Run Well

by Juliet McGrattan

  When the acute pain has eased, start gently stretching and moving the injured area. If you’ve had a sprain, particularly a severe one, then you would benefit from seeing a physiotherapist to give you specific exercises to help strengthen the area and guide you back to running. You shouldn’t even consider running until you are pain free and can walk normally without discomfort. When you do restart then build up very gradually and be guided by how the injury feels. Any aching, twinges or increased swelling suggests you might need to cut back a bit or rest for a while longer. Patience is key!

  TRY THIS

  AT HOME

  Using PRICE

  Serious injuries where you’re unable to weight-bear, clearly have a broken bone or are in a lot of pain obviously need urgent medical assessment. Sometimes, however, you aren’t too sure of the severity or you’re confident that it’s a more minor injury and you want to treat it yourself. In this situation, follow PRICE for strains and sprains to reduce pain and help healing:

  Protect Prevent any further injury to the area. Don’t try to carry on running. Phone for a lift or get assistance from a fellow runner.

  Rest Don’t use the injured area. Use pain as your guide. If it’s hurting then don’t do it!

  Ice Apply cold packs or ice to the area. Don’t put ice directly against the skin. Always wrap it in fabric such as a tea towel to prevent skin damage. Apply it for 15 minutes every two hours. Avoid applying heat to the area for 72 hours.

  Compress Gently squeeze the injured area with a bandage. You can buy tubular elasticated bandages from the pharmacy. They’ll advise you as to which size and compression strength you need. Take them off at night. Don’t massage the area in the first 72 hours as it may increase the swelling.

  Elevate Injured tissues swell as fluid accumulates and this can cause pain. Let gravity help you and keep the injured area raised. This may mean putting your ankle up on a chair so it’s higher than your hip or wearing a sling for an injured wrist.

  Use PRICE for three days, but if you aren’t getting relief, the pain and swelling is increasing and you suspect more than just a sprain or strain, then get a medical opinion.

  Q What painkillers are best for runners?

  A When rest and ice aren’t giving you enough relief then you can reduce pain with an analgesic (painkilling medication). The safest one to use is paracetamol. Most people don’t realise that paracetamol has some anti-inflammatory actions as well as directly reducing pain. The dose for adults over 50 kilograms is 1 gram (two of the 500 milligram tablets) up to four times a day. You should leave a minimum of four to six hours between doses and not take more than 4 grams (eight tablets) in 24 hours. There aren’t many medical situations where paracetamol is not advised, but they include liver damage from alcoholism, long-term liver disease and interactions with some epilepsy and cancer medications. It’s safe to take paracetamol on an empty stomach, making it a good choice for injuries during running when you may not have eaten for several hours.

  The other common analgesics that you can buy over the counter are Non-Steroidal Anti-Inflammatories (NSAIDs). The most frequently used is ibuprofen. NSAIDs mainly work by reducing inflammation, which is an effective way to reduce pain from inflamed and swollen tissues. However, there is now an opinion that using NSAIDs within 48 hours of an injury might slow down the healing process. The thinking is that the body intentionally activates inflammation to draw cells and fluids to the area to promote healing. Disrupting and preventing this may slow recovery. So paracetamol seems the best option in those first few days.

  There are also quite a few cautions that need to be considered with NSAIDs. Check with your pharmacist or doctor whether you can use them if you have ever had stomach ulcers, allergy to aspirin, asthma (they can provoke an attack in some people), heart disease, kidney disease, inflammatory bowel disease, are breast feeding or are taking any medications that thin your blood, such as warfarin. You should not use ibuprofen if you are pregnant. The usual recommended dose is 200 to 400 milligrams three times a day. It’s best to avoid taking it on an empty stomach. Anti-inflammatories can also be given locally, through a cream or gel which is rubbed into the skin. This doesn’t reduce the risk of all side-effects or cautions, because the active ingredient is still absorbed into the bloodstream (see here).

  Did you know?

  Swelling after an injury isn’t all bad news. In the first 48 hours the body intentionally causes inflammation in the damaged area. The extra tissue fluids immobilise the joint and restrict its movement, which allows healing and protects it from further injury. The fluids are also packed with cells brought into the area to stop further bleeding from torn blood vessels, to remove waste products and debris, and to stimulate growth and regeneration.

  Q Why do I keep getting injured?

  A Are you one of those unlucky people who seems to move from one injury to another, doesn’t ever get a long stretch of training and has DNS (Did Not Start) recorded on multiple races? Is it all down to luck? Why do some people get injured all the time and others never seem to? There are multiple things to consider when it comes to recurrent injuries. Genetics and susceptibility to injury is one of them. We can’t change the genetic code that determines the exact make-up of our bones, tendons, cartilage and muscles. There are professional sports teams who do use genetic information to tailor individual training programmes, so who knows, in the future there may be similar options for recreational runners. In the meantime, and more importantly, there are many factors that we can change and influence to reduce the risk of recurrent injury. Here are some reasons why you might be repeatedly getting injured. It’s easy to see how you can correct each one:

  • Returning too soon after injury Repair may take longer than you think and even when a muscle is pain free and functioning normally, it is still healing. Rushing back and picking up where you left off leaves you vulnerable to further injury. Be patient and take rehabilitation seriously.

  • One thing leads to another Having an injury alters the way you run, walk and generally hold yourself. This can put strain on other parts of your body, making them injury prone. For example, a knee injury might result in a foot or hip injury on the other side of the body. Get significant injuries diagnosed and allow adequate recovery time.

  • Ignoring niggles It’s tempting to just keep running. After all, you can’t stop with every little twinge. However, if you’re someone who always turns a blind eye to low-grade pain and aches then it’s sensible to listen to your body, take two or three days off and then return with a lower running intensity and distance to see if they persist. Get assessed if they do.

  • Underlying weakness It might be that you have weaknesses in your body that aren’t apparent in everyday life, but when the extra load of running is added they become significant. This can result in poor running technique. Weak glute muscles from a sedentary lifestyle, for example, leave you at increased risk of multiple injuries, including Iliotibial Band Syndrome (see here). A physiotherapist assessment will pick up any weaknesses and can direct strength training.

  • Inadequate warm-ups The jury is out on how much warming up influences injury risk, but if you’re someone who gets multiple injuries and skimps on warm-ups then it’s definitely worth changing your routine to see if it helps.

  • No variation in training An interesting 2016 study of marathon runners found that regular interval training may reduce the risk of injury. Consider varying your training plan to include intervals as well as strength work and cross training.

  • Lack of recovery time Not allowing your body sufficient time to recover from training or increasing the load too rapidly could leave it susceptible to injury. Recovery time increases with age, so consider adding an extra rest day into your week and always increase training loads gradually.

  • Lifestyle issues Sometimes it’s not the running, it’s everything else! Are you getting enough sleep? Are you stressed? Is your diet poor? All of these factors have a role to play in how your body cope
s with a training load. If you’re stressed, sleep deprived and eating junk food, it’s going to be hard for adequate recovery and repair to take place. Always look at the bigger picture.

  Real-life runners

  There were times when I would despair with the injuries. It seemed unfair when I was trying to improve my health and wellbeing yet was just ending up crocked! I also know that I should have listened to my own body and not been driven by my own obsession to absolutely always complete the distance my plan said. I fundamentally compromised my Dublin Marathon 2020 by pushing my last 20-mile long run when I should have stopped. I did finish the marathon, but tapering for it was basically no running and investing in massage, a chiropractor and anti-inflammatory gel!

  Mike Whelan, runner and Leinster Rugby fanatic

  Q How quickly will I lose my fitness when I’m off ­running?

  A It’s so frustrating to be injured or ill and you can almost feel your fitness draining out of you with every day that passes. Studies on this topic, which is called detraining or deconditioning, are pretty mixed and each person will have an individual response to time away from running. The good news, however, is that if you are a regular runner, although your aerobic fitness initially drops quite quickly, after a few days of inactivity it levels off and doesn’t just keep going down and down. It won’t fall back to that of an inactive person, which gives you a higher baseline fitness. You’ll lose fitness more slowly than a more inactive person too. There’s also the bonus that you will bounce back to fitness more quickly. It’s worth also considering your structural fitness, meaning your muscle strength. This declines more slowly than your aerobic fitness, but to prevent injury it’s important to build it back up prior to returning to running.

  Some encouraging news for those that are currently side-lined is to know that you can maintain the majority of your fitness with as little as one high intensity work-out a week. This is a good reason to do whatever exercise you can. For example, if running is out then a swim or some time on the static bike will benefit you. Don’t forget you can do some form of core work or strength exercises while injured to maintain your structural fitness. In summary, with a good baseline fitness and a consistent training habit, a week off due to illness or injury isn’t going to be much of a problem. More extended time away can be counteracted by keeping up some form of maintenance activity and knowing that you will return to fitness pretty quickly when you are ready to.

  Q How many rest days do I need each week?

  A This is often a case of trial and error. While some people can get away with a running streak of a year or more, there are those who need frequent days of rest. There are a few factors to consider, your running experience being one of them. Beginners who set off with great enthusiasm and run numerous times a week can quickly become injured, whereas a seasoned runner could easily cope with the same frequency. Recovery days in those early stages, while the body adapts to running, are essential. Adaptation and repair takes place when you rest. An overnight sleep may be enough for some bodies to go through this process, but others require longer. Our repair processes slow down as we age and it’s not uncommon for older runners to feel they need more recovery days than when they were younger.

  Obviously, how much you push yourself will affect your need for recovery too. A gentle 5km won’t need as much recovery time as running a marathon PB. It’s best to take an overview of your training. If you’re remaining well, enjoying your running and making any gains that you want, then your recovery is probably adequate. If you’re new to running, finding runs harder than you feel you should, or are really cranking up the frequency or intensity of your running, then it’s advisable to factor in at least one or two rest days a week. Recovery is an important part of training so should not be associated with guilt.

  Did you know?

  Between 37 per cent and 56 per cent of recreational runners who train regularly and run the odd long-distance race will get injured each year.

  Running and food

  Q What’s the best diet for a runner?

  A There are emerging, widespread and well-advertised benefits to certain diets. Some runners following vegan and LCHF (Low Carbohydrate High Fat) diets report increased endurance capacity, quicker recovery times and easier weight maintenance. The research is growing, but can be contradictory. It is a very confusing time for the general public when it comes to diet and nutrition, with much conflicting advice. I don’t feel this book should tell you what you should be eating. It’s a very personal thing. As a runner, the best diet is the one that works for you; one that gives you enough energy to fuel your runs, that allows you to improve as a runner (if that is your goal) and supplies the nutrients your body needs to repair itself; one that keeps you healthy, that’s practical and affordable for you and that sits comfortably with your own environmental conscience. It should give you pleasure too. If you’re ticking all those boxes, then that’s perfect. If not, then it’s up to you to look at alternatives and make adjustments. It’s just important to know that you can’t put rubbish in and expect excellence out. If your diet is poor, for whatever reason, then there is lots of unleashed potential that you could gain from, both in terms of your running and your general health, so be pro-active, and explore your options and what might work for you.

  Q Why doesn’t running help me lose weight?

  A Many people start running thinking that it will be a good way to lose weight and the majority are disappointed. While for some running can result in shedding pounds, for others it actually results in weight gain, which can be incredibly frustrating and disappointing. The first and most important point is that if you have increased your fitness through running and become more active than you were, then you have improved your health, regardless of what the scales say. Yes, some of the benefits of exercise come from losing weight, but many of them are completely independent. Using weight loss as a marker of your fitness gains is not a good idea. By increasing your activity levels you will have boosted your muscle mass (which may be responsible for some of your weight gain). This results in an increased number of myokines, which are released from muscle during exercise and have an anti-inflammatory effect in the body, reducing the risk of many serious medical conditions, such as type 2 diabetes and cancer. By exercising more you will have also reduced your visceral fat. This is the harmful fat around your internal organs and it causes inflammation in the body. It is responsive to physical activity and by lowering the amount of it you will again have reduced internal inflammation and improved your health.

  So running can build muscle, which may make the scales read higher, and it can also make you really hungry. It’s so easy for the overwhelming hunger that strikes after a run (also known as runger) to result in larger portions, extra carbohydrates and multiple snacks. The cravings are real! It’s also easy to overestimate how much you’ve burned off during a run (approximately 100 calories per mile) and even easier to overcompensate with food. The same can be said for activity levels. Knowing that you have been for a run can lower the amount of exercise you do during the rest of the day – you may feel you’ve earned the right to lie on the sofa for the rest of the day. This may be a subconscious behaviour, but it still leads to using fewer calories and weight gain. Don’t forget that if you’re using sports gels or drinks they will contain additional calories that are easily forgotten. In fact, you may return from a run without a calorie deficit at all. It’s common to see some weight loss initially, but then it may plateau and even increase over time. This can be a result of the body adapting and becoming more efficient at using fuel, resulting in a slower metabolism. Throwing in some high intensity work and building muscle can help to counteract this. The moral of the story, though, is to be wary of what the scales tell you. Judge your fitness and body by how you feel and look, and find your own balance between running and eating.

  Q I run every day and train hard but my running isn’t going very well at the moment. I eat really ­healthily because I don’t want to
become overweight but I’m ­conscious I might not be eating enough for all the ­exercise I do.

  A Whatever your size, if there is a mismatch between the energy you are putting into your body and the energy you are expending, then this can potentially cause problems. There is a fine balance needed to remain healthy. You may have heard of the term RED-S, which stands for Relative Energy Deficiency in Sport. This is used to describe a situation where disordered eating results in a negative energy balance and subsequent health consequences. Disordered eating includes specific eating disorders such as anorexia and bulimia, but also includes any poor relationship with food leading to eating habits that don’t provide the body with enough energy for training and for basic bodily functions. Clearly, low energy availability will impact running performance, but RED-S is more serious than that. The body starts shutting down some of its normal functions to conserve energy. Many systems will be affected. The most significant for women is the fall in oestrogen levels, resulting in amenorrhea (a lack of menstrual periods) and osteoporosis (low bone mass). Amenorrhoea (see here) can lead to fertility problems. Osteoporosis leaves people susceptible to bone fracture and collapse. The combination of an eating disorder, osteoporosis and amenorrhoea used to be called the ‘female athlete triad’, but we now use the term RED-S because we realise that any type of disordered eating is significant. The consequences are much more widespread than just bones and periods, and men can be affected too. People with RED-S often underperform and are at high risk of injuries. There can be disruption of digestion, mood, the immune system and also negative effects on the cardiovascular system.