You Got Injured During A Run, Now What?

Approximately 50 million people in the United States run.  Of those 50 million people, close to 80% are likely to sustain some type of running injury in their lifetime.  Per statistics, about 50% of those injuries occur at the knee, then the foot/ankle, hip and lower leg. 
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There you are, a beautiful sunny day, nice little breeze and you’re on your favorite running trail.  Things seem to be going along just fine, you’re maintaining a good pace, you feel good, listening to your favorite tunes, then all of a sudden, “pain!”  I’m not just talking the physical exhaustion from running, but legit pain in the leg.  The kind of pain that you know something bad happened, because you can no longer run.  What do you do now?

Approximately 50 million people in the United States run.  Of those 50 million people, close to 80% are likely to sustain some type of running injury in their lifetime.  Per statistics, about 50% of those injuries occur at the knee, then the foot/ankle, hip and lower leg.  Not that this necessarily matters because the injury that you sustained is what is most important.  That injury is keeping you from what you like to do, your outlet, mental and physical management.  As a practicing physical therapist who specializes in running-related injuries, clients are not sure what to do next after they sustain an injury during a run.  Do I rest, do I keep running, do I do something else?


What to do when injured while on a run

  • Take inventory of the injury: Was this something that came on suddenly or has been building up? Is the pain sharp/stabbing, dull ache or cramping?  Can be helpful in determining what is actually going on.
  • Did anything pop, tear, or pull?
  • Can you put weight on your injured leg? Can you walk?  If you can and there is no pain, can you continue to run?  If it is still painful trying to run, do not risk pushing through it, which could lead to further damage.


What to do when you get home

  • This is not the time to do other exercises because you couldn’t complete your run.  This is the time to take it easy and off load the injured area.  However, this does not mean permanent rest, just for the rest of the day if possible.
  • Ice: In the acute phase of an injury (the first 72 hours), I would generally recommend icing the area for 15 minutes at a time. Always be sure there is a barrier between the ice and your skin and check the area frequently for freezer burn.
  • Compress: Yes, depending on where the injury is, knee, calf, foot, compression can be beneficial in keeping the swelling down and assisting the lymphatic system to drain the by products of the inflammation out.  A compression sleeve or ACE bandage can be beneficial to have around.
  • Elevate: Again, this helps with reducing swelling and helping lymphatic flow.  You do not need to exactly get the injured area above your heart, you should just get it out of the dependent position.
  • Should you take medication: Being a Physical Therapist, I cannot advise my patients to take medication.  It could be more of a situation when you have taken medication for pain in the past and are safe to take them, then follow the medications advised directions or directions from your primary care provider.  Common medications to take for pain are NSAIDS (non-steroidal anti-inflammatory medications) like Aleve or Advil or Acetaminophen (Tylenol).


Should you go see your Medical Doctor?

If you felt a pop or big tear while running, I would advise scheduling an appointment with your doctor, as you would possibly need further diagnostic imaging (x-ray, MRI) to see if you tore a ligament, tendon or muscle.  If you have significant sharp pain that doesn’t subside and are unable to put any weight through the extremity because of the sharp pain, I would recommend seeking an Urgent Care clinic.  However, for most injuries, you do not need to seek medical care initially.  You will just more need to monitor your symptoms and seek care if anything gets worse.


Can I still Run or Not?

The answer to this question I wish was more black and white, but unfortunately, it is not.  When patients come to my clinic with this question, my response is more, “it depends?”  Ya, nice cop out, right.  Well, then what the heck does it actually depend on?  A lot of factors go into this decision.  Now let me be honest, I hate telling runners that they can’t run.  I’m a runner myself and I wouldn’t want anyone to tell me that I can’t do the thing that I love.  Most running injuries are, in fact, over use type of injuries and more often than not, I will still advise a patient they can run, but with modifications.

Such modifications could be to reduce the intensity of the run, the frequency, the terrain, maybe walk/jog intervals.  Unless I feel someone would damage themselves further with running at all, I try to modify before I say no.  However, if something really needs to be shut down depending on the nature/type/intensity of the injury (i.e., stubborn calf strain), I will advise to put a hold on running and evaluate later.  Something to note is your pain level on a scale of 0 to 10 (subjective I know, but a good guide).  Usually, I am comfortable with patients pushing through a 3-4/10 pain that is more of a dull ache, think of like a low grade bruise that’s annoying, but not bothersome.  When you start getting past and greater than 3-4/10 pain, usually that’s more then bothersome and compensation patterns start happening.  If any pain is described as sharp or stabbing, I would definitely advise to shut it down!  I would not want any other injuries to occur because you are compensating by pushing through a painful run.


What else can I do?

When you are recovering from a running injury, it doesn’t mean that you should just rest or modify running and things will magically go away.  You can do other forms of cross training that do not exacerbate the injury.  You can still strength train, stretch, do Yoga, go to Pilates.  You can do other forms of cardio such as the elliptical, swim, hike, walk, or ride the bike, as long as these other forms of exercises do not exacerbate the injury.


Next Steps

The injury was sustained for a reason.  That reason needs to be figured out!  Is there something going on with your running gait?  Is there an asymmetry in strength or flexibility?  Did you utilize new footwear that just didn’t work for you?  If you increase your training volume too much in a week, more than 10% of training volume (i.e., miles), the magic number that research has found if we go over, then chances are likely you can sustain an injury.  Trying to figure these scenarios are helpful in coming up with the appropriate treatment plan for you.

Technology is a beautiful thing, and we can have information right at our finger tips (hey, isn’t that what I’m doing right now?!).  However, seeking the evaluation and advice of a qualified Physical Therapist is absolutely beneficial (remember what I do for a living).  They can evaluate your condition, perform a movement analysis, run analysis, and get to the bottom of what is causing your injury and map out the appropriate plan of care to get you back on your feet!

If you have any questions or want to schedule an evaluation for you run related injury and you are in the Greater Seattle Area, feel free to reach out to me and schedule at our Vida Ravenna Clinic (206-315-7998).  Follow me on Instagram @pt4inspiredrunner and/or visit my website at www.pt4inspiredrunner.com

Jason Godfrey, PT, DPT, OCS, SCS


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