We deal with a lot of athletes. From time to time athletes get injured. Here are some guidelines from both myself and Tim Noakes. Prof. Noakes wrote one of the most influential books on running many years ago. The book is one of the most important books written on running, training, and injuries to date. (The only point that Noakes has changed his stance on is that of the importance of carbs.) In the book, Noakes gives us his 10 Commandments of injury recovery. The points are brilliant, succinct, and deserve to be revisited from time to time. I am going to borrow heavily from his book in this article.
Bob goes training and feels some pain. He decides to ‘push through’ the pain in much the same way as people choose to rev engines that are not sounding well. There is always the hope that something will ‘click’ into place and the pain will go. Bob’s pain gets worse, so he decides to drug the problem away. “There has to be a tablet to solve this problem”, he thinks to himself. So, at great risk to his kidneys, he starts popping pills. This gives immediate relief in much the same way as placing a plaster over your oil warning light in the car makes the problem go away. Time will teach Bob that the pain killer has masked the pain which has allowed him to train himself further into injury. Bob now decides to get this thing sorted out and so heads off for a massage. At this point he has a 25% of recovery. If he’s lucky, his body might just need a massage and so a fully recovered Bob is able to return to his beloved sport. However, Bob might need a wider approach to his injury. If that’s the case, Bob will remain both perplexed and injured. Bob will now make one of two mistakes. Either, he will give a whole lot of treatments a short term chance and switch from person to person for help, or, he will get many sessions of a specific treatment without any improvement. We recommend four sessions of treatment. You need to stick with a plan to see results. If, however, after four treatments there is no improvement, you are wasting both time and money.
Enter Jack. Jack goes for a swim/ride/run and feels a bit of pain. His first choice is to back off a bit and see if his body will mend itself. Most of the time this strategy is sufficient and his body repairs under the lighter training load. Should this not work, Jack decides to go for a more holistic approach, realizing:
a. He needs to check that he is using the right equipment. This would include things like his bike setup and running shoes.
b. He gets advice on which muscles to stretch and strengthen.
c. He gets tight structures released through massage.
d. He continues to restrict his training until he gets better.
Most injuries will get better over time when one approaches them holistically like this.
So, with Bob and Jack in mind, let’s look at Tim Noakes’ 10 Rules of Injury recovery.
- Running injuries are not an act of God.
They result from the interaction of the athlete’s genetic structure with the environment through training methods.
- Each injury progresses through four grades.
Grade 1:An injury that causes pain after exercise and is often felt only some hours after exercise has ceased.
Grade 2: An injury that causes discomfort, not yet pain during exercise, but which is insufficiently severe to reduce the athlete’s training or racing performance.
Grade 3: An injury that causes more severe discomfort, now recognised as pain, that limits the athlete’s training and interferes with racing performance.
Grade 4: An injury so severe that it prevents any attempts at running.
- Each injury indicates a breakdown point.
This law simply emphasizes that once an injury has occurred, it is time to analyze why the injury happened.
- Most true running injuries are curable.
Only a small fraction of true running injuries are not entirely curable by quite simple techniques, and surgery is required in only exceptional cases.
- Sophisticated methods are seldom necessary.
Most running injuries affect the soft tissue structures (tendons, ligaments and muscles), particularly those near the major joints. These structures do not show up on X-rays. As with any injury, a correct diagnosis requires a careful, unhurried approach in which the injured athlete is given sufficient time to detail his or her story and training methods.
- Treat the cause.
Because all running injuries have a cause, it follows that an injury can never be cured until the causative factors are eliminated. Thus surgery, physiotherapy, cortisone injections, drug therapy, chiropractic manipulations and homeopathic remedies are likely to fail if they do not correct all the genetic, environmental and training factors causing the injury.
- Complete rest is seldom the most appropriate treatment. Complete rest is unacceptable to most serious runners because running involves a type of physical and emotional dependence. Our advice to injured runners is generally to continue running, but only to the point at which they experience discomfort.
- Never accept as final the advice of a non-runner.
– Your adviser should be a runner.
– Your adviser must be able to discuss in detail the genetic, environmental and training factors likely to have caused your injury. If the practitioner is unable to do this, together you will go nowhere.
– If your adviser is unable to cure your injury, he or she should feel as distressed about it as you do. It is patently ridiculous to accept advice from someone who is antagonistic or indifferent to your running in the first place.
– Your adviser should not be expensive as most running injuries can be cured without recourse to expensive treatments.
- Avoid surgery.
The only true running injuries for which surgery is the first line of treatment are muscle compartment syndromes, interdigital neuromas, chronic Achilles tendinosis of six or more months’ duration, lower back pain due to a prolapsed disc, and the iliotibial band friction syndrome – but only when all other forms of non-operative treatment have been allowed a thorough trial.
10) There is little evidence that recreational running causes osteoarthritis.
Here is hoping that between Bob, Jack, Tim and ourselves we have been of some help.