Note: As with all medical issues, ask a doctor who wants you to continue running.
Trail running increases the risk of foot and ankle injuries. By shortening your stride and walking through areas of rough terrain, you will reduce the risks. The reality is that most trail runners experience some irritation during a season. Here are the more common injuries that my runners deal with and their solutions.
For all injuries:
1. Take three to five days off from running.
2. Avoid any activity that could worsen the injury.
3. As you return to running, stay below the threshold of further irritation with much more liberal walking.
4. Don’t stretch unless you have iliotibial-band injury. Stretching interferes with the healing of most injuries that I’ve worked with.
5. As you start to run again, use short segments of running or more walking.
6. For the first two to three weeks after returning to running, avoid rough terrain.
Muscle injuries:
1. Ask your doctor if you can take prescription strength anti-inflammatory medication. Always follow your doctor’s advice about medication.
2. See a sports massage therapist who has worked successfully on many runners.
Tendon and foot injuries:
1. Rub a chunk of ice directly on the area for 15 minutes every night (keep rubbing until the area gets numb).
Note: Ice bags, or gel ice don’t seem to do any good at all.
2. Foot injuries sometimes are helped by an air cast at first to let the foot or leg to be stabilized so that the healing can begin.
1. Ask your doctor if you can take prescription strength anti-inflammatory medication.
2. See if you can do a little gentle walking; sometimes this helps.
3. Sometimes the knee straps can relieve pain; ask your doctor.
4. Get a shoe-check to see if you are in the right shoe (if you overpronate, a motion control shoe may help).
5. If you over pronate, an orthotic may help.
6. If you have internal knee pain, glucosamine supplement, may help.
7. Take more frequent walk breaks.
With most running injuries, you can continue to run even while the injury is healing. Always check with a doctor to be sure. First, you must have some time off to get the healing started. If you do this at the beginning of an injury, you may only need two to five days off. The longer you try to push through the problem, the more damage you produce and the longer it will take to heal. Stay in touch with the doctor at any stage of this healing-running process, follow your doctor’s advice, and use your best judgment.
To allow for healing once you have returned to running, stay below the threshold of further irritation. In other words, if the injury feels a little irritated when running at 2.5 miles and starts hurting a little at 3 miles, you should run no more than 2 miles. And if your healthy run-walk ratio is 3 minutes run/1 minute walk, you should drop back to 1:1 or 30 seconds/30 seconds.
Always allow a rest day between running days. With most injuries you can cross train to maintain conditioning, but make sure that your injury will allow this. Again, your doctor can advise.
Before doing any of these talk to your doctor. Most are fine for most injuries. But some increase the risk of irritating the injured area and delaying the healing process. For more information on this, see Running Injuries: Treatment and Prevention (Hannaford/Galloway). Gradually build up the cross-training, because you have to condition those muscles gradually as you train the running muscles. Even walking is a great way to maintain conditioning if the injury and the doctor will allow it.
1. Run in water to help improve your running form.
2. Use Nordic Track machines.
3. Walk.
4. Use rowing machines.
5. Use elliptical machines.
Knee pain
Most knee problems will go away if you stop running immediately (don’t run the last mile) and take five days off. Ask your doctor if you can use anti-inflammatory medication. Try to figure out what caused the knee problem. Make sure that your running courses don’t have a slant or canter. Look at the most worn pair of shoes you have—even walking shoes. If there is wear on the inside of the forefoot, you probably over-pronate. If you have repeat issues with knee pain, you may need a foot support or orthotic. If there is pain under the kneecap, or arthritis, the glucosamine and chondroitin products have helped. The best I’ve found in this category is the Joint Maintenance supplement by Cooper Complete.
Outside of the knee pain—Iliotibial band syndrome
This band of fascia acts as a tendon, going down the outside of the leg from the hip to just below the knee. The pain is most commonly noticed on the outside of the knee but can occur anywhere along the IT band. I believe this to be a “wobble injury.” When the running muscles get tired, they don’t keep you on a straight running track. The IT band tries to restrain the wobbling motion, but it cannot and gets overused. Most of the feedback I receive from runners and doctors is that once the healing has started (usually a few days off from running), most runners will heal as fast when you run on it as from a complete stop. In this case, however it is crucial to get your doctor’s okay to run and then stay below the threshold of further irritation.
Treatment for Iliotibial Band Syndrome:
• Stretching: Stretching the IT band releases the tightness that causes the pain. With this injury you can stretch it at the first sign that it is getting tighter during a run.
• Self-massage using a foam roller: This device has helped thousands of runners get over IT band syndrome. On www.RunInjuryFree.com is a picture of someone using a foam roller. Put the roller on the floor, lie on it using bodyweight to press and roll the area that is sore. Rolling before a run will help it warm up, and rolling afterward often helps the injury recover faster. To speed up healing, roll it for five minutes before bed.
• Massage therapy: An experienced and accomplished massage therapist can tell whether massage will help and where to massage. The two areas for possible attention are the connecting points of the connective tissue that is tight and the fascia band itself in several places. The stick is a self-massage roller device that has also helped many runners recover from IT band syndrome as they run. As with the foam roller, it helps to warm up the area before a run and to roll it out afterward.
• Walking is generally fine: Usually you can find a run-walk ratio that works. Maintain a short stride.
• Ice massage: Directly massage the pain air, completing 15 minutes of continuous rubbing every night.
Shin pain: Shin splints or stress fractures
Almost always, pain in the shin indicates a minor irritation called shin splints that allows running and walking as you heal. With normal shin splints, the greatest pain or irritation during injury is during the first mile of a run. Usually the pain gradually goes away as you run and walk. It takes a while to fully heal, so you must have patience.
Inside pain: posterior shin splints. Irritation of the inside of the leg, coming up from the ankle, is called posterior tibial shin splints and is often due to overpronation of the foot (foot rolls in at push-off).
Front of shin: anterior shin splints. When the pain is in the muscle on the front of the lower leg, it is called anterior tibial shin splints. This is very often due to having too long a stride when running and especially when walking. Downhill terrain should be avoided as much as possible during the healing process.
Stress fracture: If the pain is in a very specific place and increases as you run, you could have a more serious problem—a stress fracture. This is unusual for beginning runners but characteristic of those who do too much, too soon. It can also indicate low bone density. If you even suspect a stress fracture, do not run or do anything stressful on the leg and see a doctor. Stress fractures take weeks of no running and walking, usually wearing a cast. They may also indicate a calcium deficiency.
Heel pain: Plantar fasciitis
The most effective treatment is putting your foot in a supportive shoe before your first step in the morning.
This very common injury (pain on the inside or center of the heel) is felt when you first walk on the foot in the morning. As you get warmed up, it gradually goes away, only to return the next morning. The most important treatment is to put your foot in a supportive shoe before you step out of bed. Be sure to get a shoe check at a technical running store to make sure that you have the right shoe for your foot. If the pain continues during the day, you should consult with a podiatrist. Usually the doctor will construct a foot support that will surround your arch and heel. This does not always need to be a hard orthotic and is usually a softer one designed for your foot with support in the right places.
The Toe Squincher exercise can help develop foot strength that will also support the foot. It takes several weeks for this to take effect. This is another injury that usually allows for running as you heal, but stay in touch with your doctor. Be sure to avoid fast running and uneven terrain.
Back of the foot: Achilles tendon
The Achilles tendon is the narrow band of tendon rising up from the heel and connecting to the calf muscle. It is part of a very efficient mechanical system, which performs like a strong rubber band to leverage a lot of work out of the foot with little effort from the calf muscle. It is usually injured due to excessive stretching, either through running or through stretching exercises. First, avoid any activity that stretches the tendon in any way. It helps to add a small heel lift to all shoes, which reduces the range of motion. Every night, rub a chunk of ice directly on the tendon. Keep rubbing for about 15 minutes, until the tendon gets numb. Bags of ice or frozen gels don’t do any good at all, in my opinion. Usually after three to five days off from running, the icing takes hold and the tendon feels stronger each day. Anti-inflammatory medication very rarely helps with the Achilles tendon irritation, in my experience.
Hip and groin pain
There are a variety of elements that could be worsened in the hip area. Since the hips are not designed to move you down the road, they are usually abused when you continue to push on and when the calf muscle is too tired to keep you going at top capacity. Ask your doctor about prescription strength anti-inflammatory medication, as this can sometimes speed up recovery. Avoid stretching and any activity that irritates the area.
Calf muscle
The calf is the most important muscle for running. It is often irritated by speedwork and can be pushed into injury by stretching, running too fast when tired, too many speed sessions without adequate rest between, and sprinting at the end of races or workouts.
Deep tissue massage has been the best treatment for most calf muscle problems. Try to find a very experienced massage therapist who has helped lots of runners with calf problems. This can be painful but may be the only way to remove some bio-damage in the muscle. The stick roller can be very beneficial in manipulating tissue out of the area of damage and promoting blood flow (see our website for more information on this product).
Don’t stretch! Stretching will tear the muscle fibers that are trying to heal. Avoid running hills and take very frequent walk breaks as you return to running. A slight heel lift (felt) can take pressure off the Achilles to reduce aggravation. As the pain goes away, remove the heel pad.
