Marathon Training Program:
Injury Treatment Approaches

mrt_13.jpgIt is beyond the scope of this web site to discuss in detail the nature and treatment of most running injuries. It is also difficult to provide detailed information about the treatment of specific injuries without knowing the symptoms. Whenever you are in doubt about the nature and extent of pain you are experiencing or if you suspect you may be injured, always check with a physician who specializes in running and sports related injuries for further guidance. Included below are some helpful pointers to consider when you think you may be injured. Of course, the best approach is to train intelligently to reduce the possibility of injuries from occurring. Refer to the sections on Getting Started – Training Basics and How to Avoid an Injury for more information. Unfortunately, there are times when even the most prudent runner who follows all of the training advice still incurs an injury. By following some of the suggestions below, minor injuries can be treated with no further damage occurring.

General Guidelines

Should you continue to run when experiencing discomfort and/or if you think you may be injured? That depends upon several circumstances. You can give it a try as long as you are able to run at a level of intensity below the threshold of pain. However, do not alter your normal running stride or foot strike to avoid pain. Doing so will greatly increase your chances of incurring a secondary injury (described below).

When an injury occurs, reduce your mileage and its
related level of intensity until you can resume running without pain.
However, do not take medications or ice an injury before testing to see
whether or not you can run. If you notice that your injury remains
painful and does not respond to the treatment approaches listed below,
do not run; instead, choose a cross-training activity to maintain
cardio-vascular fitness. The following sports, as well as some others,
are generally safe for most running injuries: Walking, cycling,
swimming, deep-water running, elliptical trainer, rowing, stair-master,
and cross-country ski machines. Refer to the section on Cross-Training for more information. If you are unable to run for a continuous week or longer, ease back into your training slowly. See Mileage Buildup section further guidance. Listed below are some additional pointers.

  • Recognize the difference
    between fatigue and pain due to an injury. Unfortunately, endorphins
    (the chemicals the body produces from aerobic exercise that make you
    feel good . . . runner’s high) mask pain. Listen to your body and
    respect the feedback it is providing you. Some minor discomforts
    diminish in intensity and/or disappear once the muscles have had a
    chance to warm up. Be very cautious in this situation, as you don’t want
    to cause more serious damage to the injury site. Secondary injuries are
    oftentimes caused by suddenly changing the biomechanics of your running
    stride or foot strike as a means to minimize or eliminate pain
    experienced in a specific area. Favoring the original injury site and
    thus changing your gait oftentimes can lead to increased pain and/or
    injury elsewhere. Let’s assume for example that while running, you’ve
    been feeling discomfort somewhere in your knee region, whether it be a
    minor twinge or continuous pain. You sense that something isn’t right so
    you change your stride pattern favoring the knee. Over the course of
    your next few runs, continuing to modify your gait to minimize the knee
    pain appears to be an effective approach. However, you soon notice that
    you are experiencing pain in your ankle! How did this happen? Simply
    stated, while this new pain may seem to be unrelated to the knee issues
    previously described, the muscles, bones, and soft connective tissue in
    the ankle region did not have adequate time to acclimate to the sudden
    biomechanical change of your gait.
  • If pain becomes more
    intense while running, do not continue. Instead, walk and begin
    treatment. Above all, do not become a slave to your training schedule!
    If you continue to train and delay treatment, the injury will almost
    assuredly become more serious, thus jeopardizing the possibility of even
    being able to participate in your target event.


  • Inflammation (characterized by
    pain, swelling, redness, and warmth) is often the by-product of many
    injuries. If inflammation occurs in, or adjacent to an injury site,
    treat the area with ice (see icing guidelines below). Above all, do not
    treat the area with heat of any kind (wet or dry) for several days.
    Consider taking several days off from running along with any other types
    of sports that cause shock, pounding, jarring, etc. to the injured
    area. Try using some anti-inflammatory medication (e.g., ibuprofen) for
    injuries that are inflamed. Be careful not to exceed the recommended
    dosage as these products can cause a variety of internal problems. Heat
    is a good therapeutic/relaxation measure after inflammation of the
    injury site has been reduced significantly or eliminated.

  • If, after these approaches
    listed above fail, consider visiting a physician (who is very familiar
    with a variety of sports injuries and has experience treating runners)
    for both an assessment of the injury and treatment advice. The most
    important information a physician can provide is whether: (1) you can
    continue to run without modification of your training schedule, (2)
    continue to run with a reduced workload, (3) rest the injury site (e.g.,
    no running), and/or (4) add some cross-training activities to both
    maintain cardio-vascular fitness and to strengthen the injury site. When
    in doubt regarding the seriousness of an injury, see a physician.

Icing Guidelines

  • Use an ice cup – Fill a paper
    cup with water and then place it in the freezer. When completely frozen,
    the top of the paper cup can be peeled away to expose the ice. Massage
    the injured area with the ice cup for approximately 10 minutes or until
    the area is numb. It does little good to continue icing the area after
    that time. Repeat this process, icing the injury site two hours later at
    a minimum (or more frequently as possible).

  • If you are unable to
    create a frozen ice cup, use an ice pack or a package of frozen
    vegetables (tiny peas work great) to treat the injured area.

Information on Specific Running Injuries and Treatment Options

Check out this great web site Dr. Pribut’s Running Injuries Page
Page for detailed information regarding the description, cause(s), and
treatment options for a variety of common running injuries.


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