Running blog series: Part 9: What to do if I get injured:

Okay so the chance of injury should now be low if you have followed all the advice within this blog series but sometimes there’s not much you can do and bang, you’re injured. So what do you do then, if you are unlucky?

Obviously this will depend on the type of injury that you have. However most injuries are either from trauma (one of event that causes damage) or from cumulative micro trauma overload.

So what do I do if I get injured from a one off trauma?

An example of this would be treading on a stone and twisting your ankle. So if you cause trauma then the advice to follow is as follows:

First 48-72 hours of injury:

Use: P.O.L.I.C.E.

No don’t call the police (unless your trauma is being punched lol).

This is the latest acronym that replaces the old R.I.C.E.

P: Protect the injury from further harm: This can be stopping the activity, using crutches, strapping it up, etc.

O.L: Optimal loading: This means load it but don’t overload it! This was put in place of rest because people were being too literal with rest and actually doing nothing, which is bad! So the key here is to move it, walk on it, etc. The key thing to remember is that as long as after doing the activity it is no worse for doing it, you are fine but if it is worse afterwards, then you have overloaded it.

I: Ice: This is to minimise the amount of swelling that gets to the injury site. You should wrap the ice in a damp tea towel and roughly apply for 10-20 minutes depending on the depth of the injury (the deeper it is the longer you will apply it for).  The cooling effect should last for roughly 2 hours so you should re-apply it every 2 hours.

C: Compression:

Now most people think that ice is the most important aspect but believe it or not it is actually compression. Compression can take the form of tubi-grip or strapping and the aim is to create a back pressure that minimises the amount of swelling to the area. This is vital, as the more swelling you have, the more painful the injury will feel and the stiffer the area will become. It will inhibit muscle activity leading to muscle atrophy and it decreases proprioception. The other thing is that the more swelling there is, the longer it will take for your body to get rid of it.

E: Elevation: Basically keep the injury up as much as you can (in between your optimal loading etc.)

What about pain relief or anti-inflammatory's?

You should use pain relief as you require. For example if you are in so much pain that you aren’t moving the injury then you need to use pain relief.

On the anti-inflammatory front, this isn’t as straight forward as you may think.

This is because INFLAMMATION is NORMAL, NECESSARY and is controlled by a wide range of CYTOKINES and other CHEMICAL MEDIATORS. So you don’t necessarily want to lessen or get rid of it. You CANNOT heal without it!!!

My view is that if you have an acute injury from a trauma then take them for the first 48-72 hours or until the throbbing and heat reduce.

If you have a chronic cumulative non trauma caused injury then I would personally say just stick to pain relief. A common cumulative injury is something like Achilles tendinopathy.  In this case and in the case of most tendon injuries, anti-inflammatories create poor healing quality and slow down the healing time (Cohen et al (2006). This is slow enough already due to poor vascularisation (blood flow) (Nowak & Handyford 2000). So you don’t want to slow it down anymore!

So what do I do after the first 72 hours?

Again this will depend on the exact injury but the aim is to use the Optimal Loading aspect of P.O.L.I.C.E.  and continue to load the injury progressively (don’t overload it!).

This optimal loading comprises of working on specific exercises for the injury but generally you will work on light stretching and build up the intensity as the injury allows it. The reason for this is to facilitate the correct healing of the structure, so the fibres lay down correctly, which creates a flexible and strong scar tissue. Another aspect to start lightly with and progress is strengthening. This is because muscle strength decreases by 2-6% in the first 8 days of injury (Muller 1970) and after 2 weeks of not training significant reductions in fitness can be measured & improvements can be lost in months (Kisner & Colby 1996).

Another reason is to load the injured structure, which stimulates healing of the tissue as it increases blood flow and creates other healing effects. For example the loading of tendon creates an up regulation of insulin-like growth factor (IGF-I) & this stimulates healing (Khan & Scott 2009).

These things will also help to clear any swelling and restore normal range of movement and reduce pain. If this is slow to improve then Physiotherapy can help with various treatments depending on the exact injury.

Remember just because you’re injured doesn’t mean you can’t work on other things. For example, you can maximally strengthen the opposite limb, work on your cardio with the hand bike or swimming (depending on the injury). Work on your core stability (Almeida et al 2013), upper body strength etc. You get the drift anyway.

Back to the injury: Each structure of the body heals at different rates and each person does too, so you can’t use time as an exact guide of progression.

To give you a rough idea of average healing times in the body they are listed below. You will be surprised, as not many people I meet give enough time to rehabilitate before going back to running fully, and guess what? They re-injure!

Muscle: 2-6 weeks

Bone: 6 weeks

Ligament: 6-12 weeks

Tendon: 8-16 weeks

Stress fracture: 4-6 months

Meniscal tear of the knee: 6 months (or never)

So through this process you need to work on your flexibility, strength, endurance, core stability, power and proprioception in a gradual progressive way that doesn’t cause pain during or after the exercise. At first you can do general exercises that may not resemble running and as you improve you should start to bring in progressive sport specific exercises for each element. (Examples of these will be found in each corresponding blog post previously).

When enough time has passed and you have no pain on any sport specific exercise, full range of movement, good proprioception, good endurance etc. then you can start to run but don’t go mad. You should start with short flat slow runs and check afterwards that you have coped. If you have, then advance next time until you are back to 100%.

So it may seem long winded but if you don’t want to be one of the many people that I see with recurrent injuries then you should follow this guide.

Remember this blog article is a guide and is quite generalised. So if you are in any doubt you should consult your Physiotherapist or G.P.

If you need any further information or would like to book an appointment then call Hawkes Physiotherapy on 01782 771861 or 07866195914

WWW.HAWKESPHYSIOTHERAPY.CO.UK