R.I.C.E. – When you listen to your body, “R.I.C.E. is very Nice!” PLUS BONUS TIP OF RUNNING SAFETY – HEAT AND LIGHTNING
As we proceed with training, the combination of our aggregate weekly mileage and everyday life can often result in levels of fatigue, stress and pain (both physical and mental) that may not be considered “normal” or typical–and (if left unattended) can lead to injury. We will address some of the physical issues here; and those that are psychological in a later marathon training tip.
Many of you have asked questions about little aches and pains, some of which have developed into more significant injuries. Common questions include: “Is this something to worry about? What do I do for treatment? Will this fatigue or soreness or injury impact my ability to complete my marathon training and reach the start line (virtual or real) on October 11? Do I need to reduce my training or take a break from training or can I ‘run through’ this?”
This is a good time to review how we feel at various stages of our training and what to do when we feel a bit ‘spent’.
Training injuries take various forms. First of all, it’s important to understand that it is common for one (or more) part(s) of our body to hurt or feel sore during or after a training run or a ‘race’ like a half marathon. Often, this soreness goes away quickly with no lasting effect. This is to be expected. With training runs, as mileage increases, muscle soreness and fatigue are common, though this type of soreness will usually (and SHOULD) subside within 36 hours.
Other injuries are more traumatic and may last a short time; while still others are more significant and long-lasting. In the case of significant pain (regardless of duration), or of pain and swelling lasting more than a few days – stop running(!) and seek professional advice to diagnose and treat the injury. Seeking professional medical advice and seeking early treatment will almost always prevent a minor injury from becoming a serious injury.
In many other situations, soreness (usually in our legs) develops, and we are able to continue with training since the soreness ‘doesn’t hurt too much.’ Minor aches and pains are to be expected as mileage (long run, weekly and season aggregate) increases. Listen to your body when soreness develops. If muscle fatigue or soreness lasts more than 36 hours, it is a sign to reduce training and seek medical advice. Trying to run through the early stages of what might be (or become) a serious injury can negatively impact recovery and future training if not handled appropriately.
Whenever seeking professional advice for any type of training-related injury, check the credentials of the doctor or physical therapist before or during your visit. I always recommend seeking the advice of a medical professional who either (i) is an endurance runner or (ii) treats endurance runners as a primary practice. The reason? Medical professionals who understand the nature of the source of the injury and the mindset of an endurance athlete are better able to balance their medical advice–weighing the consequences of a runner’s desire to return to training as soon as possible with benefits of longer-term treatment. A medical professional who treats endurance athletes is less likely to say “stop running” without a more complete diagnosis and treatment plan to safely return to training IF, WHEN, and AS SOON AS practical.
The most common method of treatment for minor injuries is R.I.C.E., which stands for Rest, Ice, Compression and Elevation.
The first element, REST, is often overlooked and often the hardest treatment to follow. With a desire to continue our training (or to train more or train harder), rest is a concept many runners don’t like to follow–but it is the first (and possibly the most important) step in our recovery.
A common error I see runners make all too often is returning to running much too soon after an injury or returning to training at “pre-injury” levels of exertion—when a s-l-o-w and steady return are what is right and best.
Taking a day off from training or taking a few days or even a week off from training allows the body to heal itself. If soreness persists after a few rest days, or if soreness recurs when running after a few rest days, your body is telling you to seek medical advice. Listen to your body.
Failure to rest an injury usually sets in motion a chain reaction. When we try “running through” pain, our body will often compensate for the injury by finding a way to run which alleviates the soreness. However, this usually leads to a change in our gait or stride, and a breakdown of the good running form we have developed. In this way, our body often ‘overcompensates’, resulting in a secondary injury, usually on the opposite side of our body, resulting in multiple injuries with which to deal.
Many of our injuries result in swelling of joints—particularly ankles or knees. Minor injuries are usually effectively treated with ICE to reduce swelling and inflammation. Muscle soreness beneath skin level is often due to inflammation of muscles, tendons and tissues. Whether treating joints or muscles, ice is most effective in reducing swelling and inflammation when applied during the first 48 hours after the injury.
Recommended methods of icing:
- Lay an ice pack over the affected area, with a small towel between the ice pack and the skin for protection. This is referred to as ‘passive icing’ and an ice pack may be left on the affected area for 15 – 20 minutes. If you don’t have an ice pack, try using a bag of frozen peas or corn – which will mold to the area being iced.
- For lower leg (along shins or Achilles) soreness, a form of ‘aggressive icing’ can be used. When icing the area along a bone or big muscle group (shins, calves, quadriceps), use a small paper cup (easier to hold in your hand and the paper can be torn away as the ice melts), filled with water and which you have kept frozen in your freezer. Gently rub the affected area in circles, starting with a small circle and widening the circle for 5 or 6 revolutions, reverse the flow into smaller circles. Icing areas such as an Achilles tendon is a little different, and an effective technique is using two small ice cubes, applying one ice cube on either side of the Achilles, rubbing up and down the tendon from the heel to the lower calf. This method should be applied for approximately 30-45 seconds, and certainly no more than 2 minutes at a time, as prolonged aggressive icing can damage the skin and underlying tissues. Limit this exposure.
- Where possible, use a barrier between the ice and skin. A small kitchen towel or even a paper towel can reduce the effect of ice on the skin. Icing an area for too long can cause skin burns or damage tissue.
- Do not use any of these techniques to the point where the area becomes numb or burns. If these occur, immediately remove the ice.
When an area of our body is injured, blood flow to and around the area is affected as our body responds to the trauma. COMPRESSION helps circulation. Wearing compression socks or wrapping the sore area with an Ace bandage helps maintain good circulation and helps the healing process. If using an Ace bandage, do not wrap too tightly as this can reduce circulation, not induce better circulation.
Finally, ELEVATION of the affected area will help recovery. For lower body injuries, lay on a couch or bed, with the leg elevated at a level higher than your heart. Gravity helps remove excess blood accumulation around the injured area (a naturally-occurring protective mechanism in our body), moving blood into our torso and reducing inflammation and swelling from the injured area.
For minor injuries, R.I.C.E. is nice!
Always listen to your body and train safely.
BONUS TIP – RUNNING SAFETY (HEAT AND LIGHTNING)
We are into the toughest part of the summer months when heat and humidity in many parts of the country reaches dangerous levels. High temperatures and heat indices mean there is a significant danger to our bodies if we run too long in hot and humid conditions.
It takes about 14 days for our bodies to adapt to high temperatures and high humidity. During and after this adaption phase, our bodies can suffer significant and long-lasting heat related illness and injuries. To lessen or avoid heat illness or injury, do not run outdoors when the temperature or the heat index exceeds 100 degrees. Even at lower levels (in the 90’s) reduce exposure.
A few alternatives:
- first, run shorter distances or times thereby reducing your exposure to heat;
- second, run early in the morning (preferable as temperatures are usually the lowest in the early morning) or late at night – times when heat and humidity are lower;
- third, split your runs into two segments a few hours apart in order to allow your body to recover from heat stress.
If you notice signs of heat stress – lack of sweating, headaches, nausea or light-headedness, stop running and seek a cool place to cool your body temperature. IF this persists after your run, seek medical advice and do not run while these symptoms remain.
With the summer months, many of us live in areas where thunderstorms are routine. With thunder comes lightning. Lightning is a dangerous natural phenomenon and can be deadly. If thunderstorms and lightning are present, do not go outdoors for a run.
If you are on a run when thunderstorms or lighting occur, seek shelter indoors or under a concrete viaduct or similar structure. Standing under a tree is NOT a place to seek safety.
When lightning is present, after seeking shelter, do not resume you run for at least 20 minutes after you see lightning. Give at least 20 minutes to allow the lightning and the thunderstorms to pass. If lightning strikes or flashes again, the 20-minute timer goes back to zero and once again allow at least 20 minutes to pass before leaving shelter and resuming your run.
“Good form will carry you through”®