Injuries, Part II: Don't Be So Stressed

Last week, I wrote about a set of common running pains that, while perhaps innocent-seeming at first, can quite quickly turn into nightmare injury scenarios for the unwitting runner. This week, I'd like to review some pains that, while sometimes worrisome because of the suddenness of their onset and acuteness of their intensity, are quite often relatively benign-- pains that represent the other side of the injury coin, if you will.

I begin with the same disclaimer as last week: I am not a trained sports-medical professional. Everything I have learned has been from my own long experience grappling with injuries, and with helping others suss out and cope with theirs. Nothing I say is a foolproof substitute for advice from a trained and experienced sports-med pro; but, my general advice may just save you some time and money, as well as alleviate some of your stress.

The first common but usually benign "pain condition" on my list would be severe "delayed onset muscle soreness" (DOMS). DOMS is what happens when an athlete-- usually, but certainly not always, a rank beginner-- plunges headlong into an exercise program and ends up all but crippled with muscle pain and stiffness 24-48 hours later (the pain and stiffness often peaks at 48 hours). This condition can feel like a serious problem, and very occasionally it will leave behind a longer term problem, such as a micro-tear; but, it is rarely more than a nuisance, and can often be trained through, albeit very slowly and gingerly. In fact, many people report a reduction in the pain and stiffness of DOMS if they're able to at least get up and move around a bit during the acute phase. I'm certainly not recommending that anyone over-do a new fitness activity, or dramatically increase their volume of training in an activity they're generally accustomed to; my point is that, if you do happen to overdo it once in a while, and your DOMS makes you feel as though you've done something really serious to yourself, you probably shouldn't worry about it, and you might not even have to take a day off. A good guide to assessing whether you just have really bad DOMS, or you have "blown" something, is if your pain in pretty generalized and bi-lateral (e.g. equally bad in both calves). And note: massage is generally pretty useless in helping recovery from DOMS, which will run it's course in 2-5 days no matter what you do. Your instinct may tell you to go for a massage, but don't waste your money. Icing and anti-inflammatories, on the other hand, might provide some relief, and maybe even speed of the process of recovery.

Next on the list is pain in the tendons that run along the top of the foot, known as extensor tendonitis or tendinopathy. When I was getting started in the sport back in the 1980s-- when running shoes didn't always fit as well, and/or when our parents couldn't, or didn't want to, shell out for new ones every 3 months-- this kind of pain (usually along the tendon of the big toe) was so common that my training partner and I referred to it as "the toe thing". What would happen is that, as our shoes began to wear out and fit less snugly, we would have to tie the laces tighter and tighter across the top of our feet in order to get the foot-bed of the shoe to maintain proper contact with our soles. The result would be that the laces would restrict the normal action of our extensor tendons, causing bruising, pain, and swelling. The pain was often pretty acute, but it rarely "went anywhere" in terms of more serious injury, and it was usually solved completely by wearing a slightly thicker sock, or simply replacing our shoes. Occasionally, I get reports of this kind of pain from my athletes, who worry that continued running will lead to bigger, longer term problems. I almost always advise them to keep training, or perhaps take one day off, but to address the root cause of the pain, which is usually quite simply done. The main danger of failing to properly address this problem is rarely the problem itself; the danger is in the risk of causing an injury to some other more central area of the support structure through excessive compensation, due to limping or otherwise adjusting foot-strike.

Another unsettling but usually benign condition is pain and tightness in the mid/high-arch of the foot. Justifiably wary of the dreaded PF, athletes often worry about any pain or tightness in this area of the body. However, while tightness in this part of the foot can set the stage for PF,it is not in itself cause for immediate concern, or reason to take a precautionary rest, particularly in younger runners, and runners with no history of PF. Many things can cause temporary tightness and soreness in the arch, chief of which are: running around the tight corners of an indoor track (left foot); switching too quickly into spikes, running on sand; and, running in shoes with too high arches (or, sometimes, breaking in orthotics with stiff arch supports). In the vast majority of instances, this pain will be temporary, and can be trained through. As I suggested last week, the real danger is with pain under, or just to the medial side of, the heel, and which is worst on getting out of bed or starting to run.

Finally, I would mention another kind of tendon pain: that which sometimes flares up in the tissues that join the groin and hamstring muscles to the end of the femur or top of the tibia (biggest bone of the lower leg). Like extensor tendonitis, but unlike the potentially catastrophic ITBFS, this problem is usually nothing more than a very painful nuisance; and, in addition to the pain, it can sometimes mess significantly with normal running form and posture. However, it rarely requires more than a couple of days of down-time, and perhaps a week or 10 days of rest from faster running, and can very often be trained through without serious complications. Runners who are repeatedly stricken by this condition, however, should definitely seek out professional advice in order to isolate the cause or causes of the groin and/or hamstring tightness that are usually at its root (e.g. a significant leg-length discrepancy). However, often a little rest and some Active Release Therapy (ART) are enough to put this problem right. (I have found that this pain is often set off by trying to run fast on very loose surfaces, such as snow or dirt, or by running fast downhill. It is therefore probably a good idea to refrain from these activities in particular. However, this condition usually temporarily precludes any kind of faster running; so, this is likely a moot point.)

P-K Racing Update: Wykes in Vancouver

Dylan Wykes finished a close and strong runner-up to Alberta-based Kenyan runner Willy Komsop, who is fast becoming Dylan's west coast road racing nemesis, having also bested him in the latter stages of last year's Sun Run. Results, pics and story are here available runnershoice.com

Coming off a late winter of hard but slightly patchy training, this was a very encouraging season opener for Dylan, who will be spending the next two weeks in the Vancouver area, getting some group support from Richard Lee's people, including Steve "OZ" Osaduik and Richard Moseley. (Rich was my university training partner, and coached of one of Canada's all-time best female athletes-- two-time Olympian, former road 4 mile world record holder, and long time Canadian 10k record-holder, Sue Lee-- who also happens to be his wife. And he was an elite-- and hardcore training machine-- in his own right, with P.B.s of 3:45/1500m, 13:59/5,000m and 29:35/10k). Dylan will race next in a low-key 5k in Stanley Park in 10 days.