Dealing With Injuries During Training

The New Year can be an exciting time for runners. Typically this is when we plan our race season, put our training plan together, and dream big about what we can accomplish in the coming year. However, some of you, like me, might be starting the year injured or recovering from a major injury, which makes it hard to plan ahead. Studies show that 65% of runners will experience an injury in a given year, whether it’s a sprained ankle, an overuse injury, or a freak accident while playing with your dog or toddler. This column is meant to provide a brief but comprehensive overview of how to deal with various injuries depending on the type of injury and timing, and how to move forward after an injury. While I am not a physical therapist (and highly recommend consulting one for any injury!), this column is based on my run coach training, my own experience, and observations with athletes I’ve worked with.

Prevention

Obviously the most desirable outcome is to prevent an injury from happening in the first place. Prevention is most relevant when it comes to overuse injuries. If you are training for a race, it’s important to have a reasonable training plan for the level you are currently at, or better yet, a coach who can help guide you when niggles or unexpected events pop up. You should generally avoid huge jumps in mileage from week to week. For women especially, I believe it’s important to have one complete rest day every week with no impact or intensity (light yoga or walking is fine). Even if you feel like you don’t “need” a rest day, taking one gives your body a chance to truly recover from your training and will help address any tiny niggles that you aren’t even feeling yet. Among the athletes I’ve worked with, a strong predictor of injury has been inability or unwillingness to take a rest day.

In addition to reasonable training, you must eat enough. Recent research suggests that 41% of female athletes are at risk for Relative Energy Deficiency Syndrome (RED-S), meaning they are not eating enough to restore training-related energy expenditure. Symptoms include low energy, amenorrhea (absence of periods), low bone density, compromised immune function (getting sick often), gastrointestinal issues, signs of anxiety or depression, and frequent overuse injuries (especially bone stress injury such as stress reaction or stress fracture). If you think you may be at risk for REDS and aren’t sure how to move forward, it’s a good idea to consult a sports dietician. That being said, some simple rules to decrease your risk for RED-S include avoiding fasted training, fuel during training sessions that last 90 minutes or more, and avoid low-carb or keto based diets. Your bones will thank you!

Finally, there is evidence that lifting heavy weights and including plyometrics in your training can both muscle strength and bone density, both of which reduce injury risk. However, these interventions can backfire if you add them when overtrained or under fueled, so it’s best to start slow and make sure you are using proper form.

Bone stress injuries

If you do experience a bone stress injury, these require a different recovery plan than soft tissue injuries. So it’s important, if possible, to rule this out by consulting a physician and/or physical therapist for any pain that lasts more than a few days. If you can’t rule out or confirm a bone stress injury due to insurance restrictions on imaging (many require an MRI for diagnosis), it’s best to proceed as if you might have such an injury. These usually require 6-8 weeks of non-impact activity before you can start a return to run program. This is because bone, unlike soft tissue, requires a period of complete rest to remodel properly.

Early to mid-season injuries

The most common type of injuries I’ve observed in athletes are soft tissue overuse injuries as they begin to ramp up training, or after a few weeks of higher volume and/or intensity. When my athletes report any pain that is more than a 3 out of 10 while running and/or causes them to limp, I recommend 3 days of no running to start with. They can walk, bike, or swim if there is no pain with these activities. If 3 days off does not result in improvement, I recommend getting into see a PT. In the meantime, we will cautiously resume any activity where pain stays at a 2 or below, with daily check-ins to make sure the injury is not getting worse while we await recommendations from a professional. On an encouraging note, I recently coached an athlete who had to take a month off running due to various nerve and soft tissue injuries in the middle of her training block, but she sought PT, cross-trained on the bike, and was able to resume running a few weeks before her first 100k and ran a great race.

Injuries close to a race

Injuries very close to a race or even during the taper period can be tricky. Sometimes during the taper, little aches and pains pop up that turn out to be nothing. We don’t exactly know why that is, but it’s very common. Unfortunately it’s hard to tell whether something is serious or not, so we generally will play it safe and drastically reduce running if the race is within two weeks. An athlete can keep up their cardio using non-impact training as long as it causes no pain. If the pain is fairy intense, of course it’s ideal to get x-rays and rule out a major bone injury (but again, x-rays often don’t show a small stress fracture). When it comes time to decide whether to line up on race day, I advise athletes to go with their gut, but try not to let their ego get in the way. I will typically program a shake-out jog the day before to help them make this decision.

Post-race

Sometimes athletes develop an injury during a race. Usually this is something like a sprained ankle or a bruise from a fall, but occasionally an overuse injury could manifest during a very long race. While this might not seem like a big deal since the race is over, it can be psychologically devastating because of the post-race blues. Often, even uninjured athletes will feel perplexingly down in the weeks after accomplishing a big goal, and being injured only intensifies these feelings. I experienced this last fall when I ran 100 miles on an undiagnosed bone stress injury, which obviously worsened that injury and led to compensatory issues in my other leg. Not only could I not run for 3 months, I was unable to even walk comfortably or get a diagnosis for several weeks, which led to a bout of depression. During this time, it’s important to let others around know that you are feeling down and get the help you need (both medical and psychological). It can be a very tough time to be injured post-race but you will get through it! The best things you can do are get a diagnosis, get a treatment plan, work with a PT that has experience with runners, and (if possible) avoid signing up for more races until you are healed!