RUNNING – Great advice from our Osteopath Will Green

In this blog I look at some of the factors I focus on in helping someone deal with injury and return to activities – how life factors and goals can influence decisions, when it is appropriate to stop running (something every runner hates to hear) and when we can continue, and how we judge how much running we should be doing. 

I will write about the role of rehabilitation exercises, managing aerobic conditioning, progression and getting race ready in a further blog.

1. What else is going on in your life? What are your goals?

• In thinking about your injury, remember you cannot separate the injury from the injured, so to speak.    Your other life factors (work, family, friends, stress, nutrition, sleep, mood) are important factors that in varying degrees can influence why you got injured, and how you will recover.  

• Injury can at times be a depressing event – be kind to yourself.  Exercise is a hugely important part of our wellbeing and the impact of not being able to do it is something I readily associate with.   Talk about it, discuss what you are worried about and try and address any fears or concerns you have.

• Think about your goals – ultimately, these form the framework for the decisions to take about how you will manage your rehabilitation process.   There are, as ever, a lot of uncertainties, but if you have a goal race in a couple of weeks, it will likely involve some different conversations and plans to a race that is 6 months away or a race where your goal is more focussed on completing the distance.   There is a risk/reward balance here that cannot be ignored.

• Should I stop running? Can I start running?

• The key consideration that should be guiding your decision here is whether the need to ‘heal’ or they ‘irritable’?  

• If the answer is tissues need time to heal (think in varying degrees of seriousness examples including a stress fracture to a recently torn calf muscle), at this point unfortunately, it is time to stop – the risk of re-injury and potential for more serious injury means continued running at that point is not going to be helpful. 

• Judging ‘healing’ times can be difficult (and individual) and there is very little good research/guidance on what constitutes ‘readiness’ to run here but if you err slightly on the side of caution and ‘go small’ on the return to running your risk of re-injury is greatly minimised.   It sounds slightly obvious, but as a simple example I have seen any number of calf issues (a lot of them my own)  be ‘tested’ by running distances that were in hindsight simply too much for the current state of the tissues with less than positive results.

• If the tissues are irritable (think ‘runner’s knee’, ITB syndrome, early tendon issues) then there is often scope to continue running, within a framework of reduced load focussed on reducing the irritability and pain levels and performance/functional goals that are acceptable to you.

• As ever, there is a (big!) grey zone – you may discover this when assessing ‘how much can I run’, but there are cases of irritable tissue that need complete rest from running because the capacity to run is so low that it makes sense to stop – you are not necessarily ‘damaging’ tissue here, but you can be making something that is already irritable unbearably so.

• You have allowed time to ‘heal’, or your tissues are not so irritable to stop you completely, so how much running can you do?

• Testing run tolerance can be more of an art than a science. There is no magic tool or test to assess your capacity to run and there is always an element of ‘testing the water’– experienced advice can really help here.  

• Key to me is how does it react to the running you are doing – small increases in discomfort (think 1 or 2 out of 10), with pain levels no more than say 3 out of 10, which calm down to original levels promptly once activity has stopped, and are no worse within 24 hours are generally ok.

• I like to try and focus on the medium-term trajectory – it is sometimes hard to decipher progress and changes in irritability across time periods.  It needs a bit of personal reflection too – if a few weeks into your rehab, your levels of irritation are creeping up, perhaps it is time to consider that you need to unload further.  

• Remember a goal of the rehab is to be getting better – it perhaps again sounds obvious but it is not uncommon to fall into a grey zone of neither getting better or worse which over time leads to an inevitable deconditioning (as you are running at less than full capacity) and prolongs the return to full training.  Again, hitting a plateau at the very least is a reason to consider how much running you are doing.

• Think about where you want to be in 6 or 8 weeks-time.  It can sometimes be worthwhile considering that the running you are doing in 8 weeks-time is likely going to be more important and more relevant to your overall return to performance than what you are doing now.  So, if you have to run slightly shorter now to manage some irritability, that can be hugely beneficial.

• Start small.  My advice to even the most experienced runners if they have had a chunk of time out of running is start a lot smaller than you think.   This can be difficult, especially for more seasoned runners, but ticking off the first 5 x 2minute easy, and getting the first run successfully under the belt can be hugely beneficial

More next time – any questions, give me a shout.  Will

• The role of rehabilitation exercises and maintaining fitness

• Keep in mind that sleep, nutrition and other stressors are hugely important in helping rehabilitation so should be considered part of your programme
• My personal approach is to look at exercises that address both local tissue sensitivity/repair, as well as global or comprehensive capacity. 
• Although the evidence is actually quite poor in terms of why certain exercises help in certain circumstances, what we do know is that overall, improving ‘global capacity’ seems the best way to help manage a large number of lower limb exercises (so for example, there are probably more similarities than differences in rehab programmes designed generally for hamstring tears or knee pain) putting aside sport specific differences that become relevant later in the programme.   Local (i.e. more tissue specific exercises) play a role in promoting healing and reducing irritability when you load correctly.
• You will likely hear the phrase ‘graded exposure’, ‘progression’ ‘rehab stages/steps’ quite often in terms of managing the exercises and return to running. 
• How can I maintain fitness?