Aches, pains & niggles – Should runners rest or run?

Runners are often faced with something of a dilemma if they are suffering a aches, pain or have a niggle and this is whether they can run through it or will that put them at risk of developing a more serious problem. Possibly you are suffering with an injury and you are trying to decide whether to run, rest up and recuperate or even seek professional sports injury advice.

The following guidelines will help you to assess your situation and make a better informed decision regarding your complaint.

Are there any signs of significant injury?

First of all it’s important to eliminate some of the more serious signs and symptoms that may require you to seek medical attention. These are as follows:

• Swelling
• Joint locking or giving way
• Severe pain
• Loss of sensation or numbness
• Pins and needles or tingling
• Pain upon pressing a bone
• Limitation of movement in a joint (i.e. not just feeling stiff, actual physical restriction of movement)
• Pain on impact or landing
• Painful weight-bearing

If you have any of these signs and symptoms it may be advisable to seek medical opinion. A little swelling or tingling may just require caution and not necessarily a GP visit, but if the problem persists then it is wise to get it checked out.

How often are you getting these symptoms?

If you have only experienced these symptoms on one occasion and have been running fine since then the chances are it was just a freak one-off. It is recurring symptoms that will be worth investigating.

Should you run through it or rest?

For the more severe injuries your body will tell you what to do, most significant pain and injury will stop you from running. Pain, with time will worsen and almost always mean you have to stop. However with the adrenaline coursing through your veins the pain can sometimes be disguised. Certain minor niggles may actually get better as you warm up and improve with each step, in these instances you are probably not at risk by carrying on. It is important to remember that you should not grin and bear pain and push yourself with tears welling in your eyes! With any uncertainty, don’t push it, stop running, see if it eases or get it checked out.

What if your pain is fine when you stop running?

This is usually a good sign, pain with running is certainly more of a problem than being pain free at rest. If however, pain continues to interfere with your regular day to day activities, then this is probably going to require attention.

Can you alter your running to reduce your pain?

Decreasing your speed, increasing your cadence, reducing stride length, running on a softer surface or stopping and stretching out, are all factors in running that can be manipulated. Making these adjustments may well ease your pain and if it stops, then that is very positive. Maintain what you have changed for a short while and you may find it eases sufficiently to resume your regular running style without pain.  For a number of running related injuries, the repetitive nature of running, causing recurring stress at a vulnerable area is to blame, but this can occasionally be resolved by making some small adaptations.

What is your mileage?

Large increases in mileage, for instance following a marathon training programme over a period of a few months, especially if you are a beginner will of course leave you feeling achy, you are not necessarily injured though. Stiff heavy legs can be a sign of fatigue and this will normally be resolved with a 1-3 rest days.

How much time do you have?

An injury shortly before an event, perhaps or week or two prior to a race is almost always going to mean you will have to pull out. The volume of training and time invested to get the level of fitness required for a half or full marathon, only to risk greater injury by running through it, is probably not worth it – there will be other races you can run. If you get a problem in the early days of training then you will have adequate recovery time and this poses less of a problem.

What other types of training will be more valuable?

With injured runners or those looking to reduce injury risk, the addition of a cross- training session to their weekly training regime will add great value. Strength and conditioning, core stability training or working on flexibility may well be of more benefit than running through a niggle. If you focus on stabilising and building strength around the problematic area and giving yourself time for a decent stretch, this will be better than heading out for a half decent run.

Are you training too much?

Overtraining is a big one in the running injury world; some of the signs to watch for are as follows:

• Low energy
• Abnormally Stiff muscles
• Weary after training
• Taking longer to recover
• Sleep loss
• Decreased appetite
• Poor immunity
• Training is more of an effort
• Poor performance

When is rest the absolute best thing to do?

To start with, if your training schedule does not include any rest days then seriously consider adding them in. Your body needs rest to strengthen and adapt to the training that you are doing, failure to do so will inhibit your body’s natural cycle when training, the careful balance of breaking down and building back up again. No runner likes to rest, but it really is an important consideration when planning your training.

To make the all-important decision of whether or not you are going to carry on running, again be guided by your body and make your decision based on how you feel. A feeling of lethargy and heavy legs, often just take a bit of a mental ‘get up and go’ and will in fact feel better for a run. But if you are overcome with pain then don’t be disheartened and substitute your usual running session for some valuable cross-training instead. It’s useful to allow yourself some training flexibility, avoid a rigid unforgiving programme and mix things up a bit. If you are too tired, inject some pace with a good speed work session or take an easier recovery run.

Most importantly with injuries, if you have any degree of uncertainty, it is better to act and get some professional help to find a resolution, sooner rather than later.

For Immediate Treatment Of A Sports Injury, Think R.I.C.E.

This may be obvious to the seasoned athlete but it is worth discussing the significance and reasons behind following the RICE protocol after injury, later on you will appreciate the benefits of this simple form of first aid.

The first 24 hours – Remember this is the most critical time for treatment, immediately after an acute soft tissue injury. When you injure a soft tissue such as a muscle, ligament, or tendon there is a very likely chance of injuring blood vessels too. As a result blood gathers around damaged tissues causing compression within the neighbouring tissues, which causes a secondary ‘Hypoxic’ injury that deprives the tissues of oxygen, causing more harm. As a result, every attempt should be made to decrease the bleeding at the injured area. This is where RICE comes in, a simple mnemonic to summarise 4 actions to take after injury:

Rest

Ice

Compression

Elevation

So why follow RICE and what does it do?

Rest

Where possible following injury, you should try and stop activity to reduce the bleeding and swelling. If you injured say, the muscles in the back of your lower leg (calf) bleeding will increase as you exercise these muscles whilst running. If your injury is so severe that you cannot walk without limping, then a rest from weight bearing can be achieved by using crutches for a lower body injury or a sling for an upper body injury.

Ice

Straight after injury ice is mainly used to slow down the rate at which the soft tissues work and respire. Later on after the acute phase of injury, ice may be used as therapeutic treatment for its pain-relieving affect. There are numerous ways to apply ice, this could be crushed ice wrapped in a damp cloth or tea-towel, reusable frozen gel packs or immersing injured area in a bucket of icy water. Cold water and cooling sprays are often used but these rarely penetrate enough to affect the deeper tissues. Opinions vary for how long and how often to apply ice, but a useful guide is to generally apply ice for 15 minutes every 1-2 hours, steadily reducing the time of applications over the next 24 hours. Care should be taken to protect the skin with a towel or similar barrier to avoid the ice burning the skin or causing nerve damage. People with cold allergy or peripheral vascular disorders such as Raynaud’s phenomenon should not apply ice to treat an injury.

Compression

Compression of the injured area with a firm bandage reduces bleeding and, as a result decreases swelling. It is important to apply compression during and after the application of ice, so make sure a bandage is applied throughout. The size of the bandage is dependent on the size of the injured area and should be cut accordingly. Tubigrip type bandages come in a variety of sizes and widths. The bandage should feel firm but not so tight that it aggravates painful symptoms. If bandaging from a roll, the application should start at the furthest point away, wrapping each layer so it overlaps the layer below by half and should continue to extend upwards to at least one hands width higher above the margin of the injury.

Elevation

Elevating the injured area can be accomplished by using a sling for upper limb injuries and by resting the lower limb on a chair, cushions or bucket. For this to be effective the lower limb must be elevated higher than your hips/pelvis, this enables gravity to draw away fluid accumulation at the injured area and therefore decrease pressure within the fluids that bathe all the surrounding tissues around the injury.

Remember this advice is for a soft tissue injury, If you are in any way concerned that your injury is more severe in nature, it is vital that you seek medical advice immediately.

Once you feel more comfortable and the initial swelling and inflammation is more bearable it is then time to seek the advice from a musculo-skeletal specialist such as an Osteopath, Physiotherapist, or Sports Therapist.

Follow the advice of an injury professional, in addition to therapy, you may need to do exercises and follow a rehab programme.

Finally, whatever you do avoid the temptation to return to your sport too soon. Be guided by your therapist and rest for as long as is required, or you could end up doing more damage and need even longer away from activity.

At Chart Clinic, we are happy to discuss your individual situation and advise you the best course of action for your injury, so do feel free to get in contact.

Reference:

Brukner and Khan, Clinical Sports Medicine 3e, McGraw-Hill Professional (2007)