The Injury Question

Shit happens. There is no way you can stay injury free forever. If you are out there running, cycling, even casually walking, you will get some sort of injury ultimately. It is only a question of when. Dealing with injury is perhaps the trickiest skill to master in sports. Our bodies are fragile. As I get older, I became more and more injury prone, had more frequent attacks and had to go through longer and longer recoveries. In the long run, learning about and dealing with injury could determine whether your experience with sports will be miserable or enjoyable.

There are zillions of web pages, books ranting endlessly about “staying injury free”. You can read useful as well as misleading and harmful advice. You can find numerous examples to reinforce your biases. Most of those resources are anecdotal and conflicting, rarely backed with useful science. Telling the difference between science and bullshit is becoming very difficult. Very few physicians have experience with sports. A “shin split” is nagging, but does not constitute an “emergency” for most people.

Until 40, I never had an issue that worried me about my ability to train. That includes a long list of fractures and soft tissue traumas including but not limited to finger, tibia, rib, hand and shoulder fractures, chronic disk bulging, herniated disks and pneumonia due to overexertion. When I restarted training regularly after 40, my first two years were blissfully uneventful despite pushing myself to my limits all the time. In 2016, I made a big mistake by trying to race with injury and that started a domino effect which took me almost three years to recover.

My “herniated disk” diagnosis is more than 30 years old. I experienced my first debilitating back pain in my early twenties. Running, walking long distances and carrying super heavy backpacks used to be my job (used to be in the army), so not running was not an option. In time, I somehow learned how to muddle through and live with intermittent bouts of back pain attacks. I had my first attack when I was 32 years old, probably due to sitting for long hours in the office and I almost had surgery. To this day, I am thankful to my elder sister, also a physician, who told me to not to be stupid and stopped me.

In 2016, I caused a hairline fracture in my hip bone and disk herniation simultaneously while building up for a marathon in 2016. During the race, I had to quit at 16th km due to debilitating pain and I barely made it back to my hotel room jumping on my left foot.

I did not get smarter and tried to come back before a full recovery after six months. But meanwhile, I probably developed a bad habit of using my right leg a bit more and skewing my posture chronically to left. This caused a grade 2 calf strain.

My physician told me to stop running immediately and use crutches for 3 months. Of course, I did not. Pushed my luck and returned to easy running after 4-5 months. Then one day, after an easy 10 k, I tried to play soccer with my colleagues at a company event and that was it. The same calf snapped-I could literally. It took me another six months in the second half of 2017 but I never had a day without pain.

For a long time I thought it was over. 2018 was a recovery year. I took things extremely slow, did everything my physician asked me to do and behaved myself in every conceivable way. At the end of 2018, I was well enough to do long slow distances and could complete a marathon just under four hours in December.

My recovery could have been somewhat quicker if I did not have to travel like hell for business in 2019. I decided to have an easy year, keep away from racing, spend time cycling and swimming rather run running. I ended up doing almost nothing that resembles training in the first half of 2019 and had a terrible sciatica attack in December. It was so bad I had to attend to my meetings standing- sitting, driving, cycling was out of question. This is the year I watched the entire Game of Thrones in one huge binge.

Yes, it is much much better to not to get injured in the first place. It is very curious how we don’t learn something by just reading about it. I read this so called Golden Rule of Training years ago, then I needed my own mistakes to deeply learn what it really means. You should stay injury free to be able to continue your training. The question is how?

Again, there is simply no way anybody can stay injury free forever. That is against the spirit of competition and come on, how could we learn our limits without testing them? The best we could do is to be watchful, hope for the best and keep pushing the boundaries a little bit now and then. Sacrificing the joy and spirit of running and being “too safe” would be dull and boring.

It is not my place to give advice but by if any chance if you stumbled upon this post because you have your first(isth) injury or if you are new to the sport, here is what seems to be working for me.

If you are acutely injured

1. This too shall pass. Try to remember that there will be a day when will forget about your current pain. All you need to do is be patient and do what you need to do to recover.
2. Try to find a physician that understands your current dilemma and what running means to you. A fellow runner physician is your dream scenario.
3. No elective surgeries. If you have choice, try to see a Physical Medicine and Rehabilitation (PM&R) physician, not a surgeon. No offence but surgeons tend to solve things with surgery (naturally) and PM&Rs tend to lean on rehabilitating first. Any surgery has an inherent risks and should be the final option. Trust your body to recover first. Don’t believe in aphorisms like “cartilage does not heal”. A friend who has had surgery with great results is not a guarantee that it will work for you as well. You are a different person.
4. Remain active. Don’t speed up or go back to recovery until you feel totally all right but don’t be lazy either. In my experience, keeping active always helped. Cycling, walking were my alternatives.
5. Find out what went wrong. If you can not get to the root cause of your injury, in all likelihood, it will repeat itself. Most injuries does not happen “because you are running”. I believe most people have back pain because of sitting jobs or stress, most knee problems are related to weight and so on and so forth. It should be your job to identify and eliminate the root cause.

To remain injury free

1. Stretch, stretch, stretch and stretch some more. Grabbing your ankle after your 30 k for 30 seconds is not stretching. Setting aside time like three 30 minutes slots weekly with a yoga mat and going through your entire body is stretching. This should be treated as an integral part of the sport.
2. You can always stretch some more. Especially your hamstrings, if you are a road runner and white collar sitting on a chair 8 hours per day like me.
3. Shoes with cushioning, preferably with minimum drop. In my view, anybody over 70 Kgs should prefer shoes with enough padding, especially for long runs. These days they finally figured out how to make light shoes with enough padding. Avoid light racers shoes on asphalt.
4. Maintain a reasonable body weight. I don’t know anyone who remains at racing weight year round, still, anybody who expects to run and stay injury free should realise that runners can’t be to heavy. Starving yourself is also a sure way to injure yourself physically and mentally. I believe my “ideal” racing weight is around 77 Kgs. (This is a highly subjective and variable subject, be careful). I experienced all my troubles either under 75 (possibly because I was under nourished, affecting my recovery) or over 83 (again, possibly because I was trying to run like I was 77). Therefore I try to maintain 79, which I believe is reasonable and sustainable tradeoff. Please remember this number also changes with your age. I used to be under 70 in my earlier twenties.