Is It Really An Injury?

Note: This post is an adaptation of an article that I wrote for the February 2011 issue of the Austin Runner’s Club Newsletter.

When training for or competing in any event, be it your first 5K or your 10^th marathon, there are always going to be some nagging aches and pains. It is a reality of training. As you place demands on your body, it has to then recover from the training sessions and adapt to the imposed demands. During this cycle of training and recovery, your muscles, bones, and tissues undergo transformation. There may be times when the rate of recovery and adaptation is diminished relative to the actual training demands. It is at this time that an “over-use” or “under-recovery” injury may occur.

But how do I know that what I am experiencing is an injury? I have little aches and pains all the time. I need to know which aches and pains should be considered an injury that would benefit from the advice of a health care provider – and those which don't require that level of attention. And I definitely don't want whatever this is to limit my training. How do I know that this is something that I need to have assessed?

There are some basic rules to help assist you in this decision making process and that can guide you in the appropriate steps to take – “injury” or no injury. By making good informed decisions, you as an athlete can not only know when an injury exists, but what appropriate avenues exist should a problem arise – in essence, making you an informed consumer of health care.

There are three primary questions to help establish your injury status:

• Does the problem limit your training volume or current level of training?

• Does the problem cause you to alter your running mechanics?

• Does the problem affect any of your normal activities of daily living?

Now, at this point I am sure you’re saying, “well, it doesn’t really cause me to limp TOO much” or something like that! This is where self-responsibility (and good self-care) come into play. Your body provides you with feedback, and pain is one of those feedback mechanisms. It is when you choose to ignore those warning signs that problems can arise. Listening to your body is critical to effective training.

There is a difference between “hurt” and “harm” – and knowing how to differentiate between these two is key to understanding the injury process.

“Hurt” would be an awareness of symptoms that don’t increase during the training activity – and, 20 to 30 minutes after activity, have fully subsided. “Hurt” is generally an indicator that you are stressing the tissues but not producing any damage to the tissues. “Harm”, on the other hand, would be an awareness of symptoms that increase during the training activity and persist for greater than 20 to 30 minutes after you’ve stopped and are at rest.

Establishing the difference between the two is very important in terms of how to approach the problem most effectively. “Hurt” would be an indicator to monitor the status of the issue, to adjust training loads, or to emphasize other recovery-based aspects of the program. Perhaps the awareness you have is related to a decreased ability of your body to adapt to the current training demands – either too much, or too soon. This can be a reminder to focus on the primary elements that prevent injury and foster good recovery from your training - strength training, nutrition, etc. For many athletes that are having “hurt” (as opposed to “harm”), these elements are enough to resolve any minor issues that are being experienced as a normal part of the recovery and adaptation process.

“Harm”, on the other hand, becomes a primary indicator that it’s time to have the problem assessed. This is the first warning sign. As an example, most running injuries are related to the body being unable to adapt readily to the imposed training demands. Although “complete rest” may at times be a part of the short-term solution, it is generally not a complete solution. Sadly, this is oftentimes the number one treatment approach utilized by athletes and their health care providers! Tissues respond and adapt to movement and become stronger when they are challenged in an appropriate fashion. With this in mind, an active approach to injury recovery is accepted in the literature to be the most effective in the greatest number of cases. Fortunately, most running injuries respond readily to appropriate guidance and education (and typically minimal intervention) from the health care provider once an assessment of the injury has been performed.

Remember that although injury is not something that anyone ever wants to have, it can be an opportunity to learn and to ultimately optimize your training – making you, in the end, a better athlete.

Knowledge and self-awareness is key in making good decisions about your self-care. Being responsible and listening to the feedback your body provides are the most important factors in maintaining a healthy and safe training environment.

Photo credits: Wikipedia