Note to an injured runner

Here is something I wanted to talk about because in a previous class I got a student question on injury that gave me the feeling something else was under the surface - their motivation had been shaken too. I used the Dear Abby format to keep everything anonymous - I advise a lot of folks - not just in Elkins. Running is a great thing but we must progress carefully and support each other for it to work as well as it should. I feel like running is the best thing going and I want it to work for you if at all possible. I hope another person's question is a learning experience for others. Let me know.

Dear Carl: I wanted to touch base with you about my knees. After our run the other day, I drove twenty minutes to get home, and it was all I could do to climb 5 steps to get in the house. The next two days were better...and I could go up and down the stairs without hurting. I went for a run today and started off by walking, my knees bothered me and after the first walk run interval I could feel it just wasn't right, so I took a rest. I am I cut out for running?

Dear runner: here are several suggestion to your very big question.

You’re hurt. Maybe not bad, but you need to walk for now and here is why. We rarely get better standing still and when you see an “injury” in the real world (say a bird flies into your window) they get up right away because they know they are cat bait if they do not. Simple. Oftentimes some gentle movement will tell you more about the condition without making it worse and help you loosen up. Remember that stairs are easier walking backwards if your knees and quads are sore. Hold onto the rail! Never-the-less you have heard the prescription before of, activity as tolerated. This is what you need to do along with things like Rest, Ice, Compression & Elevation (RICE) and being good to yourself while staying confident that you can do this if you choose.

Whatever is bothering you is difficult to diagnose over the phone (or email) w/o a lot of trial and error but there could be several possibilities to consider right out of the gate that I see a lot (sort of FAQ’s from class) so without making light of your predicament – I’ll use the opportunity to teach a bit and toss around several of the possibilities that may be working on your knees.

You simply ran too far and are suffering Delayed Onset Muscle Soreness. We did run a 30 minute workout instead of the prescribed 20 minutes and while ten minutes of TV does not seem like a lot, we added 30% to your workout on a nice day of talking and running slowly. Honestly, maybe we should not have – I apologize for talking more than I was looking at the watch. When I run too long I am sore afterwards too – sometime for many days. I take responsibility for running too far on Saturday and I am sorry, you have my word that I will not do that again.

Your knees, shoes, or gait are bothering you. While I do not know your prior history with the knee ( your doc should always ask you “has this ever bothered you before?”) You may have a historical imbalance that we can work out slowly over time. We would do this with a gentler plan, once you are not sore. Stretching daily, and strengthening the muscles that support the running, including your knees. If your shoes are not new or brand new, they can tweak you the wrong way. When I have a runner in front of me I ask “what has changed since the problem began?”, and begin there. Think about that one and we can get back to it because small changes can have profound effects - good and bad.

I am always sore when I drive after running and this never changes for me. I have to stretch to get my muscle relaxed after a run and driving forces me into a long term, unnatural position, that often makes it tough to rise from the car. Perhaps you have seen me stretching between class breaks in nursing? I just cannot sit for very long anymore – I guess my lower body was made for nursing now. You may have to incorporate a 10 minute cool down and snack time before you drive home. When I ran the Tucson marathon my Dad read the paper for an hour while I stretched, ate, stretched, walked and then I could finally get in his car to head to the hotel.

Anything that hurts for two or more days needs a 2 day break before returning to running. You can always walk your miles, as this uses different muscles and you can self regulate easily. Wear you running shoes while walking to see if they are part of the issue (scientists control as many variable as possible) and to pad your feet/body. If after two days of self-rehab (which would be walking, stretching, using RICE on your affected area) you do not feel better let’s talk again with greater specifics about what is going on and in the meantime schedule with your Health Care Provider (HCP).

Remember that your homework assignment was to let your doctor know what you are doing and why you wish to take on this project. This last part is as important as the first, because I have heard doctors tell people they just cannot run and in my opinion this is hogwash. Most people can “ambulate for exercise” if they choose to – we need to modify our expectations of what running and realize that less is more. We start slow and many of us stay that way, only to just have the fitness experience simply get easier and maybe a little quicker. We do not go out and try to force change on our bodies but let it happen gradually. I would tell you to have the attitude that you can do it if you do it gently and that you advocate for this when you visit you’re HCP.

Of course, there are folks who develop stress fractures, have injuries they have never known about and other conditions that I have no business to diagnose - and you know that is why I am sending you to your HCP. But I know you signed up for class for a reason, and a very good one is that you are making an investment in yourself. Lobby for that and I will too. In the meantime walk, eat right and get back to me with more about your condition after two days rest.

There are several good links on the website and one of them is injured runner where they’ll ask you what hurts, then tell you what it might be, and try to sell you a book. While you may not need the book you gain some more insight about typical running related injury. Please understand that 90% of running related injuries are the result of overuse/overtraining. We’ll spend the next five months talking about all of the ways to over train and again I apologize for showing you one of them on Saturday- running too long. Also read the website entry on stretching and strength. I can tell you first hand that these two components greatly helped my running. I learned about the parts of me that were not adequately trained and works holistically to fix these areas to improve my running. In addition to these two key techniques that were covered this week many folks use other tools as well such as yoga (see Sage Roundtree on the site) and massage to again, open up, relax the body and strive for better symmetry.

We are seeking a new path and while I did say that you can do it, I will never say that it will be entirely easy. I was sincere when I said that I honor and admire the courage it requires to take up something new and challenging. I do try to make it a seamless transition for people and we should ease into it, know that everybody will adapt slowly at their own pace and can choose to triumph in the end. The most unlikely folks have come to fall in love with running over the years and one reason for this; I believe, is that we were built to run. Nobody said how fast or how far- you choose those variables with some guidance.

Misery loves company and if you really want to read a “crash and burn” story while you rest and RICE, try Tom Holland’s tale of his first marathon attempt (pages 9-16) which will cover at least a dozen things you do not want to do. In spite of his debacle, Tom not only went on to write a great book but holistically corrected his problems to run well. His story is one of many and I have heard countless others from people who were not runners (before they started) and are still not going to tell you that they are athletes, even today, when they are wonderful examples of a healthy lifestyle. Why did Tom Holland become a runner after that dismal race day? Because he wanted to, and that is the 1% inspiration that somehow weighs in as almost heavily as the 99% perspiration that he applied afterwards to surmount his goal. Please understand that I will never tell you to “gut it out” like the high school football coach did, because I do not think it is responsible guidance – it is not congruent with an injury free fitness program. But I do wish that you maintain your hopes to be a runner. I do hope you understand that there are a lot more possible solutions than there are reasons to quit. I hope I have begun to illustrate that when your body is new at something you approach the solution to success as a puzzle to solve and that we well may be able to do that together.