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Dealing With Injuries

You Can Run Smart And Cross Train, Too

Published May 26, 1997, in The Post-Standard.

By Dr Kamal Jabbour, Contributing Writer

A running injury brings on the emotional reactions normally associated with the loss of a friend. At first, the runner goes into denial: "I will be fine tomorrow." Anger follows denial: "why me?" Bargaining comes next: "I promise not to run two marathons in the same week again." Depression sets in: "Leave me alone." Finally, acceptance allows the start of the healing process: "I will cross train to retain my fitness." A runner's first injury is usually the most traumatic emotionally. With experience, seasoned runners learn to go through the grieving process a lot faster.

Running books are full of advice for injured runners. Writers claim that the secret to a quick recovery lies in the acronym RICE. "R" stands for rest, to allow the body's healing mechanisms to come into play. "I" refers to icing the injury to enhance the flow of blood and speed recovery. "C" is for compression, to limit swelling. Finally, "E" stands for elevation of an injured foot to facilitate circulation. Conveniently, many runners have developed their own interpretation of RICE. They believe that "R" is for running through every injury. "I" is for ibuprofen, in 500-count bottles. "C" is for cortisone injections. To their horror, "E" becomes an emergency room trip, when a stress fracture turns into a compound fracture at mile 22 of a marathon.

Running injuries are a fact of life for competitive runners. Dr. George Sheehan writes that health ends where competition begins. The rate of injuries increases dramatically as the total weekly mileage increases. Statistically, runners who train over 50 miles per week are likely to get injured at least once a year. Running smart reduces the rate of injuries. Healing smart reduces the layoff period and the risk of setbacks.

Runners learn quickly to recognize the early sign of an injury: pain. Experience determines their reaction to pain and their ability to differentiate between good pain and bad pain. The dictum of "no pain no gain" holds some truth in running. Muscle soreness is normal after a hard workout or a good race. A runner who does not feel sore after a race has cheated by running a sub-par performance. However, pain in the bones and recurring soft tissue pain must be taken seriously. A minor injury may deteriorate into a major injury if left untreated, and requires a much longer recovery period.

When a runner tries both interpretations of RICE without relief, it may be time to seek professional medical help. The injured runner faces a spectrum of experts eager to help. With the evolving landscape of managed health care, the primary care physician has become the gate keeper to treatment options. Select a physician who runs, or at least one who is sympathetic to runners. When you convince the gate keeper that you need a specialist, it helps if you know your options before you ask for a referral.

The medical specialists who treat running injuries include physical therapists, podiatrists and orthopedic surgeons. Your physician can help you determine which one you need. Talk to fellow runners to identify specialists who run or who treat running injuries. Stay away from practitioners who see running injuries as self-inflicted predicaments, wasting medical resources. While I do not favor running through an injury, I have encountered two exceptions. If a specialist prescribes quitting running, or undergoing surgery, it is time to run away and seek a second opinion.

Finally, take advantage of the recovery period to maintain your emotional and physical fitness levels. Call a race director and volunteer to help at the next race or track meet. There you can meet members of the local chapter of Injured Runners Anonymous, disguised as race volunteers. They will give you support and advice. On the physical front, cross-training can keep you active and lessen the impact of layoff. It can keep off the extra pounds, maintain aerobic capacity, and bring in some endorphins. Non-impact activities are an obvious choice for an injured runner. Depending on the injury, biking, walking, stair climbing, swimming, rowing and weight-lifting are good options. Urban folklore tells of an injured runner who biked through a foot fracture by strapping his cast to the pedal of his bike. Another runner engineered an aluminum insole to protect a fractured metatarsal while climbing a stairmaster. Other runners have worn flotation vests to stay off the bottom of a pool, since their low body fat gave them little buoyancy. One runner, who suffered stress fractures in both feet during an indoor 15km race, wore color-coded casts to brighten the situation. Necessity is the mother of invention when an injured runner seeks that elusive runner's high.

Kamal Jabbour runs and writes on the hills of Pompey, New York. He gained 10 pounds sampling new recipes during his latest injury. His RUNNING Column appears in The Post-Standard on Mondays. He maintains The Syracuse Running Page and receives email at

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