How to Train with a Running Injury

A successful race is determined by the time on the clock relative to your expectations. For athletes at any level, the key to meeting personal goals is showing up healthy, fit, and ready to race. Unfortunately, many athletes face the frustration of being sidelined by an injury after months of training. So, what do you do when an injury threatens to derail your preparation? 

First, it's always a good idea to have a qualified physical therapist who specializes in running injuries on hand. I offer a free 10-minute "Runner’s Screen" to help identify the issue and determine whether you can manage it on your own, need physical therapy, or should consult a doctor for further evaluation or imaging. 

Not all injuries require a therapist or doctor. Many running injuries are overuse-related and can be addressed with some self-care and adjustments to your training. Running injuries fall into two categories: traumatic (e.g., sprains or fractures) and overuse (also known as repetitive use). Overuse injuries develop gradually and can be harder to diagnose. 

Here are a few practical suggestions for adjusting your training while recovering from common running injuries: 

Injury: Sprains 

A sprain is a ligament injury that can range from mild stretching to a complete tear. It typically causes pain, swelling, and bruising, and may require time off from running. Training Adjustment: Start with RICE (rest, ice, compression, elevation), and modify your activity. For more severe sprains, a boot or cast may be necessary. Once symptoms ease, reintroduce low-impact activities like hiking, biking, and water running. Gradually increase intensity as ligaments do take time to heal. 

Injury: "The Itises" 

Plantar fasciitis (now called plantar fasciosis) is inflammation of the ligament on the bottom of your foot, while Achilles tendonitis involves inflammation of the tendon that starts behind your calf muscle and runs down to your heel. It is the largest tendon in your body (which can transmit force up to six times your body weight). Both are commonly involved with overuse injuries, although there are many other locations an “itis” can be. Training Adjustment: Pool running, biking, and elliptical workouts are great alternatives to pure run training. These exercises, combined with RICE, can help you stay active. It's also important to assess what caused the injury to prevent it from recurring. The most likely culprit is changing/increasing the intensity or volume of your training “too much too soon.” 

Injury: Stress Fracture 

A stress fracture is a small crack in a bone, usually from overuse. Common sites for running-related stress fractures include the sesamoids, navicular bone, tibia, 2nd metatarsal, and pelvis. Training Adjustment: If diagnosed with a stress fracture (via X-ray or MRI), you don’t have to abandon your training entirely. Follow your physician’s directions such as use of a boot to off-load the bone, RICE, and dietary adjustments. Cross-training with activities like biking and pool running can help maintain fitness. If possible, consider using an Alter-G treadmill for reduced impact running. It's also important to check for metabolic issues, such as calcium or vitamin D deficiencies, that may contribute to stress fractures. For female athletes, checking for hormonal imbalances may also be necessary. Remember the rule: “Eat enough, always,” to support your body and minimize fracture risk. 

Injury: Neuroma 

A neuroma is a nerve entrapment, usually between the third and fourth toes, caused by tight shoes, abnormal foot mechanics, or repetitive stress. Symptoms include numbness, tingling, and sharp pain. Training Adjustment: The good news about this injury is it is more of a nuisance than anything else so your focus can be pain management while remaining active. Start with RICE and consider anti-inflammatory medications to manage swelling. Metatarsal pads in your shoes can help offload pressure on the affected area. For a holistic approach, adding B-vitamins can aid in nerve repair. 

When injured, your goal is to recover as quickly as possible. However, remember that quick fixes aren't always the best solution. Taking a smart, measured approach to managing your injury will help you recover and get back to the road or trails sooner.