My cousin Carin is suffering from Runner's Knee and she found herself at the orthopedic doctor, waiting well over an hour in the exam room, then getting an xray (near worthless for running injuries but a hoop they make us jump through) and being sent home to "wait and see" how it is. That's the pretty typical scenario and she sounded justifiably frustrated. I started to think about all the things she can do in the meantime that may be more productive than "waiting" so decided I would pull them together into a post.
Having been through my share of injuries (ITB, two fractures, shoulder impingement, drop foot, peronial tendonitis, hip issues, pulled hamstrings, piriformis...) and having been asked by others in the past about how to cope and manage, I thought I'd share a few things that I do to be proactive in my own rehab that might be helpful for others. In fact, in the last ten days I've been rehabing an overused and abused sartorius (front quad). It's always something, but part of the athletic journey!
(Disclaimer: Yes, I am a PhD, and not an MD or DO, but as a mom I'm automatically qualified to dish out unsolicited advice ;-) Seriously, this doesn't replace qualified medical opinions, blah blah blah, and what I have to share wouldn't apply to things like more serious or acute injuries or degenerative bony degenerative changes.)
Like many, I believe a large number of typical runner's injuries are caused by areas of tightness and weakness that require compensation by other muscles/ligaments/tendons. They can compensate only so long and eventually something becomes overused to the point of pain and inflammation.
The good news is that often there is more that can be done than just waiting. This is a big list of all I could think of, in no particular order. I'm not suggesting they all need to be used each time, but you can mix and match!
- Get The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief by Clair Davies, David Simons Amber Davies. My friend Sheila turned me onto this book that does an excellent job of saying if you hurt here, and if feels like this, look to these areas as the culprit. While you may hurt in your knee or foot or whatever, the issues may be further up the kinetic chain. It's nice to read the short case studies and be able to say, yeah, that IS what it feels like! Then the book shows you how to massage the trigger points (basically tender areas of muscle/nerves) to break them up.
- Use a quality hard foam roller and massage stick daily or even several times a day. I like the Trigger Point foam roller and the "stick". It's not that hard to learn how to use them and the foam roller is a great relaxing evening thing to do anyway. Roll everything - back and legs. There are lots of videos out there on how to use them.
- Ice is a great tool. It's a pain, and it takes effort, but initially it's really important so get a system and make it as easy as possible for yourself. If it's a lower leg issue, stick your foot in a garbage can of water with ice. You can even make giant reusable ice cubes in ziplocks and just put those in the water. For other areas, get a quality gel ice pack (or several) and figure out a way to stuff them in a compression sleeve or wrap an ace bandage around them, or shove them down the back of your pants if it's your back. The key is to make it convenient.
- See a Sports Med DO (Doctor of Osteopathy) and/or Physical Therapist. Ideally they are or were a runner/athlete or they work with them. They will dig beneath the surface symptoms to find the root cause. DOs can do adjustments and manipulations and PTs can set you up with a set of rehabilitative exercises. (Contrary to popular belief for running injuries you can actually see a PT just one time or two and do the work at home). Then no matter how silly and weird the exercises seem, DO THEM. Consistently.
- See a chiropractor to get realigned and stay aligned. I've seen Dr. Tilley regularly for years and not only does he keep me structurally sound, he's a trusted advisor for my overall athletic health.
- Get deep tissue massage. When you are injured it can set off a cascade of tightness elsewhere. The rollers can only get you so far, but a qualified SPORTS massage therapist can break up trigger points, areas of tightness, and flush out the bad stuff. This is not a fluffy spa massage, these hurt, but it's well worth it. This year I've been getting fairly regular massage work (thanks, Mario!) and it's made a big difference.
- When you have a really stubborn tendon injury, consider acupuncture. This can break up established pain pathways and stimulate blood flow. This is especially useful for tendonitis problems that heal so slowly because they have very little blood flow.
- Sports tape can help. I'm a little less convinced of this but in the latter stages of healing and in the return to running, I think it just helps to have the distraction. Then your mind can focus on the pull of the tape rather performing a constant OCD assessment of pain levels.
- Compression may be useful. You can find compression garments and sleeves for nearly every body part now and not only does the support feel good when needed, they are also useful for holding ice packs in place! I have compression socks and just added compression quad sleeves.
- Strengthen areas that are contributing to the overcompensation area. A physical therapist is essential for prescribing the best course of action! Often the exercises are very small and simple movements that use bodyweight or just stretch bands. You don't have to be pain free to start the strengthening process.
- Dial in the nutrition and hydration and be sure your body is getting all it needs to heal. Adjust your intake to match reduced training.
- Do what you CAN do in terms of exercise. If you can't run, can you still bike? Swim? Lift weights? Work your core? Don't abandon your fitness because it is essential to mental well-being and happiness too.
- As you recover, begin planning for your return to running. How you can keep the injury from recurring and continue gaining strength. Do you need a better warm-up plan? Cool down? More stretching?
- Examine your running technique. Think critically about ways to improve. Do you need a quicker cadence to prevent overstriding? Are you underutilizing particular muscle groups? A professional video analysis from a qualified running coach can help.
- Get new shoes and consider a different model or brand. A little change-up in foot-strike might alleviate what led you to the injury in the first place.
- Return to running gradually. You don't have to be pain free-to resume, but go very slowly and start with a jog-walk cycle. Stick to level, non-cambered, smooth surfaces -- ideally a soft grass or mulch trail. Then ice immediately afterward and continue with the rolling, stretching, and exercises. Keep that up until you are running pain free.
- Stay positive, even if you have to fake your way through it. Be kind to those around you who are having to deal with your non-running self. There are more races and training days ahead. I have taken something positive and learned from every injury I have had and you will too. Heck, it was a running injury that led me to triathlon!!
- Finally, COMMIT to your recovery and healing! Be proactive! Do the regular icing, stretching, massage, rolling, and strengthening. Do what needs doing like it's a part-time job and have faith that in time, you WILL get through it, because you will!