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“Medication
can never treat the cause of a running injury” |
Resources for treating a Running Injury - Miami, Florida |
Can I Run On This Injury?
Avoiding the Abyss: When runners should seek
professional help |
The
Wilk Scale:
5 Stages of Severity in Running Injuries |
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Pain upon exertion
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Pain at rest
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Pain that persists during
normal daily activities
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Pain that you take
medication for
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Pain that cripples you
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F.A.Q.s |
Q: How would you treat a patient with stage 3
injury differently than with stage 1?
A: If pain is disturbing their sleep, I’m
probably going to tell them to cease running
until they improve – you know, get some rest for
a couple of days.
Q: Do you tell all your patients to stop
running?
A: No! We’re telling them it’s okay to run as
long as they are following their specific
instructions for protecting the structure and
recovery. For example, changing the shoes, doing
less mileage, toning it down, going slower – if
they make the changes, that’s okay, they’re
protecting it.
And during recovery, if they’re doing their
stretching exercises and improving (going in the
other direction on the scale), we’re telling
them it’s okay. We’re telling them it’s okay as
long as it’s not disturbing their sleep, they’re
not progressively having to modify or reduce
daily activities, and they’re not using
medication.
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Running Shoes & Running Injuries |
Running brought me to physical therapy, physical
therapy brought me to triathlons, and running
injury brought me into studying running shoes.
Shoe problems are an avoidable cause of running
injuries. Around 1998 I got a pair of running
shoes that were defective and picked up an
injury (plantar fasciitis) while doing a race.
Because I was really able to identify a very
specific injury in my mind with a very specific
source, and a very specific pattern of shoe
defect, I did the research and started
publishing articles on running injuries and
defective athletic shoes.
As I researched it, I learned about the running
shoe industry – that’s when I opened up a shoe
shop for runners called The Runner’s High, where
runners can come in and get expert advice on the
right shoe for them.
You can learn more about athletic shoes on my
website
www.therunnershigh.com |
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I’ve seen runners crippled
by running on injuries. An injury that cripples
you, that’s the Abyss. It prevents you from
running, sometimes temporarily – sometimes
permanently. That should be a wakeup call for
all runners.
Here’s an example: While training for a marathon
in Miami, I was running with an acquaintance who
mentioned that her foot was bothering her. At
the time, I didn’t pay it much mind. Later,
during the marathon, she complained again and I
paid attention. When I spoke to her the next
morning, she was crippled with pain – she
couldn’t even walk. |
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What happened? I discovered that
she had been getting cortisone shots throughout
the course of her training program. She had gone
to a sports medicine doctor, a podiatrist, who
repeatedly injected her with cortisone and told
her it was okay to run.
At the time, she thought she was doing the right
thing. She knew the foot wasn’t getting better,
but she ran on it anyway. She got her last
cortisone shot on a Thursday, ran the marathon
on Sunday, and ripped her plantar fascia. It
took her four weeks to walk without crutches,
six weeks before she could work or exercise –
and she never ran again. She fell into the
Abyss.
Why do runners run on an injury? They don’t
perceive that it’s going to cripple them. This
woman would not have continued running if she
thought she was going to wake up one day and be
unable to care for her children, unable to walk,
unable to fulfill her responsibilities. No adult
would do that. They don’t know they can risk
everything by taking pain medication in order to
race. They don’t know they can fall into the
Abyss.
It doesn’t have to end up that way. You can
avoid the Abyss by understanding and following a
few basic guidelines for identifying the
severity of an injury, knowing when it’s okay to
run, and when to seek qualified professional
help.
How Bad Is My
Injury?
Running injuries can be complicated. There are
over 20 different types of running injures,
including plantar fasciitis, shin splints,
Achilles tendinitis, runner’s knee, and
iliotibial band syndrome. Most are caused by
training errors that can be corrected.
When it comes to deciding whether or not to seek
professional help, however, the type of injury
doesn’t really matter – what matters is the
severity.
Unfortunately, most runners don’t know how to
rate the severity of running injuries. So, over
the years, I’ve developed my own practical scale
of factors, increasing in severity from stage 1
to stage 5.
Stage 1 is pain upon exertion. It might be a
pain that comes after 10 miles, or after one
mile, and continues as long as you are running,
but stops when you stop running – this is the
first warning sign of an injury.
Stage 2 is pain at rest. The pain is there after
you stop running, and it does not go away – this
is the time to start self managing.
Stage 3 is pain that persists during normal
daily activities, like walking to the car, or
walking up steps. You may be sitting at your
desk and have some ache or nagging pain that
bothers you. Pay attention, if it doesn’t
improve in a few days, or worsens as you do your
self management, seek professional help.
Stage 4 is pain that you take medication for.
This is a very important factor. Medication
masks the severity of an injury and allows it to
get worse if you keep on running. If you are
taking medication, you must cease running until
it is out of your system. At this stage, you’re
on the edge of the Abyss. You must stop running.
Stage 5 is pain that cripples you. It stops you
from running, or maybe even walking. That’s the
Abyss.
Any type of running injury can be staged this
way. When a patient calls me with an injury, I
start to stage it over the phone. For example,
the patient might say, “Bruce, I’m training for
a marathon, and at ten miles my foot is killing
me – I can’t get past ten miles.” I ask him, do
you have pain when you stop? He says, no, it’s
okay. I ask him if he’s having pain that
interferes with daily activities. He says no,
when he stops it’s okay. I ask if he’s taking
any medications, and he says no, he’s not taking
anything. That’s stage 1.
Note that, even if a runner is at stage 1,
pain-wise, if they’re taking any medication for
it – suddenly they’re at stage 4, which is one
stage from crippling. Say you take Advil, and
keep taking Advil, you need to address that.
With pharmaceuticals or injections, if one keeps
running, the medication could mask the pain just
enough to cripple you.
I want to make it very clear that at stage 4, if
a patient insists on taking medication to keep on
running, including prescribed oral or injected, I can’t
help them. In my professional practice, that’s a deal
breaker. I have patients who say “Oh, it was prescribed,
my doctor said it was okay.” Well, if you’re going to
run on cortisone |
shots, I say you’re out of
here. I don’t want anything to do with it. You’re not
going to stage 5 on my watch.
Again, the type of running injury is not a
factor when deciding whether or not to seek
professional help. Any running injury can go
from stage 1 to stage 5. Sometimes runners think
oh, it’s just muscular shin splints; that’s not
so bad. Then they start taking Advil and keep
running on it, or go to a doctor and get
cortisone shots and keep running on it. That
injury can go to stage 5 – and when one is
crippled, one is risking not coming back. You’ve
fallen into the Abyss.
Self Management
The self management for running injuries is
PRICE; protection, recovery, ice, compression,
and elevation.
Protection means identifying and modifying, as
well as you can, the reason for your injury. The
main cause is usually training error, which is a
broad area and hard to define. The first thing
you do is protect the injury and allow it to
recover. That could mean a change in footwear,
or modifying your exercise program, or resting.Recovery is about moving from later stages on
the Wilk Scale back to earlier stages, regaining
the movement, strength, and function of the
injured structure. One can still train, working
to regain movement and strength, as long as it’s
moving back. Massage could be part of it. Rest
could be part of it. Modifying your training
could be part of it. But it’s actively working
to regain the normal function of the structure –
not passive.
Medication can be a part of recovery if one’s
sleep is disturbed and medication is necessary
for rest – but there must be no running until
the medication is out of your system. You’re at
stage 4 now, and you don’t compete.
Ice means cold compresses. There’s a lot of
discussion about applying ice packs. We go 360
degrees around the structure whenever possible.
Compression: We compress the ice pack. We put
toweling around the ice pack and put pressure on
the injured structure (basically ankle, shin,
knee, or hip) using Ace bandages or Velcro
straps.
We then elevate the injured structure above the
heart, so ice, compression and elevation are
combined.
When to Seek
Professional Help
When you are a runner, pain upon exertion is
kind of always there, to a greater or lesser
degree. It’s okay to run some, but we have to
keep our eyes open. My rule of thumb is, if
you’re concerned, you should come in, even at
stage one.
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.
Seek professional help immediately if you
encounter any of the following warning signs:
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If you are taking medication and continuing to
run.
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If you are being prescribed, or injected
medication and being told you are allowed to
run.
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If you are consistently having pain at rest or
pain disturbs your sleep.
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If you’re having pain
that’s interfering with normal activities
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If you’re having trouble walking, if you can’t
take the stairs and it continues for more than
a day a two, or is worsening and not getting
better.
Professional help often 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
easy.
If you are going to a doctor who prescribes
medication, or injects medication, and tells you
its okay to run, that’s not professional help.
In my world, that’s just wrong. Medication can
never treat the cause of a running injury; it
only masks it and allows it to get worse if you
continue to run. You can be crippled. Even if
you’re only taking Advil, it may mask it enough
for you to lose daily function.
Most adults are going to limit their running and
employ self-management techniques early enough
to prevent loss of daily function. When they
don’t, the things to worry about are pain during
daily activity, taking medication, and becoming
crippled.
Staying Safe
Left to itself, any running injury could be
crippling. We’re not talking about post-marathon
sore – we’re talking abut the inability to live
your responsibilities or meet your commitments.
It doesn’t matter if it’s plantar fasciitis or a
stress fracture, if it cripples you, you might
not come back. It’s not worth the risk. Even if
you’re crippled for a week, who wants to be
crippled?
Crippling doesn’t necessarily mean you won’t run
any more. One could still recover from stage 5.
But one may not recover from stage 5. You do not
want to be at stage 5. Please seek specialized
professional help early, and avoid the Abyss.
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 27 years. He is
also an experienced runner who has been running
for 35 years, including 22 marathons, four
Ironman competitions, and many triathlons. |
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