Athletes and injuries seem to go together like summer and sunshine. Our member survey says that 90% of American Running Members missed a workout sometime because of injury. Some injuries are traumatic events, such as a pulled hamstring, while others are due to biomechanical problems, such as over-pronation leading to knee pain. But overuse accounts for the majority of runners' pains: runners doing too much, too fast, with too little recovery. There are many ways you can avoid injury, or take quick action to counter a minor problem before you turn it into a chronic injury.

Train Smart
Conventional wisdom says limit increases in training to 10% or less a week, and avoid increasing duration and pace at the same time. But runners vary widely in their powers of adaptation, and this may be too much for some people. American Running Editorial Board Member Jack Daniels, Ph.D., advises runners to take two or three weeks between increases in training, to allow for complete recovery from your last increase in effort. Pay attention to how you feel. If you feel completely recovered and ready to roll after a week's recovery, that's fine. But if there is the slightest doubt that every part of your body has recovered, take some more easy time.

"Active rest is better than inactivity, because exercise promotes healing," says American Running Editorial Board Member Paul Kiel, M.D., from where. "If slow running is painless, but picking up the pace makes you sore, then stick to the slow stuff until you feel better."

If running hurts, you can swim...or bike...or row. Or possibly a number of other activities. Cross training helps you keep fit while you work out of an injury. But equally as important, cross training helps you achieve total body fitness so that all your muscles are worked and ready to go. By only working one set of muscles, or doing only one sport, you could develop muscle imbalances and flexibility problems that lead to injuries. In fact, one of the few training programs that have been shown to reduce running injuries is cross training with weights.

Increase in training and performance is not an ever increasing process. Every human body has a breakdown point: no exceptions. This means if you try to increase your training for long periods, your risk of injury increases greatly. A useful guideline is to limit increases to 12 weeks. Again, runners vary, and some may do better to try to improve for only eight weeks, or maybe even six. Keep a training log, and pay attention to what you're doing. When things are going well, don't be tempted to push farther than you planned. Experienced runners who stay out of trouble have learned that the trick is to back off BEFORE you become injured, not wait until there are signs of trouble. You need hard days and easy days, hard weeks and easy weeks, and hard periods followed by easy periods. The changes in your body that lead to improved performance occur during periods of recovery, not during periods of stress.

How do you tune in to what your body is telling you? By concentrating on how you feel for your level of effort, and making sure that everything feels normal. Check how your feet and leg muscles feel, how your ankles, knees and hips feel. Check how your breathing and heart beats feel. Is there normal sensations in your neck, shoulders and arms? You don't have to do this all the time, but make a habit of doing a self-check every 10 or 15 minutes. Any sensation that doesn't feel the same as usual, such as a slight tightness in your shin, may be an early warning of overuse. How do you feel after your workout? Any stiffness or soreness that doesn't go away in your usual day or two, and during your next warm-up is an early warning signal. "If exercise causes pain which doesn't go away during a warm-up, take a rest," says American Running Editorial Board Member Marvin Bloom, M.D., from where?

Respond to Your Symptoms
If you have pain after a workout, use ice massage or a cold pack. Apply cold treatment for 10 minutes every two to four hours to relieve pain, and reduce inflammation and swelling, if present. If you use a cold pack or wrap, make sure it is not too tight. Too much pressure from cold wraps can cause nerve damage; this usually goes away in a few hours, but in some cases can persist for weeks or months. Loosen your wraps every few minutes to check for numbness or tingling, not only at the point of application, but places farther away. An ice wrap on your knee can cause pressure on a nerve that will give symptoms in your foot.

If you didn't have pain after a workout, you may have discomfort when you wake up next morning. This is another signal of overuse. This kind of pain is often associated with tendons and ligaments, and it may go away when you've been up and around for a while. If it doesn't interfere with your next workout, it's okay to continue, but take it easy until you wake pain free.

In addition to cold treatment for pain after a workout, try to keep the injured area as high as possible for the next 48 hours. "This assist circulation by encouraging blood flow back to your heart," explains Clinic Advisor Robert Erickson, M.D., from where?

After 48 hours of ice treatments, if inflammation has dispersed you may benefit now from heat treatment to speed healing. Heat before working out tunes up tissue metabolism and repair processes. Heating pads, moist hot packs, and hot baths all work. Whirlpools are a source of moist heat and feel good, too. You may not have the luxury of a whirlpool tub, but you can buy small portable units that work well for feet, and ankles. After a workout you can apply cold treatment to prevent recurrence of inflammation.

Massage reduces muscle tension, helps relieve swelling and prevents soreness. And, it feels good. You can reach most injured areas to massage yourself. Use finger or thumb pressure or the heel of your hand. Use petroleum jelly, liquid paraffin, topical cream, or perfumed massage oil to reduce friction and prevent skin irritation during massage. Make your massage strokes move along the length of muscles and tendons toward your heart. Also, try cross-friction massage in the perpendicular direction. Another way to break up knots and adhesions formed as a result of inflammation is to knead in small circles with your thumbs. You may also want to consider a Swedish massage unit, which straps to the back of your hand and vibrates so that you can deliver pulsing finger pressure to sore areas.

Get Help If You Need It
Ultrasound massage, with or without anti-inflammatory cream, is effective for deeper injuries because ultrasound penetrates skin to reach underlying tissues. This treatment improves blood circulation, carry away waste products from injured areas, and research suggests it can promote collagen synthesis to repair injuries. You may see catalog and magazine advertisements for units that promise ultrasound, but it's wiser to see a health care provider for treatment. You need training and experience to use ultrasound effectively and safely, because the units have variable intensity. Misuse can cause burns.

Another useful technique used by health care providers is transcutaneous electrical nerve stimulation (known as TENS). When you move a part of your body, it is responding to signals sent by your brain to the nerve cells that control that body part. When you are injured the nerve cells in that area may cause pain, become sluggish, and slower to promote healing. They can be tuned up by TENS, to relieve pain and make nerve cells respond better.

Cold is an anti-inflammatory and pain reliever and so are many drugs. Aspirin, ibuprofen, and naproxen are effective non- prescription drugs, when used according to directions. But remember, they reduce inflammation (inflammation is the body's answer to injury--the clean-up and repair process) but do not speed up healing. In fact, some health care providers believe they slow healing. Since anti-inflammatory medication relieves pain, they allow you to work out without pain while your tissues are still damaged. It is a good rule that you should not take medication in order to complete workouts. Take anti-inflammatory after workouts, not before.

There are also topical products that can help relieve mild discomfort. Some contain counter-irritants, such as menthol, to stimulate nerve endings (makes them tingle) and blood flow. Others contain an anti-inflammatory ingredient, usually related to aspirin (look for the word "salicylate"). Used according to instructions they can relieve symptoms, but there's no convincing evidence they speed healing.

It is always better to prevent an injury than to have to deal with it. Train smart. Don't ignore your symptoms. And don't delay in getting professional help if you need it.

Stay Positive
When threat of an injury interferes with your normal workout program, there's a tendency to worry about losing endurance or speed, and you get impatient to get back to normal. But as you have seen, there are plenty of things you can do for yourself to help speed recovery from minor setbacks and prevent them from developing into chronic problems.

A positive attitude and the conviction that you can control a threatening problem go a long way toward making it happen. Your immune system fights injuries with a complex army of nutrients and special cells. These hustle to an injured area to kick out damaged cells and help build up new, healthy ones. But your immune system doesn't work alone.

"Your mind also has a voice in what goes on," says Fred Surgent, Ed.D., coordinator of the exercise physiology laboratory at Frostburg State University in Maryland. There is a communication network between your brain and your immune system, "Like telephone lines between a general and his field commanders," says Surgent. Feelings, attitudes and beliefs are organized in your brain and communicated to your immune system by chemical messengers. These can have either a positive or negative effect.

If you do everything you can to promote healing, you can speed the process by having a positive attitude, and avoid fretting that your training is being disturbed.

Volume 16, Number 4, Running & FitNews
(c) The American Running Association.

The American Running Association is a non-profit, educational association of runners, medical professionals and corporations dedicated to promoting running nationwide. For over 30 years, The American Running Association and its sister organization, The American Medical Athletic Association, have been influential clearinghouses, providing information and support to runners nationwide. All proceeds support the association's mission. To learn more about the benefits and resources of the American Running Association, click here.