Recovering from a running injury requires a systematic approach, one that shows progress, plateau, and progression. Let’s get started. You’re injured. It’s been weeks since you’ve ran & all you’ve heard is “rest”. It feels a little better so you go back at it (days, weeks, months later) and attempt your first run. The first few minutes cruise by and you’re thinking, “I did it! I am pain free! I can run!” However, ever so slowly as the minutes tick by–your thought process shifts, it probably goes something like this:
I feel great.
I feel something; it must be all in my head.
It’s definitely not in my head.
Ok. It doesn’t hurt that bad.
It will work itself out.
Is it getting worse?
Please, please, please go away.
Yep. It’s getting worse.
Wow, this hurts.
This will never get better.
I am losing all my fitness.
So why isn’t that leg, foot, hip, etc getting better? Why isn’t the rest working?
The acronym R.I.C.E. (rest, ice, compress, elevate) is an important component in injury prevention and rehabilitation, however, only for the initial stages. When you suffer an injury inflammation can run rampant—irritating and lighting a fire to all tissues within reach, a term I call “inflammation by association”. Distinguishing the fire (inflammation) is the main goal here—R.I.C.E. Unfortunately, clinicians and athletes over utilize this approach in injury rehab and it’s the main reason you’re left frustrated, eating the costs of race entries for weeks or months.
Protecting an injury is important, but can’t happen forever. You eventually need to “cut the cord” as they say, and get back in the game. Enter my problem with rest. Most athletes go from weeks to even months of rest and then attempt to resume normal training. After all, you’re psyched that the pain is gone, aren’t’ you?
Just reading it doesn’t make sense. Going from weeks of rest to resumption of training, but face it, you’ve probably done it. Heck, it doesn’t even need to be resumption of training. Most runners say it’s 30 minutes or nothing, “If I don’t run at least 3 miles, I don’t run.” There needs to be a transition. Running is highly compressive (reported as high as 5x your body weight in pounds of force). The transition must include the dreaded elliptical’s and steppers of the world. You say, “But Steve, that doesn’t mimic function, it doesn’t mimic running.” True, but it does present the ability to load your injured wheel with thousands of painless repetitions. Afterall, we all can’t afford a zero-g treadmill. The elliptical and stepper is used as transition equipment for sub threshold loading.
The benefits of sub threshold loading:
[The above graph illustrates that as time goes on, our threshold for activity decreases. Some machines will provide sub threshold loading, while running does not.]
Repetitive painless loading increases blood flow while allowing repairing tissue fibers to align and strengthen. Painful loading is associated with tissue degradation and inflammation.
Goals of sub threshold loading:
This is a difficult concept, at least mentally. The goal here is to not improve fitness, but rather load the tissue and promote healing. Remember, you’re rehabbing an injury here, not improving fitness. One of the hardest things to do is to stop running when things are painless and good.
The sub threshold loading increments can range from mere minutes to ten’s of minutes. Since no one wants to suit up for a 3 minute run, the use of transitional equipment is important. Utilization of a bike-stepper-elliptical-run progression can benefit the damaged tissue as well as your psyche. The transitional equipment provides prolonged sub threshold, painless loading, (think increased healing and fiber alignment) with a transition to function (running). The small doses of running at the end will build tissue tolerance to longer and harder runs.
First Things First:
You need to establish a run interval that doesn’t inflame & degrade healing tissue. Most injured runners can approximate how long they can go before pain becomes an issue; if you’re not sure, go for a run and note your onset of pain. Your sub threshold number should represent 75% of this time. Your rehab should include transitional equipment followed by runs at this threshold time. For Example:
You’re thinking “this will take forever”, but the key is to never let an injury get this point. Rest initially (3-5 days) followed by a gradual progression back to activity. Falling into the trap of playing catch up is a strong urge. Fight it. Listen to your body. It will relay messages of how it’s handling your plan.