Adventure Racing:  How runners should treat acute injuries

Runners traditionally suffer from chronic, overuse injuries from the mile after mile their bodies log on a weekly, monthly and yearly basis. However, with the popularity of adventure races such as Warrior Dash, Tough Mudder and Spartan Race that mix obstacles with distances up to15 miles, there has been a significant increase in the number of acute injuries that runners suffer.

Acute Injury

When an injury occurs, you can speed your recovery by working with your body’s natural healing process. Initially, your body will create swelling in the area. This serves several beneficial purposes:

Self bracing
Swelling provides immobilization of the body part by limiting its range of motion. This keeps from overstretching damaged tissue, which could lead to further injury.

Pain
Since most joints do not have additional space any amount of extra fluid will put pressure on the surrounding nerves creating pain. Pain is your body’s way of trying to keep you from using that area so that you do not worsen the injury. This also gives it a chance to heal.

Temperature Increase
The increase of blood to an injured area not only acts to stabilize it but also increases local metabolism. This raises the local temperature to kill any bacteria in the area. However, if the temperature increases too much, it can cause structural damage to the muscles in the area.

Immediate Care, 1-3 days

There are numerous acronyms for immediate care of an acute injury.
RICE – Rest, Ice, Compression, Elevation
PRICE – Protection, Rest, Ice, Compression, Elevation
PRINCE – Protection, Rest, Ice, NSAIDS, Compression, Elevation

However, this is not all accurate and guidelines should be followed.

Rest
Rest is designed to prevent further injury and to allow healing. Often, people, especially runners who do not like to miss a run, will try to train through an injury. They make the mistake of thinking the pain will “just go away”. However, the endorphins and adrenaline released during running can be powerful pain blockers. Furthermore, your brain will automatically change how you run to try to avoid stressing the injured area; this will eventually lead to pain in other areas of the body.

Active rest may be a better option, especially for runners due the fairly rapid decrease in cardiovascular fitness. Active rest should focus on training around the injured area. Non-weight bearing exercises such as swimming and cycling can keep your heart and lungs working while you heal.

Ice
Ice is the easiest way to treat a new injury. Ice decreases the blood flow to the area to limit both pain and swelling. Ice also decreases the actions of the nerves in the area to further help with pain relief. However, you should only ice an initial injury for 10-15 minutes every 2-3 hours. Icing for more than 15 minutes can invoke hunter’s response and actually increase blood flow to the area, which would worsen symptoms.

Compression and Elevation
These are both designed to limit the amount of swelling that can occur. Compression decreases the space the swelling can inhabit. Elevation uses gravity to drain swelling from the area.

What to Avoid

Stretching
A new injury typically is the result of tissues, either muscle or tendon or ligament, being overstretched or partially torn. Stretching may make the injury worse by causing more tearing of the injured fibers.

NSAIDs
Most people, even healthcare providers, think that anti-inflammatories should be started immediately after an injury. However, several research studies have found that taking anti-inflammatories (ibuprofen-Advil, naproxen-Aleve) can interfere with the body’s natural healing process; therefore they should be delayed by 7-10 days. Aspirin should also be avoided because, as a blood thinner, it may increase the amount of swelling. For initial relief, acetaminophen (Tylenol) would be the most appropriate for pain relief.

Pain
Pain is your body’s way of saying “stop” typically before an injury occurs or, if one is already present, before it can worsen. While we do have the ability to override our body’s signals, we put ourselves at great risk when we do so.

Post-Acute Care, 3-14 days

Stretching
At this point, the tissues are beginning to heal. Stretching can be beneficial to encourage the proper healing of the area and limit the amount of scar tissue.

Increasing blood flow
At this point, it becomes logical to increase blood flow to the area. The swelling has served its purpose and needs to be flushed out. Moist heat packs can be used to provide inactive increases or, if able to do so, light aerobic activity will help bring in new blood and the necessities for healing.

Protein
Most structures in the body are comprised of protein. By increasing protein consumption by 20-40 grams a day can supply the amino acids necessary for the repair of the muscles, tendons and ligaments.

Conclusion
Any time you do not feel that your injury is healing appropriately, it is best to follow-up with an appropriately trained healthcare provider. Certified athletic trainers (ATC) are trained to evaluate and treat most musculoskeletal injuries while understanding the demands of activity. Some physical therapists (PT) have advanced certifications in sports (SCS) or orthopedics (OCS). Also, some physicians have completed sports medicine fellowships, which allows them to understand and treat the demands of running as well.