What To Do If You Get Injured Four Weeks Before Race Day
by Eric Oliver, PT, Run Specialist
During the average training cycle, running injuries begin to pop up during the later stages of training more so than at any other point. By this time in the training program, your body has already endured through hundreds of thousands of steps, and if you have any movement faults, strength deficits, running form issues, or a training plan that is not appropriate for you then your body has a higher likelihood of breaking down resulting in an injury.
An injury can present itself as either a sharp pain or a gradual build-up of aches and pains. These symptoms do not feel the same as general post-workout fatigue or discomfort resulting from the activity. Rather, these are the “this doesn’t feel right” kind of soreness, aches, burning, jolts, and zings that build up in intensity or frequency over time. Sometimes, though, these pains come out of nowhere, piercing you like a hot knife. In either case, both scenarios will bring your training to a halt or at the least a snails pace.
So what do you do when this happens four weeks before your race?
1. Get a proper diagnosis for your symptoms and the root cause of it, but not from Dr. Google. If you search “pain on the outside of my knee when running” five of the top six search results will talk about '“IT band syndrome” which then prescribes a healthy dosage of foam rolling, massage, stretching, icing, and heating along with various strengthening exercises. This is fine if you truly have IT band syndrome. What you may not get as options with that Google search, though, is that outer knee pain can also come from an LCL sprain, meniscus irritation, patellofemoral stress, proximal tibiofibular sprain, and outer hamstring irritation to name a few. This shouldn’t provide a lot of confidence for you to self-treat. If you begin treating your outer knee pain as if you have an IT band issue when it is not, you could be wasting precious healing time. Worse yet, you could do more harm than good.
When a skilled clinician correctly identifies your injury, initiates treatment, adjusts your training program, and instructs you on effective home treatment strategies you will more efficiently get on the road to healing your tissue. Each day of optimized healing is critical when your race is just a few weeks away, and you don’t want to waste a minute of that dilly-dallying on Google guided treatments. When recovering from a running injury it’s especially important to work with a provider who no only understands the anatomical/physiological characteristics of injuries but also the nuances of running (principles of aerobic/anaerobic training, shoes, run form, and advanced strength and conditioning) in order to receive a more comprehensive plan to your treatment and training.
2. Don’t over-react. Your race aspirations are not over yet. Once you know the source of your pain, you can put together a plan. In a marathon/half marathon training plan you typically have one more long runs left to perform before race day. If you have already performed at least a 10-mile run (half-marathoner) or a 18-20 mile run (marathoner), know that you are prepared enough to finish your race, BUT only if your injury isn’t too serious AND it has enough time to heal. There’s a saying I like to tell runners who are on the mend: It’s better to go into a race healthy and under-prepared rather than going into a race injured and hurting.
If you go into a race actively injured, you’ll be guaranteed to have a bad race. Not only will your pace suffer, but you may advance your injury further which could in turn can jeopardize your running for months after your race. On the other hand, if you make adjustments to your training while also giving yourself time to heal you may be able to salvage your race. At a minimum you’ll be able to run your race, albeit with adjusted expectations based on how much fitness you were able to retain.
If your goal is to compete at a high level, then some serious conversations regarding your injury prognosis and training strategy needs to happen between you, your coach, and your physical therapist to determine whether you’ll be ready enough to compete or if it makes more sense to defer your efforts to another race. Personally, I have had many conversations with athletes trying to weigh the pros and cons of competing. In some instances, a decision was not made until a couple days before a race so that we could fully evaluate the athlete’s health in order to provide a fair assessment regarding the pros and cons of racing. Open dialogue between the athlete, coach, physical therapist, and doctor is key in these types of situations.
3. Find ways to train around an injury for the remaining training cycle so that you can continue to work your aerobic and anaerobic energy systems without the weight-bearing stress of running.
Adjust your running schedule
If you were running five to six days per week, reduce your run frequency to 1-3 times per week. Your body needs time to heal. Unless the injury is really bad, soft tissue injuries can undergo significant healing within four weeks time. You should get approval from your rehab specialist to make sure it is okay to continue running at this reduced frequency.
If you’ve been given clearance to continue running within the four weeks leading up to your race day, your last long run should be performed no later than two weeks before your race. If you’re a half-marathoner aim for 8-10 miles (rather than 12 miles). If you are a marathoner aim for 16-18 miles (rather than 20-22). By keeping the mileage a little lower and by doing the run two weeks before your race, you will allow yourself time for your body to recover and heal. Stop your run if your pain returns.
If you are cleared to run but you are not allowed to run long distances, then you will need to get creative with how you train your aerobic/anaerobic energy system. A good option is to break up your long run into two different sessions. Another option is to do a combination of running/cross-training. For example, run 5 miles followed by using a stationary bike for 30 minutes. Again, don’t exercise through pain.
Cross-train with machines
If you are either unable to run or you’re restricted to running at a lesser frequency, then utilizing cross-training machines can be very effective in continuing your training. This includes using the elliptical machine, indoor bike, swimming, or aqua jogging. The fact that you can’t run outside or on a treadmill does not mean you can’t train the same aerobic and anaerobic energy systems. Training these systems with cross-training machines (while also developing your leg strength with resistance exercises) will ensure a level of preparedness that can help you run on race day.
You must find a cross-training tool that does not exacerbate your symptoms or cause new injuries. A good example of misusing cross-training is when runners either ramp up their swimming intensity or their swimming volume in the pool when they aren’t adapted to high amounts of swimming. Many times this leads to shoulder injuries.
When you implement a cross-training program to take the place of running you can still follow your running schedule but with obvious adaptations. A general rule is for you to perform the cross-training workout at the same intensity and duration as the scheduled run workout. For example, if your run schedule indicates that you are supposed to run 6 miles at a 10k pace, then your conversion to an elliptical machine would be to perform the workout at the same 10k effort for the same amount of time on the elliptical as it would have taken you to run that workout.
4. Use as many strategies as you can that will promote tissue repair.
DO include warm water epsom salt baths, hot packs (as directed by your rehab specialist), pain-free movement exercises, good sleep, and good nutrition.
DO NOT aggressively stretch your muscles, overly ice the area (this can lead to local constriction of blood vessels, thus reducing the flow of blood that is necessary to heal the tissue), aggressively foam roll, or perform deep massage. Runners who are dealing with an injury tend to stretch themselves too aggressively or roll on a foam roller/ball as a tactic to heal themselves faster. In actuality, this may actually worsen the injury and delay the healing process.
When gently stretching, do so in a pain-free range for 10-15 seconds. This will prevent your tissue from getting too tight. If it reproduces your pain, though, STOP!
Following these tips is not guaranteed to get you ready in four weeks after sustaining an injury, but it just may give you a darn good fighting chance to get to that start line!
[Want more? Learn how to reduce your risk of injuries while running on hills.]
Want even more information to help you become a better runner? Check out The Runner’s Corral for tons of free content about training, injury prevention, and performance!