How to Return from an Injury by Charles F. Peebles DPM

Guest Column

The Safe Way to make a Comeback

The worst part of my job is telling someone they have an injury that is either going to alter their training or take them out of competition for some period of time. The best part of my job is seeing someone return to their event stronger and better than before their injury. The “dash” that occurs between injury and the event is the crucial piece of the puzzle and what happens during that “dash” will determine how well and how quickly you can return to top form.

Injuries are inevitable in athletes training for endurance events. A recent Runners World article (October 2006) based on an Active.com survey of 510 competitive runners/cyclists/triatheletes found:

90% had injury in past year

50% out of competition  > 2 weeks

25% out of competition > 1 month
 

When these injuries occur they must be diagnosed expediently and appropriately. Some injuries may be resolved with just a decrease in intensity of training or a modification of an athlete’s equipment. Twenty percent of the injuries which are treated in our office are the result of improper or worn out shoes. Pain that does not resolve with rest or that is isolated to one specific site should be evaluated by a sports medicine physician to determine an appropriate treatment plan.

Once the injury is treated, what does the athlete do next. A patient of mine who lives and trains in Florida recently called after 6 week layoff after a tibial (leg) stress fracture diagnosed just before a big 10K race. We stabilized and began treatment of the injury and she followed up with a physician in Florida and had x-rays which revealed healing of the fracture. She asked about returning to running and the Dr. said “take it easy”.

What does “take it easy” mean to you. If you are Dean Karnazes it means a marathon every other day as opposed to daily. If you had been training for a Marathon and your long run was 20 just prior to your injury, does that mean you can return to running 10 miles right after your doctor says “take it easy”.

We need to define “take it easy” but more importantly we need to make sure the return to activity does not cause the injury to reoccur or a compensating injury to develop. If the injury was due to a training error we need to work with you and your coach to develop a modification of your treatment plan. If it is due to bad shoe choices, that needs to be corrected. If you have poor biomechanics you may need orthotics. Whatever the underlying cause is, it needs to be corrected. It is essential to use this time of healing for solving the problem but also for maintaining fitness.

“Taking it easy” as you recover does not mean “sit on the couch”. Cross training is essential in maintaining fitness. Aqua jogging is a great non-impact way to stay in shape and most closely mimics the running gait. Water creates almost 800 times the resistance of air and therefore keeps the muscles strong and the endurance high as you recover from an impact injury. Elliptical trainers are another great way to stay in shape if your doctor ok’s it. Cycling is an excellent alternative but I usually recommend staying in the saddle to prevent further strain on the feet and legs. Swimming will improve upper and lower body conditioning.

Once you are cleared to run the fun part starts. A gradual return to running and impact activity is the best way to guide your return. Start with an every other day schedule to give your body a chance to recover and cross train on the alternate day. Begin with a run-walk program dominated by walking the first week (2 minutes run: 5 minutes walk) followed by (3 minutes run: 3 minutes walk) the next and then (5 minute run: 2 minute walk) the third and then returning to running full time by the 4th/5th week. Once you are back to full-time running the 10 % rule comes into effect. Do not increase you mileage or speed by more than 10% per week. This allows your body to respond appropriately to the stress placed on it and to build back while allowing your body to have recovery days.

You may find your body is in better shape after an injury if you continue to cross train because you have given it a chance to heal and recover. Unfortunately, injuries are a part of running but by listening to your body, using sound training principles, allowing recovery, and protecting your body with a gradual return to activity you can be an even better runner after an injury.

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