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The Two Week Running Injury: Preventing Meltdowns in Training

I know better than this. I know the consequences. “I’ll just get them tomorrow.” Well, two weeks went by and I have yet to rectify a looming disaster. The writing was on the wall (and in my training log). I haven’t made the switch in a long time. The legs were painted with an underlying “ache,” while other signs might as well be shooting injury flares—I better hurry up and fix this issue.

Broken and worn, I trudged through the first six weeks of my Boston training plan living on the “I’ll get new shoes tomorrow.” My Nike Pegasus were a mess. Between procrastinating and simply forgetting, I backed myself into a dark corner.

The first blow came at the expense of my left calf. A few short weeks later (still in the same shoes), my right heel began to have a bite. This article isn’t about the “listen to your body” or “don’t be a dumby like me, change your shoes,” but rather how I managed to work through two injuries within a month while sacrificing only a week of running each time.

Truthfully, I haven’t had an injury last longer than two weeks in the past four years. (man, I really hope this doesn’t jinx me) I’m not going to lie, I’ve had a few scares: hamstrings strain, calf strain (x2), Achilles tendinitis, plantar fasciitis and IT Band Syndrome.

Each injury presented with an underlying fear that THIS will be the injury that completely derails my training. The injury that puts my tail between my legs and leaves me explaining why I’m not running to you and my patients.

The two-week fix has worked time and again for not only me, but my patients. The two-week fix isn’t really that difficult to perfect, either. The trickiness comes with execution. It will go against your better judgement. An inner dialogue will leave your denial and doubt bullying your logic and reason.

For me, I’m somewhat of an “expert,” but you don’t have to be to execute a plan to ensure a quick recovery. The secret lies in being truthful to yourself, admitting you’re in trouble, and taking the appropriate steps moving forward.

Recognizing and Healing Any Injury in Two Weeks

Rarely will you find an injury that has an abrupt onset. Injuries that are accompanied with a quick, sharp pain are less common. Most running injuries are either a gradual onset over the course of weeks (the I’ll just run through it type of thing) or present as pain following a run.

The “slow onset” injury can be a disaster. Slow onset is tricky. These injuries usually “only hurt after” or “get better after I get going for a few minutes.” This leaves much to interpretation and unfortunately most runners live in a distorted reality. “I’ll just ignore it and hope it goes away.”

Avoiding major setbacks is pretty simple, but you’re going to hate what I have to tell you. You’re going to have to stop running. Don’t paint me as that typical clinician who tells everyone to stop running. Hear me out. A simple, short hiatus has been crucial to help me avoid major setbacks in my training.

If you’re going to grumble and get aggravated by the fact that I told you stop running then you should stop reading.

Truth is, most running injuries are intolerant to impact. Every impact aggravates injured tissue. With an average of 80 impacts a minute, how can you expect something to recover/heal when you bash the hell out of it a few thousand times every run?

Instead, accept that something is wrong and remove the high load of running. The key to a quick recovery is quite simple: stop running and cross train. The bike, elliptical, and my online strength workouts have been staples in every effort to ensure a quick recovery.

Here’s how I responded to my calf injury:
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It’s worth noting that my 8 mile run on Sunday went “ok.” Just ok. I was sore and tight, but I knew I was about to tip in the wrong direction. For better understanding the difference between every day ache and injury click here. Paired with a lot of heat, isolated stretching and cross training I started to feel better fairly quick. I bailed on the entire week of mileage (I was supposed to run 60 miles that week—Total? 9).

Here’s a look at my heel injury (plantar fasciitis). This is by far one of the worst injuries I get to see, but I’m not confident that my patient is usually at fault. Most of my patients stroll in after months of bashing their heel into the ground and hope I have a miracle cure. Plantar fasciitis is typically a slow progression from tightness to absolute agony–but it doens’t have to be. This is an injury that is just terrible at healing once you light the match and start the fire.
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I substituted runnig for cross training and I wore the Strassburg Sock every night. Here’s another week that was supposed to measure 60+ miles, yet I settled for eight. I’m not going to lie… I was battling demons who were pushing me to “just test it out” and “see how it goes.” More demons shouted that “you’re losing all your fitness” and “you’re going to suck on race day!”

I’m happy to report that the following week was a nearly (not completely) symptom free week, totaling 60 miles and one 16 mile run.

The take home message is that you can’t just run on hope and early detection is crucial to avoid major set backs. Once you detect an injury start by taking a deep breath. Then plan on forfeiting two weeks of training. You don’t have to do nothing. In fact, that might be the worst thing (learn more here).

Being resilient and tough are embedded with every step we take. Runners are tough. After all, what other non-professional athlete subject themselves to the torment of running in sub-zero temps, scorching heat, and efforts that leave your body pleading with you to stop?

Maybe that’s our flaw. We participate in a sport that breads toughness and willingness to show we can persevere. Either way, your desire and need to run can’t be destructive—not if you want a long career.

If you’re looking for strength workouts that I use weekly to not only prevent injury, but to also get over my previous run ins, click here.

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How I Chopped Over One Hour Off My Marathon

What’s the goal of your training plan? Is it to run a specific time? Tackle a new distance? Qualify for Boston? How much does your training plan match up to your goal? Really, all training plans are the same. Whether you’re looking to run a sub-3-hour marathon or to simply cross the finish line the structure of a given training plan should be consistent.

That’s right. There’s little difference in the structure of a marathon training plan that aims to run a four-hour or three-hour plan. Sure, the total weekly miles and the speed at which they’re run are different, but the overall structure is (or should be) the same.

I’ve been following the same set of principles (with little tweaks over time) to continually improve my marathon time. In 2008 I transitioned away from rugby due to injury and filled my competitive void with running. 2008 brought me my first marathon finish in 4:06.

Through the next four years I refined my training plan and schedule. I toed the starting line at the 2012 Hamilton Marathon, culminating in a massive PR: 2:57:59. This was the start of five consecutive marathon PR’s, culminating in a 2:51:59 at Grandma’s Marathon in 2015. From 2012 to 2015 I’ve slowly and consistently chopped time off every consecutive marathon. I’m not going to lie, it took some patience, persistence, and consistency.

My training plan is fairly consistent from one year to the next. My average running paces are faster as my fitness improves from one year to the next, but my max mileage and structure of when I add specific pieces of training (ie speed work) rarely changes. I’ve seen the system I use work not only for me, but for other runners in the past.

What does your training plan look like? Is it just a list of miles to run for the week with an occasional tempo and speed workout?

Here are the three biggest training plan mistakes:

Not Building a Base

Building a solid base is a staple of every great training plan. It doesn’t matter if you’ve been running for 30 years and already think you have a solid base. Base training allows you to do a few things:

• Build your mileage at a pace that doesn’t cause you excessive breakdown
• Forge stronger joints, tendons, and muscles that can withstand higher mileage and faster running
• Grow an aerobic base of fitness. Essentially, you’re building the engine that you can build speed around

Base building typically encompasses the first 30-40% of your training plan. Building your base is more than running, too. During this period of relatively slower running you should have a strong focus on strength training—typically twice weekly.

Speed Work Too Early, Often

Harder runs, typically built from tempo or interval work, are intended to boost your speed; however, speed work has a shelf life. Starting your speed work too early may result in peaking too early. Who wants to maximally fit three weeks before race day? Not me and I’m guessing not you.

Generally, you’ll want to start working on speed work within two months of race day. Think about starting with long, tempo-based intervals and progress to shorter intervals. Make a commitment to nix the one speed workout a week until race day.

Poor pacing for Training

Are you heading out the door with a pacing or heart rate plan for your run? Most runners log their miles at “comfortable hard.” Each run is sustainable, but not at that “this sucks” type of pace. Unfortunately, this is a bad place to train. Comfortable hard causes breakdown and is the quickest path to injury. Not only that, it will leave you feeling flat on race day.

Ultimately, you want to have a training plan that is specific to your fitness, minimizes injury, and leaves you feeling fresh on race day. Long periods of base training (at the correct pace), incorporating strength workouts, targeted speed workouts, paired with an awesome taper plan is ideal.

I’ve outlined all my training principles in this online seminar. I outline how you can build your own plan or modify one you find online. You’ll learn how to determine your training paces, how to build your base and add strength workouts, when to add speed, and how to taper. These are the exact principles I’ve used to cut over an hour off my first marathon and PR my last five marathons.

To access the seminar, you can download it here and save $20 or become a member of and get access to my PEAK on Race Day seminar, all 18 hours of strength workouts, and much more (including a private Facebook group with me!).


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Running on Different Surfaces: What You Need to Know

The best part about running (in my opinion, at least) is that you can do it pretty much anytime and anywhere, at your own discretion and with minimal equipment. Of course, there are always conditional factors to consider when planning a run. No, I’m talking about matching your shoes to your outfit or vice versa. For the most part, as long as you have two feet and ground to run on, you are off to a good start.

What factors are you considering when you run? Strength and flexibility? Warming up? I’m sure you’re thinking about temperature or wind. Maybe the surface you run on? Most of these factors are out of our control. has plenty of content about how you can leverage your strength and flexibility, so let’s talk about a factor you can manipulate to optimize running economy and minimize risk of injury: the best ground surface to run on.

Running economy is the idea of harnessing and directing energy to maximize running performance. One external factor that can affect running economy is the ground reaction force (GRF). GRF is simply the force that the ground exerts on the body. GRF between runners differs largely based on running style, shoe-wear, body shape and size, and differences in forces produced by the muscles in your legs. Recent research has shown that runners are able to subconsciously adjust their leg stiffness to accommodate changes in surface. The softer the surface, the stiffer a runner’s legs are during the stance phase of the running. Based on this knowledge, Ferris, Louie and Farley have suggested that distance runners and runners with preexisting joint pain may benefit from training on softer ground due to decreased joint compression on impact.1


Asphalt is a hard(er) running surface that, for most recreational runners, is even harder to avoid. Running on asphalt is certainly less forgiving than the much softer gravel. In a black-and-white world, there would be no need for this discussion; the way to prevent injury would be to always run in the grass, period. The list of best (soft) to worst (hard) surfaces would read as follows: trails, gravel, cinders, synthetic tracks, treadmills, asphalt, and finally cement. Like always, there’s a caveat. Nothing is ever simply black and white. There are always other factors to consider.

Soft Surfaces

Although a softer surface may be easy(ier) on your joints, running on softer surfaces can increase energy cost by 1.2–1.6 times that of running on a firm surface. Softer surfaces produce challenges to stability, resulting in an increase in muscle activity. Grass or trail running often results to increased fatigue for newcomers. That once forgiving “softer surface” could transform to a liability and eventually–an injury. It’s always important to remember that your body craves consistency. Something as simple as an occasional dabble in trail running or running through slushy, snow covered streets could tip the scales. Your body (mainly ankles) are simply not accustomed to soft or slippery surfaces. From an running efficiency standpoint, softer surfaces result in increased stance time, cadence, and decreased stride length leading to decreased running economy.2

The Track

So what about running on a track? Tracks tend to be more forgiving than running on a treadmill or asphalt. Similar to above, there are cons when running on a track vs. the road. Other than the mind-numbing hamster wheel sensation the track offers; a larger con includes continuous left turns.

For anyone heading to the track, think about the counter-clockwise direction for all warm ups and cool downs. It will help you avoid asymmetry that is bred with continuous left turns. The same applies to running on cambered surfaces (most roads). It may be wise to switch sides of the road periodically throughout a training run to avoid injury. You could also hop onto a sidewalk, as the sidewalk slants opposite of the road.

The Treadmill

Running indoors is another adventure that most of us (but not all) in the Northeast have learned to tolerate. Running on the treadmill provides a softer surface than asphalt and it can be helpful if you’re working toward pace maintenance or through injury recovery. On the downside -you won’t get the benefit of having a natural breeze while running indoors, which is a trade-off to avoid lousy weather.

The take home point is that there’s always a trade-off. Running injuries can be caused by a variety of factors and it is important to train under similar conditions that you plan to confront on race day. If you’re race has a long downhill section, plan and train for it. If you’re going to be running on the right side of the road for 26.2 miles, train for it. Trail race? Train for it.

Your body will adapt to stressors applied to it, the key is to do so in a progressive manner (mileage, running surface, etc.). In essence this is why we slowly build our mileage—to let our body adapt and strengthen.

1. Ferris DP, Louie M, Farley CT. Running in the real world: adjusting leg stiffness for different surfaces. Proceedings of the Royal Society of London. Series B: Biological Sciences. 1998;265:989-994.
2. Pinnington HC, Lloyd DG, Besier TF, Dawson B. Kinematic and electromyography analysis of submaximal differences running on a firm surface compared with soft, dry sand. European Journal of Applied Physiology. 2005;94:242-253.

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4 Rules for Running in the Snow

El Niño has trudged through the northeast providing unseasonably warm weather while shattering record high temps. One-hundred-year old snow records have fallen here in Buffalo and for the first time in the past six years, I find myself running in shorts at the end of December. (You should know that I’m cold intolerant and shorts are hard to come by)

Make no mistake, the snow will be here and with that many runners hobbling into my office. It’s a conversation I have hundreds of times every winter.

There’s this aura of toughness by trudging through awful conditions. We tout our frozen eye brows with knee deep snow selfies hash tagging our way through social posts. But are you really growing your toughness or simply making poor choices that lead to injury?

“Hey, you want to go play basketball?”

You get a call from a friend who asks you to fill in for a basketball game; after all, you’re “that runner” who can run up and down the court all day. Prior to joining the roster your friend sneaks in a small detail that you’ll be playing outside and the court is land mined with patches of black ice.

Hiding behind every jump, pivot, turn, and push off resides the opportunity to rip and tear at your muscles, tendons, and joints. Would you still play? Just to state the obvious—you shouldn’t.
Your body (neuromuscular system) craves stability. When we run our muscles generate hundreds, if not thousands of pounds of force down through our leg and into the ground. Passing this force down through the leg happens regardless of surface you run on.

Structurally our anatomy is designed to be in a specific position as we progress through the running cycle. For example, at push off our foot point down (plantarflexion) and turns in (supinated), the knee straightens (extends), and the reaches backwards (extends).

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Now imagine a scenario when you’re trudging through snow. Right at the final point of push off. The point where all the force is transferring from your foot to the ground. Suddenly, the foot loses traction and slips. The foot turns out (everts) and experiences relative dorsiflexion (doesn’t point down), the knee bends (flexes) and falls inwards (adducts), and the hip spins inwards (internally rotates) and avoids reaching backwards (extension). Now replicate that a few thousand times over the course of a run.


What was once a smooth, predictable push off surface is now a cluttered mess of varied foot strikes that are highlighted with poor alignment. Plantar fascia’s, Achilles, and knees are ripped through torsional forces that they simply cannot withstand.

Now, I’m not saying that you should NEVER run in the snow, but there are a four rules to follow to weather the storm (pun intended):

1. Stick to pavement: If it’s safe (and you have a choice) between a poorly groomed sidewalk and a salted and plowed road, take the road. Keep to the surface that is more predictable.
2. Work into it: Unless you’re a regular trail runner, your body will need some time to adapt to running on unstable surfaces. As the cold weather approaches try to get a few weeks of occasional trail running under your belt. If not, spend a minimum of two weeks running easy outside.
3. No Speed Work: If you’re not running on dry pavement you should not be running hard. This includes racing, tempo runs, and track workouts.
4. Trail Shoes: If running through snowy, slippery surfaces is inevitable, toss on a pair of trail shoes or other traction devices (i.e. YakTrax). The extra traction will help improve communication between your foot and the ground.

Despite the awesome weather we’ve had here in Buffalo, I’ve already seen patients from a single snow fall (which happened to fall on a race day). The key here is to minimize your risk. Find dry pavement or head indoors. A single treadmill run is far more tolerable than dealing with a 3 to 6-week injury because you wanted to update your newsfeed with a bad ass profile pic.

If you know a cold weather runner, help them out (and me) by sharing this article below. Thanks!

Posted in Prevention | 3 Comments

4 Training Changes to Stay Healthy (That Don’t Involve Running)

Who’s ready for 2016? I know I am.

It’s been awhile since I last raced. After Grandma’s Marathon I shut it down (even though I swear I wouldn’t) as I focused more on work and less on running. Sure, I continued to run, but most of that was to keep me sane and burn off far too many IPA’s.

The racing season started out a little rocky back in May, where I suffered my first DNF. Per usual, hindsight is 20/20. Three days before Buffalo I came down with something nasty. Succumbing to fatigue, dizziness, and the inability to breath I pulled the plug at mile 17.

The writing was on the wall earlier in the month. Work weeks that blurred an uncountable number of hours, paired with 70 mile training weeks and averaging 5-6 hour work weeks as a new dad took their toll. After Buffalo I regrouped, placing a greater focus on rest and family. It paid off, clicking through a new PR in 2:51:57 five weeks later at Grandma’s Marathon in Duluth, MN.

The plan is to learn from Buffalo, recognizing the warning signs of over training. Here’s what’s different for 2016. Let me know if you can relate or would add to the list in the comments below:

1. Getting More Sleep: For me this isn’t about cutting out TV. I don’t watch it much. Between the clinical and online aspects of my work, it tends to lead to many late nights. A late bed time is tough particularly when I’m up at 5am every morning to get to the clinic.
2. Working Efficiently: I work a lot, but I find that it’s not always productive. I’m going to master list making in 2016, prioritizing everything by importance. This should hopefully leave more time for #1 and my family.
3. Saying No: There’s an urge to take on more. Earlier in my career I was fearful of missing a great opportunity. Prior success has amplified my opportunity. I’m fortunate enough to pick and choose now (I just need to exercise my right to say no).
4. Smell the Roses: Stacking your plate with work and training can leave you feeling constantly rushed. After dabbling with “mindfulness” literature I recently committed to shutting down my zombie-like autopilot that has left me simply “going through the motions” for most of the day. It should also help with my forgetfulness! (fingers crossed)

Dropping out of the Buffalo Marathon was a tough pill to swallow. As I said, hindsight is 20/20. I’m 100% at fault. I was fit, but not healthy. I was tired.

As I begin laying out my “master plan” for the 2016 Boston Marathon I plan tracking more than miles and heart rates. I plan on tracking my sleep.

Using the principles above I plan on running my way to another PR in April.

Did I miss something? Is there another piece you need to work on? Drop me a comment below and let me know if you agree, disagree or would add to my list.

Posted in Personal, Prevention | 6 Comments

Normal Bones That Break: Preventing Stress Fractures

Bone injuries suck. There’s no quicker way to grind your season and training to a halt than hearing your doc murmur the “s” word: stress fracture. For most women, the diagnosis is often accompanied with a test to determine bone density. For men the answer is typically along the lines of rest for six weeks then start back slow.

For those referred on for bone density testing, it’s not uncommon for the test to come back negative. The question then becomes “why?” Why, if your bones are deemed healthy, do they break?

Knowing that our bones grow stronger through a response to load (Wolff’s Law), we would expect that the running would actually yield bones. High, repetitive impact should forge steel-like bones through adaptation.

A study comparing bone health in female long distance runners and sedentary controls found that, although runners were more fit, the runners had identical bone density measurements compared to controls.1 Another study in 1998 found the same results: runners are more fit but measure similar bone density when compared to sedentary controls.2

Well that stinks. Ideally you would like stronger bones than those who don’t run, right? It’s worth noting that both the runners and sedentary controls had rather normal bone density results. It’s just stating that runners don’t have stronger bones that those who don’t run.

The question returns: if my bones are healthy, why are they breaking?

A five year study following female master runners found no significant change in bone density over time.3 This is great news! Running can keep your bones strong as we age.; however, the “s” word arises when we deviate from the typical running plane.

The answer comes down to strength. Ugh. Not another “you should be incorporate strength training” article. Well, I’m sorry. When we begin connecting the dots in the “why do my bones break” mystery, it’s clear that poor training and weakness are the result.

Milner et al. found that the occurrence of stress fractures in female runners was related to greater and faster initial loading of the lower extremity.4 In less fancy words—you’re not shock absorbing.

What slows initial loading of your leg? Well, muscles of course. Muscle fatigue and weakness will cause normal bone to load faster with less control… eventually straining the bone until it breaks.

I get it. It’s tough to incorporate strength training into your training plan. The system (and thinking) is ass backwards. Think about it… when someone gets injured what do they do? They seek exercises to rectify the problem. Have you ever thought about protecting yourself before you’re injured?

It comes down to supplementing your running. If you’re not on the prevention wagon it’s time to rethink the way you train. “I don’t have time isn’t really an excuse.” It’s only a matter of time before the wheels fall off.

This is particularly true for women and even more so for those who are post-menopause. Fluctuating estrogen levels can put women at a huge disadvantage to avoiding a stress fracture. Paired with fluctuating hormones, fatigue and weakness can easily send you to the “s” word.

My typical recommendation is to work strength in twice a week during lower mileage or base building phases. Obviously time can be the limiting factor. As your mileage increases do your best to stay true to twice a week; however, dropping to once a week is better than nothing at all.

If you’re looking for quick, effective strength workouts that are specifically designed for runners, stream my online runner-specific strength workouts. You can perform each workout from work, home, or on the road (aka you have no excuses!): sign up by clicking here.

1. Kirk, S., C. Sharp, N. Elbaum, et al. Effect of long distance running on bone mass in women. J. Bone Miner. Res. 4:515–522, 1989.
2. Ryan, A. S., and Elahi, D.. Loss of bone mineral density in women athletes during aging. Calcif. Tissue Int. 63:287–292, 1998.
3. Hawkins, S., Schroeder, E., Dreyer, H. Five-Year Maintenance of Bone Mineral Density in Women Master Runners. Med Sci Sports Exerc. 35(1): 137-144, 2003.
4. Milner, C.E., Davis, I.S., Hamill, J., 2005. Is dynamic hip and knee alignment associated with tibial stress fracture in female distance runners? Medicine and Science in Sports and Exercise 37, S346.

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Five Point Scale Every Runner Should Memorize

I use the scale outlined below daily with my injured runners. This scale works for nearly every injury. The image above is a scale that is likely burned onto the whiteboard in my office.

A professor in college drilled into our brains that: a tissue, is a tissue, is a tissue. For those with no medical background, it equates to the underlying fact that a tendon injury in your ankle will likely respond the same as a tendon injury in your shoulder: a tendon is a tendon.

The same rationale can be said for joints, ligaments, and the like. In my work with running injury rehab I’ve developed protocol/system that is based on the “a tissue is a tissue” method. My patients have likely heard at one point or another. Although rather simplistic, the rule applies to nearly all running injuries and is rooted on a foundation of tissue resilience and the ability to accept load. Two very important principles if you’re looking to successfully run after an injury.

Load acceptance and loading until failure reaches far beyond injury rehab. Engineers know this fairly well. For example, a bridge can accept a certain load before buckling. An elevator cable can withstand a specific weight limit before straining (or breaking). The same can be said for your (insert your running injury here). It can withstand so much load until re-injury.

My simple scale can help you better understand the threshold of breakdown for your injury. I’ve used this thousands of times in practice and actually developed it when dealing with my own injuries (yes I get injured, too).

The Scale: 0 to 5, How Much Does It Hurt?

Zero (0): “I don’t feel anything.”

Zero is pretty easy. This is typically the point you’re thinking yourself, “hey, maybe this is the time it won’t hurt?” It’s usually a subconscious hail mary that your (insert injury here) is finally gone for good.

One (1): “I think I feel it?”

A one rating is that “is this all in my head” question. You’re running and you think you feel it, but are typically unsure. This isn’t anything to fret, keep going (not that you were going to stop anyways).

Two (2): “It doesn’t hurt, but I definitely feel it.”

Ok, so at this point you’re fairly positive you’re not crazy. You definitely feel it. A “two” on the scale can go either way. It can loosen itself up and retreat to a “one” or “zero” or can progress. This is where you ideally stay close to home. You can keep running, but the street signs now read “proceed with caution.”

Take home from zero to two:

As you can see, I’m not telling you to stop running. I equate the sensation of “feeling” your injury or “being aware” to loading tissue that is simply not fully healed. News flash, it can take up to six months for tissue to fully remodel (heal back to normal).

The zero to two stage can (but not usually) last months. Just proceed with caution and patience.

Three (3): “It hurts a little, but I can run through it.”

There’s no doubt that this thought has crossed your mind when attempting to return running. Crossing over from a two to three on my running scale equates to the beginning stages of breakdown.

The “slight pain” you feel may be manageable, but it’s a sign that your injury is failing. The bridge is beginning to buckle.

Four (4): Pre-Limp – “I probably shouldn’t be doing this.”

Although you shouldn’t be running, you’re likely still putting one foot in front of the other. At this point every foot strike is shredding, tearing, and destroying your injury. It doesn’t matter than you only have a few minutes left of your run.

Think of it this way: the average runner hovers around 80 steps a minute. An additional 10 minutes of running exposes your injury to 800 additional repetitions when it’s already sending signals to stop. If you had a sore arm, would you lift a weight 800 more times? (Please say no)

Five (5): Limping

So by now the pain is fairly strong. You can’t hide your limp and it’s clear you shouldn’t be running. You’ve gone overboard at this point. Plan on resetting your injury clock a few weeks or even back to day one.

Progressing Through the Scale

Most runners will progress from a 0 (“I feel nothing”) to a 3 (“It hurts just a little”). The progression of symptoms is a clear indication that your injury is failing to withstand the barrage of foot strikes. If you start at “three” within 30 seconds you’re not ready to run (sorry).

Don’t run on denial. It either hurts or you feel it. Black and white. Once you’re at the “it’s about to start to hurt” pull the plug. Walk. It doesn’t matter that you’re only a block away from home. Every foot strike is damage.

With time, you’ll slowly watch your time to symptoms or pain onset increase. What started at five to 10 minutes is now 30. If you continue to run with patience you’ll avoid becoming a patient.

These articles will also help you safely return to running: First Run After Injury, What to Know When Running After Injury, and “Am I Ready to Run?”

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#1 Thing to Know When Returning to Running Post Injury

“It doesn’t hurt.” This simple phrase can mean so much to so many. It can be a frustrating experience for my patients when they utter those three words. Without hesitation they find themselves being bombarded with follow up questions.

Pain is different for so many. This is more than your pain tolerance. Pain is pain and it’s the one thing that dictates how you handle an injury. Pain is typically a sign of failure. Failure of a joint, tendon, ligament or muscle to accept load (you running). In prior articles I’ve talked about pain that improves while you run.

The way we talk and describe pain varies between patients, but with the right poking and prodding I usually can get the information I need to determine if my patient is ready to run or progress their rehab program..

Answers like “kind of,” “I’m not sure,” “yes and no,” and the alike cast a cloud of confusion when determining the status of an injury. My favorite thus far? “It doesn’t hurt… it just feels awful.” Yep. True story.

Boiling down the verbiage to a simple “yes” or “no” can certainly help, but those “kind of’s” may be warning signs for worse things down the road… literally and figuratively.

Pain is a product of inflammation. It can be easy to ignore as the damage is typically deep. The healing of superficial cuts and scrapes are easily seen so it’s easier to understand if you’re officially healed or not. Our tendons, muscles, and joints cannot be seen without imaging, so it’s much easier to ignore, block out, or simply neglect the healing process

Verbalizing your symptoms will not only help you avoid re-injury, but also help any clinicians who are attempting to help you return to the roads.

“Yes. There’s pain.”

Simply put, you shouldn’t run. Pain is more than your everyday ache, too. It’s often described as “sharp,” “burning,” “stabbing,” or “just plain hurts.” Pain causes you to change the way you move, often accommodating a limp or “near-limp” running. Think of it as re-irritating or worsening a cut on your skin. Pain is simply the signal that your underlying injury is tearing apart.

“It doesn’t hurt, but I feel it.”

Damaged tissue always progresses to a blurred line. “It doesn’t hurt, but I feel it.” This simple phrase is the deciding factor between bagging a run or cautiously proceeding. “Feeling it” equates to loading tissue that has not returned to its full strength. It can stay constant (feel it throughout a run) or progress in either direction (diminishes or progresses to pain).

Injured tissue can take up to six months to fully remodel. Expect to “feel” your injury site for a few months when returning to running. Most are gun shy, particularly after forging mental scars from not running during the “it hurts” phase.

The “feel it” stage enables you to reload the injury site so that it can gain strength and return to normal. Too little load and the tissue never regains normalcy. Too much load and the weakened tissue tears, regressing back to pain.

Here’s a quick video to help you fully understand:

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Will More Cushioned Shoes Decrease Impact Running?

Add more cushioning and you get better shock absorption. It makes sense on paper, right? Most of us, me included, shook our heads at the thought of the running shoe industry returning to where it started: bigger, more cushioned shoes.

Surely the already crowded shoe market would find little room for a shoe at the opposite end of the spectrum, particularly when maximum cushioned were demonized in Chris McDougals book, “Born to Run.” The maximalist shoe market has yet to squander a growing army of maximalism evangelists.

More cushioning sounds great on paper, particularly for those who are struggling to tolerate the impact of running (speaking to my master runners here). Sore joints diagnosed as “typical” wear and tear on x-rays leave countless runners struggling to tolerate impact with asphalt. It’s not surprising that the maximalist shoe market hasn’t crashed and burned. After all, the market for runners who are over 40 is only growing.

Ideally, more cushioning on your feet would simply provide downstream benefits to the knee, hip, and spine; however, the body’s actual response to more cushioning might be contrary to what you expect.

Your body needs to anticipate and feel impact. Your nerves and muscles (neuromuscular system) collect data from ground impact, transferring it to the brain, which in turns relays information to your tendons and muscles on how to respond.

With a softer barrier to dampen impact, our bodies may, and often will, crash down hard seeking to collect data. Clinically, we see this in patients suffering from peripheral neuropathy, a condition that often results in the loss of sensation in the bottom (plantar aspect) of the feet. Those struggling with decreased plantar sensation will often slap their feet or slam their feet into the ground with the ultimate goal of allowing their skin, muscles, and joints to send information back to the brain for interpretation.

Like the article? Help me find more runners who would benefit:

Slapping a big thick pad on your foot can likely provide a loss of “feel” for the ground. The natural, automatic response of the body may be to land harder to provide neuromuscular feedback. A study published in April 2015 by Baltich, Maurer, and Nigg found that as the shoe midsole became softer, joint stiffness increased, particularly at the ankle. The apparent increase in stiffness was found in other joints, too, resulting in an increase in vertical impact force peaks (less shock absorption).1

That’s right. A thicker, padded shoe may actually increase your impact forces when running. Now before you start shaking your head that you may have fell for another marketing gimmick, hang with me. I still and will continue to recommend these shoes to specific patients… but it comes with a caveat.

Ultimately, your movement trumps all. I have and will continue to recommend these new “maximalist” shoes to my patients who fit the bid. The recommendation now comes with a plan to alter their movement that in turn, maximizes the cushioned footwear. You need to teach your body to avoid altering joint stiffness.

Engaging your natural shock absorbers (muscles and tendons) through a midfoot strike should be the number one priority, particularly for those feeling “beat up” by the road. Relearning to run with a midfoot strike is more than running on your toes. I outline that in depth in my free run faster in 30 days program

I encourage any runner, young or old, to commit to improving their movement and utilizing their anatomy to the full extent. Your ability to absorb and control landing forces falls back on what your momma gave you (well, more than your butt). Off the shelf products should be used to supplement your run form and strength, not as a Hail Mary pass. Pairing better movement with that softer, more cushioned shoe may be the homerun you seek.

Not sure how to **properly** improve your run form, strenght, and flexibility? Try our runner-specific strength programs, stretches, and running form programs. You can get started for $1/month.

1. Baltich J. Maurer C. Nigg B. Increased Vertical Impact Forces and Altered Running Mechanics with Softer Midsole Shoes. PLOS. 2015; DOI: 10.1371/journal.pone.0125196.

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Am I Ready to Run After Injury?

The injury rehab water is murky. Most runners forego seeing a doc altogether. After all, who wants to be told to stop running? Those two words (stop running) have bred a distrust for doctors within the running community. Runners have sought asylum in the confines of Google searches and the forever “valuable:” phone a friend option. The obvious troubles linger on both sides of the latter options. For one, doc’s are stereotyped as running haters, all spewing the same “stop running” treatment option. The flipside offers little hope, too, as your friend is likely affirming what you read on Google (which is where they found their answer).

The distrust for the medical community is real—I know that. Timid runner’s visit me every week hoping those two austere words aren’t mumbled from my mouth. “Please don’t tell me to stop running,” they interject. Luckily, I’ve built my brand as being “runner friendly.” Mainly for being a runner and infrequently murmuring the forbidden words.

Whenever I’m working with an injured runner the number one question is “when can I start running again?” Through my work and own injury experience I’ve developed a protocol of sorts. The purpose of this article is pass on a piece of my injury rehab protocol. It precedes my “10 Minute Feeler” article that discusses the importance of keeping a short run on your first outing. Using the repeatable and rather simple test I’ve built to answer to the ultimate question: “CAN I RUN?”

I’ve used the test outlined below for nearly every runner I’ve seen since its inception two years ago. It’s worked nearly (but not always) flawlessly when determining the burning question on every runners mind. The test is my own little bearer of bad (or good) news. It’s easy for a runner to infer that they are/aren’t ready to run.

The test mentioned below is on the tail end of my return to running protocol. It’s part of the madness that is my treatment. It won’t tell you what you need to fix, how to fix it, or much in the details of your injury, but it will tell you if you’re ready to run. Whether you’re dealing with a banged up knee, sore Achilles, or a forever lingering hip injury, this test can make the “am I ready” conversation an easy yes or no answer.

The Test

Running through this test is fairly simple, requires no equipment, and is easy to score (pass/fail). The primary goal of the test is to determine if the body is ready to accept impact. It will test the injured tissue in multiple planes of motion, insuring that some degree of healing has occurred.

If you fail the test it becomes incorporated into treatment, which I discuss in the video below. If you pass the test you’ll simple move on to the next phase of my injury rehab protocol: the 10 minute feeler. Check out the video below to learn how to check your body’s readiness to run:

Remember, there are multiple steps that precede this test. Those steps are injury and patient specific (me saying I really can’t give them to you). A simple rule: if you’re not functioning without pain in your daily activities, then you likely have no business attempting the test.

If you pass this test: on to running! Learn about your first run after injury by clicking here.

If you fail this test:
You should continue lower impact and functioning activities specific to correcting and re-loading your injured tissue prior to attempting the test.

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