Rehabilitation after a running injury
The way we approach rehabilitation affects how quickly we can get back to training. Neil Black looks at what steps we can take to ensure the rehab process is as swift as possible.
The immediate steps taken can to a degree determine the speed or completeness of recovery. These steps should help:
As soon as you get home follow the R.I.C.E. procedure below
- Stop running. Walk home or contact someone to come and pick you up (this is important, so make a reverse charge call if necessary).
- Cool the injury as quickly as possible (use a stream or available running water if practical, call into a pub, a sports centre or even knock on someone's door!).
- Do not test it to see if it is 'better'.
- As soon as you get home follow the R.I.C.E. procedure (see below).
- Make a call to a sports injury specialist for an appointment.
You may need a diagnosis from a practitioner clarifying exactly what the injury is, and the main contributory factors. From this point your practitioner should be able to determine what processes of rehabilitation need to be completed with ideas of timescales. As far as the local tissue is concerned, the process your practitioner will probably be focussing on is:
- Settle acute inflammation.
- Encourage correct healing of tissue in terms of fibre alignment.
- Restore elasticity and flexibility to the healing tissue.
- Restore inherent strength of the healing tissue.
- Restore the functional strength of the tissue.
- Progress towards 'normal' training.
- Progress towards return to competition.
A practitioner can help you work on the causative or maintaining factors of the injury such as joint stiffness, reduced flexibility or imbalance.
Other causative or maintaining factors for you to look at (and the steps to take) include:
Other general practical steps you can take to assist are to:
- training errors (Discussion with coach)
- faulty equipment (Check your shoes or orthoses)
- inappropriate surfaces (Find new routes or courses).
Stretching and strengthening exercises
- maintain adequate sleep
- maximise nutrition to assist the healing process
- work on other areas of 'weakness' in a performance enhancement or preventative manner without stressing the injury site
- maintain positive motivation towards recovery.
Stretching and strengthening exercises could vary at different stages of the rehabilitation process so advice on them should be sought from an appropriately qualified practitioner.
For example the stretching performed in the earlier phases to encourage correct fibre alignment would be quite different to that done during the stage of return to normal training. Strengthening exercises done at the beginning of restoring strength of the healing tissue would be quite different to those performed in the later stages etc. Therefore it is important to have guidance through these processes.
Self help measures
R.I.C.E. Theory and Cold Treatment
As a generalisation it is appropriate to cool or ice (remember to protect the skin) as part of the early rehabilitation process following injury.
Most people follow the R.I.C.E. theory: REST, ICE, COMPRESSION and ELEVATION. If practical, one would cool or ice the local area under light compression (e.g. an elastic bandage) in a comfortably supported and elevated position. In ideal circumstances this would be performed for 20 - 30 minutes every 2 hours during the first 24 - 48 hours. Make sure you follow your practitioner's advice about rest.
As the acute inflammation settles the frequency, length of application, method etc could all change. In an acute injury (e.g. an ankle sprain ) the SPEED of icing or cooling is the most important. i.e. the quicker the application of ice to the injury, the better!
At other stages of the rehabilitation process cooling or ice may be appropriate to dampen an inflammatory potential after exercises or training of some kind and would perhaps only be applied at that time. This approach may have to continue for some time even when the pain from the injury site has gone.
Heat encourages elasticity, pliability, relaxation and increased blood flow amongst other things. Once the acute inflammation has settled there may be a place for heat in your rehabilitation programme.
Heat can be applied in the following ways:
- applying 'hot packs' which can be purchased and heated in a microwave
- use of a hot water bottle
- immersion in hot water
- taking a bath
- directing a shower jet onto the area.
Depending on which method is practical and under the guidance of a sports injury specialist heat could be applied for 30-40 minutes and up to a maximum of 4 times a day.
This can have effects similar to heating (and many more) and can be very valuable at many stages of the rehabilitation process. Be a little wary of deep massage techniques during the acute inflammatory stage or if an injury has just occurred. Sometimes it might feel helpful at the time but could further traumatise the tissues. Ideally the site, depth and choice of technique should be determined by an experienced sports massage therapist.
The concept of cross training during rehabilitation to maintain or improve fitness, work on weaker aspects of fitness, maintain sanity or avoid potential overload due to too much of the same thing is generally a good one. However, make sure you are clear about the specific aims of cross training and that you are satisfying these aims with your selected methods. Make sure you are not 'accidentally' irritating the injury site indirectly and thus slowing down the recovery process. Be aware that to suddenly do a lot of a different form of exercise could carry with it the risk of another injury potential.
Maintaining positive motivation
Rehabilitation myth 1: 'I will be able to run it off'
Through understanding exactly what the injury is, what processes need to occur, what complimentary things need to be done and the timescales of the whole process it is much easier to maintain a positive approach throughout rehabilitation. Some common sense tips to bear in mind include:
- Put the same time and effort that you would put into your normal training into your rehabilitation.
- Some runners 'distract' themselves by helping out with club activities whilst others throw themselves into other activities.
- Some use the time to analyse, learn from their mistakes and re-plan where appropriate.
- Some spend more time with family and friends or just do things they would not normally do and enjoy the change.
In simple terms try to avoid being dragged down by the injury. Use it as an opportunity to re-think, plan and ultimately gain. By having a clear rehabilitation plan it can be exciting to be completing the different stages of the rehabilitation process with the end goal getting closer every day.
'I will be able to run it off'
Many injuries initially feel as if they can be 'run off' but then suddenly get worse and no longer disappear when running. Running will aggravate and therefore prolong most injuries.
'It will be alright tomorrow'
If something is painful today it is unlikely to be recovered by tomorrow. Even minor inflammation will take 2-3 days to settle.
'It was painful earlier, feels better now, it must be ok'
Many inflammatory conditions feel 'easier' once you 'get them going'. However working them often maintains the inflammatory process and therefore aggravates the problem.
'It goes away during the run. It must be ok'
There are a number of conditions which will ease off during a run. This process is usually a downward spiral over time taking longer to disappear during the run or not quite going. Again this is a route to serious and prolonged injury.
'Give it a good rub and it will be ok'
'Rubbing' injuries can help but can also aggravate them. Be cautious with the firmness of the 'rub' and if things do not improve over a few days then visit a sports injury specialist.
'I cannot feel it when I take anti-inflammatories'
Anti-inflammatories often also contain painkillers. The severity of the injury can easily be disguised by this so be very careful.
Rehabilitation myth 4:
'It is a waste of time going to see the doctor'
'It goes away during the run. It must be ok'
GPs generally are much more interested and knowledgeable these days. Give them a chance to help you.
'I will keep going until the end of the season and then get it sorted out'
This hardly ever works. Sadly it often contributes to the development of a chronic or even a degenerative injury which can be very troublesome, often taking a long time to recover.
During rehabilitation following injury if there is ever any doubt then do less rather than more. Waiting a little longer before you move on to the next stage, giving you a little more time to truly assess the feel of the tissue and its responses, could save a lot of time and heart ache in the future. Remember that injuries are not necessarily 'cured' at the point at which they have just stopped hurting. You may need to carry on with rehabilitation exercises or treatment for some time after this point.