Listen To Your Body

Most runners including myself, are somewhat addicted to running. When an injury affecting the training programme occurs we go through withdrawal symptoms, quite frequently becoming irritable or depressed.  Often this leads many runners to ignore an injury, or irritation by forcing themselves to run through pain.  I see the results of chronic or degenerating injury caused by athletes doing this, resulting in aggravation to the injury and much longer rehabilitation.  From the outset it should be made quite clear that all injuries, or so called initial irritations, should be treated with caution and respect.

Without doubt the most important factors when an initial irritation is felt are :

• Whether to continue activity or not.
• To what degree activity can be maintained or is there a temporary substitute to maintain cardiovascular fitness: e.g cycling, swimming.
• If the decision is made to discontinue activity, what steps should be taken to alleviate the problem?

Hence the first 48 hours are very important in terms of not only decision making but also early remedial treatment, which will influence the length of time it takes to return to normal activity.  Learning to recognise and intelligently evaluate the nature and extent of sports injuries is of the utmost importance.  Seeking medical attention does not have to be the very first reaction  to an ache or pain.  On the other hand to ignore the problem and continue activity could lead to a more severe injury.  A logical evaluation process is imperative in order to establish the cause , extent and effect of the injury.  Indeed many runners need an injury or two to remind them that their bodies are being subjected to physical stress.  The general approach to most irritation or injury should be :

Reduce Mileage or total activity for at least two to three days and longer if necessary.  'Mileage addiction' must be resisted when there is the slightest hint of an injury.  Remember you can always make up for it later on when you are feeling good.  A simple adjustment to your programme will avoid a longer delay in returning to normal activity.  The legendary Kenyan marathon champion, Olympian Douglas Wakiihuri once said that if he had an injury or didn't feel like running for two or three days, he'd have a rest.  Suffice to say most of the time he actually returned to his programme feeling rejuvenated mentally as well as physically.

Learn to Listen to your body when running it is continuously conveying messages about it's tolerance to exercise.  Remember acute injuries have a cumulative effect and although some are not painful to begin with, they can become chronic and eventually threaten the athlete's future running career.

Try to access the seriousness of the injury before you decide to continue training.  For the inexperienced runners this can be difficult, but you should determine whether a minor irritation is a result of a fairly intense workout, or specific injury.

Seek professional assistance if you have any doubts on your findings after making this initial assessment.  The more serious signs of tissue reaction to injury are inflammation, localised redness, or increase in temperature, bruising, swelling, haemorrhaging (bleeding) loss of function, muscular spasm, acute pain.  These symptoms may require sports medicine assistance.

Try to located the pain or tenderness and relate it to the surrounding structure.  Is the pain reflexing to another area? If the injury causes you to put undue stress on another part of the anatomy it will lead to further problems.

Look for the cause : -

Think back - can you relate the irritation to a specific incident? It could have been a sudden change in your training programme, such as hill work, fartlek, or speed work.  In which case modifying the programme will help to ease the problem.

A sudden change in the training surface -  some runners prefer grass, others hard surfaces.  Decide what suits you best, but remember both have advantages and disadvantages.  The grass is soft but unstable, the road can have a jarring effect as well as a camber, but generally provides more stability.  Most runners vary the surface on a percentage basis - 70% grass and 30% road or vice versa.

Excessive mileage or excessive speed work - causes the 'over use injury syndrome', chronic fatigue and neuro-muscular breakdown. There is no short cut to attaining high standards of performance.  So-called 'crash training programmes' are not worth the risk and inevitably lead to injury.  The road to success is a long arduous process and involves progressively increasing the workload.  But you must first decide on how much mileage and speed work you can tolerate, without the likelihood of injury and stick to it.  The fact is that you can only progress when you are free of injury.  In preparation for any event there is a fine line between conditioning or de-conditioning the body.  Experienced runners know the law of diminishing returns.  Once they go beyond a certain level - disaster occurs.

Check your shoes - do they fit well, are they in good condition, are they worn down? Shoes are like tyres.  When they are worn down they are dangerous and when they are re-treaded their capabilities are suspect.  Quite frankly some of the shoes I've seen wouldn't have a hope of passing a 'warrant of fitness' test.  Make sure also that the heel counter is providing some stability and not leaning to one side.  Overall a high percentage of injures can be traced to poor shoes.  It may take a while to find out which shoe model suits you best.   In the beginning this sometimes involves experimentation for example when you initially feel an aggravation in some area.  If you have another shoe try it out to see if the same aggravation continues.  This helps to eliminate unsuitable shoes.  A sports-oriented podiatrist can also help you select the best shoe.  However, with regard to shoe selection, it is not a good idea to have numerous different models of shoes.  It is preferable once you have found a suitable shoe, to stay with is so that the body becomes used to the shoe  leading to more consistent and comfortable training.

Injury Prevention - can be psychological as well as physiological - avoid conflict and run relaxed. Be-aware of and come to terms with any underlying psychological problem whether domestic or work-related.  Often an individual's psychological condition has a direct bearing on the neuro-muscular or physical response.  Emotional stability or conflict will directly affect the elasticity, flexibility or strained condition of the muscles.  Anger, anxiety, frustration produces tension in the muscles, which can lead to injury.  Adequate and restful sleep is also very important in terms of hastening recovery from difficult workouts and alleviating fatigue.  An individual who is unable to sleep because he is worried, may become worried because he is unable to sleep.

Biomechanical imbalance and/or muscular-skeletal weakness - are a common cause of injury in runners.  These may be congenital or acquired, but will predispose the athlete to injury.  Early detection and treatment will help avoid further problems as well as assist rehabilitation.  It is important to develop and stretch the antagonistic muscles to offset the power an force of the muscle imbalance created by running because every muscle which moves a limb in one direction has an opposing muscle that moves it in the other direction.  When one muscle is stronger than the other it will overpower and damage the fibres and tendons of the weaker one.  For example, the quadricep muscle raises the knee, followed by the hamstring which lowers it.  Similarly, with shin splint problems the most common cause is muscle im-balance , where the calf muscles which pull the forefoot down overpower the shin muscles which pull the forefoot up.  Through continued exercise the calf muscle becomes disproportionately stronger than the shin muscle, necessitating stretching of the stronger calves and  strengthening of the weaker shin muscles.  Therefore stretching, flexibility and resistance exercising is vital for balanced bilateral muscular strength as well as antagonistic muscle balance.  As far as stretching is concerned static stretching is much safer than ballistic.  Ballistic stretching such as jerking, bobbing or bouncing invokes the stretch reflexes which actually oppose the desired stretching.  Over-zealous or ballistic stretching imposes a sudden strain upon the tissues involved, countering the desired effect and causing injury.  Static or passive stretching if performed correctly, helps the muscles to be more flexible.  The safest approach is to slowly ease the stretch out to the point of slightest discomfort, hold, relax and release.

Rod Dixon New York marathon winner has a sensible approach to stretching.  He suggests starting a run by shuffling slowly for up to five minutes to improve circulation and warm up the muscles.  Then stop, do your exercise routine and recommence the run, steadily increasing the speed until you reach your normal training pace.  I consider this technique very important, particularly in the morning, or after a long tiring day at work when the neuro-muscular system is tight, somewhat restrictive and very prone to aggravation from stretching.  Used correctly, stretching not only helps to avoid injury, but also makes you feel more relaxed while running.

Warm-up and warm-down - are of equal importance and are frequently over-looked.  The purpose of warming up is to slowly increase the body temperature without undue fatigue.  This facilitates quicker nerve impulses and decreases the viscosity of the muscle, making contraction and relaxation easier.  'Cold' antagonistic muscles relax slowly and disproportionately when the antagonists contract, which restricts movement and co-ordination leading to the tearing of microscopic muscle fibres, or their tendon attachments.  With the gradual increase in temperature and metabolism, oxygen uptake and physical working capacity is improved as well.  For casual or inexperienced joggers warming-up is particularly important to protect the heart from ischemic (reduction of blood supply) changes that can occur if the onset of exercise is sudden or strenuous.

Warm-down after a hard workout (particularly anaerobic).  Fatigue develops with the accumulation of acid waste products (mainly lactic acid) in the muscle.  This has to be absorbed into the blood and then transported to the liver and other organs for disposal.  The waste products in the muscle cause it to swell, become shorter and thicker which is aggravated by continuous hard training.  The metabolic overloading subsequently causes neuro-muscular breakdown and injury.

As a rule a five minute jog after any run, or a 20 minute jog after strenuous training or racing will considerably reduce (by at least 50%) lactic acid accumulation.  In addition to the ward-down procedure regular sports massage is just as vital for athletes in order to hasten the removal of these metabolic waste products of fatigue or inflammation.  In turn this helps prevent injuries starting, as well as allowing faster recovery from workouts and harder training all of which result in improved performance.

Finally in considering the cause of your injury - it may be that you have a susceptible area and possibly this is a recurrence of an old injury.  Reverse the factors which precipitated the injury by retracing your steps and endeavour to eliminate what seems to be initiating the irritation.  This is particularly important for over-use injuries resulting from repetition, when the onset and progression of symptoms are slow.  Treatment with drugs, injections, or just a rest period is no better than no treatment at all.  However, professional guidance or treatment involving additional stretching, resistance exercises and orthotics may be necessary to prevent further occurrence of an injury.

A change of training habits can prove to be very beneficial by allowing the body recovery time between hard and long work outs.  The coach has a major responsibility towards prevention of injury to his or her charge.  Before initiating a programme the coach must be aware of the risk factor in certain training procedures.  Also the physiologic limitation, inherent problems, or previous injury history of the athlete.

The coach or athlete has to decide how much, how long, and how often.  More specifically it is a question of intensity, difficulty, duration and frequency, and recover required.  Each athlete must be considered individually with a programme designed to minimise undue stress to enable adequate recovery.

In terms of injury management, once these procedures have been followed it must be stressed that speed in applying active proved treatment to an injury is vital for quick healing.  Regardless of the cause of an injury, treatment using cold applications with its vaso-constriction and analgesic effect will help to prevent and control excess swelling, as well as relieve pain in the early stages of an injury.

Apart from  ice there are numerous other factors which influence recovery.  The 'RICE' approach i.e Rest, Ice, Compression, Elevation, for example can, when prescribed for a certain injury hasten the healing process.  But I am not advocating total self-diagnosis or treatment; far from it.  You must appreciate that essentially you are the first person to recognised a problem and to be able to determine what to do immediately is absolutely vital.  Treat injury or irritation logically and with respect, as soon as it occurs and always follow this evaluation procedure.  If you resist mileage obsession and think constructively about your injury, it will certainly help you to avoid future problems and achieve success.  With reasonable foresight many athletic injuries can be easily overcome, or avoided in the first place.

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