For minor niggles that you can treat yourself, remember the golden rule: RICE – Rest, Ice, Compression and Elevation.
For anything that lasts more than a day or two, or which causes severe discomfort, pins and needles, paralysis, sharp localised pain, or discolouration, seek medical help as quickly as possible.
A general guideline is that if you have aches and niggles that don’t hamper your running performance, you can probably go on running. But if you have discomfort which you would describe as pain, or if your running is affected, then you probably need to ease back or stop running.
Ice any inflammation early and often. It increases blood flow to the injured area, reducing swelling and dramatically speeding healing. The first time you try it, you will be surprised at how effective this is at accelerating the healing of minor knocks.
(As I was writing this chapter, I hit my leg against a rubbish bin while out running, and a got a nasty bruise on my lower leg which made it difficult to walk. With rapid and repeated icing, the bruise had gone by the next day.)
To ice an injury, use a bag of ice cubes or a bag of frozen peas, wrapped in a damp tea towel to avoid ice-burn, for 15 minutes. (You should not ice for longer than this, or your body will begin to cut off the blood supply to the iced area, which is the opposite of what you want.) You should ice an injury as quickly as you can, and repeat up to once an hour.
For inflamed muscles and joints, you can use a pressure bandage which you can buy in your local chemist. This will help to reduce the swelling and speed recovery.
Finally, you should try to raise the injured part of your body above your heart – for example, by stretching your leg out on the armrest of a couch. At night, try putting a telephone directory under the legs of your bed or under the legs at the foot end of the bed, so that your bed is at a slight slope down towards your head.
Other treatments for minor injuries include:
- anti-inflammatory drugs – such as aspirin, ibuprofen. In the US these are often called non-steroid anti-inflammatory drugs (NSAIDs). They can be useful to reduce inflammation in the short run, which can help to accelerate recovery. They may also help blood flow to repair microscopic muscle damage caused by long runs. But you should not get into the habit of taking anti-inflammatory drugs regularly, since this may simply mask a serious injury. Prolonged use of anti-inflammatory drugs can also contribute to kidney failure.
- ultrasound – this is a high-frequency wave which is applied by a trained professional (e.g. a doctor or physiotherapist). It can help to stimulate blood flow, and break up bruising and clots;
- massage – by a sports masseur or physiotherapist can help to improve blood flow and to realign muscle fibres. This is discussed in more detail below.
The jury is still out on the benefits of stretching. The current wisdom is that static stretching before you train is unlikely to be beneficial, and may even be harmful; but that stretching after you run may improve muscle recovery and reduce muscle soreness.
In addition, as many runners who stretch will attest, maintaining flexibility makes you feel better, improves running performance and reduces the long run risk of injury. Stretching can also contribute to a programme of developing core stability, by correcting imbalances in muscle length which lead to poor biomechanics. So in general, runners should stretch more, though they don’t need to combine stretching in the same workout as running.
A particular problem for runners, because of the repetitive nature of the sport, is hamstrings and calf muscles that are too short and need stretching. These problems are reinforced by the fact that many of us spend much of the day sitting down, which leaves these muscles in a short position. This can often result in injury, including hamstring strains and Achilles tendonitis.
How to stretch
Most people prefer to stretch warm muscles, and do some light jogging or cycling to warm up before they stretch. However, there is no evidence that warm muscles can be stretched more easily than cold muscles, nor that warming up before stretching reduces the risk of injury.
The days of bouncing up and down to touch your toes are, mercifully, over. Rapid movements trigger a “stretch reflex” in the muscle being stretched, which causes it to contract. Just as you are trying to lengthen the muscle, it is trying to contract, and you will put undue stress on the muscle. So you are at considerable risk of injury if you try to stretch by bouncing up and down.
Instead, you should gradually stretch out the muscle, and hold the stretch while breathing deeply. After 20 seconds or so, the muscle tension falls, and you should be able to stretch the muscle a little more. Remember to breathe deeply, and push the stretch a little further as you breathe out. Hold the stretch for about 60 seconds in total for each muscle.
Don’t expect immediate results from stretching. The benefits take time to build up. But once you have increased your flexibility, it can be maintained with much reduced levels of stretching.
Key stretches for runners
The most important stretches for runners are the hamstrings, calves, quadriceps, back, hip flexors, groin, and iliotibial band. Get a physiotherapist or a qualified fitness instructor to show you how to do these.
Regular massage reduces injury and improves performance. It does this by stimulating blood flow to muscles that are recovering, helping to expel waste and toxins and bringing fresh nutrients needed to rebuild body tissue. It also has psychological benefits, by increasing the runner’s sense of well-being and relaxation. If you can afford regular massages, they will help your running performance.
Massage can also be used to treat minor muscular injuries, such as muscle tears. A good sports masseur will find the site of the injury and apply cross friction massage – an extremely painful but very effective treatment. (This is one of the very few cases when the old phrase “if it ain’t hurtin’, it ain’t workin’” is actually true).
Physiotherapy, podiatry & orthotics
There is a saying among cynics that “doctors are people you pay to distract you while nature heals your problem.” Many runners think that their physiotherapist is someone they pay a lot for the privilege of being watched while they heal.
If you run regularly you will eventually have some kind of injury or niggle which might warrant the attention of a physiotherapist or podiatrist. What’s the difference? Physiotherapists are dedicated to restoring and maintaining physical function of the body. Podiatrists diagnose and treat disorders, diseases, and injuries of the foot and lower leg.
If you have a running injury, it really is worth seeing a good sports physio. This will reduce the time it takes to recover, through advice and treatment (such as massage and ultrasound). It is true that, if you rest, the symptoms of most injuries will disappear over time of their own accord. But the main point in seeing a physio is to get a diagnosis of the underlying problem that caused the injury in the first place.
The best way to find a good physio is to ask for a recommendation from a fellow runner. In the course of 18 months, I suffered four episodes, of about 3-4 weeks each, during which I couldn’t run due because of pain in my Achilles tendon. On the first three occasions, I tried three different physios, each of whom treated the symptoms, thus enabling me to run again – only for the problem swiftly to recur. And each time, the pain got worse. The fourth time it happened, I was fortunate enough to have a friend who recommended a new physio. This physio refused to treat the symptoms – at least until he had identified and addressed the underlying problem. Since he treated me, I haven’t had any further problems with my ankle.
Rebecca Stubbs, 30. Great Britain age-group triathlete
How to find a physiotherapist
In the UK, you may be able to persuade your doctor to refer you to a physiotherapist: in this case your physio treatment will be paid for by the National Health Service. However, an NHS physio is unlikely to be a specialist in sports injuries. If you have private health insurance, you will need to get a referral by your doctor, and you will need to check that the physio you want to see has been approved by your health insurer. Alternatively, you can pay for your own physio appointments, which costs £30‑£50 for a half hour appointment.
Your local running club or specialist running shop should be able to point you in the direction of a good physiotherapist. You should look for a physio who:
- runs, or is at least physically active; there is little worse than a physio who does not understand your need to get back running as soon as possible;
- looks for the underlying causes of the injury, does not just treat the symptoms and looks at the alignment of your entire body, not just at the site of the symptoms;
- works in tandem with a podiatrist, so that you can get an expert opinion on the mechanics of your foot, and if necessary inserts for your shoes.
Podiatrists (which is the same as a chiropodist) specialise in the treatment of feet and lower limbs. They can help you to identify, cure and (importantly) prevent problems with your lower leg that may result in injuries. A particularly common problem is overpronation of the ankle, which, as we have seen above, can cause a variety of injuries. Overpronation can often be solved by selecting an appropriate model of running shoes; or by using orthotic inserts in your running shoes. Other treatments that a podiatrist might provide include manipulating or massaging the feet or legs, or recommending particular muscle strengthening exercises or stretches.
A good podiatrist will work with a physiotherapist to ensure that a proper diagnosis is made, not only of any shortcomings in your feet, ankles and lower legs, but more generally, so that you identify and tackle contributory factors elsewhere.
Orthotic shoe inserts
Although running shoes can help to limit biomechanical deficiencies, they cannot always do so if the problem is acute, or much more pronounced on one side than the other. One increasingly common solution is the use of orthotic shoe inserts, which are designed to fit inside your shoe and help to control the way the foot moves when it hits the ground. (These are properly called orthoses or orthotic shoe inserts but they are generally known as orthotics.)
Orthotics can bought off the shelf, designed for runners with common symptoms. These are widely available in running shops and chemists, and are quite cheap. Alternatively, orthotics can be purpose-made for the individual runner. These can be quite expensive – about £100 – £200 for a pair – though they last a long time and can be transferred from one pair of shoes to another. To get purpose-made orthotics you need to go to a podiatrist, who will take plaster casts of your feet.
The design of orthotics varies; the most common are arch supports that stabilise the foot and ankle; but there are other inserts for specific conditions, such as heel cups (which go under the heel to relieve plantar fasciitis) and metatarsal cushions (which go just behind the toes to relieve pain in the forefoot).
Chiropractors and osteopaths
Chiropractors and osteopaths manipulate the spine, on the basis that this will affect either muscular-skeletal problems, or that it will address general health problems by affecting the nervous system.
Systematic reviews have not shown any evidence that manipulating the spine is effective, with the possible exception of some kinds of back pain. At best manipulating the spine is the medical equivalent of thumping the side of a malfunctioning television in the hope that it fixes something; at worst it is bogus medicine which is not only ineffective but dangerous.
Chiropractors should not be confused with chiropodists.