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Injuries and Treatment

We Aren’t Immortal, So Injuries Are Inevitable

What can we do in the face of our own fragility? We can keep moving forward.

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It’s easy to idealize running.

Frolicking through forests! Jumping over rocks and bounding down mountains! On a training plan, the miles come so easily. But that’s not reality.

As a coach, I try to never lose sight of that fact. It’s so easy to write down “8 mile run” and not think about what that actually entails. That’s more than 10,000 steps, each one with significantly more impact forces than walking, each one with the potential to go horribly wrong. That training log entry seems simple, but it’s asking an athlete to do something that many people can’t do in the first place.

Our heads may be up in the clouds, but our bodies are on the ground, and they can feel the pounding. The process of building up endurance risks breakdown with each step. Running is a lot like life in that way. Every day that passes brings us one day closer to the ultimate breakdown.

What can we do in the face of our own fragility? We can keep moving forward.

That sounds melodramatic. I promise this article will not be too serious. But it is important to understand that we get running injuries for the same reasons that we die—our bodies are only capable of so many miles, even if our brains can expand to encompass infinity. Just as life requires death to have meaning, so too do runners have to get injured for the miles to be more than numbers in a training log.

So let’s celebrate the whole journey, including the parts that might be less fun to talk about. Let’s talk injuries.

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To understand injuries, we need to take a step back and think about the purpose of running training.

What happens when you go for a run? The answer: nothing good.

As you run farther and with more intensity, your body experiences cellular-level breakdown and system-level fatigue. That’s why you finish your long run ready to collapse into a pile of pancakes. Your body is undergoing fundamental deformations that reduce its current capacity.

Then the good stuff happens. Your body adapts to that stimulus, building back stronger. Push a bit too far, and the breakdown doesn’t lead so simply to adaptation. This interconnected process of adaptation and injury is most clear for bone.

As you run, bone cells and networks of cells undergo stress. Over time, that can lead to extremely strong brontosaurus bones. In bone-density scans of healthy runners, I have seen some astronomically high relative densities in shins and femurs.

But what if the stress goes just a bit too far? In the moment, it’s probably tough to know. Maybe it starts aching slightly a week or two later, the whispers of a stress reaction. Maybe it waits to become a sharp pain a month later, the screams of a stress fracture. The same thing that creates strong bones that can withstand countless miles causes breaks that make a single mile impossible. And it’s darn near impossible to know where the line between adaptation and injury lies.

Stress plus rest equals adaptation is a complicated equation.

Good training and self-destructive training often look similar, because there are unknown variables in the stress-and-rest equation. As much as we want to have control, we can’t really measure all of the stress in a complex life.

It gets back to one of the most frustrating elements of running training and coaching. The body doesn’t know miles; it knows stress. What seems like a carefree, easy eight miles could actually be more like running 20 hard miles if it’s coming near a hard work presentation, or a late night feeding a baby, or a generalized bout of anxiety about existence. An interval workout is hard, an existential crisis is harder, and the body doesn’t distinguish much between the two.

The same principle applies to rest. A pro athlete might take a nap, sleep 12 hours and get a back massage from a litter of soft golden retriever puppies (if running coaching doesn’t work out, I call dibs on that start-up idea). A parent might sleep four hours and get yelled at by a crappy boss (that boss should try Spuppy, my new puppy-massage spa). Our brains like to simplify the adaptation equation, but every honest training plan would come with a disclaimer—“I think this should work, maybe, but who the heck knows?”

Overuse injuries don’t always have obvious causes.
The clearest example of the adaptation equation breaking down is when the body rebels with overuse injuries. Run a lot, maybe a little too hard, and you get hurt. Duh, of course that happens, running is hard on the body. As your neighbor who hasn’t walked a mile since the first Bush administration says, “Aren’t you worried about your knees?”

It’s not that simple, though. Overuse injuries can happen when athletes do everything right, precipitated by a tough day at work as much as a tough interval workout. Or maybe it’s a chronic-on-acute injury, where an initial ankle sprain causes a future stress fracture in a bone near the ankle that was weakened. Injured athletes are often filled with regret and self loathing, but overuse injuries can just be unlucky spins on the Universe’s roulette wheel.

Plus, overuse injuries are the necessary flip side of pushing your limits. Your sedentary neighbor probably doesn’t have a tibial stress fracture or hip tendonitis, and that’s because their hardest workout is bicep curls with the remote control. If you go for it in an athletic life, injuries are an inevitable consequence at some point.

Traumatic injuries are totally unpredictable.
Sometimes, though, it’s just crappy luck. Here is a list of the worst traumatic running injuries I have seen:
• compound tibia fracture from a trail running fall,
• ruptured hamstring from stepping in a prairie-dog hole,
• broken ankle from hitting a rock on a switchback,
• broken toe from banging it in the sauna,
• deep thigh laceration from running into a tree.

I stopped myself there, but I could go on all day, with photos too. The amazing editors of Trail Runner wouldn’t put those in the magazine, so I suggest sending them a donation in gratitude.

Or it can be acute-on-chronic injuries. An underlying weakness caused by a bit too much stress opens up the body to be more susceptible to trauma. It might be as simple as lower bone density from training hard while not fueling quite enough. Or it could be something like that hamstring rupture in the prairie-dog hole mentioned above, which happened after a year of high-hamstring tendonitis. In court, the prairie-dog lawyer would make an argument that the hole wasn’t the proximate cause of the injury. The argument would be adorable.

The takeaway is that we don’t have as much control as we think. If an athlete never gets injured in their entire career, I’d guess that they aren’t truly pushing themselves, or maybe they won the genetic lottery. For everyone else, injuries are so closely tied to growth that they have to be viewed as part of the process. Do what you can to prevent injuries, but embrace them as an essential step on your badass journey.