by Marnie Caron
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:
1. Seek professional advice to create a rehabilitation plan that meets your needs.
2. Make a detailed plan to stay active while injured.
3. Consider various cross-training activities that are of interest to you.
4. If you normally run after work, make sure you fill that time with one of your cross-training activities.
5. Look at this time as an opportunity to try a new activity and a chance to strengthen areas that complement your running. For example, weight training or yoga will help build your core muscles, which are essential to good posture and running technique.
6. Continue to meet up with your running partners. If you usually go for breakfast after your weekend long run, plan to cross train and then meet them afterward. This way, you won’t feel grumpy for having missed out on a run, and you can share with them aspects of your cross-training activity while catching up on what’s new with their marathon training.
7. Remember, most people experience an injury from time to time. When you return from your injury, you will be rested, wiser, and ready to run!
The Uncomfortable Aspects of Running
Blisters
Blisters may seem a minor issue in comparison with an injury, but any runner will tell you that a blister, especially one left untreated, can really slow you down. Once a blister develops, it doesn’t take long before you find yourself cutting short a workout. If left untreated, a blister can easily become infected, forcing you to take several days off training. The good news is that they’re easy to care for and avoid. Proper running shoes, socks, inserts, and petroleum jelly such as Vaseline all minimize the formation of blisters. Before a long run, apply a thick coat of Vaseline over your entire foot. This will reduce friction and prevent hot spots. Another suggestion is to reduce calluses with a pedicure file so that you can get at and treat new blisters that develop.
Tips for handling blisters
• Sock seams often blister feet. If this is the case for you, try wearing your socks with the seam facing out.
• Visit your local drugstore and check in the first-aid section for “second skin” products. They are literally a synthetic “skin,” and when placed over your blister, coupled with a good adhesive strip, will bind and protect the area until the new skin is formed.
• Apply an antibiotic ointment to the blister, add a good adhesive plaster, and finally, stick a strong strip of duct tape directly over the tender area. It won’t breathe and needs to be removed after your run, but it offers the best on-the-spot protectio
n.
Ingrown nails
Ingrown toenails can be nasty. Square off the edges of your toenails, get rid of any rough edges with a nail file, and file down the centers of your nails so that they are quite thin. This takes the pressure off the nasty edges that otherwise might dig into the corners of your toes.
Chafing
Chafing occurs when you sweat during the early stages of a run, then become dehydrated and stop sweating; the sweat dries, causing your skin to become salty. In turn, your skin becomes sticky and scratchy, which causes chafing. Deodorant can also become sticky and cause chafing.
To prevent chafing, try to stay dry by using a drying agent like talcum powder or starch, or continue to sweat by staying hydrated, which requires carrying water and drinking regularly on your run. If you do find that you have certain red and irritated spots on your body, perhaps under your arms or under the edges of your sport bra, be sure to apply a generous coat of Vaseline to the spots before heading out for your run. If left untreated, a chafed area can quickly turn into an open sore, which is even more painful and difficult to treat. You could also try a lubricant in areas that are predisposed to irritation, and one final suggestion is to wear breathable clothing that is snug but not tight.
Cold or flu
Over the course of your 26-week training program, it’s likely that you will wake up one morning with the nag- ging feeling that you are coming down with a cold or flu bug. It happens to all of us, but what do you do when your training schedule has you running 5 miles? Should you rest, or persevere through the cold and hope for the best? Before you answer that question, check your symptoms. If you’re feeling sick above the neck, such as having a sore throat or stuffy nose, a little running should be fine, but you might want to cut back and do only half the distance suggested in your program. Monitor yourself on your run—if you feel dizziness, have nausea, or experience excessive sweating, stop running. If you are feeling symptoms below the neck, such as muscle aches, chills, swollen glands, or a fever, that suggests a virus and increases the likelihood of dehydration. This can lead to more serious problems, so you should not run until you are completely recovered. If you are forced to take a few days off, it may take you a while to get back to where you were in your training, but before long you will be feeling like yourself again. Any more than a couple of days’ rest shouldn’t wreak havoc on your training plans, but if you have taken a week or more off, refer to chapter 4 for details on how to resume your distance-running program.
Rest
Sleep and rest are the building blocks of solid training. It’s fine to occasionally miss a few hours of sleep, but not getting a sufficient amount on a regular basis will lead to problems. Your body’s ability to recover diminishes with inadequate rest, so you need to make sleep a priority just like eating, drinking, and training.
Overtraining
Overtraining occurs when you run too frequently or too fast and with too little rest and recovery. The theory among those runners who overtrain often seems to be that if a specific amount of training is good, then more must be better. As a result, instead of running 20 miles (32 kilometers) a week these folks begin running 40 miles, then 50 miles, and maybe even 60 miles a week. Increased training might seem a good idea, especially if you are seeing an initial improvement in your fitness level and running ability, but the body has limits. It is especially important for beginning marathoners to realize that more is not better—marathon training in moderation is the best approach. But overtraining does happen, and it leaves runners at a much higher risk of injury and burnout. Some of the common signs and symptoms include:
• Ongoing muscle fatigue and soreness that does not dissipate
• Fatigue at the start of a run and difficulty meeting target pace goals
• Waning interest in training
• Unexplained weight loss
• Headaches
• Insomnia
• Inability to relax; twitchy and fidgety behavior
If you are suffering from a number of the above warning signs, take a few days off to rest and recover. Drink plenty of liquids, alter your diet if necessary, and if the symptoms don’t go away within 2 or 3 days, be sure to check with your physician so that any potentially serious problems can be ruled out.
Tips from an elite athlete: Find some cold water
After a long run or hard workout, elite marathoner Art Boileau often heads to the ocean. With a large coffee in hand, he forces himself to wade in up to his waist and stand in the chilly water for 10 minutes while sipping his hot drink. He shivers through the whole experience, but the cold water reduces muscle swelling and inflammation. Great for speedy recovery!
Staying Healthy
Overtraining is the most common cause of injury. Consistent training is definitely essential to making it to the marathon finish line. Sometimes, pushing through fatigue is needed in order to achieve your desired training effect, but it’s important to get to know your body and to recognize when it’s safer to back off and take a rest. In this respect, it’s better to undertrain than to overtrain. Taking a break is not a sign of weakness. Rather, the opposite is true: it’s smart training, because consistency over time is what’s key.
Returning to Activity after Injury
Many exercisers endanger their immediate or future health by returning to action too soon. If you suffer an injury, keep in mind the following principles before returning to activity:
• Ensure pain-free range of motion in the previously injured area.
• Check that your strength, endurance, coordination, and speed of movement are equal to the uninjured side or back to pre-injury levels.
• Ensure that you are psychologically prepared to return and confident you will not be reinjured.
Alternative Training If You Become Injured
Injury rarely means complete rest is required. Try pool exercising or stationary cycling as a way to maintain your fitness level. You will keep your muscles in shape without the impact of running/walking. When you are ready to resume your run/walk program, remember to ease into it slowly. Your body needs time to readjust itself to exercising with full body weight.
What to Do If Forced to Miss Some Training
If you miss a session, don’t fret—it happens to all of us once in a while. All you need is a good plan. The following are suggestions for returning to your training program in a safe and comfortable manner. Find the scenario that most closely resembles your situation, and follow the guidelines for returning to your marathon or half-marathon program after injury, illness, or unavoidable family or work demands.
Scenario 1: I’m not injured, but I missed almost 1 week of training
Return-to-activity guidelines
• If your program indicates that this should be an easy recovery week, you’re in luck! Jump back in and resume training as though you haven’t missed a beat.
• If your program indicates that this is not an easy recovery week, it’s a little trickier, and you need to be cautious. For session 1, complete only the first half of the workout outlined for the current week. For sessions 2 and 3, complete workouts 2 and 3 from the previous week’s training schedule. By doing two of the missed workouts from last week, you will be up to speed and ready to rejoin the current week’s training program.
Scenario 2: I’ve missed more than 1 week, but not because of injury
One of the greatest benefits of walking and running is that you can do them anywhere, at any time, and all you need are a good pair of shoes and a program to follow. If you’ve missed more than 1 week of training but the interruption was not due to injury or illness, you may want to re-evaluate your commitment to your distance-running goal. In order to be successful in completing a marathon or half marathon in a safe and comfortable manner, you need to do your homework. This means following the suggested three sessions per week.
Return-to-activity guidelines
Week 1: Rejoin the program in the current week, but do only half the workout
for each session.
Week 2: Continue with the program in the current week, but do only three-quarters of the workout for each session.
Week 3: Now you are ready to complete the full workout in the current week for each session. And from now on, do your homework!
Scenario 3: I’ve missed up to 1 week because of injury
Cross training
If you have a nagging ache or pain that has been bothering you for a few days, and as a result you need to take a week off from the impact of running or walking, no worries! Cross training will maintain your fitness, and pool running is an effective way to duplicate your running and walking form.
In all cases, the very best scenario is to simply take the suggested workout of the day and transfer it directly to your cross-training activity. For example: if you were to do change-of-pace intervals of 2 minutes of brisk walking or jogging followed by 2 minutes of a slow and easy recovery, then you would jump into the deep end of a pool (or take to the cross-country trail or stationary bike) and do exactly those intervals, including the warm-up and cool-down. Remember, all the same principles apply: “brisk” means just slightly faster than a talking pace, and the rest is done at a nice, easy, talking pace.
Return-to-activity guidelines
Because you were sidelined by an injury, you need to be careful not do too much, too soon. It’s important that you don’t try to start back where you left off. Review the injury-awareness scale earlier in this chapter, and when you are ready, follow the suggestion in scenario 1.
Scenario 4: I’ve missed up to 2 weeks due to an injury
Cross training
See scenario 3. You need to make the effort to cross train for your three weekly sessions by transferring your marathon or half-marathon workout to pool running or a stationary bike, as described above. By doing this, you will maintain your fitness. You may feel a little awkward when you return to training on land (running or walking), but before you know it, these feelings will subside.
Return-to-activity guidelines
Because your injury likely was the result of impact, overuse, or pushing yourself too hard, it’s important to carefully plan your return to activity. Review the injury-awareness scale earlier in this chapter. Avoid hard surfaces in favor of softer terrain such as grass or dirt trails when you resume training.