step? Well, this depends on a number of things. Assuming your budget permits, the natural first port of call would be a good sports physiotherapist who might advise stretching, strengthening or further medical attention based on what they find. If your budget is a little tight, you may prefer to attempt the self-diagnosis and self-management route, at least initially. I find it helpful here to take some time to reflect back on my injury and record the details. When did I first notice the discomfort? Was it acute onset related to a specific traumatic incident? Was it initially mild and gradually intensified? Or has the pain remained at a constant level and now become chronic? Is it similar to an injury or condition I’ve experienced previously? Could it be related to a change in my training or footwear?
Your answers to these questions certainly won’t be conclusive but they will hopefully steer you in the correct general direction in terms of what to research and how you might attempt to manage your injury. Bear in mind though that there is a plethora of information available online and you can quickly become swamped with thousands of “n=1” solutions to your supposed problem. Try to focus on reputable sources of advice, assume that you have a more common running injury than that one of which nobody has ever heard, and start with the basic exercises and stretches most frequently recommended for your suspected ailment.
If you’ve rested, stretched and strengthened for a few weeks but to no avail, then it’s definitely time to seek professional help. Start with an experienced sports physiotherapist. If they’re able to identify a basic and treatable injury they’ll prescribe a rehabilitation plan. This is best case scenario. If your physiotherapist decides that you require further diagnostics for a potentially serious issue, you’ll probably be referred to an orthopaedic surgeon for evaluation. Radiographs, ultrasonography and/or an MRI might be performed in an attempt to visualise bone discrepancies, cartilage damage or soft tissue inflammation. If the diagnostic imaging doesn’t provide many clues but you’re adamant on getting a diagnosis, prepare yourself for the possibility of multiple referrals, bills the size of which may seem oddly disproportionate to the length of your consults, and zero insurance on a successful outcome. It’s easy to convince yourself, or be convinced, that the next specialist will have the answer, but unfortunately not even the medical field is an exact science.
If you are diagnosed with a condition for which there is a corrective surgical procedure available, you may be faced with the decision of whether or not “to cut”. Factors to consider then include the cost (physical and monetary) of the operation, success rate of the procedure, length of the rehabilitation period, prognosis for recovery without surgery, personal medical beliefs and future athletic aspirations. At the end of the day every body is unique, anatomically and physiologically, and therefore responds differently to surgical procedures and rehabilitation programs. Also, every injury, regardless of treatment and management protocols, is going to take time to heal. Remember that ninety-nine percent of the time there will be no quick fix. A proverb I appreciate in terms of how I think about injury is time is the greatest healer.
Over the course of my ten year athletic career I have dealt with injury several times. Fortunately, I have found that making sense of the physical aspect of an injury is something at which one improves with experience. Recognising, classifying and managing pain becomes easier as your knowledge of general physiology and anatomy, as well as your own body’s strengths and weaknesses, grows. Unfortunately, however, I have found that for me and many other athletes it is the mental side of dealing with injury which never seems to get easier. Upon delving into the research on this topic I discovered a wealth of information which led to my writing Part 2 of The Injured Runner. Here I cover the psychology of the injury rehabilitation and recovery process and dig deeper into the core of the injured runner’s identity crisis!
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