Nearly every day, I have an injured runner call me for advice. So I thought it was time to share some of my rules when it comes to managing running related injuries(RRIs) in an effort to foster longevity in this great sport. These rules are based on my professional work as a physical therapist in conjunction with my successes and failures as an avid runner and long course triathlete.

1. FACE THE MUSIC – acknowledge the fact that you have an injury. Too often, I find that injured runners, who seek my physical therapy services, are in denial. Consequently, they do not
take the proper measures to address the problem, but rather make the situation worse or prolong it by trying to run through it. Poor decision making inevitably leads to further injury and time away from running. Let me remind you that one can never make performance gains in the context of injury.

2. ICE IS UNPLEASANT BUT EFFECTIVE – I always make sure to educate my patients on how to properly ice. I generally advocate putting crushed ice in a bag of water and drawing the air out so the ice pack easily conforms to the affected region. I also encourage my patients to secure the ice pack in a 360 degree manner if possible and to incorporate compression by simply using an ace wrap or velcro strap. Lastly, make sure to elevate the affected region to facilitate resolution of swelling especially in the case of injuries involving the lower half of the body. Ice should be applied for 10-15 minutes every hour.

3. PILLS & NEEDLES ARE NOT A SOLUTION – resorting to pills and needles is part of denial process. Do not take anti-inflammatory medication (NSAIDs) or opt to receive a corticosteroid injection to help you return to running! Neither will address the factor(s) driving the problem but will give you a false sense of being able to run. My general policy is that I will not work with a runner who has taken NSAIDs or received a corticosteroid injection for 24 hours and 3 weeks, respectively. As my friend Bruce Wilk (physical therapist and running coach) says, “If you want to blow up on a run, that’s fine, but not on my watch!”

4. PAINFREE DOESN’T MEAN READY TO RUN – a grave misconception among runners is that once their pain resolves, it’s OK to start running. Nothing could be further from the truth! This is particularly common following a “simple” ankle sprain, which is how the term “functional instability” came into existence. Freeman and Wyke coined this term in the1960s to describe a condition in patients, who had a normal clinical exam but continued to experience recurrent injury. Please take my advice on this one as I don’t want you to find out the hard way.

5. SINGLE LEG BALANCE AND PAIN-FREE WALKING ARE PREREQUISITES TO
RUNNING – I never cease to be amazed about how challenging it is for most injured runners to simply balance on one leg. This is possibly one of the most common impairments I see in patients suffering from RRIs. Poor single leg balance stems from an inability to stabilize the leg and manifests as a wobble and typically occurs at the level of the ankle, knee, and trunk. If a runner has difficulty with balancing on one leg on solid ground, running will be that much more difficult due to the increased forces and dynamic nature of the sport. Therefore, it is imperative to first restore single leg balance and
initiate a fitness walking regimen before progressing to a walk-jog and finally a running program.

6. SHOES ARE IMPORTANT – despite the hype surrounding barefoot running as well as the current medical research downplaying the importance of proper shoe selection, prescribing an appropriate running shoe is vital to safeguard against injury. Suitable running shoes should afford balanced cushioning for shock absorption and stability for abnormal movement. If you still insist on running barefoot, please make sure that you have good medical coverage in the event that you need a tetanus shot or antibiotics secondary to sustaining a cut and subsequent infection as these are real concerns.

Hope this information is helpful and keeps you running HAPPY, HEALTHY, and STRONG!

Yours In Sport

Chris Johnson