Managing time off from injury

Dealing with an injury is always a challenge. Many runners that I see in the clinic struggle with injury. Their focus often settles on what they can't do: run. My role as a PT often encourages injured athletes to change their focus onto what they CAN do intead. There are plenty of options out there for the injured. In most instances, the focus should be on relative rest versus complete rest. Obviously if the athlete is dealing with 7+/10 pain, then complete rest is the answer. Most nagging running injuries tend to be in the 0-3/10 pain range. At this level, it is ok to keep running as long as ther is no obvious impairment of ruuning form. It is in the middle ground, the 4-6/10 pain range, that the cross training and relative rest is key. I like to think of it as the pushing buttons range. The reason being that most runners just want to run. They usually do not want to fool with much else. That is except for the champion runners who recognize the value of mixing it up when they can't run at the level they want.

As I mentioned above, there are numerous different modes of exercise for the injured runner.
At the top of the list is pool running. This form of exercises most closely follows the actual form of running. In deep water, an athlete can go through the motions of running without having to deal with the ground reaction forces that typically are pounding on the legs. It is a great first choice to take a load off. It requires the use of a buoyancy belt and not a whole lot else. I typically cup my hands into small paddles so I can actually move back and forth in the pool. I suggest that the runner focuses on the movement of their legs so they can try to mimick their on-ground form. Many studeis suggest that pool running can maintain fitness for up to 6 weeks. If you think about this in terms of common running injuries, think stress fractures, it works out quite well. A runner can maintain fitness and in 6 weeks be nearly healed.
A progression from deep water pool running would be running in shallow water. It requires water shoes so you do not tear up the soles of your feet. The buoyancy effect unweights most of the body weight but now the runner enjoys the benefits of weightbearing, albeit usually only 25% of bodyweight. Running against the resistance of the water causes the runner to forward lean whihc encourages a mid foot strike. Needless to say, these running form priciples are key for on-ground running.

Another option for injured runners is the use of an ellitical machine. There are many makes and models out there. One in particular I like is made by Cybex. The machine has a large foot platform and optional hand use to work the arms. The fluid motion of the machine cycle very closely mimicks running. Resistance can be added for increasing the intensity of the work. It is a great machine that i now use as an adjunct to my normal training even when not injured. I can use it in place of a recovery run. I can the work for my legs without the pounding. I can then proceed directly to my core/lifting routine without a hitch.

Using an exercise bike is another option for injured runners. It hardly mimicks running but think of it as just priming the engine. You are getting a hearlt rate response which get the cardiovascular system active. With runners who are not able to weightbear, I frequently start with use of the bike.

One question I often get from clients is "how do I know if I can still run my target race after this injury?". Advance Marathoning by Pfitzinger provides a useful guide. It breaks down the number of days missed because of injury compared to number of days to target race.

<10 days missed: resume schedule if race is 8weeks or more away, AND if it is less than 8 weeks off

10-20 days missed: resume schedule if race is 8 weeks or more off. REVISE goal if less than 8 weeks off

>20 days missed: Revise goal if race is 8 weeks or more off, AND revise goal if race is less than 8 weeks off.

Nothing too fancy there but it provides a framework to get started on regarding whether you can keep targeting a race or if you should realistically chose another one. Hope it helps......