Monday, 12 November 2012

It's such a PAIN not being able to run!

It's such a pain not being able to run when you are injured, especially if you are training for a race. So is there anything you can do to get back running pain free? Are there things you can do that will prevent the pain returning? And how do you know when to stop?
In the late 70's and early 80's there was a buzz phrase "No pain, No gain" which is now know to be untrue. There are plenty of gains from exercising in a pain free zone and I would promote all training at a beginner and intermediate level to be performed pain free. However there are times at an advanced level where you might need to push into a slightly painful environment in order to maximise the power output you are training towards. It's during these small periods where you must "Know pain, Know gain" as recommended by Lorimer & Mosley (both are Australian neurologists that specialise in Pain) in order to avoid injury. 
If you are a runner or triathlete who feels they are unable to train due to injury then perhaps you need to think again. The following information is in direct relation to a person who is suffering from a mechanical injury resulting in pain. This type of injury really should have aggravating and relieving factors, it should also respond to NonSteroidal Anti Inflammatory Drugs and/or pain killers. If the condition is of pathological origin then the following principles may not apply to you so easily.  
As we have seen in the entry "What does it mean when I am injured?" the body becomes injured and the symptoms of pain appear when you have reached the limit of adaptation. You body is failing to function within its usual capacity, you are still asking it to continue as before, eventually some structure will break, which is why you get the pain and dysfunction. Structure and function are completely reliant on each other. If the structure fails (let's say tendinitis, muscle strain, ligament sprain or fracture) then the function of that body part will fail too. 
To give an example, imagine how your calf muscle would feel the day after a training session that involved 20mins running uphill. If you were not used to this sort of training the calf muscles (gastrocnemius and soleus) would have micro tears in the muscle fibres and the cling film (fascia) that supports them. These micro tears will not allow the muscle to contract quite as smoothly as usual, which means when you require these muscle to function during an activity like walking they can't because the structure has changed (micro tears) and you need to adapt by walking funny. After a few days, so long as you don't continuously over stretch the muscle (maintaing factor) the micro tears will repair and the function will be restored. But on some occasions the causation and maintaing factors may not be that easy to recognise so the pain and dysfunction lingers, perhaps for a few months. The function can not be restored unless the structure is repaired. 
The first thing for anybody to do that has an injury is to try and identify the initial cause, the specific injury and the maintaining factor if it's not getting better. It is essential to know what caused your injury and what is maintaining the injury if you are to recover. If you have no idea, I would suggest seeing an Osteopath or another manual therapist to discover this. Our bodies have a fantastic mechanism to repair themselves but sometimes the surrounding factors of the adaptation failure (work stress, family demands, training goals, infections, poor diet among other things) prevent this repair process. An osteopath or manual therapist may guide the body back onto this path of repair in order to achieve a speedy or full recovery. 
Assuming you know the causation and maintaining factors, you need to first address these. You need to discover the amount of function you have available in the affected area and you need to stress this in a pain free manner if you want to recover. Pain is a subjective experience which means your pain experience is completely different to anybody else's. How you feel about and respond to pain is determined by how threatening the cause is to you. One of the biggest barriers to recovery from pain is fear avoidance. 
If you really enjoy running but have stopped due to pain and injury. You need to discover if there is any amount of running you can do without pain. Even if it's only 5-10 mins it is very important to do this so long as there is no pain. A complete avoidance of the activity (running, cycling) when you have the capacity to do a small amount without pain is going to stand as a barrier to your recovery and prolong you pain perhaps for months. 
If you run with a club or a group you are probably used to socialising after the run with a coffee or refreshment. I would suggest doing the 5-10min run (or whatever you can manage pain free) followed by joining the group for the social aspect, this you will find goes a long way to over coming the fear avoidance and will keep you motivated to make a speedy recovery. Avoiding running and missing out on socialising with your friends will allow you to focus more on the pain and your inability to run. This will make it more and more difficult to perform the function even if the structural damage is repaired and the function is available. 
If you do this you will discover very quickly that you can do a little bit more each time with out having any pain. However if there is pain it is advisable to stop, continue the techniques you are using to rehabilitate the problem (strapping, ice, heat, manual therapy) and then continue try to maximise the function at the next available opportunity. 
Once you are fully recovered you can combat re-injury by staying aware of the initial causation factor and by not allowing the maintaining factors (whatever they are) to prevent structural repair. If you feel the area becoming symptomatic follow the appropriate guidelines set out by your Manual Therapist, address the cause and continue running if possible. Remember "know pain, know gain", you will know your body and it's limits better than anybody else. If you feel damage is being done then stop immediately, if you feel pain but are still within your functional limits perhaps you can do a little more. Always run sensible.