12/4/13

Returning to running after an injury


Ask any family member, training buddy or close friend to a runner (or triathlete) who is recently injured and can not run and you will quickly learn that an injured runner is no fun to be around. Sure, there are the athletes and fitness enthusiasts who keep a smiling face and a positive attitude while coping with an injury but it is completely normal to feel frustrated when you dedicate yourself to a goal and then receive a setback.

So when you get injured the focus should not be on "when can I run again" but instead, "why did this happen and how can I become a smarter athlete because of this injury."
As an athlete who enjoys to stay active, I have had many setbacks with training for events due to hip/back issues and anywhere from 6-12 weeks of no running. Although I can't say that I am always optimistic at the beginning of an injury, I have learned how to focus on the CANs and understand the physiology of my body better with an injury than when I am 100% healthy. I have worked with amazing physical therapists which I highly recommend when you are injured. I also recommend to wait no more than 7-10 days of experiencing a chronic ache before you see a sport physician to help you diagnose your symptoms. With my disclaimer that I am not a MD or a PT, I write this blog with a lot of experience in overcoming injuries and learning from MDs and PTs (from my own experience) and I have been very successful in overcoming injuries to arrive to starting lines healthy, strong, happy and hungry to race. Despite many "learning experiences" with my body, I have arrived to every Ironman starting line that I have signed up for and have finished every Ironman distance triathlon I have started. Although I am not sure of the reason behind it, my very first blog post on Trimarni was my first and only DNF. 

Because many runners struggle with returning back to running after an injury, I'd like to point out a few considerations before sharing my "return to run" plan that I have used many times (and I have also shared with several other athletes to assist in a healthy return back to structured, consistent training). 


-Many runners feel depressed after an injury. Even if running feels like it is your life, it is not. It is your lifestyle and thus you must have something else in your life that brings you joy, balance and relieve stress just as much as running. Start your list now as to what you will do if you ever get injured from running: another sport, train for another event, water jog, elliptical, painting, etc. Find something that will challenge you but will also bring you happiness when you are engaged in the journey. 

-Many runners love the endorphins or the rush of blood when they run. Nothing wrong with that. But identify if you are using running for weight maintenance or weight loss and recognize that running is not the only thing that will help you reach your body composition goals. The idea is to focus on what you CAN do to move your body and many non weight bearing activities can be performed so long as you convince yourself that yes, it's not like running but it will do the trick (check with your physician and PT first before engaging in another activity while injured. I work with great PT's that endorse activity as the body is not designed for rest). 

-Don't convince yourself that all is lost or ruined just because you can't run. If you are training for an event, the best place to start is to talk with your coach or an experienced training buddy on the best route to take. You may not like to hear it but it may be smart to pass on the race in order to ensure good health for the rest of the year. From Feb - April this past year I did not run, not even once because of my hip/back issues. I worked super hard with my PT sessions and continued to swim, elliptical, water jog and bike after the first two weeks of letting my injury flare up calm down. After 90 days of running, I still continued to believe I could qualify for Kona at IM Lake Placid. Not only did I qualify for Kona but I had a 10 min PR at IM Lake Placid but also went on to have a 6 minute PR in Kona, 14 weeks later. I know many athletes, pros and age groupers, that do not give up on their dreams and instead of spending energy on excuses they work hard and end up impressing themselves on race day. Every injury, person and scenario is different so remember that your health is the priority and no medal or t-shirt is worth racing in pain. Also, don't tell yourself you will gain weight, get fat or lose fitness because you are injured. I feel the best time to focus on your diet is when you are not expending a lot of calories because you can then get in-tune with your normal hunger signals and what it feels like to be satisfied without burning 500+ calories a day. Remember, your body burns calories every time you move so you don't have to just run to burn calories. 

-There will be a day when you can run again (hopefully) so keep reminding yourself of this. One thing I stress to every athlete is to remember the moments when you are injured when you tell yourself "if I could only run 5 minutes or 1 mile or 20 minutes I would be SO happy" or "I will appreciate every step when I can run again and I won't overtrain again" or "I will promise to fuel better, stretch more, strength train, etc. when I can run again" Be proactive during your injury and be sure you address anything that may have increased the risk for injury so that you don't make the same mistake twice. 


Below are three workouts that I recommend you perform (discuss with PT if you have one - which I highly recommend to assist in your rehab process to identify any weaknesses) so long as you are given the OK to run again. My general rule with coming back from an injury is to not rely on anti-inflammatory medications (or cortisone shots) to help you run again, especially if you are still in pain. Those medications have their place for some individuals but they do not make most running injuries go away so that you can run pain free and still recover. You do not want to mask pain when you are trying to return to an injury for you will only make the situation worse. Also, you must start slow. The goal is to make progress and to get yourself strong again. Understand that you will have inflammation and a few natural aches after you have not ran for a period of time. That is normal and shouldn't be confused with "I am injured again." The plan I have developed will allow you to stop before you need to stop and to hopefully encourage a gradual run back to running. Lastly, after you are 100% pain free and feel the itch to run - wait 2 more days. 
I promise that you will thank me for waiting those extra 48 hours for many runners are near the verge of full recovery but when they run again (pain free) for the first few minutes, endorphins take over and it's really hard to stop. Thus, the body takes too much stress and the athlete is out for more days and possible a few more weeks. Play it smart. If you have waited 2, 4, 12 weeks to run, why not wait 48 more hours just to be safe. 

A few key points:
-Understand that training won't be what it was before and the goal is to be able to resume consistency with training. Remove any pressure about fitness goals, races, etc. Just enjoy the beauty of a body in motion.
-I am a big fan of run/walk for training and thus I feel it is essential in returning to running after an injury. The less stress on the better, the better for you will run with better form, you will postpone fatigue and you will still receive the physiological benefits of covering x-miles or x-minutes. 
-Perform workouts without focusing on pace or miles. Focus only on time and celebrate every milestone. 
-Don't get stuck on a schedule. It's really amazing how sometimes it just feels "right" to run. I try to avoid telling myself that I have to run mon/wed/fri for my return to running plan. Instead, I give 24 hours in between workouts to ensure good recovery and to reduce inflammation but I also listen to my body. Maybe Mon, Thurs and Sun feels better or perhaps Mon morning and then Tues evening. The goal is to accomplish three workouts within a 7 or 10 day span, only focusing on one workout at a time. 
-Keep in mind where you are running. Always perform a good dynamic warm-up before you run to warm-up your cold or tight muscles. There are thoughts as to how to progress back to running on different surfaces  - anti gravity treadmill, track or packed trail, street (no sidewalks). Discuss with your PT who specializes in your injury to determine the best course of action. 
-Do your homework!! Don't just say that you will keep up with stretching and strength and then stop when you can run again. You are better off cutting a run short to dedicate time to recovery and strength than just focusing on the miles - which may cause another injury. Also, determine the time you have to run which includes time for a pre run snack (if needed, but I recommend one), dynamic stretching and also stretching post workout. You may say you only have 45 minutes to run but really, you may only have 25 or 30 min which is fine. 
 
 I can't promise that these workouts will allow you to be 100% healthy enough to run again but they will tell you the following
 1) If you are able to return to running training again in the next two weeks
2) If you are still injured or recovering and it is not wise to train or race in the next two weeks
3) That you are making progress with your rehab 
 

Two great dynamic warm-ups to perform for 5-15 minutes before you run:
Dynamic warm-up
(I personally recommend compression - shorts, socks/sleeves. Also, run at whatever pace feels "right". Typically trying to run "slow" may affect your form so just run whatever feels the best at this time - not having a GPS will help so you don't get focus on your pace but instead your form and RPE)

Workout 1:
Run 3 minutes, walk 2 minutes
Assess the body - are you OK to continue? If not, stop. If ok,
Run 3 minutes, walk 1 minute.
Assess the body - are you ok to continue? Do you need to scale it back to 2 minute walk or 3 minute walk? Assess form and aches, not HR or pace (no GPS needed - wrist watch is fine).
If OK - go back to 3 min run, 1 minute. and assess.
If semi concerned, 3 min run, 2 min walk and assess.
Right now you are getting close to 15 minutes of running. WAHOO!
If you feel OK -  run for 5 minutes continuously. However, you've made it this far. The moment you feel an ache that doesn't feel right, stop! This doesn't mean you can't run again for workout #2 in a few days, it just means the body needs a little more recovery. 15 minutes is more than you have done in the past x-weeks so be happy in this moment (remember, there was a time that you would give ANYTHING to run for 5 minutes).
After the 20 min workout, stretch and ice and perform normal recovery strength/stretches/rolling, etc.
 
Workout 2:
Run 3 minutes, walk 1 minute, run 3 minutes, walk 1 minute, run 3 minutes. - anytime in here that you are concerned, add 1 extra min walking and during the walk, assess if you should continue. This doesn't mean you can't run workout #3 in a few days, it just means your body needs to recover more.
After 11 minutes of run/walk, walk an extra 2 minutes and stretch/shake out the body. Congrats!!
Now run 5 min run, 1 min walk, 5 min run, 1 min walk. Again - stop and always assess throughout. Focus on really good form and think about being light on your feet.
Congrats, you are almost at 25 minutes of run/walk - 10 more minutes than workout #1!
Walk a few minutes here and if all is OK - you can do 5 min continuous running as a cool down to reach 30 minutes total. Way to go!
Anytime during this workout it doesn't feel right, stop and be smart.
 
Workout 3:
Run 5 minutes, walk 1 minute, run 5 min, walk 1 minute. You should now feel like a "runner" again.
Stop and assess - this was a lot of run stress on the body in the past few days, more stress than the past x-weeks of no running.
Be smart here - should you continue? If you are OK, then walk a few minutes and continue on with the workout.
10 min run, continuous (be smart - walk as needed and always assess). Walk 2 minutes.
If all is ok,
10 min run, continuous (assess and be smart, walk as needed).
Congrats - if all went well, you just ran your longest run in x-weeks!! You should be so proud of your body. 30 minutes of running and then 6+ minutes of walking. Way to go!
 At this time, you may want to repeat these three workouts for 1 more week or you can gradually get back into your structured training if you feel 100% healthy.