Return To Running Post Injury

Davina is suffering some tight glute and hip flexor tightness after returning from an injury sustained through a fall last month.  Loosing form and returning to running is tough and she’d like to hear about how my return is going.  Have I lost form?

Hi Davina

Sorry to hear you are experiencing the rough ride of returning to running.  “Have I lost form?” you ask!  Have I ever!  I had 3 months off.  I wasn’t allowed to cross training until late in the piece and by that stage I had completely lost where I’d come from post Games so why bother with a strict cross training regime. 

Instead I focused on my rehab exercises.  An hour a day of rehab and stretching has been more beneficial to me than worrying about how ‘running unfit’ I am.  And I have found that in a week I even cut 90secs off my lap around Princes Park!  I know I started off very slow in the first lap, but progress is progress and that is what makes a return to running program fun and builds your confidence.

Do you have a friend who is at your current level of fitness?  Luckily for me my husband has been injured for the same time and is coming back to it with me.  So we are walk jogging our way back to fitness. 

Before you know it you will be fit again.  The first 4 weeks are tough, you have to do all the little things, like take a day off in between and do your rehab and stretching.  Plus get a massage.  When we’re resting from injury the muscles get used to contracting and being in a shortened state, so get yourself walking and light stretching to help.  Even add in some water running if you don’t want to take rest days.

Don’t forget not to increase intensity and volume in the same week.  As you’ll end up hurting something else.

Set little very achievable goals like Lac and I are at the moment so you grow your confidence.  ‘Running fit’ comes back, unfortunately you have to be patient….something us runners aren’t!

Happy Running

Lisa

How important is keeping lean while injured

Emma is in her late 20s and started running distances in a less than traditional manner!  She started with half marathons and marathons and is now focusing on improving her cross country and 10k performances.

She leaned up and was happy with her progression, however, when it came to race day she started breaking down.  She made it to race day but wasn’t right on the day.  She ran all the same and for almost 12 months has been battling chronic injuries from bone stress to lower back tightness. 

Cross training was difficult and keeping her lean frame has become a challenge without the ability to run. 

Emma is now running shorter distances and has the original goal of running a faster marathon in her sights.  She is looking for some advice on next steps in the return to running, on how to stay positive during the tough times, on how to get off the injury-train-injury merry-go-round and whether focusing on the shorter distances for a year is the best approach in the short term before setting a new marathon goal.      

Hi Emma,

What you have described is not uncommon.  Running is addictive and so is getting lean for some of us.  I on the other hand have a Cadbury Chocolate addiction to uphold!!  Therefore, I am less focused on getting lean and let the training take care of that naturally. 

If you eat a balanced diet and consume a little more protein in the evening meal than carbs, this may help weight control.  I really don’t obsess about my weight.  I too put on 2kg during my 3 months off (no cross training allowed either for my injury, which was extremely frustrating!).  I was not happy about it, but also not phased either as I know in another month I’ll be back to normal with a consistent and slow build up to return to running. 

My first question regarding the decision to wait a year before the marathon would be, were you running much before you took the marathon plunge?  As if you haven’t got the miles in your legs then you may benefit from some consistent miles before running your next marathon, particularly if you are targeting 2hr45m.  You might even want to send me a standard week of your training and I’d be happy to check it over for you. 

If you do want to get close to a 2hr45m then you will definitely benefit from some shorter races, where you can practice running at a pace which is a fraction harder than your goal time.  Perfect distance for that is around 16km.

Running is a balancing act, you need to do enough intense running and slow recovery running each week without increasing your mileage and intensity at the same time to avoid injury.  You also need to focus on the little things, like the boring exercises related the any imbalances you may have. 

Another question I have is did you change your diet before the marathon to get lean or did it happen naturally through training?  As a quick visit to a dietitian to get a meal plan is well worth the money, both from a training and recovery perspective and for advice on what to eat the week before the marathon.  It takes the guess work out of it all. 

Finally, staying positive.  My advice here is ‘get angry’ when you feel you need to get angry.  It is part of the process.  But once you’ve spent a day or so getting angry about it, turn yourself around by focusing on ‘why’.  ‘Why’ did I get injured before Gold Coast? 

Look at the training diary and check out any patterns that may have formed with regard to increases in distance and mileage, look at your diet, perhaps you weren’t getting enough protein after training (I use Ascend Recovery 3 times per week, happy to provide some samples if you want to try protein as part of your recovery regime), how about your iron?  My iron always got low just before I got injured.  I am not sure of the science behind it but there was definitely a pattern for me.  Worth checking out.  If you’ve had your biomechanics checked then you are already ahead in that department.  Another thing to check is your footwear.  Have you changed it while riding the injury roller coaster?

All these things tell a story.  You need to read that story. 

This is how I stay positive, but through it all, Cadbury chocolate helps and trying other activities that take your mind off not being able to run! 

Happy Running!

Lisa

Managing Shin Splints

19 year old Max has been suffering from recurring injury troubles and has developed shin splints after exhausting himself to dehydration in a local race a few weeks ago.  His training has been a little up and down due to injury and desire to get quality training sessions done in order to run his best.  He has been icing his shins regularly and would like some advice in a fast recovery and in preventing their recurrence.

Hi Max

Sorry to hear you are suffering from shin splints.  I do know how you feel.  Hopefully you can rid yourself of them quicker than I did and get yourself on track to running your best with a few tips! 

Is the pain sharp and localised to a particular area?  If so then you need to cautious with your return. If you run on pain you will eventually end up with a stress fracture.  No good ever comes of that and it sounds like you have caught it early which is great.

I highly recommend taking it easy for a couple of weeks by getting in the pool until the pain settles down.  Get into the pool and do some water running with a belt. In the meantime, you can use that time to sort a few things out.  

Get the physiotherapist to look at your strength and biomechanics.  Take your shoes in when you go as they can tell a story.  Always ask the question of ‘why did I get them in the first place?’  

Get yourself off to a good masseur straight away who will work on your shins directly.  Get a few treatments of about 30mins on your shins and calves to break up the shin splints and loosen up the calves.  It hurts, so hold onto the massage table and think happy thoughts !! 

I hop to strength the calves and shins, 6x30 hops on each leg.  If you are going to try it you may want to work up to that as you don’t want to create another injury for yourself.  I hop after my easy runs straight away before I get cold.

In order to prevent sore shins from recurring you really need a structured training regime.  You need to ensure you have a hard day followed by an easy day and that your easy days are EASY and your session days are good quality runs.  At 19 I don’t think you need to be running 7 days per week, but that’s up to you and your coach to decide.  Make sure you don’t increase your mileage and your intensity all in the same week.  Running is about gradual progression.  If you rush it you need an expert to help you with that and most of the time, rushing ends in tears!

Severely dehydrating yourself (as I did in Delhi) could also be a contributing factor to your injury as your muscles get damaged when they don’t have enough water to function and cool the body.  Perhaps next time you send yourself to the well, a few rest days or cross training days might be worth their weight in gold! 

Happy Running

Lisa.

Hip Pain & Running

Simon has been preparing for his first marathon at the end of August. However, over the past month or so, when doing his long run once a week (20 – 30 kilometres), around the 15km mark, his right hip joint starts to become quite sore. On completion of his run, his hip joint is sore for a couple of hours, but then it is okay after this period.  Recently, he read doing squats and lunges could assist with the strengthening of the hip.  Do I have any tips to overcome the hip soreness, or does he just need to ‘grin and bear it?’

Hi Simon,

Unfortunately I can’t give you a definite answer. What I can say is that with my experience with 7 stress fractures, 2 hamstring tears and osteitis pubis I don’t subscribe to the ‘grin and bear it’ policy.  The only time I deploy the ‘grin and bear it’ policy is during the marathon when I am pushing myself to achieve my goal, never for an injury. 

I found that resting didn’t help prevent stress fractures of the shins, nor did it get me back running after osteitis pubis, not without strengthening.  The best advice I can give you is that you are on the right track with your enquiry regarding the strengthening exercises.  You need to see someone in the know with regard to rehab.  I have some contacts in Melbourne I can recommend.  It is a little harder for me to recommend someone if you are interstate. 

A sports doctor may send you for an MRI, which will help you determine if you have any sinister issues, such as a labral tear or a cam lesion.  In serious cases these conditions can be improved with arthroscopic surgery, but the best approach is to try the strengthening first. 

I do specific physiotherapy exercises a few times per week now to prevent shin splints and osteitis pubis.  My guess is a simple program tailored to your weaknesses (seems most of us runners seem to have one glute (butt) muscle that is still sleeping, perhaps yours is your right!) will be all you need to get back to pain free running.  You need a medical expert to help you with it.

Keep me posted and Happy Running!

Lisa

I Have Sore Toes...Is Barefoot Running Worth It?

Firstly you are great to me and probably many others.  I would like to know what you know or think about flying before and after events?  How long before an event would you fly in? Change of time zones is not my concern.  I would like to know is there any negative effects on the body from the altitude. 

Matt recently completed the Gold Coast marathon and is now training for the Melbourne marathon. The Gold Coast marathon was his first marathon which he completed in just over 4 hours. He is now hoping to break the four hour mark in the Melbourne marathon!

Matt has suffered from many aches and pains throughout his marathon preparation but seems to be in good shape.  His frustration at the moment is that he is experiencing sore toes! They ache after running and do not recover in time for his next run. 

After some email correspondence with Matt I found out the following:

• He runs in the Asics DS Trainer which fit very comfortably. 
• He does not feel his toes hitting the front of his shoes when he runs. 
• He has started getting blisters on his toes, which is new, in addition to a couple of black spots on the toe nails!
• He runs mostly on the road (tarmac and concrete).
• He tried to run more on his forefoot after reading about barefoot running, but finds that he mixes it up a bit over long distances from heel strike to forefoot.  Heel strike is his normal pattern.

Hi Matt

Thanks for sending in your question.  It was great having a little email chat with you. 

If you have just started getting into the barefoot running fad and just started getting blood blisters under your toe nails, my guess is that you have found your culprit. 

The amount of people I have seen here in my one week in Boulder so far, running in those barefoot shoes is unbelievable. The physiotherapist here was telling me she sees so many patients wearing trying the barefoot thing who come in with heal stress fractures from changing their style and running barefoot on concrete.

My advice is let yourself run naturally.  The body decides what is good for it.  Avoid succumbing to running fads!!  One thing for sure is that we are all individuals, bare foot for some may work out perfectly, for others, a complete disaster.  Let your trainers take the load and run naturally.

I’d be keen to know if they settle down when returning to normal biomechanics.  You may need to give yourself a few days off to let the joints in your feet settle down, even some anti-inflams might help, but see the doctor first.

Happy running!

Lisa