 Your child comes home limping from foot pain after a running
event. Do you (A) ignore it as long as they’re not complaining,
(B) make them feel better with some medication, or (C) rush them
off to the doctor? Is your answer “None of the above?” or
“Maybe” or “I’m not sure?”
Running is part of the training program for all sports. If your
child is in an athletic program, then they’ve probably had a
running injury at some time or another. Your young athlete may
tell you it’s nothing, maybe their coach pushed them to keep
running, or they simply didn’t want to let down the team.
Sometimes kids think the pain doesn’t matter and it will all go
away in a couple of days. Maybe it will, but maybe it won’t. As
a parent, it’s important for you to get involved.
You can help by following a few basic guidelines to (1) identify
the severity of a running injury and know when it’s okay for
your child to keep on running, (2) understand some basics of
home treatment, and (3) know when to seek qualified professional
help for an injury.
How Bad Is My Child’s Injury?
Running injuries can be complicated. There are over 20 different
types, most of which are caused by training errors that can be
corrected. When it comes to dealing with an injury; however, the
type of injury doesn’t really matter – what matters is the
severity.
Unfortunately, most parents (and even coaches) don’t know how to
evaluate the severity of running injuries. So, as a physical
therapist that specializes in running injuries, I developed a
useful scale for staging running injuries, increasing in
severity from Stage 1 to Stage 5.
Guidelines for Running Injuries
Here are some questions you can ask to help evaluate the
stage of your child’s running injury. Keep in mind, if
you are concerned, that it is always appropriate to
consult a qualified professional at any stage.
Question 1: Does your child have pain that continues as
long as they are running but stops when they stop
running?
Evaluation: Stage 1, pain upon exertion.
Action: This is the first warning sign of an injury.
Work with your coach and/or physical therapist to
determine the cause of the pain (such as training
technique or shoe problems) and correct it.
Question 2: Does your child have pain after they stop
running but then it goes away?
Evaluation: Stage 2, pain at rest, immediately after
exertion.
Action: This is the time to start injury management
using the PRICE method.
Question 3: Does your child have pain during normal
activities like walking, climbing stairs, or sitting at
their desk? Or is there some ache or nagging pain that
bothers them?
Evaluation: Stage 3, pain that persists during normal
daily activities.
Action: Monitor this closely – this should be of concern
if it doesn’t improve in a few days, or if it worsens.
Limit running and employ injury management techniques.
Question 4: Is your child taking any kind of medication
for pain, even an over-the-counter medication such as
aspirin, Advil, or Tylenol?
Evaluation: Stage 4, pain that they take medication for.
Action: This is a very important stage. Medication masks
the severity of an injury and allows it to get worse if
they keep on running. If your child is taking
medication, then they must cease running until it is out
of their system.
Question 5: Does your child have pain that stops them
from running or maybe even walking?
Evaluation: Stage 5, pain that is crippling.
Action: Stop everything and seek immediate professional
advice.
Any type of running injury can be staged this way.
Remember, even if your child is at Stage 1, pain-wise,
if they are taking any medication for it, then they’re
at Stage 4, which is one stage from crippling. |
 Stage 1: Pain upon exertion
Stage 2: Pain at rest
Stage 3: Pain that persists during normal daily activities
Stage 4: Pain that your child takes medication for
Stage 5: Pain that cripples your child
Stage 1 is the first warning sign. There is pain, but it stops
when they stop running. This is the time to look for a cause,
such as a shoe problem, and correct it.
Stage 2 is when pain persists for a short while after running
but then goes away. In addition to finding and correcting the
problem, this is the time to start injury management.
Stage 3 is when pain, even minor aches or discomfort, continues
throughout the day. In addition to injury management, persistent
pain should be closely monitored. If the pain doesn’t improve,
disturbs sleep, or interferes with daily activities, then it’s
time to seek professional help.
Stage 4, taking medication, is a critical stage. Note, even if a
runner is at Stage 1 based on pain level, if they take any pain
medication, including over-the-counter medication such as Advil,
then suddenly they’re at Stage 4 which is one stage away from
crippling. Pain that requires medication must be addressed
immediately.
Under no circumstances should you allow your child to take
medication in order to keep running, including prescribed oral
or injected medications. Coaches, and even doctors, may be
willing to give pain medication or cortisone shots and tell you
its okay to for your child to keep running. It is not.
Medication can mask the pain just enough to cause crippling. For
anyone running on pharmaceuticals or injections the finish line
is Stage 5.
Stage 5 is a crippling pain that keeps your child from running,
or maybe even walking. Crippling doesn’t necessarily mean
they’ll never run again. They could still recover from stage 5.
But they may not recover from stage 5. You do not want your
child to be at stage 5. Seek specialized professional help
early. |
Injury Management at Home: PRICE
 Home management for running injuries is PRICE: protection,
recovery, ice, compression, and elevation.
Protection means identifying and modifying the reason for the
injury. The main cause is usually training error, which is a
broad area and hard to define. The first thing to do is protect
the injured structure and allow it to recover. That could mean a
change in footwear, a modified exercise program, or resting.
Recovery is actively working to regain the normal function of
the injured structure and may include massage, rest, and a
modified training routine. It’s about moving from later stages
on the scale back to earlier stages and regaining movement,
strength, and function. It’s okay to train, as long as the
injury is improving.
Medication may be a part of your child’s recovery if their sleep
is disturbed and the medication is necessary for rest, but there
must be no running until the medication is out of their system.
Medication means Stage 4, and they can’t compete.
Ice means cold compresses. There’s a lot of discussion about
applying ice packs. I like to go 360 degrees around the
structure whenever possible.
Compression includes placing pressure on the injured structure
(ankle, shin, knee, or hip) by wrapping toweling around the ice
pack and using Ace bandages or Velcro straps.
Elevation means raising the injured structure above the heart –
so ice, compression, and elevation are combined.
|
When to Seek Professional Help
For runners, some pain upon exertion is not unusual, but if you
are concerned, then go ahead and take your child to a
professional for evaluation, even at stage one.
Seek professional help immediately if you encounter any of the
following warning signs:
• If your child is taking medication and continuing to run.
• If your child is being prescribed medication, or injected with
medication, and being told they are allowed to run.
• If your child is consistently having pain at rest or pain that
disturbs their sleep.
• If your child has pain that interferes with normal activities,
such as walking or climbing stairs, and pain continues for more
than a day a two or is worsening and not getting better.
Ideally, professional help means knowledgeable help by a runner
with licensed medical credentials. Most doctors and physical
therapists aren’t trained in running injuries, and finding a
professional with specialized knowledge isn’t always easy.
Beware of any doctor who prescribes medication, or injects
medication, and tells you its okay for your child to run.
Medication can never treat the cause of a running injury; it
only masks it and allows it to get worse. |
F.A.Q.s
Q: Can I give my child medication for pain?
A: Always consult your doctor about giving any
medication. The important thing is not to run while
taking pain medication.
Q: Does my child have to stop running?
A: Not necessarily. Its okay for them to run as long as
they are following their specific instructions for
protecting the structure and recovery, and their
condition is improving. (For example: changing the
shoes, doing less mileage, going slower, doing their
stretching exercises.) They can continue to train as
long as pain is not disturbing their sleep, they do not
progressively have to modify or reduce daily activities,
and they’re not using medication.
Q: Can the right shoes help protect my child from a
running injury?
A: Shoe problems are an avoidable cause of running
injuries. You can learn more about athletic shoes at
www.wilkpt.com/articles and at www.defectiveshoe.com.
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Staying Safe
As parents, it’s our job to watch over our kids’ health and ask
the right questions. Left to itself, any running injury could be
crippling. It doesn’t matter if it’s plantar fasciitis, shin
splints, or a stress fracture – taking Advil or receiving
cortisone shots from a doctor and then running can progress any
running injury from Stage 1 to Stage 5.
Remember, the first rule of management is protection. It’s
better to put a management system in place early (such as the
right shoes, exercises, or training routine) that can correct
the problem before it progresses to higher stages.
Catching problems early is the key. Running is an important part
of all sports, and making sure our kids are safe will keep it
fun!
Bruce Wilk is a board-certified physical therapist, a certified
running coach, and director of Orthopedic Rehabilitation
Specialists in Miami, Florida, where he has managed running
injuries for 28 years. He has 35 years of running experience,
including 23 marathons, four Ironman competitions, and many
triathlons.
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