Running Safe:
A Parent’s Guide to Managing Kids’ Running Injuries
By
Bruce Wilk, PT, OCS
Your child comes
home limping from foot pain after a running event. Do you (A) ignore it as long
as they’re not complaining, (B) make them feel better with some medication, or
(C) rush them off to the doctor? Is your answer “None of the above?” or “Maybe”
or “I’m not sure?”
Running is part of
the training program for all sports. If your child is in an athletic program,
then they’ve probably had a running injury at some time or another. Your young
athlete may tell you it’s nothing. Maybe their coach pushed them to keep
running, or they simply didn’t want to let down the team. Sometimes kids think
the pain doesn’t matter and it will all go away in a couple of days. Maybe it
will, but maybe it won’t. As a parent, it’s important for you to get
involved.
You can help by
following a few basic guidelines to (1) identify the severity of a running
injury and know when it’s okay for your child to keep on running, (2) understand
some basics of home treatment, and (3) know when to seek qualified professional
help for an injury.
How Bad Is My Child’s
Injury?
Running injuries can
be complicated. There are over 20 different types, most of which are caused by
training errors that can be corrected. When it comes to dealing with an injury;
however, the type of injury doesn’t really matter – what matters is the
severity.
Unfortunately, most
parents (and even coaches) don’t know how to evaluate the severity of running
injuries. So, as a physical therapist that specializes in running injuries, I
developed a useful scale for staging running injuries, increasing in severity
from Stage 1 to Stage 5.
Stage 1: Pain upon exertion
Stage 2: Pain at rest
Stage 3: Pain that persists during normal
daily activities
Stage 4: Pain that your child takes
medication for
Stage 5: Pain that cripples your child
Stage 1 is the first
warning sign. There is pain, but it stops when they stop running. This is the
time to look for a cause, such as a shoe problem, and correct it.
Stage 2 is when pain
persists for a short while after running but then goes away. In addition to
finding and correcting the problem, this is the time to start injury
management.
Stage 3 is when
pain, even minor aches or discomfort, continues throughout the day. In addition
to injury management, persistent pain should be closely monitored. If the pain
doesn’t improve, disturbs sleep, or interferes with daily activities, then it’s
time to seek professional help.
Stage 4, taking
medication, is a critical stage. Note, even if a runner is at Stage 1 based on
pain level, if they take any pain medication, including over-the-counter
medication such as Advil, then suddenly they’re at Stage 4 which is one stage
away from crippling. Pain that requires medication must be addressed
immediately.
Under no
circumstances should you allow your child to take medication in order to keep
running, including prescribed oral or injected medications. Coaches, and even
doctors, may be willing to give pain medication or cortisone shots and tell you
it's okay to for your child to keep running. It is not. Medication
can mask the pain just enough to cause crippling. For anyone running on
pharmaceuticals or injections the finish line is Stage 5. Stage 5 is a
crippling pain that keeps your child from running, or maybe even walking.
Crippling doesn’t necessarily mean they’ll never run again. They could
still recover from stage 5. But they may not recover from stage 5. You
do not want your child to be at stage 5. Seek specialized professional help
early.
Injury Management at
Home: PRICE
Home management for
running injuries is PRICE: protection, recovery, ice, compression, and
elevation.
Protection means
identifying and modifying the reason for the injury. The main cause is usually
training error, which is a broad area and hard to define. The first thing to do
is protect the injured structure and allow it to recover. That could mean a
change in footwear, a modified exercise program, or resting.
Recovery is actively
working to regain the normal function of the injured structure and may include
massage, rest, and a modified training routine. It’s about moving from later
stages on the scale back to earlier stages and regaining movement, strength,
and function. It’s okay to train, as long as the injury is improving.
Medication may be a
part of your child’s recovery if their sleep is disturbed and the medication is
necessary for rest, but there must be no running until the medication is out of
their system. Medication means Stage 4, and they can’t compete.
Ice means cold
compresses. There’s a lot of discussion about applying ice packs. I like to go
360 degrees around the structure whenever possible.
Compression includes
placing pressure on the injured structure (ankle, shin, knee, or hip) by
wrapping toweling around the ice pack and using Ace bandages or Velcro straps.
Elevation means
raising the injured structure above the heart – so ice, compression, and
elevation are combined.
When to Seek
Professional Help
For runners, some
pain upon exertion is not unusual, but if you are concerned, then go ahead and
take your child to a professional for evaluation, even at stage one.
Seek professional
help immediately if you encounter any of the following warning signs:
- If your child is taking
medication and continuing to run.
- If your child is being prescribed medication, or
injected with medication, and being told they are allowed to run.
- If your child is consistently having pain at rest or
pain that disturbs their sleep.
- If your child has pain that interferes with normal
activities, such as walking or climbing stairs, and pain continues for
more than a day a two or is worsening and not getting better.
Ideally,
professional help means knowledgeable help by a runner with licensed medical
credentials. Most doctors and physical therapists aren’t trained in running
injuries, and finding a professional with specialized knowledge isn’t always
easy.
Beware of any doctor
who prescribes medication, or injects medication, and tells you its okay for
your child to run. Medication can never treat the cause of a running injury; it
only masks it and allows it to get worse.
Staying Safe
As parents, it’s our
job to watch over our kids’ health and ask the right questions. Left to itself,
any running injury could be crippling. It doesn’t matter if it’s plantar
fasciitis, shin splints, or a stress fracture – taking Advil or receiving
cortisone shots from a doctor and then running can progress any running injury
from Stage 1 to Stage 5.
Remember, the first
rule of management is protection. It’s better to put a management system in
place early (such as the right shoes, exercises, or training routine) that can
correct the problem before it progresses to higher stages.
Catching
problems early is the key. Running is an important part of all sports, and
making sure our kids are safe will keep it fun!
Guidelines for Running Injuries
Here are some
questions you can ask to help evaluate the stage of your child’s running
injury. Keep in mind, if you are concerned, that it is always appropriate
to consult a qualified professional at any stage.
Question 1: Does your child
have pain that continues as long as they are running but stops when they stop
running?
Evaluation: Stage 1, pain
upon exertion.
Action: This is the first
warning sign of an injury. Work with your coach and/or physical therapist to
determine the cause of the pain (such as training technique or shoe problems)
and correct it.
Question 2: Does your child
have pain after they stop running but then it goes away?
Evaluation: Stage 2, pain at
rest, immediately after exertion.
Action: This is the time to
start injury management using the PRICE method.
Question 3: Does your child
have pain during normal activities like walking, climbing stairs, or sitting at
their desk? Or is there some ache or nagging pain that bothers them?
Evaluation: Stage 3, pain that
persists during normal daily activities.
Action: Monitor this
closely – this should be of concern if it doesn’t improve in a few days, or if
it worsens. Limit running and employ injury management techniques.
Question 4: Is your child
taking any kind of medication for pain, even an over-the-counter medication
such as aspirin, Advil, or Tylenol?
Evaluation: Stage 4, pain that
they take medication for.
Action: This is a very
important stage. Medication masks the severity of an injury and allows it to
get worse if they keep on running. If your child is taking medication, then
they must cease running until it is out of their system.
Question 5: Does your child have
pain that stops them from running or maybe even walking?
Evaluation: Stage 5, pain that
is crippling.
Action: Stop everything and
seek immediate professional advice.
Any type of running
injury can be staged this way. Remember, even if your child is at Stage 1,
pain-wise, if they are taking any medication for it, then they’re at Stage 4,
which is one stage from crippling.
FAQs
Q: Can I give my
child medication for pain?
A: Always consult
your doctor about giving any medication. The important thing is not to run
while taking pain medication.
Q: Does my child
have to stop running?
A: Not necessarily.
Its okay for them to run as long as they are following their specific
instructions for protecting the structure and recovery, and their condition is
improving. (For example: changing the shoes, doing less mileage, going slower,
doing their stretching exercises.) They can continue to train as long as pain
is not disturbing their sleep, they do not progressively have to modify or reduce
daily activities, and they’re not using medication.
Q: Can the right
shoes help protect my child from a running injury?
A: Shoe problems are
an avoidable cause of running injuries. You can learn more about athletic shoes
at www.wilkpt.com/articles
and at www.defectiveshoe.com.
Bruce
Wilk is a board-certified physical therapist, a certified running coach, and director
of Orthopedic Rehabilitation Specialists in Miami, Florida, where he has
managed running injuries for 28 years. He has 35 years of running experience,
including 23 marathons, four Ironman competitions, and many triathlons.
The
Runner’s High
11209
S. Dixie Hwy., Miami FL 33156
305-255-1500
Copyright 2010 by Florida East Coast Runners and
Bruce Wilk. Reproduction or reprinting
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