13. Injuries and Ailments

‘If I train too hard I get injured, and if I race without having done any training I get injured.’

How to avoid injury

From our questionnaires, the most frequent comment was: ‘Injuries and niggles seem to crop up more frequently as I get older’. When we realise that muscles and ligaments lose their elasticity as we get older, this is hardly surprising, but there are remedies, and a few people were able to report that they seldom get injured.

A man’s greatest strength is often his greatest weakness and this is particularly noticeable amongst athletes. The compulsive streak in their character which drives them to train hour after hour, day after day, is their worst enemy when it comes to handling injuries. The obsessive runner is all too apt to go out ‘just to try it out’ well before the injury has cleared up, resulting in further injury. Some veteran runners seem to have learned from their mistakes and some do not. The next most frequent comment in the questionnaires was: ‘it takes me longer than it used to to recover from a hard session.’

The best thing is not to get injured in the first place which means putting ‘avoidance of injury’ high on the list of priorities. When we are making out training plans we always start by listing the objectives – such things as ‘improving aerobic fitness’, ‘maintaining endurance’ and ‘maintaining flexibility’. Putting ‘avoidance of injury’ on this list keeps it at the forefront of the mind when plan-ning the week’s training. These are the guidelines:

Never train hard when stiff

This seems obvious,but it is seen all too often at the beginning of a season or in a training camp. Some people turn up very fit and set a fast pace in training –and the others suffer for it the next day – but instead of waiting for the stiffness to ease off they try to go on training as hard as the day before. Stiffness is caused by the leakage of tissue fluid, causing tightness in the compartments which enclose the muscle fibres. If muscles cannot contract without pain, running becomes awkward, movements are not co-ordinated and injuries are more likely.

‘I think that the vast majority of injuries I suffered occurred because I did not have the time to train. Now, at 58, I can pick my time of day to train and rest when I need it. For the very first time I am actually enjoying it and really looking forward to the next race.’

Introduce new activities gradually

Ideally, one would never introduce anything new at all, but there are bound to be changes of emphasis – the switch from indoor to outdoor training or from grass to a synthetic surface. The solution is to start switching well before it is necessary. In switching from cross-country running to the synthetic track, for example, one might include a bit of running on the track whenever the opportunity arises, even if it is only three or four laps and a few strides after a steady run. The first track session of the year would only be half a normal session, and it would be done mostly in trainers. The following week one might do most of one session on the track, but only part of it in spikes, and for the next two weeks one increases the proportion done in spikes. After a month we might be running three times a week on the track, with other sessions being done mostly on grass

Warming up and cooling down

In the British climate this is particularly necessary. Warm muscles stretch much more easily than cold muscles. Ligaments and tendons are more likely to tear when the muscles are cold and inflexible, and of course this applies even more forcibly to the older athletes, where the tissues have become less elastic than they were. The warm-up procedure helps in several other ways too, both physically, in diverting the blood flow from non-essential areas to working muscles and mentally, in focussing the mind on the job to be done. Very often, particularly in winter, one goes out with reluctance, not feeling like training hard, but after ten minutes of easy running to warm up one feels more enthusiastic.

We would recommend at least fifteen minutes and up to thirty minutes warm-up before hard training starts. In training for ball games this can often be done with a ball, carrying out various skill routines, but in all cases it should start with five to ten minutes of gentle movement, gradually increasing in pace, followed by five to ten minutes of stretching, still in warm clothing. After that one moves to fast strides and eventually to short sprints, then stays warm and loose until the start. A sprinter might well take forty-five minutes to warm up for a ten-second burst of energy. During the cool-down period,which should last for ten to fifteen minutes after a competition or a hard training session, the body tempera-ture returns to normal and the fatigue products are flushed out of the muscles, which reduces the chances of stiffness the next day. This is also the right time to do your stretching exercises (see Appendix 1.)

Check the course beforehand

In cross-country and road running there may be unexpected traps for the unwary – potholes in the road, sudden ups or downs, all of which could cause trouble if you are not prepared for them, and of course this is closely linked to the next rule:

Wear the right shoes

Wearing shoes which are too light and flimsy or which are unevenly worn are two very common causes of injury. If you turn up expecting a soft course and find that it is frozen hard you could be in a lot of trouble. Bruce once arrived for a so-called cross-country race in Madrid to find that it was 90% road; luckily he had brought his road racing shoes, but his England colleague, who had only spikes, had to run the race in dance shoes strapped on with pink ribbon! At a higher level, Liz McColgan threw away her chance of winning the World cross-country title in Boston in 1992, because she had not checked out the length of spikes necessary on the snow-covered course. Perhaps the commonest cause of all injuries is training too much on hard surfaces. In the spring of 2001, when the foot and mouth epidemic closed the fields and footpaths, there were far more people suffering from Achilles tendon problems, through running entirely on the road. Running fast on roads and tartan tracks causes a lot of impact shock. It is vital that you have trainers which will protect you – and we also recommend getting off the road onto a softer surface at least one day in three.

Shower and change after training

This reduces the likelihood of stiffening up and your chances of catching a cold.

Aim for comfort when travelling

The first thing is to give yourself adequate time to get to your race venue (which means knowing exactly where it is). Sitting in a cramped position for hours before a race is not a good thing. Aim to get up and walk around once an hour. If possible, give yourself space to stretch out. For journeys lasting several hours, take water with you and a bit of fruit and chocolate to keep up your energy levels. If you are running a marathon, make sure that you have got someone to drive you home afterwards.

Stay away from infections

This is particularly important immediately after a race or a very hard training session, when you are feeling tired and run-down.

Be fussy about hygiene

Again, this matters most when you are training really hard. Things like washing hands regularly, cleaning pans, plates and cutlery thoroughly and not eating stale food are all a part of taking good care of yourself.

Maintain all-round muscular development

Injuries to joints often happen because the muscles around the joint are not strong enough to keep the joint firm when stress is placed on it. The older we get, the more our muscle strength declines (about 0.5% per year) and the more necesaary it becomes to do regular strengthening exercises (see Appendix 2.)

Have at least one non-running day in the week

Running injuries are often repetitive strain injuries, so if you avoid running one day it gives your body almost 48 hours of recovery. If you have to take exer-cise, make it something quite different – cycling, yoga, swimming, weight training.

Monitor yourself

Another important adage is: ‘if in doubt, ease off’. If you are feeling tired in training day after day for a whole week, if you feel dizzy or feverish, or if your resting pulse rate is ten beats or more above normal, don’t go out running that day. Listen to your body and do not allow your dedication to regular running to over-ride commonsense.

How to stay fit when injured

An injured sportsman is like a sick gorilla – no use and a lot of trouble. The coach has to deal with the mind as well as the body in maintaining the athlete’s equilib-rium. We heard a story about one our leading middle-distance runners who went out to a training camp and injured himself on the first day. ‘Right,’ he said, ‘I’m on my holidays now’, and off he went to the pool hall for the next week. This approach scores high marks for relaxation but very few for intelligence. The first thing to do, obviously, is to get treatment, but the very next thing is to redesign the programme and start on rehabilitation. A few days away from the regular training routine can have a beneficial effect, particularly if the athlete has been training very hard. The injury may force him to take the rest which the body needs and he will be much better for it.

However, total inactivity is a bad thing, particularly since most sports-men are accustomed to an organised programme and may lose their sense of direction if deprived of it.

The first step is to decide which movements the injury will and will not allow. If we take for an example a lower leg injury to a runner – shin splints or a stress fracture – then running itself is ruled out as an exercise and so are sports which involve running on hard surfaces. However, it should be possible to construct a programme which will train most of the attributes of a runner, so that he can go straight back to running when the injury has cleared up. It may even be possible to improve his capabilities in some respects – those things which he has not had time for. The things which make him a good runner are:

There are several good ways of maintaining cardiovascular fitness, so you should choose the ones which put no strain on the injury. Gym work is probably the safest thing, using static bicycles, rowing machines or Nordic ski machines. Mountain biking is excellent if the injury allows it. If you can only do non-weight-bearing exercises then you have to turn to swimming. The most effective way of staying fit in the pool is by wearing a ‘wet-vest’ and doing interval training –alternating minutes of running on the spot with minutes of slow paddling. Whatever method you use, the heart rate monitor is a great help in these situa-tions, because you can push yourself up into the right training zone. If you don’t use a monitor, measure your resting pulse rate every day to reassure yourself that you are not losing fitness.

‘In my view, most runners don’t change their training once they become vets. Those who trained like crazy and without science continue to do so, while the more thoughtful runners continue to use their brains rather than brawn.’

There are several good ways of maintaining cardiovascular fitness, so you should choose the ones which put no strain on the injury. Gym work is probably the safest thing, using static bicycles, rowing machines or Nordic ski machines. Mountain biking is excellent if the injury allows it. If you can only do non-weight-bearing exercises then you have to turn to swimming. The most effective way of staying fit in the pool is by wearing a ‘wet-vest’ and doing interval training – alternating minutes of running on the spot with minutes of slow paddling. Whatever method you use, the heart rate monitor is a great help in these situations, because you can push yourself up into the right training zone. If you don’t use a monitor, measure your resting pulse rate every day to reassure yourself that you are not losing fitness.

For attribute B you need to weigh yourself regularly, to watch the food intake and to burn off enough calories in the various types of exercise to keep your weight down to its normal level.

For attribute C – muscular strength – weight training using fixed resistance, as in the Multigym, Schnell or Nautilus systems, is the best thing, but the other activities will all help. The attraction of weight training is that it is measurable and the athlete can work to a schedule and see that he is actu-ally improving both his strength and his endurance in the exercises he is allowed to do.

Attribute D may present problems, as you will be unable to use exactly the same action in training as you would in running. Cycling on a cycle ergometer is probably the best thing here, as it works the leg muscles hard. Using these machines you can increase the resistance and follow a definite programme, so that you can see that you are making progress.

General Endurance, attribute E, allows plenty of variety, but we would choose walking as the best activity, wearing boots and walking on soft ground to prevent any shock to the injury. The advantage of a prolonged low-intensity exer-cise is that it is therapeutic, it allows the athlete time to think, it calms him down and gives him the assurance that he is doing something positive.

F is for Flexibility, something in which many athletes are lacking. The important thing here is continuity. A series of exercises, depending on the injury, should be planned to last fifteen to twenty minutes a day, generally after some other type of exercise to get the muscles warm. It should be possible for the athlete to be more flexible at the end of the rehab course than he was before the injury. A typical weekly programme might take the following form:

The last attribute, of course, is the very one which makes it possible for him to work on such a programme, even though he may not be able to train at his usual sport. A few years ago we got to know Dieter Baumann, the Olympic 5000metres champion in Barcelona. He suffered an ankle injury at the beginning of the 1993 season and was unable to do any serious training. He kept up a programme of cycling, swimming and gym work right through the summer and kept his fitness so that he was able to get back to off-road and off-track running in the 1993/94 winter. Whereas a lesser athlete might have been discouraged by being unable to race, the strength of character which enabled him to win the Olympic title in 1992 put him back on the track in 1994, fit enough to win the Europa Cup 5000m in his first major race. As with other forms of training, the way to make a long rehabilitation period tolerable is to periodise it, spending, say, six weeks on weight and ergometer training, moving on as mobility improves, to pool and bicycle training, and setting specific targets for these, over a period of three or four weeks. Specific flexibility exercises, as recommended by the doctor and the physio, will be part of the programme almost every day. Walking should be started as soon as it is safe, and this can move onto slow jogging on soft surfaces, then running slowly up a gentle slope.

‘Savour it rather than suffer it, that’s my attitude. What a privilege it is to be up and running.’

However thorough the rehab. training has been, it will take time to get back to your best performance level, because you cannot duplicate the hardest running sessions. Once you are back to normal training, allow at least a week of training for every week that you have been rehabilitating, before you start to compete.

Whatever the injury, athlete and coach should never give up. The training of the will which comes from overcoming adversity will make the athlete much stronger in the competitive situation.

The older you get, the more likely you are to get injured and so the more careful you have to be in coming back into competition. There may well come a time when it is best not to compete, in the sense of pushing yourself to the limit, but to run at the pace which suits you, regardless of what others in the race are doing. The Bob Pape story (see below) is a good example. When he was in his forties and fifties he was running thirty races or more per year. The year he was sixty he ran 13 races, at seventy only two – but at seventy-seven he is still running.

BOB PAPE

Age: 77

Occupation: retired Naval officer

Bruce: ‘When I was a young man doing National Service in Hong Kong, I won the colony 5000m title. I thought I was quite good until Bob Pape, the Navy runner, came on the scene. In the heat of Hong Kong he ran a world best time for thirty miles (2 hr 54 mins), and I realised what hard training could do.’

Bob had his first serious race in 1939, soon after joining the Royal Navy as a boy seaman, and he had his last race sixty years later. In between those times he enjoyed considerable success, chiefly at the longer distances. A turning point in his career came in 1952, when he raced against Jim Peters, then the world record-holder for the marathon. Peters advised him to double his training, and to keep a record of all training and racing. From then on up to the age of forty, he pushed his training up to five thousand miles a year, which brought him several marathon titles and his world best for 30 miles. At the age of 35 he finished 6th in the Boston Marathon in 2 hr 28. At 50 he was still running 60 miles a week, and won the British vets 10000m title. In all this time he was seldom injured, and never out for more than 10 days – something which can probably be put down to his excellent all-round muscle development. Two events which might have been catastrophic for a lesser man – a burst appendix and peritonitis when he was 45 and a brain tumour when he was sixty – were merely temporary interruptions in his running; his fitness enabled him to recover quickly and in both cases he was back running again six weeks later.

‘I always enjoyed running and would train twice or even three times a day when it was possible. I said that I’d retire when I ceased to enjoy it or when I became too stiff to run, but it hasn’t happened, and at 77 I’m still jogging every day.

‘My policy has been to train hard only when I feel like it, and to run relaxed if I’m not feeling so good.’

The benefits of this attitude are shown by the fact that he has had fewer injuries as the years have gone by, rather than more.