Monday, August 21, 2006

Dealing With Injuries - I

The Achilles Lament
Help! Help! It's my Achilles
That's hurting when I run.
Will you help me please,
To make my runs more fun?

The legendary Greek fighter,
Vanquished Hector, a Trojan.
My tendon, getting tighter,
Is what I fight on every run.
I know there's hope for me:
Some of you have been there.
I'm truly at a loss, all at sea;
Help me please, if you care.
Like Achilles, I don't want it to defeat me,
I'll do anything to cure it, whatever it may be
.

All of us, at some time or another, elite or not, have suffered some sort of a running/sports related injury that ends up making us take time off from the activity that we love.

Over the years, starting in March of 1996, I've experienced most of the common injuries that afflict runners. Stress fractures. Stress reactions. ITB. Shin splints. Tight hamstrings. Tight hip flexors. Tight quads. Achilles tendonitis.

How did I deal with them as they happened? It was always tough mentally. Not being able to run made me feel like I was missing a vital part of my life. I have, however, learned to read about and study the injuries in order to prevent them from occurring again. This has not only benefited my running but also that of the runners that I helped in my role as coach of Team Asha.

ITB
This was the injury that caused me the greatest emotional suffering. I had discovered Utopia in running. That was a land where nothing ever went awry. Until the day it all came crashing down around my ears. Pain on the outside of my right knee. A PCP advised me to stop running since he had diagnosed my problem as Chondromalacia Patella. No help there. He was busy trying to reduce insurance costs instead of helping me.

A physical trainer in my gym turned out to be my savior. He correctly diagnosed it as Iliotibial Band (Friction) Syndrome. Even after resting a couple of weeks (I was going out of my mind by then at not being able to run), the pain returned in as little as half a mile of running. I knew that this injury was not going away in a hurry and that I would have to tackle it head on.

I set about learning about ITB. Diligent stretching, biking and strengthening exercises eventually got me back to running in 4 months. I also had custom orthoses made and it is safe to say the ITB has not been a problem since I started wearing them in 1997.

Achilles Tendonitis
Acute Achilles tendonitis in my right foot sidelined me for 2 weeks in early 2002. By this time I had become an expert in diagnosing my problems and taking corrective/preventative measures to prevent their recurrence. I started on a program of strengthening my Achilles tendons with specific exercises. These exercises are described here and shown pictorially here. Did they ever help! AT has not really bothered me since.

Stress Reaction
A stress reaction in my left shin sidelined me for 3 weeks in early August 2003. I biked like crazy (including spinning classes) to keep my fitness up. I went on to run my marathon PR of 3:37 a couple of months later, up in Victoria, British Columbia.

These days I prefer to run at least once a week in a pool. This form of running has been prescribed for injured runners, of all levels, as a way of keeping their running fitness up. I tend to do speedwork in the pool. These workouts are so different from any running you will ever do, even on a trail. Absolutely non-impact but still able to tax the body and keep it on its toes. David Holt has a good Web page on pool running.

Over the years I have learned to ask the following questions about injuries, both mine and those of others (in my capacity as a coach the last 4 years):

(a) Did the pain come on suddenly? If so, are your shoes old? How many miles do they have on them?

(b) Knee pain? Just started a running program? 8 times out of 10, strengthening the quads will eliminate the pain

(c) Pain in the front of your shins (Anterior Tibial Stress Syndrome)? Strengthening by walking on one's heels will do the trick

(b) Are you landing on your heels when you run? Not advisable. Heel landing causes the body to brake the forward motion, leading to a slew of problems. Switch to a midfoot landing.

(c) So what did you do differently in the past few weeks before/while/after running?

(d) Ankle/arch problems? Loosen your shoe laces in order to permit the inside arch to have more room to do its stuff. Try lacing your shoes so that the foot does not slide forward. This lacing method (for people with narrow heels) is the last illustration (Lock Lacing) on http://www.fieggen.com/shoelace/lacingmethods.htm

(e) The pain is where? Please check if any of the connecting muscles are tight. For example, these days, when I feel a bit of tightness in my Achilles tendons, I know that it's because of a slightly tight ITB which, in turn, is tight because of tight quads or tight hamstrings or glutes. Ergo, fix the source i.e. the quads or the hams or the glutes.

R (Rest) I (Ice) C (Compression) E (Elevation) are still valid in order to deal with injuries. They are not everything though. If the root cause is not tackled, the injuries might surface again. It is important to address the cause and to eliminate any problems caused by biomechanical imbalances brought on by an imbalance/tightness in musculature on the two sides of the body or from using the wrong kind of running shoes etc.

Core strengthening will go a long way in helping one run better. There are numerous sites out there that describe such exercises but my personal favorite is here.

Stretching regularly also helped me over the years. As did the use of a Foam Roller.

The following are resources for identifying and addressing some of the common running problems:

* http://www.sportsinjurybulletin.com/archive/
* http://www.smiweb.org/massage_clinic/guides.html
* http://www.instantanatomy.net/sitemap.html
* http://www.drpribut.com/sports/spsport.html

To be continued ...

4 comments:

Anonymous said...

Very informative! Thanks Rajeev. I learn a lot from your article.

I'm thinking if the injuries from running ultra's have anything different from those discussed here.

Perhaps swollen feet, blisters are only temporary and minor since they disappear after one week rest.

Chihping

angie's pink fuzzy said...

Rajeev, this is a great resource! I will add a link to it on my page...very cool stuff.

Rajeev said...

Chihping & Angie,

Thanks. Trying to spread the knowledge I've gained over the years dealing with people's injuries.

As Karl King says in this informative article, blisters may be prevented by making sure your salt levels are up. Read more at http://www.succeedscaps.com/blisters.html

Rajeev

Tiny Seal said...

Nice compilation, Rajeev! Thanks for sharing! Hope RDL training is going well. Please write about it, share the prerace jitters, help us live vicariously :-)