The balance between continuing to train through a problem and in turn making it worse versus stopping every time you feel anything and therefore never training is an essential balancing act to strike.
Different structures present with different sensations and patterns of pain. For example, mild tendon pain can ease with activity and then will return afterwards, whereas a muscular or more structural injury will usually progressively get worse. Calf and ankle pain can be worse when running up hill and knee discomfort when downhill. Sometimes significant swelling is experienced and other times very little. Therefore it is hard to give definitely advice on when to stop running, however our suggestion would be…
If you have consistent discomfort that is localised and you can point to it with one finger, or experience any pain that gets worse with activity, we recommend not running through this; if you listen to the whispers you will never hear the screams.
Should I stretch my injury?
There are very few injuries that respond well to a static stretch. If there is a small tear in a muscle or tendon then stretching can exacerbate the injury. Many irritations and discomforts induce a protective mechanism where the muscle does not fully relax in order to protect that area. This can feel tight and restrictive although holding a static stretch will only increase this protective mechanism and increase the tightness. Even a mild cramp is usually due to fatigue, dehydration or electrolyte imbalances which cannot be totally released by stretching. We see lots of people that stretch and foam roll a painful area to try to assist and actually this can be detrimental to some injuries.
So what is recommended for the initial approach to a soft tissue injury?
We recommend the F.A.S.T. I.C.E. approach.
F – Feel the injury
This initially sounds obvious and some injuries are impossible to ignore, for example the sprained ankle in a rabbit hole or sudden muscle strain. However, feeling and accepting the more subtle injuries is essential as the early recognition of these problems can stop them deteriorating. Time and time again we see instances where runners have tried to initially run through problems or have rested for a period of time and then tried running again without addressing what is causing the discomfort.
A – Analyse
To help with understanding the injury it is important to analyse and ask questions around it. We suggest making notes or documenting how the injury occurred. Consider questions such as ‘was there a reason why it happened’? ‘Was there a change in training load, terrain or footwear’? ‘Which positions, movements or activities irritate and which help ease or alleviate the symptoms’? ‘Are there patterns of discomfort throughout the day’? Analysing an injury is important to gain an understanding which will help to avoid unknowingly irritating the problem and to decipher whether there is any change or improvement in symptoms. This will also assist your therapist with creating a diagnosis and offering accurate advice regarding rehabilitation and suitable training.
ST – Suitable Training
Once the injury has been analysed there will be an understanding of what the area can tolerate without irritating and what it cannot. This is important as there are very few injuries that respond best to total rest. It is important to keep mobile and active beneath the threshold of what training aggravates the injury. This can help to relax any guarding and is also a perfect opportunity to focus on other areas of the body to ensure you return from injury in a better condition than before. There is usually a way of maintaining your cardiovascular fitness during this period without irritating the injury using alternative training options.
We recommend seeking advice from a suitably qualified therapist to help this process for progressive rehabilitation of the area too.
Ice
If the injury is hot to touch or pain is experienced, ice can be effective at reducing these symptoms during the inflammatory phase (0-72 hours post injury). The research suggests icing the area for up to 10 minutes, a maximum of every 2-3 hours that you are awake. This can be in the form of frozen peas wrapped in a towel or a bag of ice. If you have access to specialised equipment, a Game Ready device can also be used. Do not apply ice directly to the skin as this may result in an ice burn.
Compression
Compression can be effective at reducing swelling and improving recovery. This can be in the form of a simple Tubigrip (elastic bandage) or using compression garments such as a NormaTec. It is important that the compression is not too tight and we recommend removing the compression at night.
Elevation
Try to keep the injury above the level of the heart to help reduce swelling in this initial inflammatory phase. Our recommended approach would be to place some books or pillows underneath one end of your mattress for a lower limb injury to help elevate whilst you sleep.
This is our recommended approach for soft tissue injuries. The management for bony / neural issues are different. Please always seek advice from your doctor or suitably qualified therapist to determine if this is the correct approach or whether imagery or further investigation is required.