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Marathon Training Program:
Injury Treatment Approaches

It is beyond the scope of this web site to discuss in detail the nature and treatment of most running injuries. It is also difficult to provide detailed information about the treatment of specific injuries without knowing the symptoms. Whenever you are in doubt about the nature and extent of pain you are experiencing or if you suspect you may be injured, always check with a physician who specializes in running and sports related injuries for further guidance. Included below are some helpful pointers to consider when you think you may be injured. Of course, the best approach is to train intelligently to reduce the possibility of injuries from occurring. Refer to the sections on Getting Started - Training Basics and How to Avoid an Injury for more information. Unfortunately, there are times when even the most prudent runner who follows all of the training advice still incurs an injury. By following some of the suggestions below, minor injuries can be treated with no further damage occurring.

General Guidelines

Should you continue to run when experiencing discomfort and/or if you think you may be injured? That depends upon several circumstances. You can give it a try as long as you are able to run at a level of intensity below the threshold of pain. However, do not alter your normal running stride or foot strike to avoid pain. Doing so will greatly increase your chances of incurring a secondary injury (described below).

When an injury occurs, reduce your mileage and its related level of intensity until you can resume running without pain. However, do not take medications or ice an injury before testing to see whether or not you can run. If you notice that your injury remains painful and does not respond to the treatment approaches listed below, do not run; instead, choose a cross-training activity to maintain cardio-vascular fitness. The following sports, as well as some others, are generally safe for most running injuries: Walking, cycling, swimming, deep-water running, elliptical trainer, rowing, stair-master, and cross-country ski machines. Refer to the section on Cross-Training for more information. If you are unable to run for a continuous week or longer, ease back into your training slowly. See Mileage Buildup section further guidance. Listed below are some additional pointers.

  • Recognize the difference between fatigue and pain due to an injury. Unfortunately, endorphins (the chemicals the body produces from aerobic exercise that make you feel good . . . runner's high) mask pain. Listen to your body and respect the feedback it is providing you. Some minor discomforts diminish in intensity and/or disappear once the muscles have had a chance to warm up. Be very cautious in this situation, as you don't want to cause more serious damage to the injury site. Secondary injuries are oftentimes caused by suddenly changing the biomechanics of your running stride or foot strike as a means to minimize or eliminate pain experienced in a specific area. Favoring the original injury site and thus changing your gait oftentimes can lead to increased pain and/or injury elsewhere. Let’s assume for example that while running, you’ve been feeling discomfort somewhere in your knee region, whether it be a minor twinge or continuous pain. You sense that something isn’t right so you change your stride pattern favoring the knee. Over the course of your next few runs, continuing to modify your gait to minimize the knee pain appears to be an effective approach. However, you soon notice that you are experiencing pain in your ankle! How did this happen? Simply stated, while this new pain may seem to be unrelated to the knee issues previously described, the muscles, bones, and soft connective tissue in the ankle region did not have adequate time to acclimate to the sudden biomechanical change of your gait.
  • If pain becomes more intense while running, do not continue. Instead, walk and begin treatment. Above all, do not become a slave to your training schedule! If you continue to train and delay treatment, the injury will almost assuredly become more serious, thus jeopardizing the possibility of even being able to participate in your target event.
When in doubt, it's always a good idea to seek professional medical care for painful injuries that don't respond to ice, anti-inflammatory medications, and rest.Treatment
  • Inflammation (characterized by pain, swelling, redness, and warmth) is often the by-product of many injuries. If inflammation occurs in, or adjacent to an injury site, treat the area with ice (see icing guidelines below). Above all, do not treat the area with heat of any kind (wet or dry) for several days. Consider taking several days off from running along with any other types of sports that cause shock, pounding, jarring, etc. to the injured area. Try using some anti-inflammatory medication (e.g., ibuprofen) for injuries that are inflamed. Be careful not to exceed the recommended dosage as these products can cause a variety of internal problems. Heat is a good therapeutic/relaxation measure after inflammation of the injury site has been reduced significantly or eliminated.
  • If, after these approaches listed above fail, consider visiting a physician (who is very familiar with a variety of sports injuries and has experience treating runners) for both an assessment of the injury and treatment advice. The most important information a physician can provide is whether: (1) you can continue to run without modification of your training schedule, (2) continue to run with a reduced workload, (3) rest the injury site (e.g., no running), and/or (4) add some cross-training activities to both maintain cardio-vascular fitness and to strengthen the injury site. When in doubt regarding the seriousness of an injury, see a physician.
Ice is the number one treatment measure for injuries characterized by inflammation.Icing Guidelines
  • Use an ice cup - Fill a paper cup with water and then place it in the freezer. When completely frozen, the top of the paper cup can be peeled away to expose the ice. Massage the injured area with the ice cup for approximately 10 minutes or until the area is numb. It does little good to continue icing the area after that time. Repeat this process, icing the injury site two hours later at a minimum (or more frequently as possible).
  • If you are unable to create a frozen ice cup, use an ice pack or a package of frozen vegetables (tiny peas work great) to treat the injured area.
Information on Specific Running Injuries and Treatment Options

Check out this great web site Dr. Pribut's Running Injuries Page Page for detailed information regarding the description, cause(s), and treatment options for a variety of common running injuries.



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