Early Detection and Treatment of Running Injuries

by Warren Finke, Team Oregon
By most estimates, 70% of all runners will experience an injury annually that will cause them to take time off from their sport. Fortunately, running does not produce the traumatic kinds of injuries that might be experienced in sports such as sky diving or downhill ski racing. The preponderance of running injuries are, in fact, chronic soft tissue inflammations. The onset of these injuries is not sudden, but usually follows a history of neglect and abuse. Running injuries are caused, they don't "just happen".

This class of soft tissue inflammations are often referred to as "overuse" injuries, a term which may be misleading since they are more often a result of changes in training rather than only volume of training.

Because of their progressive nature, three fourths of running injuries could probably be avoided or reduced in severity with early detection and treatment.

There are four stages exhibited by running injuries:

    Stage 1

    Symptoms : Pain noticed only after running, sometimes hours after or the next morning.

    Prognosis: 1-2 day recovery possible with proper treatment and elimination of the cause.

    Treatment: Ice, Compression, Elevation, Massage

    Stage 2

    Symptoms: "Discomfort" or "tightness", but not pain felt while running. Normal running and racing still seems possible.

    Prognosis: 4 - 7 day recovery possible with proper treatment and elimination of the cause.

    Treatment: 2 - 4 day rest or a non-exacerbating alternate activity, Ice Compression, Elevation, Massage, Anti inflammatories, Seek professional help if no improvement or worse after 7 days rest and treatment.

    Stage 3

    Symptoms: More severe discomfort described as "pain" felt while running. Runner feels compelled to reduce training and/or racing levels.

    Prognosis: 2 to 4 week recovery possible with proper treatment and elimination of the cause.

    Treatment: 4 - 7day rest or a non-exacerbating alternate activity, Ice Compression, Elevation, Massage, Anti inflammatories, Seek professional help if no improvement or worse after 7 days rest and treatment. Requires rehabilitation with a return to running when no pain on activity.

    Stage 4

    Symptoms: Severe pain. Runner cannot run.

    Prognosis: 6 week or longer recovery possible with proper treatment and elimination of the cause.

    Treatment: Seek professional help immediately. Requires professional treatment and rehabilitation. Return to running only when no pain with activity.

The Bottom Line

Most injuries do not develop through these four levels overnight. This is why most of them can be dealt with before they affect performance. The key is detection at stage 1 or 2 and aggressive treatment before further progression. Unfortunately, this is not often done. The usual scenario of progressive injury is: "Gee, my foot, leg, etc is sore. Couldn't have been the running I did this morning". "Hmmm, when I'm running it feels kind of tight where it was sore yesterday". "Wow, that was tight yesterday too, maybe I'll run fewer miles tomorrow". "Well, it's still sore, I'll go run on it to see if it still hurts". "Ouch! Better not run on this , it might cause permanent damage".

Rather than denial or fear of the loss of fitness, the runner needs to adopt a defensive posture that assumes a potential injury and treats it in an early stage. This aggressive preventative early treatment behavior should be considered part of the sport of running; not the "wait till it's broken to fix it" behavior that most runners do.

Steps to proactive injury prevention and treatment

  1. Expect to get injured. If you are aware, you will be able to detect injuries in the making.
  2. Keep a first aid kit. You should have several paper cups with water frozen in them for ice massage, ice cubes and zip lock bags for ice packs and an elastic bandage for wrapping the ice packs against the injury. To avoid frostbite only use water ice for cold packs.
  3. "Nuke" injuries in the making. Immediately ice after running any spot that "feels" funny. Ice massage with paper cup popsicles or wrap with an ice bag for 10-20 minutes then allow area to warm. Repeat several times a day if possible until there are no more symptoms. Rest the injury a day or two.
  4. Admit that getting well is more important than training. Keep injuries from progressing beyond level 1 or level 2. At those levels, a little rest and treatment can prevent lots of time off later.
  5. Admit that injuries are caused. They are not an "act of God". If you want a long term fix for your problem, you must identify and treat the cause, not just the symptoms.
  6. Use Anti-inflammatories only for inflamation not to kill pain. Most anti-inflammatories are also pain killers. If you are using anti-inflammatories you should not be doing it and continuing to exercise. This is dangerous since they will mask the pain, possibly leading to more severe injury.
  7. Don't be afraid to seek professional advice. Some doctors actually know what they are doing and can help you get back to the sport quickly. If your doctor is not interested in seeking the cause and returning you to running as soon as possible, get another doctor.
  8. Use caution coming back. If you have had your training interrupted for 10 days it will take you 10 days to come back. Don't try to get from zero to your previous level of training any sooner than the amount of time you were off. Plan a gradual increase from zero to your previous training level and stick with the plan.
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