Marathon and Half-Marathon (22 page)

Common Reasons for Injuries

Running with pain

If something hurts, don’t try to “run through it.” Always listen to your body. Pain is a warning sign that should not be ignored. In the beginning, there will always be a few aches and pains that come with starting any new activity. However, they should dissipate within 24 to 48 hours. If they don’t, or if the pain intensifies, seek professional assistance. Early identification and treatment of an injury will result in minimal interruptions to your training schedule. It’s important to listen to your body and distinguish between an ache and a pain. An ache is a low-level discomfort associated with exercising; a pain is a sharp discomfort that can be localized. This is not to say that you should ignore the aches that accompany running.

Not sticking with your schedule

The most common running injury is overuse, or chronic injury that can result from overtraining. Dr. Jim Macintyre, a sport physician in Salt Lake City, says many overuse injuries result either from incomplete rehabilitation of an old injury or from individual anatomical variations that lead to injury when put under stress. The results are the same: when there’s a weak link in the kinetic (moving) chain—some part that’s not moving properly as the result of an injury—the other joints and muscle tendon units will compensate, leading to overload of another site as the runner tries to keep going. This usually leads to a different, new injury. For Dr. Macintyre, the red flags go up when runners go to him suffering from a cycle of injuries to one side of their body.

Choosing a poor training surface

Injuries for runners are often the result of impact, overuse, or pushing yourself too hard. A contributing factor is training on hard surfaces, which increases the level of impact on your body. The majority of runners log the most miles on asphalt. This is not the softest surface, but it is easier on your joints than concrete. Try to run or walk on the most level part of the road or pathway. Cambered roads will lead to imbalance and possibly injury. Try to log some of your miles on softer terrain such as grass or dirt trails, but remember, when you’re doing your off-road runs, you need to look out for things like hard-to-see bumps, holes, sprinklers, and tree roots.

Returning to running too soon following an injury

Many runners, especially those with a specific goal such as a marathon in their sights, frequently endanger their immediate or future health by returning to action too soon after injury. Not allowing yourself to complete your rehabilitation program can potentially lead to more injuries. New injuries, notes Dr. Macintyre, can also be caused by old injuries that haven’t healed properly. An ankle sprain, for example, might result in a loss of motion at the subtalar joint of the foot, which controls pronation and supination. Dr. Macintyre says he’s looked at thousands of people with one pronated foot and one supinated foot, and at first he thought it odd that these people were born like that. “But the truth is, they weren’t born like that. Somewhere along the way, something happened to the ankle that changed the range of motion or flexibility. The alignment was thrown out of balance, and the rest of the links in the chain started to compensate. Before the person started running, they may never have noticed this.”

Sadly, some runners get into a cycle of injuries and eventually throw in the towel. “I used to run,” you’ll hear them say, “but my [fill in the blank] couldn’t take it.” Maybe it couldn’t, but more than likely these runners didn’t have a proper diagnosis of the problem or follow the right course of treatment.

If you do sustain an injury, and if you don’t see fairly rapid improvement from some initial self-treatment, get help from a professional who understands sport injuries. Sport medicine is not a strict discipline in the way cardiology or neurology are, but an increasing number of physicians focus on sport-related injuries. Other practitioners who may focus on such injuries include podiatrists, chiropractors, physiotherapists, athletic therapists, athletic trainers, and massage therapists. You will benefit most from someone who will examine the entire chain of your moving parts—someone who can assess the body of motion and not just look at localized pain.

Most Common Injuries

Dr. Jack Taunton, a sport medicine physician at the University of British Columbia’s Allan McGavin Sport Medicine Centre, says, “It is normal for beginning marathoners to experience some degree of muscle soreness.” Use the 2-day rule: if you’re still feeling some degree of soreness 2 days after a training session, take an extra rest day, or do a cross-training activity like swimming or some easy cycling that is non–weight bearing.

Information to prevent injuries

By following the programs in this book—giving sufficient time to warming up and cooling down, watching where you are going, and investing in proper footwear, not to mention feeding your body properly and keeping it hydrated—you are going a long way toward preventing injury. Nevertheless, injuries occur, so it’s best to be prepared. Dr. Taunton says beginning runners, not surprisingly, experience injuries primarily in the lower parts of the body: hips, knees, shins, ankles, and feet.

Table 11

RICE

RICE
stands for Rest, Ice, Compression, and Elevation. It is a common and effective procedure that is often used alongside anti-inflammatory medications such as ibuprofen (Advil or Motrin). Anti-inflammatories are used to reduce swelling but should not be used to mask pain in order to train through injuries.

Rest
is essential to keep an injury from getting worse. This doesn’t mean you should stop all activity. In fact, complete immobility is rarely recommended. Stimulating blood flow to the injured soft tissue is necessary for healing. Speak with your sport medicine practitioner for recommendations on how best to strengthen the muscles around the injured area. Also ask about ways to increase flexibility and enhance circulation in and around the area.

Ice
is a great way to decrease swelling, minimize pain from an injury, and speed recovery time. Apply ice as quickly as possible, and do so for approximately 20 minutes at a time. Allow for at least an hour between treatments. Make sure you place a thin layer of wet cloth (for example, a tensor bandage) between the bag of ice and your skin. It is best to use crushed ice, but when it is not available, gel cold packs or even a frozen bag of peas can be used. Take care when using any chemical-style packs.

Compression
using an elastic wrap such as a tensor bandage can prevent swelling, reduce pain, and mini- mize bruising. Compression needs to be firm but not too tight. The process is extremely effective when combined with ice and elevation. A compression bandage should not be left on for longer than 3 hours and never left on overnight.

Elevation
refers to elevating the injured area above the heart, which minimizes pooling of the blood and therefore reduces the swelling of the injured area.

How to prevent injuries

• Forget fashion. Find shoes that fit you and meet your biomechanical needs.

• Don’t jump ahead in your training schedule. A gradual and progressive approach is best when it comes to distance running.

• Listen to what your body is telling you. If it hurts, back off. If the pain persists for more than 48 hours, be sure to see a sport medicine practitioner.

• Take a day off if you’re feeling under the weather, and rest until you’re feeling back to normal.

Orthotics

What are orthotics?

A Vancouver podiatrist, Dr. Joseph Stern, describes custom orthotics as a functional and correctional device to help in prevention and treatment of injuries, biome-chanical abnormalities, and anatomical misalignment. The realignment of the muscles, tendons, and joints allows the foot to be more efficient. If the bones are not in proper alignment, there can be stress on the tendons and joints that, if left untreated, can lead to problems in the feet, back, or hips. To minimize, stop, or even reverse these problems, the foot needs to be placed in a neutral position. The neutral position is attained with the use of custom orthotics, which are placed by hand into the footbed of your shoe and can be easily removed and used in other shoes.

What is the difference between orthotics bought in a
running store and ones that are custom-made?

Store-bought orthoics are known as over-the-counter arch supports. These are accommodative devices that provide some cushioning and minimal control. They are not specific to one’s foot, but they are a starting point to establish whether an insert is helpful. In creating a custom orthotic, a podiatrist will examine the lower extremities (hips and knees), provide a gait analysis, and complete a biomechanical analysis of the feet. This examination includes reviewing a foot’s range of motion, muscle strength, and positioning.

Will it take time to get used to orthotics?

Orthotics require a period of adjustment. Start by wearing them on an easy 20- or 30-minute walk. Once you’re comfortable walking, you can begin wearing them for 10 or 15 minutes during an easy run. Gradually increase your running time by 5 or 10 minutes. Breaking in orthotics can cause various types of pain in the feet, ankles, knees, legs, hips, or back. If this happens, see your podiatrist for a possible modification of your orthotic.

Should I take my orthotics with me when I buy
running shoes?

Before you purchase new runners, try them on with your orthotics. Make sure the orthotics don’t slip around in the runners; they should fit snuggly into the shoe.

How long do custom-made orthotics last?

Most orthotics will last 5 to 6 years, but the additional padding can be changed when needed.

The Injury-Awareness Scale

Imagine a scale between 1 and 10; “1” represents very little awareness of pain, and “10” represents an extremely high awareness of pain. Your injury-awareness level needs to be down to 2 or 3 before it’s safe for you to return to activity, and it should not increase to a higher rating as a result of returning to activity. Ideally, your level of pain awareness should decrease to 1 or 2. If your awareness increases, return to cross training until it settles down. Be sure to monitor yourself honestly and carefully, and talk to your sport medicine physician for guidance in making your decision to take time off.

When it comes to injuries, it’s very important for you to be honest with yourself. If you’ve returned to training and your injury/pain awareness starts to increase again, this is a serious indication that your body needs more recovery time. Only you can truly judge what you feel, and it’s much better to take an extra week or two to rest than to risk doing serious damage to yourself. Too many people resume activity before complete recovery from injury. The result is often further time off or, worse yet, a more serious injury. If this happens to you, discuss your recovery plan with your sport medicine practitioner in order to establish the flaw in your previous process.

Coping with the Psychological Effects
of an Injury

Vancouver sport psychologist Dr. David Cox says that if you’re well into your marathon-training program and starting to enjoy the benefits of an active lifestyle, chances are you will have to overcome a sometimes-lengthy adjustment period after an injury. “The adjustment period is characterized by five stages: denial and isolation, anger, bargaining, depression, and acceptance.” An injury that stops or slows your marathon training can cause harm to your emotional health and well-being. Here are a few suggestions for minimizing the emotional lows: