Coping with Injuries

Drinking my tea this morning, I came across a saying on my tea bag that I thought seemed a fitting analogy on injury:

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“One thorn of experience is worth a whole wilderness of warning” – James Russell Lowell. 

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Whether major or minor, injuries happen to the best of runners, including the elite and pros. Run long enough or hard enough and you’ll probably get an ache that will temporarily sideline you. Fortunately, most injuries are short-term; yet, to the affected runner, they seem devastating.

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An injury can be just as difficult mentally as they are physically. In addition to physical symptoms, injured athletes experience a range of emotions, which experts say is normal and healthy.

 

It’s helpful to realize injured runners tend to follow a pattern of psychological reactions similar to how we respond to grief and loss. In the book Running Within, psychologist Jerry Lynch and Coach Warren Scott outline a connection between these reactions and the 5 stages of grief.

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If you’ve ever been injured, you’re probably familiar with the “it’s the end of the world” feeling, a loss of identity and even symptoms of withdrawal, not just from the myriad of physical benefits like the endorphin rush a daily run delivers, but also from the social benefits of feeling “included”. Add to that anxiety regarding the perceived loss of fitness, having to forfeit a goal race, or the loss of registration fees for races already entered, and you have someone who becomes cranky, irritable and lacks patience with everyone around them. Just ask my husband!

If you’ve experienced an injury, see if you recognize yourself in any of these stages:

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Denial 

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It’ll go away. I can run through this. If I refuse to accept the pain, it doesn’t exist, right? You pray to the running gods, scan the Internet for diagnosis and say that doesn’t fit me. Hard-core runners often deny the significance of their injuries because they have been conditioned to run through low-grade pain and fatigue. Running through the on-set of an injury often makes the injury worse.

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I tried running through an injury for 3 months prior to the 2016 Gasparilla half-marathon. I had a metatarsal stress fracture and refused to get confirmation or treatment until after the race. Instead, I adjusted my training, reduced my mileage, taped my foot and switched up my shoes and inserts. I prayed I would get to the start line, finish the race, and then I would take a 3-week break. I finished the half-marathon in 1:24, placing 3rd local, but could barely walk after I crossed the finish line. Furthermore, my denial turned a 3-week break into 6 weeks on the injured list.

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Anger 

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Why me? Why now!? I can’t be injured, I have a major event coming up! You can’t do this to me! Panic, anxiety and pain ushers in anger when you are unable to perform optimally. An injured runner will become angry at everything and everyone. Often in a cloud of denial, they continue to train, doing whatever they can to maintain fitness. This often can have disastrous effects and create biomechanical problems as one tries to compensate for the pain. Once an injury forces you to stop, it’s best to channel that anger towards getting a diagnosis and designing a recovery plan. Use your passion and energy constructively - learn why the injury happened and how to prevent recurrence. View rehab as a form of training and leverage the discipline you demonstrate when training for a race to set goals for your rehab. Give yourself a few days to be angry, then look forward. Elite runner and Greek Olympian Alexi Pappas suffered a hamstring injury shortly after the 10,000m race in Rio in 2016. Unable to train and not wanting to let anger and self-pity get the best of her, she focused her attention on a number of creative projects, such as the promotion of her film Tracktown that she starred in and directed. She focused on positive opportunities that she wouldn’t have had time for if she were training, such as shooting film on the 2018 Winter Olympics in South Korea, writing a book of essays called Bravery, and producing a television series with her husband. 

 

Bargaining 

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Please, just get my body through this next race. I promise I’ll stop and address the injury. Or as I call it, “praying to the running gods”. We plead to have “just one more run” which, if you’re like me, never stops with “one more”. Jeff Galloway once told me that you always have to pay the piper whether it’s now, later, or in several weeks, and that it usually occurs at the most inopportune time when you don’t want to be sidelined. Your body will tell you when it wants to take a break and if you don’t listen to the signals, you will be forced to stop.

 

I have often used bargaining to get me to the start line; however, I would not advocate it. Weeks before the 2015 USATF Masters Half Marathon Championship in San Diego, I had plantar fasciitis and was getting physical therapy and massages. Prior to a run, I would warm up the tendon by walking our dog, Ursa. However, as soon as I finished the run, the pain and stiffness would come right back. I also knew the sides of my feet and hips were compensating. Two days before the championship, I got a massage that brought a great deal of relief. On race morning, I applied fresh Rock-tape and ran my second fastest half-marathon in 1:22:29, placing fourth Master. I also hobbled all the way back to my hotel. The next weekend was the start of the Watermelon 5K Series. I bargained for just “one more run” and placed first female in 18:50. The next day, my body rebelled. The pain was so intense that I finally said, “I can’t do this anymore”. That resulted in a 4-month setback. Lesson learned.

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Depression

 

I don’t even want to look at Facebook and see everyone’s race results. Research conducted by Diane Wiese-Bjornstal, Ph.D. associate professor of kinesiology at the University of Minnesota and a leading researcher of injury psychology, shows that athletes with severe injuries that require long amounts of downtime are likely to linger in this stage. The enthusiasm you initially had for your rehab routine fades. You miss the endorphin fix running provided and you feel cut off from the running and racing community. 

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While sidelined with plantar fasciitis, I became depressed and felt isolated from my running friends. Eventually I got over feeling sorry for myself and accepted that the injury would heal in time. During the time spent recovering, I immersed myself in projects I had put off, walked daily with a neighbor and our dogs, made new friends outside of running, and went to concerts that I wouldn’t have been able to had I been training. Simply put: I stayed busy.

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Acceptance 

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I’m injured, but I must go on with my life. The final step. This is when healing usually takes place. Use your injury as a helpful wake-up call. When you accept that you’re injured, and understand it takes time to heal, then you can properly treat and manage it. 

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Ellie Greenwood, British ultra-marathoner, suffered an 8-month injury only to rebound and win the 2014 Comrades Marathon (~89km/55 miles). In an article in Trail Running magazine, she stated, “Everyone gets injured if you’re trying to run at your maximum potential. You’ve got to deal with it and get on with it.” I think that sums it up perfectly. Every runner is pushing their body to see how close they get before they step over that fine line where their body breaks down. A smart runner knows the possibility of injury could happen if they push too hard, while a stubborn runner thinks it will NEVER happen to them. 

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While commenting on her withdrawal from 2018's Chicago Marathon due to a repeated calcaneus fracture, elite runner Jordan Hasay (3rd in Boston 2016 and American fastest ever debut in 2:23:00) put it poetically: “Things end up happening for a reason. You really don’t know the reason until later.” 

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When you get the “all-clear” to resume training, start back slowly, perhaps a bit more conservatively than you think. Often times, after an injury, your muscles and joints aren’t as strong as prior to injury due to the lack of running mechanics. Depending on whether you were able to cross-train to maintain fitness, I would suggest beginning with a walk/run regimen. In the beginning, measure your running cycles in terms of time and not distance. As you become stronger, increase mileage slowly, using the 10-percent rule. Although you’d rather eat asphalt than be caught walking, do it anyway. You’re still exercising your muscles. If you try to take shortcuts or to cheat your body’s natural timetable, you’re asking for trouble. You can’t rush your recovery. 

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While recovering, be sure to eat well. Most runners cut back on their diets to prevent weight gain. Personally, I find I am not as hungry and have fewer cravings when I am sidelined. It’s almost like I’m “re-setting” my appetite. But if you do gain a few pounds while recovering, don’t stress. Your body will burn them up once you resume running. 

Stay positive. Stay mentally busy. Eat healthy. Train wisely. And hopefully, you’ll get over this hurdle and train year after year without injury.