Can I Run
On This Injury?
Avoiding
the Abyss: When runners should seek professional help
"Medication Can
Never Treat the Cause of an Injury"
Orthopedic
Rehabilitation Specialist
Bruce R. Wilk, P.T., O.C.S. Individualized coaching
Running Injury Management
I’ve seen runners
crippled by running on injuries. An injury that cripples you, that’s the Abyss.
It prevents you from running, sometimes temporarily – sometimes permanently.
That should be a wakeup call for all runners.
Here’s an example:
While training for a marathon in
What happened?
I discovered that she had been getting cortisone shots throughout the course of
her training program. She had gone to a sports medicine doctor, a podiatrist,
who repeatedly injected her with cortisone and told her it was okay to run.
At the time, she
thought she was doing the right thing. She knew the foot wasn’t getting better,
but she ran on it anyway. She got her last cortisone shot on a Thursday, ran
the marathon on Sunday, and ripped her plantar fascia. It took her four weeks
to walk without crutches, six weeks before she could work or exercise – and she
never ran again. She fell into the Abyss.
Why do runners run on
an injury? They don’t perceive that it’s going to cripple them. This woman
would not have continued running if she thought she was going to wake up one
day and be unable to care for her children, unable to walk, unable to fulfill
her responsibilities. No adult would do that. They don’t know they can risk
everything by taking pain medication in order to race. They don’t know they can
fall into the Abyss.
It doesn’t have to
end up that way. You can avoid the Abyss by understanding and following a few
basic guidelines for identifying the severity of an injury, knowing when it’s
okay to run, and when to seek qualified professional help.
How Bad Is My Injury?
Running injuries can be complicated. There
are over 20 different types of running injures, including plantar fasciitis,
shin splints, Achilles tendinitis, runner’s knee, and iliotibial band syndrome.
Most are caused by training errors that can be corrected.
When it comes to
deciding whether or not to seek professional help, however, the type of injury
doesn’t really matter – what matters is the severity.
Unfortunately, most
runners don’t know how to rate the severity of running injuries. So, over the
years, I’ve developed my own practical scale of factors, increasing in severity
from stage 1 to stage 5.
- Stage 1 is pain upon exertion.
It might be a pain that comes after 10 miles, or after one mile, and
continues as long as you are running, but stops when you stop running –
this is the first warning sign of an injury.
- Stage 2 is pain at rest. The
pain is there after you stop running, and it does not go away – this is
the time to start self managing.
- Stage 3 is pain that persists
during normal daily activities, like walking to the car, or walking up
steps. You may be sitting at your desk and have some ache or nagging pain
that bothers you. Pay attention, if it doesn’t improve in a few days, or
worsens as you do your self management, seek professional help.
- Stage 4 is pain that you take
medication for. This is a very important factor. Medication masks the
severity of an injury and allows it to get worse if you keep on running.
If you are taking medication, you must cease running until it is out of
your system. At this stage, you’re on the edge of the Abyss. You must stop
running.
- Stage 5 is pain that cripples
you. It stops you from running, or maybe even walking. That’s the Abyss.
Any type of running
injury can be staged this way. When a patient calls me with an injury, I start
to stage it over the phone. For example, the patient might say, “Bruce, I’m
training for a marathon, and at ten miles my foot is killing me – I can’t get
past ten miles.” I ask him, do you have pain when you stop? He says, no, it’s
okay. I ask him if he’s having pain that interferes with daily activities. He
says no, when he stops it’s okay. I ask if he’s taking any medications, and he
says no, he’s not taking anything. That’s stage 1.
Note that, even if a
runner is at stage 1, pain-wise, if they’re taking any medication for it –
suddenly they’re at stage 4, which is one stage from crippling. Say you take
Advil, and keep taking Advil, you need to address that. With pharmaceuticals or
injections, if one keeps running, the medication could mask the pain just
enough to cripple you.
I want to make it
very clear that at stage 4, if a patient insists on taking medication to keep
on running, including prescribed oral or injected, I can’t help them. In my
professional practice, that’s a deal breaker. I have patients who say “Oh, it
was prescribed, my doctor said it was okay.” Well, if you’re going to run on
cortisone shots, I say you’re out of here. I don’t want anything to do with it.
You’re not going to stage 5 on my watch.
Again, the type of
running injury is not a factor when deciding whether or not to seek
professional help. Any running injury can go from stage 1 to stage 5. Sometimes
runners think oh, it’s just muscular shin splints; that’s not so bad. Then they
start taking Advil and keep running on it, or go to a doctor and get cortisone
shots and keep running on it. That injury can go to stage 5 – and when one is
crippled, one is risking not coming back. You’ve fallen into the Abyss.
Self Management
The self management for running injuries is
PRICE; protection, recovery, ice, compression, and elevation.
Protection means
identifying and modifying, as well as you can, the reason for your injury. The
main cause is usually training error, which is a broad area and hard to define.
The first thing you do is protect the injury and allow it to recover. That
could mean a change in footwear, or modifying your exercise program, or
resting.
Recovery is about
moving from later stages on the Wilk Scale back to earlier stages, regaining
the movement, strength, and function of the injured structure. One can still
train, working to regain movement and strength, as long as it’s moving back.
Massage could be part of it. Rest could be part of it. Modifying your training
could be part of it. But it’s actively working to regain the normal function of
the structure – not passive.
Medication can be a
part of recovery if one’s sleep is disturbed and medication is necessary for
rest – but there must be no running until the medication is out of your system.
You’re at stage 4 now, and you don’t compete.
Ice means cold
compresses. There’s a lot of discussion about applying ice packs. We go 360
degrees around the structure whenever possible.
Compression: We
compress the ice pack. We put toweling around the ice pack and put pressure on
the injured structure (basically ankle, shin, knee, or hip) using Ace bandages
or Velcro straps.
We then elevate the
injured structure above the heart, so ice, compression and elevation are
combined.
When to Seek Professional Help
When you are a runner, pain upon exertion is
kind of always there, to a greater or lesser degree. It’s okay to run some, but
we have to keep our eyes open. My rule of thumb is, if you’re concerned, you
should come in, even at stage one.
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.
Seek professional
help immediately if you encounter any of the following warning signs:
- If you are taking medication
and continuing to run.
- If you are being prescribed, or
injected medication and being told you are allowed to run.
- If you are consistently having
pain at rest or pain disturbs your sleep.
- If you’re having pain that’s
interfering with normal activities – if you’re having trouble walking, if
you can’t take the stairs – and it continues for more than a day a two, or
is worsening and not getting better.
Professional help
often 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 easy.
If you are going to a
doctor who prescribes medication, or injects medication, and tells you its okay
to run, that’s not professional help. In my world, that’s just wrong. Medication
can never treat the cause of a running injury; it only masks it and allows it
to get worse if you continue to run. You can be crippled. Even if you’re only
taking Advil, it may mask it enough for you to lose daily function.
Most adults are going
to limit their running and employ self-management techniques early enough to
prevent loss of daily function. When they don’t, the things to worry about are
pain during daily activity, taking medication, and becoming crippled.
Staying Safe
Left to itself, any running injury could be
crippling. We’re not talking about post-marathon sore – we’re talking about the
inability to live your responsibilities or meet your commitments. It doesn’t
matter if it’s plantar fasciitis or a stress fracture, if it cripples you, you
might not come back. It’s not worth the risk. Even if you’re crippled for a
week, who wants to be crippled?
Crippling doesn’t
necessarily mean you won’t run any more. One could still recover from stage 5.
But one may not recover from stage 5. You do not want to be at
stage 5. Please seek specialized professional help early, and avoid the Abyss.
About the Author:
SIDEBAR 1:
The
Wilk Scale: Five Stages of Severity in Running Injuries
Stage 1: Pain upon exertion
Stage
2: Pain at rest
Stage
3: Pain that persists during normal daily activities
Stage
4: Pain that you take medication for
Stage
5: Pain that cripples you
SIDEBAR 2:
FAQs
Q: How would you treat a patient with stage 3 injury
differently than with stage 1?
A: If pain is disturbing their sleep, I’m probably going to
tell them to cease running until they improve – you know, get some rest for a
couple of days.
Q: Do you tell all your patients to stop running?
A: No! We’re telling them it’s okay to run as long as they
are following their specific instructions for protecting the structure and
recovery. For example, changing the shoes, doing less mileage, toning it down,
going slower – if they make the changes, that’s okay, they’re protecting it.
And during recovery,
if they’re doing their stretching exercises and improving (going in the other
direction on the scale), we’re telling them it’s okay. We’re telling them it’s
okay as long as it’s not disturbing their sleep, they’re not progressively
having to modify or reduce daily activities, and they’re not using medication.
SIDEBAR 3:
Running
Shoes and Running Injuries
Running brought me to physical therapy,
physical therapy brought me to triathlons, and running injury brought me into
studying running shoes.
Shoe problems are an
avoidable cause of running injuries. Around 1998 I got a pair of running shoes
that were defective and picked up an injury (plantar fasciitis) while doing a
race. Because I was really able to identify a very specific injury in my mind
with a very specific source, and a very specific pattern of shoe defect, I did
the research and started publishing articles on running injuries and defective
athletic shoes.
As I researched it I
learned about the running shoe industry – that’s when I opened up a shoe shop
for runners called The Runner’s High, where runners can come in and get expert
advice on the right shoe for them.
You can learn more about athletic shoes on my
website www.therunnershigh.com.
Contact Info:
Bruce
R. Wilk, P.T., O.C.S.,
Orthopedic
Rehabilitation Specialists
305-595-9425
Copyright 2009 by Florida East Coast Runners and
Bruce Wilk. Reproduction or reprinting
without written permission is illegal.
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