No two injuries are the same and I can’t possibly distill a three year degree and sixteen years’ experience into a single article. So, let’s look at the most common kind of sports injuries and the key principles of rehab that will help you take care of your running rehab. We can do all the injury prevention in the world, but some injuries are unpredictable and unavoidable. Collisions, accidents like a fall or crash are extrinsic factors largely outside of our control. All kinds of tissues can be involved and the rehab is highly complex. Another source of injury is intrinsic in nature, involving a sudden muscle tear or gradually increasing tendon problem. Here, we will deal with sport rehab of intrinsic injuries. It is always advisable to see a trained Sport Rehab professional, but here are the key principles in dealing with your muscle or tendon injury. In running we are most likely dealing with an achilles tendon pain, calf muscle strain, anterior (front) knee pain or a hamstring strain. You can apply this approach with equal effectiveness to a hip flexor, quad or glute muscle strain.
First 48 hours
So, you pulled a muscle during a training session or you have woken with severe tightness or pain the day after a race. What do you do? If it feels different to the normal soreness (DOMS) from training then you need to take action.
Rehab starts with first aid. The first 48 hours are when the natural process of inflammation does its thing. This is the first stage of healing and should be respected. Here is how to apply the traditional PRICE principle in the modern day.
Protection – protect the area from movement and activities that cause pain.
Rest – avoid using the affected area wherever possible.
Ice – apply regular quick ice treatments of just 10 minutes to help with your pain. Wait thirty minutes before reapplying.
Compression – an evenly applied compression garment or tubi-grip can help comfort and contain any swelling. Remove at night.
Elevation – raise the affected area above your heart to aid the return of blood and swelling from the area.
As a rule, I advise abstinence from alcohol at this time and throughout rehab to aid healing and avoid slowing your recovery.
After 48 hours, you’re straight into safe and therapeutic movement. No time wasted. This minimises loss of strength and mobility and gets you moving forward in your physical rehab. As a rule I like to use the Personal Pain Scale to know how much pain is acceptable. Where zero is no pain at all and ten is the worst imaginable pain, I like to promote good quality movement up to and including two out of ten.
Personal Pain Scale
(zero is no pain at all and ten is the worst imaginable pain)
It’s the Goldilocks effect. Totally avoiding all pain may slow your recovery. Pushing pain higher than recommended will disrupt your recovery by causing further tissue damage. Hitting the sweet spot and exercising at two out of ten gives you enough stress to encourage tissues to get stronger without causing damage. In some cases static activities are all you can tolerate and other times more movement or “loading” is tolerable. Early exercises should have the end of the limb (ie. foot or hand) staying in contact with the floor where possible, as in the example below. Other times a combination may be necessary as in an early hamstring programme with prone straight leg raises as well as the bridge exercise.
Sample Exercise Protocol – Moderate Calf Strain
Complete four different exercises consisting of straight knee calf raises, bent knee calf raises, single leg calf raises in both bent and straight knees.
Perform twelve to fifteen slow repetitions.
Rest for two to three minutes between sets.
Complete four sets per exercise.
Do this three times a week on non consecutive days.
Progressing Your Rehab
Referring to your Personal Pain Scale will help you to know when to apply additional load to your exercises. If an exercise no longer hits 2 out of 10 you need to make it harder. This may take the form of resistance bands or light free weights. In the absence of these, you may do each repetition more slowly or reduce the duration of your rests to challenge yourself.
Sport Specific Exercises
Once saved for late stage rehab, I like to tailor a person’s sport rehab to their sport and event as early as possible. So, start thinking about the demands of your event and apply the principles you’ve learned to create new drills. If you are a fell runner or steeple chaser, you need to look particularly at balance and agility. Take your early exercises and add elements of balance and stability like wobble boards or simply balancing (carefully) on your foam roll. Perform a hamstring bridge on your foam roll or with your feet on a ball. Find a way to perform your exercises on a slope or ramp to mimic a hillside or the camber of an indoor track.
Soft Tissue Treatment
Soft tissue treatment is absolutely brilliant for accelerating and improving the outcome of your sport rehab. I use a combination of traditional sports massage and IASTM (instrument assisted soft tissue manipulation) to help reduce tenderness, accelerate tissue maturation and toughness and significantly speed up recovery.
When to Start Running
Use your Personal Pain Scale when returning to walking. When you can tolerate walking well, adding some faster walking that does not cause pain during or after exercise. I like to programme on-the-spot-drills like rapid tip-toes, mini jumps and running on the spot to get ready for a return to running. If this doesn’t cause pain during or afterwards, you may try some run-walk workouts. At this point, I set workouts using time rather than distance. Start by walking for twice as long as you run. For example; warm up with a ten minute walk of increasing speed. Run easy for two minutes, walk for four and repeat. Cool down and stretch off as you would for any run. Monitor your reaction over the next 48 hours. Consider doing it again after 48 hours. Listen to your pain to guide when to run for a little longer. Avoid the temptation to replace rehab with running.
Keep doing your rehab and check in regularly with your sport rehab professional. Read about injury prevention HERE and you may not get injured at all.I hope you find this helpful, please leave your feedback in the comments below. I wish you well in your rehab and your running.