Few runners have escaped the frustration of running injuries, but it certainly need not mean the end of our world. Instead this can be a golden opportunity to take time off to rebuild ourselves and return to running stronger and better.

Once upon a time, there was a little chick called Chicken Little who lived on a farmyard in the countryside. One day, Chicken Little went to the woods. He stopped by an oak tree. Suddenly a tiny acorn dropped from the tree – wheeeeeeeeee! And hit Chicken Little on the head –  BONK! Unfortunately, Chicken Little didn’t see the acorn. He looked up at the clear blue sky. “Oh, no!” he said “The sky is falling, I must tell the king.” – From the story of Chicken Little

Running injuries – like the acorn – can seemingly strike suddenly from the sky, and like Chicken Little, we may feel the sky has fallen on our head. Dealing with a running injury, rehabilitation, and rebuilding your running is as much a mental process as a physical process.

The mental struggle accepting a running injury

The first step with any running injury is to accept it and deal with it. If the pain doesn’t disappear after a few days of rest, then you are officially injured, and staying in denial will only prolong it. 

Runners have a tendency to keep on resting, and hoping that resting for long enough will fix the injury. But that is sub-optimal as the days may become weeks and then months, while the hard-earned fitness is being lost. The old adage of RICE (Rest, Ice, Compression and Elevation), are good for the first few days. I would even say that sometimes a 10 day rest is good, as a runner may have over trained and benefit from the rest while the running injury may clear up. But if after 10 days there is no improvement, then it is important to take action.  

One of my ultra trail runners, Peter Purchase, is currently injured after tearing a hamstring on a fall during a trail run, and this is perhaps the worst running injury that I have seen in 24 years of coaching. Peter has completed the Munga 400km and the 165km Grand Raid Reunion race, and is an experienced runner. Peter immediately started the recovery process and had an MRI scan and is doing his rehab following medical specialist advice and this will take time. At this stage, as his coach, I leave it to the medical specialist, and will only start Peter on a gentle running programme once we get the go ahead from the medical specialists. 

The five stages for a running injury

I have noticed similarities in this process of moving through from denial to acceptance of a running injury to the five stages in bereavement, which are denial, anger, bargaining, depression, and acceptance. 

Let’s have a look at these, as understanding the process can help us accept it faster and get on with rebuilding our running.

Denial

I see this with many runners who try running through a running injury. It starts off with a twinge, becomes a consistent pain on the run, and then may become a debilitating pain even when not running. At the heart of denial lies the hope that somehow the running injury will magically disappear.

Anger

“It’s just not fair!” cries the runner. This anger can be self-directed, with the runner blaming herself for not recognising the warning signs of a running injury and stopping earlier. The anger may also be taken out on family and friends. After 43 years of running and 23 years of coaching, I can testify to the fact that there is nobody as grumpy as an injured runner, myself included.

Bargaining

“If only I had seen a doctor, physio, chiro, or bio!” wails the runner. In this phase, the runner starts to take control of her situation, and will seek professional advice for the running injury, visit a sports doctor, physios, chiro, or bio.

Depression

 It takes time to recover from an injury and rebuild. For months, your days have been filled with running, dreams of great runs and races to come. Suddenly, there are unfilled hours in the day with seemingly nothing to look forward to. The answer is to use this opportunity to do things you don’t normally have time for, turning the spare time into a positive.

I once coached an elite runner who had a fractured femur after a hard fall at a mountain race, and was on crutches for months. At one stage we went for a 4km walk on a horse bridle path, chatting about all the great races she would still do, while she hobbled on her crutches next to me. I will never forget her happy face and the joy she took in this. She went on to recover and compete at the world trail championship.

Acceptance

 At this stage you have received professional medical advice, you are following a rehab programme as prescribed, have accepted the postponement of your dreams, have new dreams and are working actively to rebuild your running.

Identify what caused the running injury

Running injuries can be incredibly frustrating. It can be tricky identifying the cause as the symptom may actually appear as something quite different. It could for instance be what we call a “referred pain”, where the symptom may be a sore calf muscle, but the cause may be from another area such as the hips/glute/pelvis area.

This confusion is not only frustrating, but also becomes expensive as the runner will sometimes get different answers from different specialists. When this happens, I suggest a process of elimination by first checking your alignment at a chiropractor, and then once this has been sorted, go to a physiotherapist.

With some injuries it is easy to identify the cause, such as a fall on a trail and rolling an ankle. But others can be hard to identify and may be from over-training, over-racing, or tackling a race when inadequately prepared for it. Or it may be the result of a biomechanical problem.

We tend to look for a single reason for something. But often it is a combination of factors that cause a running injury. For instance, a runner may be using old and worn running shoes and have poor alignment around the hips/pelvis area. Either of these may cause niggling issues, but the combination of the two may compound the problem and result in an injury. The cause is then multi-faceted and needs multi-faceted solutions with a chiropractor sorting out the alignment, and new running shoes.

A general rule of thumb  is that many injuries are either from doing too much or from worn or incorrect running shoes. But you may be unlucky and have a biomechanical issue. 

Who to use for a running  injury, and when

Usually I recommend starting with a physiotherapist when injured and this is usually a good first step. 

But sometimes an injury may be due to an alignment issue and then it is good to first see a chiropractor. 

Our lifestyles in which we spend a lot of time sitting at a desk or driving, can cause tight and weak glutes, as well as tight and weak hip flexors. Our running niggles and injuries are often due to poor alignment caused by these issues. Our pelvis can then tilt or drop on one side, causing back issues and leg problems. When we are out of alignment, we compensate for it, and over time this causes injuries.  Another common problem is a locked SI (sacroiliac joint), and a chiro can unlock this.

Sometimes a good approach is to use a multi-pronged approach and see a chiro first to sort out any alignment issues, and then see a physio for the actual injury.

If your chiro or physio is unable to sort out the injury, then the next step is to see a sports doctor. A sports doctor has a more overall view and then may recommend that you see a specialist. 

Many people get great results with a Biokineticist, and generally I suggest using a Bio as a proactive measure to prevent injuries. A Bio will assess a runner for any muscle imbalances and then give exercises to correct these. This is great to do out of season as it takes time to see results.

There is an overlap between a chiro, physio and bio, as many of them are able to do the same functions. I have runners that successfully stay with just a chiro, physio or a bio, who is able to do all this for them and that is fine.

Although many of our feet problems stem from poor alignment that can be fixed by a chiro and physio, there are times when the biomechanics of the foot require an assessment from a podiatrist. A podiatrist can put a runner on a treadmill, and then video the runner and analyse it. The podiatrist can then either suggest a certain type of shoe such as motion control (ant-pronation), or make orthotics.

Make use of scans and x-rays to diagnose injuries

Sometimes it is wise to arrange for a scan or an x-ray, or even an MRI if needed. This can often save weeks or months of trying to figure out what the injury is. A scan or x-ray can usually show the problem and the severity. An example is a runner with a sore knee that has failed to respond to treatment, as there is then a possibility of torn or worn cartilage that may require surgery.

Your rehab programme for running injuries

Having identified it not only makes it easier to fix the injury, but also to prevent it happening again. Your rehab programme will mostly precede your new training programme in which you start to rebuild your training to previous levels. In this rehab stage you must be guided by the advice provided by whoever is treating you.

 It may include some strength training, swimming or pool running, physio, massage, and so on. In the early stage of rebuilding you can use cross-training to increase fitness with minimal impact. This is a way of fast-tracking your progress so that once you start running you are already reasonably fit. 

There will be some overlap in these methods as you start with rehab and transition to running.

• Running on an anti-gravity treadmill enables you to reduce impact, to avoid overloading your legs.
• Pool running mimics your running action, but isn’t weight-bearing, with zero impact enabling you to get in really good sessions.

• Swimming is always great for recovery, but is not as effective as pool running, as it doesn’t mimic running.

• Cycling and spinning can be useful, but some injuries won’t allow it.
• Great care has to be taken if doing strength training, as there is a chance of injury when using equipment incorrectly or doing too much. It would be best to do this under the guidance of a personal trainer.

Getting (re)started after a running injury

Your patience in seeking medical attention, doing rehab and the above cross-training is rewarded with your first run. It is hard to say exactly what the first run or rebuilding phase will comprise as it will vary depending on how fit the person still is, the nature of the running injury and their running goals.

“Are you sure the sky fell on your head?” they said. “Well, maybe it was an acorn,” said Chicken Little. And they chased him all the way home to the farmyard.

Rebuilding your running after a running injury requires patience and rethinking your plans for the next few months. But time flies and before you know it, you will be out on roads or trails in your happy place again.