Injury is more than physical

by Susan Kalish

Your body gets stronger. Your mind becomes clearer. Your self-esteem improves. It's amazing how the simple act of putting one foot in front of the other (at a faster-than-usual clip) has such far-reaching impact on our lives. That's when the running is good.

But at least half of all runners get injured -- at least once. And that's when you become painfully aware of how entrenched your running has become in your life. An injury doesn't just force you to deal with a pain in your heel. You also have to deal with the emotional baggage of not running well, or worse, not running at all.

"Ultimately the impact of injury is the net effect of the stress of the injury itself and the athlete's coping resources. How these balance out determines how traumatic the injury will be," explains sports psychologist John Heil in his book The Psychology of Sport Injury.

Why We Get So Bummed

"One of the first signs that you are overtraining is a drop in your mood," says Donald McKenzie, M.D., Ph.D., of the Allan McGavin Sports Medicine Center at the University of British Columbia in Vancouver. A later consequence of overtraining is the onset of an injury. So actually, your mood is already on the downswing when you get hurt. The pain of the injury is just another insult to your mood.

Another reason runners have such a hard time dealing with sports injuries is that many use their running as therapy. When you can't get to your therapist (or back on the roads), you can get pretty stressed out.

Running is more than just a recreational sport to some. It's a way of life. "I am a runner. My friends are runners. We 'do' running." Some injured runners feel cut off from their support group, and that's depressing.

I run for control. As the mother of two small children and the executive director of two large organizations, I can rarely do what I want to do -- except when I run. It's my time, and if I want to do a tempo run, I do. I'm in control. But when an injury develops, I lose that control. It's as if my body, my running partner, has betrayed me. And that's depressing.

But what can really take an injured runner over the edge is his or her doctor. What runner has confidence after taking a sports injury to a physician who glibly says, "Stop running, take aspirin, and call me in two weeks if you don't feel better"? And even though George Sheehan warned us that "each runner is an experiment of one," and most sports injuries develop in a unique way, it is still very annoying when an experienced sports medicine physician can't simply look at your knee and say, "Ah, that's chondromalacia patella. It will take three weeks to heal. Do these exercises and you'll never get it again." Runners want that type of exact response, but sports medicine isn't an exact science. A good doctor is like a detective, rooting out the cause of the injury and then developing a treatment course. It may take a couple of visits to the doctor. All this takes time. And if you're not running well during this lag, it's depressing.

What to Do

If you notice a nagging ache in your groin during your weekly interval session, don't wait for a pulled muscle at your next race before you act. A groin pull takes much longer to heal than does a simple irritated or inflamed tendon. Cut back your training immediately. Ice the area after workouts. Begin treatment now! Sports injuries don't magically disappear overnight.

Give yourself about two weeks of self-treatment. If you aren't pain-free, see your doctor. Bring your running shoes and log book to the exam. Work with your doctor to determine how the injury developed. Map out a plan to rehabilitate the injury as well as to maintain your training. When you know you're working for a resolution to the injury, you'll feel more positive. Follow your rehab in your log book. Few things feed depression more than blank pages in a training log. If things don't seem to be working, don't be docile. It's your responsibility to get better. Communicate with your doctor.

Remember the saying "Fool me once, shame on you. Fool me twice, shame on me." The same is true for recurring sports injuries. Find out why you got injured -- it could be training, shoes, tight muscles -- and do something to avoid getting hurt again. By finding the cause of an injury and making note of how to avoid it, you empower yourself_ and that feels pretty good.

Keep up with your running friends while you're recovering. Work the watches at your club's weekly track workouts. Hand out water at races. Read running books. Talk the talk.

Think positive: you will recover! Jack Daniels, Ph.D., cross country coach at the State University College, Cortland, N.Y., says, "I tell runners they should see their injury as a career-prolonger. You are often sure you're on your way to a PR when you get injured. If you believe you haven't yet reached your peak, this will keep you eager to come back vigorously and prove you can do better in the future. Athletes who never get injured may quit their sport at some point simply because their goals are not met. Injuries kind of punctuate your progress."

But the most important thing you can do to improve your mental outlook during an injury is to stay active. Find an activity you can enjoy and do it. "When a torn knee cartilage stopped me from running, I turned to walking," says Trevor Smith, a seasoned marathoner with the Montgomery County Road Runners in Kensington, Md. "I increased my mileage, just like I'd do with running. I worked on my speed. I even developed track workouts that incorporated backward walking and stair climbing."

The activities you choose should be based on your goals. Are you biding your time until you are healed? Or do you need to hit the pavement running for a key race in your future? Finding any activity you enjoy that keeps your heart rate up is good if you're just biding your time. But if you have an important race in the near future, you need to work with your therapist to develop a serious training schedule that includes exercises, such as water running, that maintain your fitness level as well as leg strength and form.

Do you need to do something that feels like running? For some runners, swimming or biking just doesn't give the same feeling as a good run. If that is true for you, then try water running, race walking, or fitness walking. These sports closely mimic running but are much less stressful to the legs.

Be Prepared

In a recent study, world-class athletes who adjusted their training based on their moods were able to avoid overtraining and, consequently, injury. According to Bo Berglund, M.D., Ph.D., at the Karolinska Hospital in Stockholm, Sweden, 14 athletes regularly monitored their moods through a questionnaire that they passed on to their coach. When negative mood changes occurred, the athletes' training loads were reduced. Positive changes led to increased training. None of the athletes became overtrained, stale, or injured.

Runners should recognize that sooner or later they are likely to develop a running injury. Minor or major, it's in the stars. To be sure you can maintain a healthy positive attitude when you do get hurt, incorporate some form of cross-training into your program now. Then if you have to stop running, you'll have other activities that you enjoy to keep you fit. Weight training is a good option since it has been found to enhance your speed as well as reduce your risk of injuries.

Nobody enjoys sports injuries. The physical damage is bad enough, but injuries cause psychological pain too. Injured athletes become depressed and angry, while their energy level decreases. And the longer the layoff from your sport, the more depressed you will become, according to Aynsley Smith, R.N., M.A., at the Mayo Clinic in Rochester, Minnesota. So look for a silver lining. Pete Pfitzinger, coach and former Olympic runner, says, "If you learn from your injury, and this helps prevent a similar injury in the future, then you have benefitted from the experience."

Stresses of a running injury

• Physical Implications
• Pain of the injury
• Rigors of rehabilitation
• Potentially permanent physical changes

Emotional Baggage

• Feelings of loss and grief
• Threats to future performance
• Rigors of rehabilitation
• Loss of sense of control

Social Consequences

• Loss of important social role
• Separation from friends

Susan Kalish is executive director of the American Running and Fitness Association and the American Medical Athletic Association. She is editor-in-chief of Running & FitNews as well as author of Your Child's Fitness: Practical Advice for Parents. Susan generally runs injury-free, except for last summer -- which turned into a big wash that she's too depressed to talk about.