Category Archives: running injuries

Start and Restart

Over the last year, I’ve had to restart my running four times. It’s been very frustrating. I know everyone gets injured eventually. It’s just part of running. I skated by without injury for years and years and then it caught up to me, hamstring, rolling left ankle, and rolling my right ankle. I tried so hard to reframe and find the positive in restarting. Often, it was difficult to remain positive, especially, when you’re running better than ever and then you watch and feel all the gains you’ve made slip away.

I know many runners who have experienced injuries of all levels and never returned to running. Some picked up another sport and others just hit a wall in the area of physical fitness. There were days where I considered walking away (cause I sure as shit couldn’t run) and doing something else.

I thought maybe the universe was telling me it was time to switch to triathlons. I know, I know it’s like sacrilegious, but if I’m being totally honest that’s where I was at on some days.

How did I keep starting over? I told myself you started once and look what you achieved. You can start again. You’re not a quitter. You don’t quit during 100 milers and you’re not quitting now. I told myself it was the ultimate endurance event and I had to stay focused.

I also had a lot of support from family who reminded me I could get back to where I had been and reassured me that it would come back faster than gaining it in the first instance because the foundation was there.

This fourth time of restarting is for an amazing reason, being pregnant, but it’s still been difficult to come to terms with it and I’m sure part of that is the three other restarts and the future restart I know will happen.

Running as always is one of the best metaphors for life and teaches life lessons we often don’t learn the first go around or resist when presented in other areas. Restarting is another wonderful example of this.

I’ve restarted many times in my life, but my most epic restart was when I was 17. I had just overcome an addiction, returned to high school, recovered from a rape, and was raising my first son. This is a picture of me then. If you are needing some extra inspiration or just love stories of hope and determination, I’ve linked a short story published about my restart on Epoch Times. Here

is R.I.C.E. right?

Whenever we strain or sprain a muscle, we immediately start applying R.I.C.E (rest, ice, compression, and elevation), but is that the right thing to do?

The RICE and PRICE (protection, ice, compression, and elevation) practice came from good old medical guess work and reasoning more than actual research studies. The new studies are showing that these regimens are not the best way to speed your way back to doing what you love to do.

Let’s start with the protection and rest portion. There was a study completed in 1994 by Oregon Health and Science University. The study took 82 people with sprained ankles and divided them into two groups one group had their ankle immobilized for 10 days and then began exercises to increase mobility. The other group wrapped their ankle for two days and then began the same program. The second group was back to doing their thing much faster: 57% back to it, where the immobilization group was only at 13%.

Complete rest is not the best option for many sprains, but be smart. If you can walk on it, take it easy, but don’t completely stop. Let pain be your guide. If the pain gets worse stop. If the pain is higher than a 2.5 on a one to five scale tone it down so it’s only a two. You may have to give it 48-72 hours before you can begin, but doing some activity is better than doing nothing. It’s called active rest.

Okay so the total rest or complete protection of the joint isn’t a good thing. What about the ICE? There’s no research that shows it actually reduces swelling. It only delays it. It is a good pain reliever and the theory was that if there is less pain you’re going to be able to move it sooner. The problem is it is delaying recovery by delaying the inevitable swelling. It also delays a hormone called IGF-1, which is key in repairing damaged tissues.

And compression? Well, there’s not research, but the doctors know it reduces swelling and if swelling is down, you are able to move your joint better and sooner. Elevation to reduce swelling? Um no. It may reduce it while it’s elevated, but as soon as you put it down the swelling returns.

So what do we do? A.R.I.T.A.: active rest is the answer. Implement active rest. Start with some basic mobility exercises while keeping your pain level down. It doesn’t have to be pain free. Do things that keep the joint mobile but don’t hurt to do. Sometimes it’s the side to side strain that causes pain but forward and back is fine.

You can’t let the muscles sit idle because they tighten up and atrophy. Scar tissue builds up which will then impact the movement of tendons and muscles for a long time if not forever. Continuing motion of the joint/muscle ensures the healing process will begin and be effective.

Inhale-Exhale

Breathing is something we all do without really thinking about it, unless it’s not going well. We become very aware of our breathing when it is a struggle regardless of the thing that is making it a struggle. The athletes who, I believe, are the most aware of their breath is swimmers.

A swimmer has to have a rhythm for their breathing. All other athletes we can just go and not think about it too much until we’re huffing and puffing and even then, we merely recognize it and adjust a bit or push through. Not swimmers. A swimmer has to coordinate every movement to make sure they are able to breath when needed.

Being aware of your breathing has benefits to many aspects of your life not just running (which is what we really care about, if we’re being honest). It can reduce stress, improve physical health, and increase self-confidence.

Deep breathing releases endorphins and those make us feel good and are a natural pain killer. It promotes better blood flow and increased energy through the extra oxygen. The increase in oxygen gives your body the tools to rebuild injured muscles and build muscle.

Breathing properly can reduce anxiety. When you’re feeling anxious about something take a few deep breaths and see what happens to how you feel. Deep breathing has a relaxing effect on our body and our mind, which helps relieve you of anger, sadness, and other uneasy emotions. It reduces stress, lowers blood pressure, and helps with better sleep.

Deep breathing helps with posture. An upright posture has positive effects on many aspects of your physical health. Your internal organs function better when they are not all squished as you hunch over at a desk or table. Your spine stays healthy preventing lower and upper back pain. It massages your organs such as the heart, stomach, small intestine, liver and pancreas.

Deep breathing strengthens your immune system. Oxygen attaches to hemoglobin in your red blood cells allowing your body to metabolize nutrients and vitamins. It also removes toxins from your blood like carbon dioxide.

Deep breathing makes sure oxygen gets to all the important parts of your brain. You’re able to think more clearly and more creatively. Nerves run throughout your body sending messages from your brain to every body system and muscle. Oxygen is one of the nutrients the brain, spinal cord and nerves need to make communication quick and effective.

How do you do this deep breathing?

Ideally you would spend a few minutes each day and complete the following for two sets of ten. Sit with your back straight and tall or lay on your back. Exhale all the air from your lungs. When you think you can’t get anymore out, try a bit more. Pause for one second and then begin to fill your lungs slowly until you can’t take any more in.

Another option is to send a few minutes throughout the day being aware of your breath and make sure you’re sitting straight and breathing into your belly and not your chest. Make the breaths deep.

Hurts to Breath

Diaphragm cramp or side stitches, call it what you like it’s unpleasant. There are only theories as to why you get side stitches when you are running (or doing other sports activities). The most widely held belief is a muscle spasm of the diaphragm and/or its supporting ligaments.

Your diaphragm muscle assists you with breathing while you are running and because your need for oxygen increases when you’re running, your diaphragm works harder. The thought is that it gets tired and/or the surrounding tissues get tired and then the muscle spasms.

The second theory is improper breathing (oh yeah, you can breathe the wrong way). This theory ends the same as the above, a fatigued diaphragm and surrounding muscles which leads to spasms. The difference is breathing too shallow. Shallow breathing means your muscles don’t get enough oxygen and then get tired easier.

So what’s the proper way to breath when you are running? Deep with your belly not shallow into your chest. Breathing deep into your belly opens blood vessels found deep in your lungs and fills your blood with more oxygen. Most people breath with their chest, only filling two thirds of their lungs. To tell if you are belly breathing, lay on your back and lay your hand on your stomach. If your hand rises and falls you’re belly breathing. Most of us have to make a conscious effort to belly breath.

The third theory is we don’t time our breathing with our foot falls properly. When you are running try inhaling for three steps (right, left, right) and then exhale for two steps (left, right). This five-step rhythm will alternate your exhale from your right foot plant to your left. You have to think about it for a while when you’re first learning to do it, but it will reduce your side stitches. Practice it for a few minutes every mile and pretty soon it will become automatic. If you are climbing a hill or doing speed work, change it to a 2:1 ration for inhalation and exhalation.

The fourth theory is poor running posture, aka running with your shoulders rounded and your upper body bent forward. One belief is that hunching over like that compromises nerves in the abdominal area and then they become irritated and trigger the pain you feel and call side stitches. The other belief is that the hunching puts more weight on your diaphragm which causes it to spasm and get tired.

The final theory is dehydration. I’m not going to go into this one. We all know it’s critical to hydrate before, during and after our runs. We know we have to take in electrolytes if we’re running for more than about 60-90 minutes (depending on pace and temperature outside: faster and hotter=more electrolytes).

Bottom line: breath deep with your belly, use rhythmic breathing, pay attention to your posture, and hydrate.

Losing it?

One of the most frustrating things that happens when you take time off running is you lose your hard earned fitness and have to work your ass off to get it back. We all know the longer you have to take off of running the more you lose. This is definitely something I have struggled with as I’ve been coming back from two rolled ankles and a strained hamstring. Anyone who has been forced to take time off running due to an injury knows you go through the whole grief cycle, which I’ve written about and you can find it here.
There are two aspects of losing it: the mental side and the physical side. Let’s start with the easier of the two: the physical side. There’s been lots of research about how quickly fitness is lost when an athlete has to take time off after an injury or just because they are burnt out. We lose the most fitness right up front 20% in the first three weeks. Ouch. after that things level off and up to three months you retain 80% of your fitness. For those athletes who have trained for a long time the impact over time is less because you have a stronger base of fitness. What the experienced athletes lose is what they have most recently gained. You go back to your baseline. As much as this steep drop in fitness loss sucks, it is easier to get back to where you were than it was to get there in the first place.
You can slow the loss and maintain fitness by cross training that makes sure your aerobic system keeps working at the level you had it and doing strength training to minimize the amount of muscle strength you lose. Sport specific fitness is definitely going to take a  hit though so don’t get discouraged when you go back and are sore after a run that would have been a walk in the park pre-injury.
The mental side of it, in my opinion, is the harder of the two that you work through. Depending on how long you are injured, you may have developed a maladaptive coping skill telling yourself it doesn’t matter and maybe you do something other than running. Sometimes it can go as far as, I just don’t want to run anymore. Telling ourselves these things when there is no end in sight or we when we are catastrophizing is a way that we cope with the loss of running, which has becomes a indispensable part our life and who we see ourselves as.  The problem with this, is it makes reviving the motivation to get back out there more difficult. The best way to regain motivation is by remembering the things you love about running, which can trigger those feelings of loss all over again that you were trying to avoid in the first place. See my article on working through the cycle of grief link above.
Once you are back out there, you have to get over the fear of another injury. This takes time and building trust in your ability and self confidence. The only way to build these is to get out there. Give yourself permission to go at your own pace by taking it slow and run easier routes for a bit. It helps if you come up with a plan of action. A plan will help you come to terms with the fact that you can get back to where you were.
A critical element to maintaining motivation and avoiding a lot of self recrimination is to not compare yourself to where you were and where you are. This is a particularly difficult one for me. Try to remain positive and every time this thinking pattern pops into your head, counter act it by reminding yourself that you had to work hard to get to where you were and it’s possible to do it again because you know how and you know you are strong enough mentally and physically to get there. The other half of working through this is accepting where you are. Berating yourself and dwelling on the fitness you’ve lost is not going to help you move forward. It doesn’t change where your current level of fitness is at.
It is not easy to come back from an extended voluntary or involuntary break from running, but runners are a tenacious bunch who like challenges and this is just one more hill to climb.
I’ve also blogged about the safe way to return to running after an injury. You can find it here.
Here is a post about how to run in the swimming pool. Boo!
There is also something called forced rest depression which I talk about here.

What’s that sound?

Wondering why your knees, ankles, wrists or fingers snap, crackle, and pop? The jury is out on the definitive reason why this occurs and is unlikely to come in with a verdict any time soon. One reason is the ligaments are stretching over a bone and slipping back in place. Second is the compression of nitrogen bubbles in the spaces of the joins and then the refilling of the joint with synovial fluid, which lubricates your joints. A third reason they could be popping is due to friction between the muscle/tendons and the bone. Tight muscles/tendons make this more likely to happen. A fourth reason is called joint fixation. This is when the bones of a joint become stuck together due to suction and when the seal is broken you hear a pop. You can tell the difference between friction and fixation by the reoccurrence rate of the popping. Fixation takes time to set up, so it won’t repeat with every bend of the joint. Friction on the other hand will repeat each time you bend the joint.
Everyone has popping joints at one point in their life or another. In most cases, there is enough slack in our tendons and muscles that no harm is done. Although the sound of it can be irritating or concerning, there is nothing to worry about injury wise. You’re not causing damage and it doesn’t mean that there’s an injury. You should be concerned about a pop is if it causes pain or swelling because it can indicate a tearing or rupture of a tendon or even a fracture of a bone. You will likely know if it could be something like this because there will be an event that causes it. If there is swelling and pain try rest, ice, compress and elevate. If that doesn’t help after three or four days or if the pain is serious(painful to use for normal daily activities) and there is significant bruising, see your doctor.
If the popping is driving you crazy, there are some things you can do to try to reduce or banish the popping. First, try some stretching of the tendons and muscles around the area where the popping is occurring. Stretching should be done when the muscles are warm and not to the point of pain only tightness. Be gentle with yourself. Hold a stretch for 20-30 second and repeat the stretch 2-3 times. Try some yoga. Yoga not only stretches those muscles and tendons, but can be quiet effective at building balance and strength.
Staying active will also reduce the popping and snapping. You don’t need to sit around because you’re all creaky and poppy (I think snappy is a better way to describe it-just more positive). Continuing to stay active actually increases the lubrication of your joints. So you can tell all those nay sayers who ask “Isn’t running bad for your knees?” No it’s not. As a matter of fact, it’s good for them. You can direct them to this article or just tell them to take five minutes and google it on their smart phone.
Cracking your joints or a ongoing unintentional popping of your joints won’t cause your joints to get bigger and it doesn’t cause arthritis.

Back Pain?

Back pain is no joke. Many adults and even children suffer from back pain, specifically lower in their backs. There are a whole host of things that contribute to back pain, some are life style choices and some are genetics. Back pain can remove you from daily life activities that are both fun and necessary. Runners are not immune. Running involves repetitive stress and impact for long periods of time, which obviously has the potential to cause some back pain or tightness at some point. Maintaining good running form, following some basic training rules and keeping the back muscles loose will save you from missed work, and more importantly missed running.
Maintaining proper running form and a strength training routine (see mine here)  focusing on the core muscles (including the lower back) is going to go a long way in preventing lower back pain. Running form can make you a more or less efficient runner and it can make you a more or less injury prone runner. What is proper form? First, you don’t want to make big changes to your running form at a time, pick one of these and do it until it becomes automatic and then move to another. If you notice any pain, which you shouldn’t, make sure you are doing it correctly. If any pain continues, reduce it to every other run until it’s comfortable and then increase to every run.
  1. Head up and shoulders back, not uncomfortably but might feel a little weird if you sit at a computer for a long time each day.
  2. Chest up. Imagine a string attached to your sternum about nipple height pulling up to the sun or moon. This is probably the most helpful with aligning your body.
  3. Be aware of your legs. they should be under your body when you land not way out in front, especially downhill otherwise every step is like putting on the breaks and causes major impact to go through your body improperly.
  4. Foot plan should be mid-foot or forefoot. If you are doing one or the other, don’t switch. Basically, you don’t want to heel plant see number 3 above.
  5. Arm swing. Hold a ninety degree angle at the elbow, hands loose, like you’re holding a potato chip. Don’t cross your arms past your mid-line, center of your torso. Your elbows should come up to your hip and swing back until your wrists are at your hip. They should go straight back and then straight forward, a little pull toward the center is okay, just don’t cross over.
Another important factor, is increasing your miles by the 10% rule and taking rest weeks every 4th week (reduce your miles by 20-25% for the week). Increasing your miles too quickly doesn’t give your body enough time to build the muscle to handle the next level of training. Training with big mile jumps leads to over use injuries. Rest weeks are equally as important because they give your body time to heal and get stronger. As we run we create micro tears in our muscles. This is good because they heal stronger and build more muscle. But if you don’t give it time do do that effectively, it will just do the best it can with what it has, which doesn’t work well long term for you.
Self massage on the back. Sure being able to afford regular massages by a professional would be awesome, but not all of us runners have sponsors, which means all our money goes to our shoes and socks… That leaves massaging to our significant others or more often ourselves. The least expensive and surprisingly very helpful are La Crosse balls. Buy two of them from Amazon or a local athletic store and tape them together. Keep the tape smooth and make sure they are secure. Place the taped balls between your back and the wall with the indentation in the middle over your spine. The balls will be on either side. Now slowly raise and lower yourself against the wall. Keep your hips neutral (great squat workout too). Stop on knots for a few 20-30 seconds to see if you can get them to release. Keep going for 2 minutes or longer if you’d like.
A wonderful tool for total body massage (no they don’t pay me) is the Body Wrench, find it here. It’s a bit pricey, but remember it’s an investment in your body and it’s 100% money back guaranteed. You can use it for strength training as well (a 2-fer). It comes with a storage bag and an instruction manual. There are instructional videos online, found here.
Running forever, means we are going to do what we need to do to prevent and fix injuries and pain.