Training

Tackling the Dips

Dr Martin Yelling
@myelling

This is not medical advice. Seek guidance from your GP or a qualified sports physiotherapist on injury diagnosis and treatment.

I’m going to cut right to the chase: This marathon game just got serious. We’re now at the end of February and, with eight weeks to go, stuff just got real. This race is happening and you need to be on the train to central London with your shoes firmly laced up. That might sound all a bit gung ho, but the truth of the matter is that a marathon is a tough gig and right now you’re probably experiencing mixed emotions about the race, sometimes excited and enthusiastic and at other times petrified and filled with dread.

Some days you probably think you’re doing well with your training, the miles are picking up and you feel on top of things, and on other days you feel sluggish, heavy, slow, unfit and behind where you want to be or think you should be. This is all perfectly normal.

But, as I realised in the most recent Facebook LIVE Q&A’s that I’ve been hosting on the Virgin Money London Marathon Facebook page every two weeks (the next one is on Friday 3 March at 6pm), it’s also a difficult time because the miles are starting to stack up, the training is getting tougher and bodies are starting to creak and crack in places you didn’t know could hurt. I’ve had plenty of questions about what to do when a little pain becomes a bigger injury, how to respond, and just what to do to manage things.  

Walking the tightrope

Better running is a delicate balancing act that we don’t always get right. When you’re trying to run a marathon for the first or 15th time it means stretching your boundaries a little more than you normally would. There’s a risk with boundary pushing that can result in in injury or illness. When we push too hard, fail to listen to our bodies and over strive for personal success it’s almost inevitable that without careful management we’ll topple off the knife edge and get injured.

Depending on the type and severity of the injury it could mean a simple lay-off for a few days or, if more serious, a more prolonged period of enforced rest.
As you move through February and into March with your marathon training and things start to test your tolerance levels in so many ways, it’s increasingly important to listen intently to the signs, symptoms and signals that your body is telling you and back off (without feeling guilty!), rather than bash on, when you feel a potential injury hot spot.

Sound familiar?

It probably goes a little like this…You’ve been conscientiously stacking up the runs over the past few months, diligently committing yourself to investing in the miles. It’s all going to be worth it on Race Day so you crack on. It started as a little pain, you pretended you couldn’t feel it and pushed on: "I’ll be fine tomorrow," you assured yourself. Tomorrow, the day after, and the week after that came and went and the pain was still there. You ignored it. Then it got worse, unbearable in fact, and you were forced to stop and limp home from your long run.    

When we start to get niggles and minor irritations the trick is not to ignore them and push on with your running. But just how do you know when the pain you’re experiencing is a warning sign for potential injury, the presence of an actual injury or just those marathon miles in your legs?   

The 'three days of the same pain' rule

As a general rule, if you’re experiencing early signs of injury (recurring pain, tenderness, swelling, heat, discomfort, stiffness) then try the ‘three days of the same pain' rule.

If you do three consecutive training runs and the same pain/problem is experienced each time then it’s time to stop, step back and take appropriate action. Think about the following:

  1. Are you experiencing pain after you run? Much of this can be associated with the rigours of training and more often than not if the pain goes away and/or can be managed it’s okay to continue to train. You might need to drop a run or two and reduce the volume for a while to allow extra recovery.
  2. Are you experiencing pain during your run? If the pain eases as the run progresses or goes during the run, then you are probably fit to continue to manage the pain. If the pain persists, or worse, grows in intensity and significance then now is the time to apply the ‘three days of the same pain’ rule and stop running and seek qualified sports physiotherapy advice. This is the blurred and fuzzy area for many runners and the time where they often ignore the pain and continue to run. Pushing through the pain inevitably leads to steps 3 and 4.
  3. Is the pain inhibiting your running? In other words, you can still run on it but only just and you can’t do the amount and/or type of running that you wanted to do. You might be cutting your runs short or hobble and limp as you set off. You should definitely have stepped back or stopped your training at this point and sought some qualified advice.
  4. Is the pain preventing your running? Unfortunately, this is the stage that many runners find themselves at but it’s too late. They have developed a chronic injury and cannot run. Reacting to the injury at this stage as opposed to in step 2 normally means that the injury has progressed to such a level where a full recovery will take longer. Time saved at 2 inevitably saves time post 4.
Rest can equal training!

If you find yourself somewhere on the steps 1 to 4 spectrum right now, please take appropriate action. It’s okay to ease back, to rest from your running and to allow your body, mind and spirit a little recovery time. Having a few days (or even up to a couple of weeks) off now really won’t impact your Virgin Money London Marathon race. In fact, doing a little less when you’re tired, ill, irritable or injured can provide much needed rest and recovery and actually leave you feeling stronger, more focussed and motivated when you start running again. Please don’t feel anxious or guilty about taking a few days away from your running to help you feel refreshed. Rest can be a great form of training!

If you’re injured then the key to recovery lies firstly with speedy acceptance that the injury has reached the stage where you need help and secondly that you are proactive with appropriate accurate diagnosis, management and rehabilitation. The sooner you acknowledge the injury and seek suitably qualified advice the sooner you will be able to get to grips with the recovery and the rehab process and ultimately the faster you’ll be back out on the roads. Right now, taking the time to rest and heal during February and March is much better than pushing on, increasing the discomfort and then reaching the middle or the end of March in a much worse state and unable to run at all.

A progressive return to running

  • Be patient. Give yourself time to heal. At the onset of significant increase in pain or the ‘three days of the same pain’ rule for injury you should appropriately modify your activity levels and choices. This may include total rest from running or cross training to allow continued maintenance of fitness whilst resting the affected area.
  • Take action. Seek the early advice of a qualified sports injury and pain management professional. Be proactive – not reactive.
  • Be committed. Don’t 'yo-yo' rehab.  When you start an exercise rehabilitation/conditioning programme, stick to it and do it religiously. You may have to strengthen and adapt muscles differently instead of just running and complete a varied, sustained and progressive rehab programme that uses different principles, muscles and strategies.
  • Address underlying issues. Avoid getting injured in the first place or injury reccurrence by addressing issues of core stability, strength and conditioning and listening to your body!
  • Gently does it. Be gentle with your comeback. A classic I see with many runners is that when they’ve had an injury and are on the road back to running they seem to misinterpret ‘gentle’ return to exercise and launch back into their exit point. Namely, the level they were at when they stopped running. Build back into your training plan gradually, progressively and pain free.
  • Don’t be fearful. Don’t re-awaken your fingerprint of pain by constantly visiting the expectation that the pain will return. Instead, where you have addressed and overcome the injury your body wants to be well. If you have rested and progressively and appropriately loaded your recovery, then your body will have adapted and your injury will have gone.

On reading back through this blog I was worried it all sounded a bit negative and dramatic. So as my seven-year-old daughter would say, let’s sprinkle a little fairy dust on your marathon training to keep you going.

  1. Always keep it fresh in your mind that in training for the 2017 Virgin Money London Marathon you are inspiring those around you. That might be your children, siblings, work colleagues or friends. They are seeing you do something incredible, amazing and difficult. They are right behind you and you are helping them believe that one day they could follow in your footsteps.
  2. Search out your #reasontorun and lock it into your running mindset. Whether you are motivated to hit the streets by a great charity doing incredible good, the memory of someone you loved, or to be a new fantastic you, whatever your reason hold onto it tight and it’ll help you keep running.
  3. 38,000 other people will be with you on Race Day. You’re not the only one having doubts, anxieties and insecurities. Every other runner on the Start Line with you on Sunday 23 April is going through the same journey. Someone, somewhere is always out running, getting ready for marathon day. You can too.

You got this!