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Sports Medicine
Sports Medicine: Last Minute Injury - What To Do?
By Dr. Lee Firestone
September/October 2010
For the Washington Running Report
So, you have been training for the past several months for your upcoming fall race. Maybe it's your first Marine Corps Marathon or Army 10-Miler and things are going according to plan. Suddenly, you have one of those "uh-oh" moments! You experience pain after your long run and wonder, "Are my dreams of running this race over?"
When someone comes to me after this scenario the question I always get is, "Can I still run my race?" The answer depends not only on the severity and type of injury, but it also on how fit you are and how many weeks are left before race day.
Before seeking medical attention, gather as much information about the injury as possible. Where is the pain, how bad is it, is there swelling, is the pain worse at a certain time of the day or at a certain point in my stride? Don't forget about external factors: are your shoes too old, did you run on a banked road today, did you run too many hills, or did you increase your weekly mileage too quickly?
If you develop pain after your run, I recommend icing the area for 10 to 20 minutes a few times a day for up to three days. Avoid warmth. Take an anti-inflammatory, such as Advil. Lightly massage the area. Take the next one to three days off from running. You have more to gain than lose if you do this.
If you feel better after a few days, go out for a 30-minute run at a slow controlled pace. Make sure you do not take an anti-inflammatory before your run---you do not want anything to mask the pain.
Injuries that are more serious may require two or more weeks of rest and rehabilitation. How do you judge this? If by day three the pain does not go away, make an appointment with a doctor, physical therapist, massage therapist, or trainer who understands running injuries.
If you start to feel a little wigged-out because of lost training time and the race date is approaching, try cross training. I recommend an elliptical machine, biking, or a rowing machine. [BJB need to ask Lee if we should add, as long as you do these without pain]
Once you are relatively pain free, you can resume your training. If you return after three to seven days of rest, decrease your scheduled training by 75% for a week and then return to your planned schedule. If you have taken off two to three weeks, go back to training at 50% of your plan for a week and then 75% the next week before resuming normal training. If you resume training when you would have been entering your taper I would taper as planned.
Here are 3 of the more common running injuries I see in the office:
* Plantar fasciitis is pain on the bottom of the heel, which is often worse when first standing after periods of rest. It is treated differently depending on your arch type and other mechanical factors. I recommend replacing your shoes if you have logged more than 300 to 500 miles. Stretch your calf muscles, not your arch. Pick up an over the counter orthotic from your local running store (drug store orthotics do not count). While you are there, have them take a look at your shoes and pick up a Strassburg sock. These socks will stretch the plantar fascia while you sleep.
* Stress fractures are hairline breaks of a bone that develop from repetitive pounding on that bone. The three most common areas are the second metatarsal bone (just behind the second toe), calcaneous (heel bone), and tibia (shin bone). You will experience swelling and feel pain on impact. Unfortunately, these do not show up on an X-ray for two to three weeks. Ask your doctor for a bone scan or an MRI for a faster diagnosis. If this is indeed the diagnosis, plan on taking three months off from running.
* Shin splints will cause pain along the front of the shin bone. Shin splints are overuse injuries of the muscles in the front of your leg. An over the counter or custom molded orthotic often does the trick. In addition, perform a good stretch of your opposing calf muscles and avoid hills for a few weeks.
For most readers, your fall race is three to five weeks away. You have already put in a few of your recommended long runs and should be able to rehab your injury or begin an early taper and do just fine. As a runner myself, I know that late season injuries can be frustrating, but if you respect, understand, and address them immediately, it should allow you to complete your race goal.
Dr. Lee Firestone, DPM, has a practice in Chevy Chase, MD and Washington, DC. He is a Fellow of the American Academy of Podiatric Sports Medicine and an active member of the Montgomery County Road Runners Club. For more information: www.dcfootandankle.com or 202-223-4616 or 301-913-5225.