Re­cover Quicker!

When dis­as­ter strikes, fol­low our roadmap to re­cov­ery – a step-by-step guide to ex­actly what you need to do in the hours, days, weeks and months fol­low­ing an in­jury to en­sure you come back faster and stronger than ever

Runner's World (UK) - - Contents -

Sure­fire short­cuts for those tough times when in­jury strikes

Acute in­juries You prob­a­bly al­ready know about acute in­juries: they fea­ture bru­tal, in­stant scythes of pain and in­clude mus­cle tears, frac­tures and break­ages. If you suf­fer an acute in­jury, the ac­tion you take in the im­me­di­ate af­ter­math is key, so head di­rectly to STEP 2.

Chronic in­juries can be trick­ier to di­ag­nose, as we run­ners are con­stantly deal­ing with nig­gles that may not de­velop into full-blown in­jury. But you’re far more likely to ex­pe­ri­ence chronic, overuse in­jury than the acute va­ri­ety, ac­cord­ing to re­search at Hanover Med­i­cal School in Ger­many. The re­searchers found run­ners were 10 times more likely to have suf­fered an Achilles ten­don overuse in­jury than an acute Achilles ten­don rup­ture.

‘Chronic in­juries are es­sen­tially overuse in­juries,’ ex­plains Graeme Ever­ard of Coach House Sports Phys­io­ther­apy Clinic. ‘The most com­mon tend to be is­sues with the Achilles ten­don and smaller ten­dons around the foot and an­kle.’ You can also add the usual sus­pects, such as ITB syn­drome and patellofemoral syn­drome (aka Run­ner’s Knee).

Ac­cord­ing to Ever­ard, fail­ing to re­cover from one run to the next could be a sign of overuse. Matt Shep­herd, of Bath-based Physio Im­pulse, puts it this way: ‘Use a pain scale, where three out of 10 is your nor­mal, post-tough run bench­mark. That’s tol­er­a­ble and you can keep run­ning. But if you’re at five, six or more, there could be a prob­lem.’

Be­ing hon­est with your­self is key to di­ag­nos­ing chronic in­jury. Many run­ners try to strug­gle through, but in the long run that will mean more time out. You won’t need the same swift plan to speed re­cov­ery as you will with acute in­juries, but seek­ing ex­pert help early will have you back to fit­ness faster (see STEP 3).

Tak­ing the ap­pro­pri­ate steps in the im­me­di­ate af­ter­math of an acute in­jury is cru­cial in re­duc­ing re­cov­ery time. And re­search pub­lished in the Bri­tishjour­nalof­s­portsmedicine re­cently pro­posed an up­date to the RICE (Rest, Ice, Com­pres­sion, El­e­va­tion) acro­nym. ‘For acute in­juries, we use PO­LICE,’ says Tom Goom, head physio at Brighton’s Physio Rooms. That means:

Pro­tec­tion ‘This might be crutches, a brace or even a cast in se­ri­ous in­juries,’ says Goom. ‘This could be for as lit­tle as a few days un­til symp­toms set­tle or around six weeks in a cast/ brace for a frac­ture.’

Op­ti­mal Load­ing ‘O and L stand for op­ti­mal load­ing,’ says Goom. ‘They’re the ma­jor changes. With RICE you were ad­vised to rest but it’s been proven that if you can keep a cer­tain amount of move­ment you can re­duce in­jury time. Al­ways stay within com­fort­able pain lim­its.’

‘Op­ti­mal load­ing should come quite soon af­ter an in­jury,’ says physio Paul Sav­age. ‘Af­ter two days for a rel­a­tively mi­nor in­jury and around a week if it’s more se­ri­ous. The load needs to be ap­pro­pri­ate for the sever­ity of the in­jury and this is best di­rected by a physio.’

Ice, Com­pres­sion, El­e­va­tion The fa­mil­iar trio are grouped to­gether, as they’re all de­signed to re­duce swelling in the first 48 hours. How­ever, there is some de­bate over whether sup­press­ing this nat­u­ral

re­sponse is a good idea: ‘It is part of the heal­ing process and the ben­e­fit is that swelling brings chem­i­cals that ac­cel­er­ate heal­ing,’ says Goom. ‘The down­side is swelling re­duces ac­tiv­ity around the joint, so it leads to tem­po­rary mus­cle weak­ness and in­sta­bil­ity. It also makes the joint painful and stiff. If we can re­duce that, you’ll get move­ment and feel­ing back much quicker.’

‘I find com­pres­sion very use­ful in man­ag­ing swelling,’ says Goom. He rec­om­mends a sim­ple Tu­bi­grip ban­dage, es­pe­cially for an­kles and knees. ‘The area should feel com­pressed but not un­com­fort­able, and en­sure there’s good cir­cu­la­tion.’ Goom rec­om­mends re­mov­ing com­pres­sion at night for com­fort ‘and be­cause swelling is usu­ally well con­trolled when we’re ly­ing down’.

Ice? Ice? Maybe… ‘There’s de­bate over whether you should ap­ply ice or sim­ply com­press and el­e­vate,’ says Shep­herd. ‘It’s down to re­cent work by re­searcher and sports ther­a­pist Peter Thain.’ He ar­gues that while ice re­duces lo­cal pain, there’s no human re­search to show it re­duces swelling. For ef­fec­tive re­duc­tion in swelling, tis­sue-tem­per­a­ture re­duc­tion must be achieved at depth rather than on the sur­face and no study has proved that ice re­duces tem­per­a­ture at 2cm be­low the adi­pose tis­sue (the fat that lies be­neath the skin).

If you do want to ice, Thain rec­om­mends ap­ply­ing wet ice through a fab­ric bag, as wet ice cools more ef­fec­tively than dry, and the por­ous bag ‘pro­vides a bar­rier to stop po­ten­tial ice burn. How­ever, if it’s a sig­nif­i­cant trauma, add ice to a plas­tic bag and com­press with tape.’

‘Ap­ply ice for 10 min­utes, then re­move for 10 min­utes, reap­ply­ing the com­pres­sion ban­dage in the rest pe­riod,’ says Thain. ‘Con­tinue the 10/10 cy­cle for as long as pos­si­ble, then place the com­pres­sion wrap back on the area.’

Take the pain Pop­ping an ibupro­fen is of­ten rec­om­mended to re­duce in­flam­ma­tion, but it’s not nec­es­sar­ily a good plan, says An­drea Jack­son of Phys­iofit in Cheshire. ‘One study showed that the use of NSAIDS [non-steroidal an­ti­in­flam­ma­tory drugs] af­ter ex­er­cise slowed the heal­ing of mus­cles, tis­sues, lig­a­ments and bones. An­ti­in­flam­ma­tory med­i­ca­tion has also been shown to de­lay frac­ture heal­ing. But most doc­tors agree that if the pain is se­vere, it’s worth tak­ing them for the first few days.’

Avoid fur­ther ‘HARM’ In the first 48 hours af­ter acute in­jury, it’s not just your train­ing di­ary you need to steer clear of. ‘Avoid HARM,’ says Shep­herd. ‘That’s Heat, Al­co­hol, Run­ning and Massage.’ Jack­son adds: ‘Heat­ing acutely in­flamed tis­sue in the first few days af­ter an in­jury may in­crease swelling,’ she says. ‘How­ever, dur­ing the heal­ing phases, which be­gin 48 hours af­ter in­jury, ap­ply­ing heat to the in­jured area can fa­cil­i­tate the heal­ing process.’

In this pe­riod, heat can in­hibit pain re­cep­tors and help you re­gain move­ment pat­terns that aid re­cov­ery. Jack­son rec­om­mends a warm bath with Ep­som salts daily to re­duce pain in soft-tis­sue in­juries, and some re­search also sug­gests heat can help in­crease flex­i­bil­ity post-in­jury.

‘The sooner you can get the in­jury assessed by a phys­io­ther­a­pist who spe­cialises in treat­ing run­ners, the bet­ter,’ says Sav­age. ‘I might see some­one with run­ner’s knee but think this is an is­sue you could still run with if you add some­thing to

your pro­gramme, such as foam rolling. Or I might see some­one and say no, that looks so in­flamed that it needs a pe­riod of rest.’

There are ex­cel­lent NHS phys­ios, but wait­ing lists can mean long pe­ri­ods out of ac­tion, or the in­jury wors­en­ing be­fore you’re seen. Go­ing pri­vately can be pricey, so you won’t want to use that op­tion un­til you know it’s nec­es­sary. There’s no one­size-fits-all rule as to when that may be, but, in gen­eral, ‘if af­ter three or four days of rest­ing and ic­ing the pain con­tin­ues, see an ex­pert’, says Sav­age. That’s par­tic­u­larly rel­e­vant to acute in­juries. And if it’s truly trau­matic, you should seek ex­pert help im­me­di­ately. Chronic in­juries can be trick­ier, as pain might come and go. Be hon­est with your­self and re­mem­ber the cost of a physio can pay huge div­i­dends in the long run. Once in­flam­ma­tion’s eased, massage can also play a role in your re­cov­ery.

Your physio will give you a re­hab pro­gramme to re­duce swelling and in­flam­ma­tion, in­crease range of move­ment and ad­dress un­der­ly­ing is­sues such as weak­ness or im­bal­ance. Of course, you then have to ac­tu­ally do the ex­er­cises. If you strug­gle with mo­ti­va­tion, stay fo­cused on the goal and ac­cept that there will be psy­cho­log­i­cal hur­dles along the way (See Re­haby­our­mind, be­low). ‘Re­cov­ery isn’t a smooth jour­ney but keep with it,’ says Shep­herd.

Shep­herd says adding load comes first. ‘It might risk poor early range of move­ment, but it will pay off,’ he says. ‘Then we’d in­tro­duce iso­met­ric ex­er­cises, pro­gress­ing to iso­tonic ex­er­cises, where you move through a range of move­ment and build things up. Then comes strength and pro­pri­o­cep­tion work.’

Time for low-im­pact ac­tiv­ity. ‘Cross-train­ing is in­valu­able for re­cov­ery,’ says Goom. A turbo trainer is great, as you can ex­er­cise free from in­jury-ag­gra­vat­ing dan­gers, like stop­ping abruptly at traf­fic lights. If you have ac­cess to a pool or gym, aqua run­ning and el­lip­ti­cal train­ers are good op­tions.

‘Make sure any pain dur­ing crosstrain­ing is tol­er­a­ble,’ says Ever­ard.

As for ses­sion con­tent, Shep­herd sug­gests mir­ror­ing. In­stead of a long, slow run, do a long, slow bike or swim. In time, you can also mir­ror more in­tense ses­sions to help re­gain fit­ness be­fore your in­jury is fully healed. ‘Most recre­ational run­ners should fo­cus on the lower-in­ten­sity stuff ini­tially,’ says Shep­herd. ‘You can add speed­work af­ter about six weeks. ‘Just en­sure you in­ter­sperse with rest and re­cov­ery days.’

‘You should also walk,’ adds Sav­age. ‘You’re load­ing the same tis­sues, mus­cles and joints as you would when run­ning.’ He says there’s also a psy­cho­log­i­cal boost to a spot of am­bu­la­tion. ‘You’ll be ad­vised to hit the gym but many run­ners love run­ning be­cause it gets them out­doors. Drive some­where nice and have a walk in the hills. It’s bet­ter for the psy­che than many op­tions.’

When you’re ready to run, go easy. Stick with a cross-train­ing ses­sion or two each week, grad­u­ally re­plac­ing them with runs, and ‘start at around 10 per cent of your pre-in­jury weekly vol­ume and build up steadily week by week’, says Shep­herd.

Th­ese ses­sions should be of a light or mod­er­ate in­ten­sity; speed­work can come later in your re­cov­ery. It can take six to eight weeks to re­cover from many soft-tis­sue in­juries, but time will de­pend on sever­ity (see How­bad?how­long? p55).

Shep­herd also sug­gests do­ing some drills – such as 30 min­utes of brisk walk­ing, 30 sec­onds of bal­anc­ing on one leg, 15-20 sin­gle-knee dips, and 20-30 sin­gle-leg calf raises – be­fore you be­gin run­ning again and at the start of each run re­hab ses­sion. ‘This gets the mus­cle and joint mov­ing in a less tax­ing way, just to give it a tester. Then build up the im­pact.’

Your re­hab should also fo­cus on what caused the in­jury in the first place and what ac­tion you can take to re­duce the chances of it re­cur­ring. With many acute in­juries, the cause may have been ex­ter­nal, such as land­ing on an un­even sur­face. There’s not much you can do about th­ese trig­gers ex­cept per­haps be more at­ten­tive, or en­sure you wear suit­able footwear for the sur­face. ‘ Wear­ing rac­ing flats on a tech­ni­cal trail, for ex­am­ple, will leave you lack­ing trac­tion, and, there­fore, more vul­ner­a­ble to in­jury,’ says RW Gear Ed­i­tor Kerry Mccarthy.

With chronic in­juries, iden­ti­fy­ing the un­der­ly­ing cause is vi­tal. ‘Many are sim­ply down to sud­den in­creases in train­ing,’ says Ever­ard. ‘Peo­ple of­ten take on too much, too soon. Then there’s an­other set of run­ners who are guilty of “cram­ming”. One com­mon story is that a run­ner will reach around six miles in their long run, get in­jured and then pick their pro­gramme back up at the 18-mile mark. In­evitably it breaks them.’

When you’re fit, Ever­ard ad­vo­cates the clas­sic rule of in­creas­ing train­ing vol­ume by no more than 10 per cent each week, with a re­cov­ery week ev­ery four weeks, where you cut back by around five per cent. This cov­ers both vol­ume and in­ten­sity, which could be key, says Goom. ‘There’s re­search that shows knee prob­lems, such as patellofemoral pain, and ITB prob­lems, are linked to train­ing vol­ume, whereas Achilles, calf and foot prob­lems are more likely down to train­ing in­ten­sity.’

‘Run­ning is a lin­ear sport that puts a great strain on the knees, es­pe­cially if you’re slightly mis­aligned,’ adds Goom. ‘The greater the vol­ume, the more stress, the greater the po­ten­tial for in­jury. Run­ning faster is heav­ily down to the calf mus­cles, which in­creases the load on the Achilles ten­dons.’

But there’s a school of thought that run­ning faster might be bet­ter for your knees, due to re­duced ground con­tact time, which means, in the­ory, your knee is loaded for less time.

Think about sur­faces, too. Run­ning on con­crete has long been linked with in­creased risk, and tread­mills, which are more for­giv­ing, with less­en­ing im­pact, plac­ing less stress on the tibia and re­duc­ing the chances of con­di­tions such as shin splints. ‘But this might not be the an­swer,’ says Shep­herd. ‘Re­cent re­search sug­gests ground re­ac­tion forces are ac­tu­ally greater on a tread­mill than on the road.’

Many ath­letes, such as RW’S own five-time Olympian, Jo Pavey, cite clock­ing miles out­side on softer sur­faces, such as grass, as key in pro­tect­ing the body. So, vary­ing your sur­faces and lim­it­ing your miles on the road is good advice.

Then there’s your biome­chan­ics: it’s worth in­ves­ti­gat­ing whether your tech­nique may be con­tribut­ing to chronic in­jury. Patellofemoral pain syn­drome, for ex­am­ple, de­vel­ops when you’re not strong enough to keep your­self in good, straight align­ment, which puts un­due stress on the kneecap. Fo­cus­ing on glute strength­en­ing and cor­rect leg align­ment will pay div­i­dends.

A good run­ning-spe­cial­ist physio, or po­di­a­trist, will assess your body and biome­chan­ics as a whole and of­fer cor­rec­tive advice. ‘Knee prob­lems might stem from a dif­fer­ence in leg length, for ex­am­ple,’ says Ever­ard. ‘They’d also look at some­thing like shoul­der po­si­tion. This can put ro­ta­tion through the body, mean­ing your tho­racic spine counter-ro­tates, which may put the pelvis out of kil­ter.’

Con­tin­u­ing with strength and con­di­tion­ing work is im­por­tant in fu­ture-proof­ing your run­ning body. ‘There’s ev­i­dence that it re­duces overuse in­juries by as much as 50 per cent,’ says Goom. This time of year is ideal for do­ing strength work in prepa­ra­tion for spring marathons. It could mean drop­ping mileage, but spend­ing two or three ses­sions a week build­ing strength will be time well spent.

WALK BE­FORE YOU CAN RUN Don’t rush back into train­ing

AMAZE YOUR­SELF Take the right steps to re­cover prop­erly

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