PR Pursuit: Managing Overuse Injuries

In our space there’s this vague threshold that’s reached when you become a routine high-mileage runner (think 40-50+ miles per week) and you seem to forget that you are not immune to overuse injuries.  However, reality has a way of slapping and humbling us, particularly as we age as runners, and it routinely occurs in the form of the following:

·       Bone bruises in the feet, particularly the heel

·       Calf strains and Achilles tendonitis

·       Tibial plateau inflammation (pain at or right below the knee)

·       Patellar tendonitis

·       Hamstring strains

·       IT band inflammation

·       Hip joint inflammation or bursitis

·       Ankle sprains

·       Knee sprains

·       Low back pain

Usually, following a brief period of disbelief and denial, we predictably do what? We try to run and train through it, only to make matters worse.  Our commitment, dedication, obsession, and ego – all things that have empowered us to major athletic milestones – become negative sources of self-peer pressure, and in essence, self-sabotage.

I’ll cut to the chase here.  When overuse injuries show up, and that pain moves from a soreness to a sharpness (you all should know exactly what I am talking about), you have to shut it down…for a least a week.  That’s step one – rest.  My recommendation is to start with 3 days, but usually our body needs 7-14 days to recover.  The asterisk that can be added here is to find an alternative form of aerobic exercise to substitute for running in order to give the muscle, tendon, ligament, bone, joint, bursa, etc. a break (no pun intended) while we continue to train.    The modality used here will vary depending on the area that needs to be isolated, but swimming, rowing, and biking are frequently used.

Step two is to ice the inflamed area.  This needs to be done with intention however.  When treating patients for inflammatory conditions, I routinely advise icing the affected area twice daily for at least 20 minutes.  Of note, heat is not a substitute for ice.  Heat warms up the muscles and joints and can even feel better than ice at times, but heat does not get rid of the inflammation.  Ice does.  Use ice, and use it for 7-14 days.

Step three is use of an anti-inflammatory.  I know, I know – many of you don’t like the idea of using medicines.  Neither did I until I turned 42 or 43, and I still am not a personal fan…but NSAIDS (or non-steroidal anti-inflammatory drugs) are an important part of injury recovery and healing.  NSAIDs include things like ibuprofen, naproxen, diclofenac, etc. – think Advil and Aleve.  Acetaminophen or Tylenol is not an anti-inflammatory.  Like heat, acetaminophen does not get rid of the inflammation despite working well for pain.  Use NSAIDs, and use them for 7-14 days…UNLESS you have kidney issues or issues with stomach or other gastrointestinal inflammation and bleeding.  In that case, NSAIDs are a no-go, and you should see a physician for alternative therapies. 

Step four is to simply ease back into activity once you are pain free.  Being pain (that sharp, stabbing kind) free usually dictates the length of your rest period.  Fight the urge to pick up where you left off, and instead gradually increase your activity.  Don’t worry – you did not lose months or even years of endurance conditioning by sitting out for a week or two.  Your body will get back to where it needs and wants to be.  You just have to listen to it and treat it with respect.

PR Pursuit: Tips to Go Farther and Faster

Throughout July, the TCM Motion Experts have shared advice from their areas of expertise focused especially for more experienced runners aiming to go farther or faster with their running.

If you're a new runner looking for information tailored to your situation, check out our Running 101 content from earlier in the year, here.

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Kenneth G Poole, Jr, MD, is an internal medicine physician with a special interest in running. He is one of the team of Motion Experts TCM has gathered to help its subscribers and participants get the most out of their running. Instagram: @renaissance_doc; X: @KPooleMD