Thursday, July 11, 2013

How to get back in the (running) game as fast as possible

It has come to my attention that there is a pretty crazy rash of injuries amongst the runners I know right now. Between my Oiselle teammates and my Bull City teammates, I need both hands to count the number of folks who are down for the count/on the DL/benched....whatever you want to call it. The bottom line is, a ton of folks are hurt. And, if you have been following twitter or Facebook or have (gasp!) had a live conversation with me, you would know that I spent a month on the injured list as well. I even missed running with my best friend when she came to town for my 40th birthday.  Luckily I am now back in the game, ready to start rebuilding my speed and returning to racing shape.

This isn't the first time I have been sidelined by an injury. As distance runners we are, unfortunately, prone to overuse injuries and injuries that result from anatomical imbalances. I am additionally prone to injuries borne from total klutziness and bad luck so I have a higher than average experience with injury.  Fortunately this has given me the opportunity to become pretty darn good when it comes to injury recovery. So, in light of the current popularity of getting injured I thought I would share my techniques for getting back on your feet as quickly as possible.

This is the part of the post where I have to include a disclaimer. I am not a doctor nor am I a physical therapist. I am, however, a total klutz who is great at getting injured, a pro at getting healed, a USATF Level 1 certified coach and a lapsed certified personal trainer. So while my recovery secrets are not rooted in medicine they have been tested and refined and retested multiple times on me by me and are rooted in my education as well as in good, old-fashioned common sense.

So, what's the secret? Lean in, really is.......PATIENCE. The biggest secret of all is patience. It isn't the only part of the equation, but it is the most important. You simply cannot rush your body through injury recovery and if you try to, I can guarantee you that you will be out of commission for a longer total time than if you were just patient from the get go.

So what goes with patience? Let me list off all the elements of my formula for successful recovery. If you have questions or feel like I missed anything, please don't hesitate to comment!

1. Patience. Obviously. I know that I already said this but I still can't stress the importance of patience enough. I am not, by nature, a patient person. Ask my husband, my coach, my parents, even my kid. I am seriously lacking in this department. But when I get hurt I turn into a totally different person, if only in this one area. And it has served me well over and over again. So when your doctor says "you are going to be in this boot for 4 to 6 weeks" I recommend that you just suck it up and make your follow up appointment for 6 weeks out. Because you know what? Two extra weeks in a boot isn't going to hurt you long-term. But the demoralization of going into a follow up appointment at 4 weeks thinking you are going to get the boot off and then hearing that you have to stay in it for 2 more weeks is much more devastating than just patiently waiting for the entire prescribed time.

2. Get a thorough diagnosis, both of the injury and the cause of the injury. So, say you develop a spontaneous (i.e. no pain preceding the break) stress fracture in the second metatarsal of your foot 7 and 1/2 weeks before a major marathon. It is all well and good to get a proper diagnosis of the injury ("stress fracture of the second metatarsal") but if you don't get a proper diagnosis of the cause ("patient tweaked their orthotics and ran with an adjusted gait for a week") then guess what? You are likely to re-injure it over and over again. Often times a proper diagnosis doesn't require lots of fancy, expensive tests, it just requires an observant doctor and a patient who is willing to be brutally honest about their behaviors leading up to the injury. I have had many injuries that have healed completely and never, ever recurred. I also have one injury that recurred "mysteriously" for almost a year. Only when I teamed up with a doctor who looked at my biomechanics from head to toe and asked me questions about the incident that led to the injury in great detail were we able to get that injury licked permanently. (And in just a matter of weeks.)

Also in this category I would like to mention the importance of finding the proper medical professional. If you are working with someone, be they a physical therapist, a chiropractor or an orthopedist, and you aren't getting relief from pain or progress towards recovery (or if you just don't feel comfortable with what they are telling you) then do not hesitate to get another opinion. I have worked with plenty of medical professionals who are stars in their field but who just were't the right person for the particular injury I had at the time. Don't be afraid to try out another doc! Now, this isn't suggesting that you just bounce around until you find someone who gives you the news that you WANT to hear (a.k.a. that you are fine and can just resume running). This means look around, ask fellow runners for recommendations, even ask your current medical provider for recommendations, until you find someone who you feel confident is looking at you holistically and who has both knowledge of your specific type of injury and a plan for recovery.

3. Once you have found a doctor/chiro/PT who you are comfortable with, have received a thorough diagnosis and have asked all the questions you can think of, FOLLOW THE DOCTOR'S ORDERS. Again, if the doc says "6 weeks in a boot" don't start testing it out just because the pain is gone after 3 weeks. Pain goes away before healing is complete. If the doc says "do these exercises every day for a month" and you choose to not do them and then re-injure yourself, well, don't blame the doctor. Obviously no medical professional is perfect; they are human and they don't have a crystal ball that can guarantee that their recommendations will be accurate all the time, but you would be amazed by how many athletes I know who have not followed the course of treatment laid out by their doc and have then wondered why they are not healed.

4. Don't take any short cuts. Cortisone shots and anti-inflammatories like advil can be very tempting when you are injured: they reduce inflammation and mask pain. When you are limping around that sounds awfully tempting, doesn't it? Unfortunately these therapies can reduce inflammation so much that they remove the body's natural inflammation response which is a critical part of healing soft tissue and they can mask pain so thoroughly that you may think that the injury is healed sufficiently to train on. Both scenarios lead to one thing, and it isn't good....they lead to testing out the injury before it is healed. Now, I am not saying that there aren't specific situations in which cortisone is the best course of treatment and in which the inflammation is SO severe that NSAIDS are a prudent therapy. But I AM saying that, again, runners tend towards impatience and all too often turn towards these risky treatments more out of desperation than common sense.

5. Have a pity party. Every day. This one is really, really important. The truth of the matter is that it just plain stinks to be injured. I would hope that you all run for the same reason that I do: an irrational, indescribable love of the sport. So when we are temporarily unable to participate in this sport that we have an ongoing love affair with, well, it is miserable. I have found that it helps to acknowledge the degree to which injury sucks on a regular basis throughout the duration of the layoff. I take a few minutes each day to pout, throw (soft) things, even cry. And then I dust myself off and get on with the business of the next part of the plan.

6. That said, DO throw everything that is prudent at your injury. Make it your mission to be the most compliant, thorough patient that ever graced your doctor's office. When I broke my foot before the New York City Marathon my doctor suggested I incorporate the use of a bone stimulator to my arsenal of therapies. After a little research that taught me that bone stimulators can help heal breaks up to 40% faster (than just letting the bone heal on its own) I was all in for the idea. There was no downside, no risk, as long as I used the device correctly. And guess what? It totally worked. Other therapies I have used in injury recovery include the traditional ice and heat rotation, calcium citrate when recovering from bone injuries, crutches, a walking boot, hydrotherapy, active release technique, nerve flossing, stretching, not stretching, specific rehab exercises, Graston and good old fashioned rest.

7. Take the long view, part one. With my most recent injury (caused by mowing my lawn), after 3 weeks of aqua jogging my doc and I realized that even the aquajogging was aggravating my injury and the only way my soft tissue was going to fully heal was for me to take full, complete rest. No cross training AT ALL. Limited walking. Nothing. He prescribed 7 to 10 days of such rest. I took 9 and took it very seriously. After 7 I had healed so well that I was cleared for light walking and cycling, after 9 I was cleared to test run. Guess what? The rest totally did the trick and I have had a successful return to running. Did I loathe the idea of sitting on my rear for 9 days doing NOTHING, especially during my big 40th birthday weekend? Heck yeah. It was pretty sad. But was it worth it? Absolutely. The bottom line is that sometimes rest is the best treatment available. And contrary to popular belief, a little rest isn't going to kill us as runners. (Also along these lines, my 7 year old son wants me to tell you that I took the long view and bought a better [used] lawn mower that will help me not re-injure myself. A little pricy but much, much cheaper than all the doctor's appointments!)

8. Take the long view, part two. If rest isn't the best option then work with your doc and figure out what cross training is safe for you to do. There are plenty of options out there: I have swum laps with a pull buoy between my legs, aqua jogged, cycled, used the elliptical, run on an Alter-G treadmill, even used the hand cycle. The "right" method of cross training depends entirely on the location and nature of your injury. I know, I know...cross training is BORING. And it isn't RUNNING. I can hear people whining about this right now. But you know what is even more awful than cross training? Being totally out of shape when you are healed and ready to return to running. Obviously there is a time and place for full rest (see above) but otherwise there is no reason to lose your aerobic fitness during an injury. Nothing will ever keep you as fit for running as running can but proper cross training will definitely keep the fitness losses to a minimum and will help you get back on your feet faster.

Another thing about cross training: as boring as it is, it can also be the avenue towards keeping a long term goal alive. I have trained for more than one marathon while injured and have been able to successfully complete every one. Two examples: in 1997 I broke my femoral neck (the top of my thigh bone) and was restricted to crutches and swimming with the pull buoy for 8 weeks. It was miserably, mind-numbingly boring to swim freestyle for 60 to 90 minutes a day, but I had a marathon 12 weeks post-injury that I really didn't want to miss. And guess what? I maintained enough fitness to be capable of running, my bone fully healed and I finished that marathon in 3:24 with no ill effects. In 2008 I broke my foot just 7 and 1/2 weeks before New York. The plane tickets were purchased (for my entire family no less!), the rental house was paid for, the entry fee was paid. I was NOT interested in missing out on this marathon. So I worked with my coach and translated all my running workouts over to time and aqua jogged each and every one of them. I did VO2 Max intervals at such effort that I nearly lost my lunch in the water multiple times. I completed long LT efforts that bored me to tears. And I did all the long runs in the pool. Twenty two miles translated out to 2 hours and 45 minutes of aqua that is exactly what I did. And guess what? I finished that marathon too, in 3:37, without a problem and the foot was 100% healed.

9. Use the time that you are injured to improve your strength and your form...and then continue that when you are back on your feet. I learned this one from Shalane Flanagan. When she was forced to take a layoff to recuperate from surgery on her foot she used the time off to work on her core strength. Hey, if it is good enough for Shalane then it is good enough for me! So every time I have an injury layoff I look at it as an opportunity to work on my weak points: my core, my glute medius, any stride imbalances I may have at the time. I find that all too often I let these "little things" slip out of my training program when I am healthy enough to run full time so I actually have come to enjoy having the chance to prioritize these critical aspects of my fitness and strength. Just like the cross training, this part of the recovery equation also helps me return to full training faster and more successfully.

So there you have it. Like I said at the beginning, my method for recovering from injury is nothing fancy, has no super-secret elements and isn't, unfortunately, going to help you recover at a lightening-fast rate. I just rely on the all too elusive methods of common sense, patience and hard work. I'm sorry if this is disappointing to some who thought I was going to divulge some top-secret info here, but I hope that for the rest of you this can help provide a successful path to full injury recovery and a little hope that whatever blip is currently on your training screen need not signal the end of your short or long term running goals.