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A Little Proof: Case Study of a Running Injury

Introduction

 

Back in February 2012 I received a call from a client that I had seen a couple of years previously for some shoulder pain. With a little frustration in his voice, he said "Chris I'm in trouble. I've been getting pain in my left knee and hip and my running mileage has plummeted from half marathons to just 1.3 miles. The pain comes on so quickly that I'm having to stop and walk home." He continued, "I have my first ever Olympic Triathlon coming up soon and I have to manage 10km, not to mention the swim and cycle." So we arranged for him to come in for an assessment.

 

With a 'self diagnosis' of Iliotibial band syndrome (ITBS is an irritation of the tissue running down the side of the thigh from the hip to the knee causing knee pain, and very common in runners) I took a look at him and assessed the whole area.

 

You'll find many Sports Massage Therapists treat ITBS with what is affectionately know as 'Stripping'. This is where the therapist applies a lot of pressure with the forearm and tries to stretch this tissue out; and it's excruciatingly painful! I hear of this method of treatment all the time when lecturing around London and have to say that it is a completely pointless application of treating ITBS. It just causes pain, inflammation and more dysfunction, so if your therapist starts doing it to you; I suggest you jump off the couch and leave.

 

ITBS, as it turned out, was a pretty accurate self-diagnosis from the client. But it was just a symptom of what was actually a hip instability and an ankle restriction. No 'Stripping' required we set about correcting the problem.

A word of advice.

 

After our first session the client was keen to get back on track with his running and asked me how far I think he should run the next time he went out that week. Now, the one thing you have to remember is that injuries take time to heal, even when they feel so much better after Sports Massage treatment. The tendency is for people to feel a little better and immediately go out and try to perform at the pre-injury level. This really is a mistake because not only are you likely to overstress the healing tissues, but you will lose confidence in your ability to improve your performance post injury.

 

Confidence is one of the most important parts of recovering from injury and getting ready for the event again. The more times you break your confidence by going too hard too soon, the more it will effect your performance when it matters.

 

My advice to my client was to take it easy on his next run. I said "It is far more important that you get round a run pain free and you feel good about your knee. I would suggest that you do a good warm up for 10-15 minutes then go for a 1 - 2 mile run. Don't keep going further if it feels good. Keep to your planned run and come back feeling like you could do more." This approach works two fold. Firstly your confidence is sky high because all you are thinking is 'I could have gone further'. Secondly, you never over stressed the tissue so you are unlikely to have reinjured it. Then just build on it from there whilst following any home care advice of stretching and corrective exercises.

A little proof.

 

Below is a GPS tracking data sheet that the client sent me. He wears a GPS tracking watch, which can be uploaded to the internet to log all his runs and share them with friends. This data shows several important pieces of information and is also titled with his thoughts on each run. So lets go through it briefly.

 

Runs 1 - 4 show how the client is struggling with injury. His distances struggle around the three to four mile mark and from talking to him he admits that part of this mileage was walking home. You can see that he took my advice and only did a short rehab run (no.5) but look at the pace. He dropped from 8 minute plus miles to 7:37 minute miles, which is quite something in running. This speed was maintained through his second slightly longer run a week later. He came back for a follow up session after that second run. This is something I encourage because nothing ever goes away in one treatment. It is common thought, in therapeutic work, that the longer you have had an injury the longer it take to recover. Keeping up with regular treatment accelerates this process along but it still takes time.

 

The client did a slightly longer rehab run after the second session and following that felt capable of going the full 10km (6.2 mile) distance. The following week he did just that and managed his first 10km run for over 6 months. Notice also how consistent his average pace was over the last 5 runs.

 

Running Data Sheet

 

Conclusion

 

Finding a diagnosis on the internet for yourself may well help you understand your injury a little better but it won't give you any idea as to why you got it in the first place. ITBS is a classic example of this. This type of injury is common to runners and there are countless websites that mention what it is. Many of these sites advocate using a foam roller along the Iliotibial Band to 'Strip' the tissue in order to make it longer. An experienced professional however will look at the reasons for which you developed the condition in the first place. By doing so the root of the problem can be worked on and full recovery is much quicker.

 

By far the best solution though is to have regular treatments so we can catch any potential for injury before it becomes a problem for you. I have another running client that follows this advice and sees me regularly. He has remained free from injury for the last 4 years despite a heavy training schedule and competing in two back-to-back marathons every year. That's food for thought.