Since 1982 I've written a newsletter, Running Commentary. A new issue appears here each week, and material is archived.

Thu, 17 Apr 2003 10:10:52 -0400

Do-It-Yourself Doctoring


I'm not a doctor, but I often play one in my working life. Questions about running medicine come my way almost every day. I decline to guess at specific diagnoses and plead ignorance to medical treatments, despite having soaked up a little medical knowledge from editing the books of four different doctors.

But I do talk in general terms about getting hurt and getting well. In that area I am an expert, having done both so often myself. This I can tell you about suffering and rehabbing injuries:

-- They are likely, if not inevitable. Almost everyone who runs gets hurt eventually, and almost everyone gets better soon.

-- They are minor. Seldom do these injuries interfere with normal life, or require a doctor's help, or extensive and expensive care.

-- They are self-inflicted. Usually they result not from "accidents" but from the Big Four mistakes -- running too far, too fast, too soon, too often.

-- They are self-treatable. Usually they respond quickly to simple adjustments in training type and amount.

-- They allow activity. If it isn't reduced running, then it can be an agreeable alternative.

This leads to an illustrative story about a young friend of mine named Amanda. She jumped up her mileage too quickly this winter and suffered a suspected stress fracture in her upper leg.

The doctor said Amanda would need a bone scan to confirm these suspicions. "How much will that cost?" she asked.

When she heard an amount that would cut too deeply into her student budget, she said, "And if it is a stress fracture, what will the treatment be?" No cast, no medicine, just no running for at least six weeks, she was told.

Amanda decided she didn't need a definitive diagnosis. She already wasn't running, but was substituting water-running while the leg recovered. She was practicing a do-it-herself doctoring plan.

(This plan worked. Six weeks after first feeling the injury, Amanda began to run again. A month after that, she was back to her pre-injury pace.)

Let's say an injury has knocked you off your feet. A doctor can only diagnose why you're hurting and suggest what to do about it. YOU are responsible for your rehab.

Your best friend now isn't a medical professional; its your own pain. It tells you what you can and can't do while recovering.

Whatever the specifics of what ails you, there is a path back to health that lets you heal and still stay active, fit and sane. Choose your level of activity according to the severity of symptoms, then work up through these steps of rehab:

1. If walking is painful and running is impossible, bike or swim for the usual running time periods. These activities take nearly all pressure off most injuries, while still allowing steady effort.

2. If walking is relatively pain-free but running still hurts, start to walk as soon as you can move ahead without limping or increasing the pain. Observe these two warning signs at all stages of recovery.

3. If walking is easy and some running is possible, add intervals of slow running -- as little as one minute in five at first, then gradually building up the amount of running until you reach the next stage.

4. If running pain eases but minor discomfort persists, the balance tips in favor of running mixed with walking. Insert brief walks at this stage when you can't yet tolerate steady pressure. Many injuries respond better to intermittent running than to the steady type.

5. If all pain and tenderness are blessedly gone, run steadily again. But approach it cautiously for a while as you regain lost fitness. Run a little slower than normal, with no long or fast efforts until you can handle the short-slow runs comfortably.

Stretching and strengthening exercises? Again, let pain be your friend and guide. Exercise too violently, and you can set back the healing.

Run on soft surfaces? They aren't as soothing to sore legs as they may seem. Uneven ground causes twisting that can cancel the benefits of softness, so choose a smooth, flat running surface during recovery.

Also it's good to repeat yourself at this stage. Run laps instead of a single big loop to give yourself a place to stop a run early without being miles from home.

A patient patient knows when to stop. Cutting short a run during rehab isn't a sign of weakness but of wisdom.


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