Sasha's General Injury Prevention/Recovery Philosophy

[Sasha Pachev]

Ok, I'm tired of typing out the same thing over and over. So I figured I'll do a little write up and then refer people to it when I feel it would be helpful.

First, I do not consider myself an injury recovery expert. Fortunately very little personal experience. No professional training. However, I do have some credentials in the way of injury prevention which goes along with building body's resistance against injury. I am 35 years old, have run for over 23 years since October of 1984, my longest break from running for any reason has been 3 days. In the last 10 years I have not missed more than 1 day of running for any reason. My last injury dates back to 2005, it was a pinched nerve in the lower back, from which I recovered by jogging 8-10 miles a day for a month. The one before that was in 2000, same injury, the recovery happened in a week by the same method. Prior to that, overstressed knee in 1996, recovery 5 miles of jogging a day for a month, pinched nerve in the lower back in 1994, recovery was jogging 7.5 miles a day for a month, overstressed knee in 1994, recovery jogging 5-8 miles a day for two weeks, and overstressed knee in 1986, recovery was jogging 5-12 miles a day for two months. For the full disclosure, this is my entire injury history in 23 years.

Based on my experience, observations, and common sense, I have developed the following general injury prevention/recovery philosophy. If you are not injured:

* Do not do stupid things. For some people stupidity means putting more than 500 miles on a pair of shoes. For others it is running on hard surfaces. For me it is running on the track in spikes through the curve and running on a skewed surface. Know your weaknesses and keep your ambition in check.

* Train consistently. Run 6 days a week, rest well on one day. Do not skip your runs. Let your body learn to anticipate stress and be ready for it. Gradual stress does not damage tissues and bones, if it is gradual enough, the body will adapt even if the stress is very very high. It is the sudden unexpected stress that kills. Along with that goes the next principle.

* Avoid vain ambition and do not do hero runs. Listen to your body, ask it what it can do, and make it do no more than that. Overtime what would have been a hero run will become a comfortable jog.

* Keep your easy runs easy. I've had many conversations with collegiate runners that went like this: "I cannot run 100 miles a week, I get injured?" "Have you tried?" "Yes, I got injured at 80". "How fast did you run the bulk of your mileage?" "Between 6:10 and 6:30." "Can you run a 2:15 marathon?" "No". If you cannot run 2:15 or faster in the marathon, 6:10 pace is not as easy as you think. Even those who can often choose to run at 7:00 pace or slower in a lot of their runs. Why? Aerobic benefits are almost the same per mile, but the number of miles you can do injury free is increased dramatically.

* Eat healthy, reduce stress, and get adequate sleep. Every run, even a very easy run, causes a number of micro-injuries. When you eat, you supply the body with nutrients to heal those micro-injuries. When you relax and particularly when you sleep, those injuries not only heal but overheal, so you become stronger in the parts that were originally weakened by the workout. If your diet does not supply the nutrients, or your body wastes them as you run around getting too many things done during the day, or if you do not sleep enough, the micro-injuries do not fully heal before the next workout. Overtime this negative cycle converts the micro-injury into a macro-injury. Or in other words, an injury that makes you run or even walk with a limp.

* Along with the above - always plan your workouts, both mileage and intensity, based on your opportunity for recovery. Do not try to run 100 miles a week if you have a high stress job, and you can sleep only 6 hours a day (unless you are made of steel, and you are sure). If you understand this principle, you will understand why eating junk once in a while is a bad idea. Suppose you have planned a rigorous training schedule. Your body is handling it OK while you are eating healthy. Then one day you decide to give yourself a "treat". That "treat" in many cases might still be not enough to knock down your recovery below the threshold, but one day it might. Be humble, or one day your body may give you the taste of a humble pie.

If you are injured:

Follow the injury prevention principles above. In addition, we take the the following approach. The reason your body is injured is that your body does not know how to run without being injured. Maybe the form is bad. Maybe you can fix it so you will not injure the part of your body that keeps getting injured. Maybe it is bad, but there is nothing you can do about it except increase the resistance of the injured part. What exactly it is that is injured and why we are not going to care about. It is too hard for man to understand. However, God has given our bodies an innate ability to heal and adapt, and we are going to tap into those gifts the following way:

Is there a pace and a distance that you can run now such that 24 hours later you do not feel any worse than right before you start? If so, then start running that distance at that pace 6 days a week. It may be very slow, and very short, e.g 12:00 mile pace for 3 miles, but it is better than nothing. To keep up your aerobic fitness, add cross-training. But remember, you are not running for fitness, running is your physical therapy. We do not know exactly why you are getting injured. But as you run within your ability to stay healthy with very short intervals between the runs, you begin to adapt. Your running form adjusts, if it cannot, some tendon might get tougher. Maybe a certain muscle will get stronger. Maybe a bone will increase in density. Maybe a combination of the above. And the beauty of all of this is that we do not have to know exactly what needs to be fixed. We are not going to play a smart Alec and say, we'll strengthen this one muscles, or we will teach you to run this way.  We might strengthen the wrong muscle, or we might learn a form that is actually worse. Instead we let the body learn to adapt as it runs.

Overtime, we gradually increase first the mileage until you are able to jog your goal training volume. Then we gradually and very patiently start increasing the pace, no vain ambition, always willing to back off if we happened to overshoot. When the body (not the mind filled with vain ambition) says it is ready for speed, we start adding speed sessions, but again very cautiously. Overtime the healing should occur and the body should be able to run normally.

[Tom]

Thanks for posting this here Sasha. This is just what I am needing to hear right now. When you talk about a "mind filled with vain ambition" it hits a bit close to home. Even when I am certain that your advice is wise, it can still be so very hard to heed it when it's my injury and not someone elses.

[adam]

Sasha, I agree with what you are saying, and maybe I am just misunderstanding some of your statements, but I do disagree on your point that you shouldn't target specific muscle areas to recover from and prevent injuries in those areas or general form issues.

You can very much find out what muscle, muscles, skeletal or nuerological issue led to that injury, strengthen them or stretch them or heal them, and recover from that injury. In our clinic we deal with many patients who have extremely limited ROM and functional ability on shoulders, elbows, knees and over a few weeks time of targeting the specific muscle areas they increase their functional abilities and ROM dramatically.

On the issue of form, I agree that through increasing running time and mileage your body adapts to that and you become more effecient. However, proper form should be concentrated on when needed, to further increase that effeciency, and in some cases, correct the bad habits formed from the body's individual adaptation to higher mileage or from running on an injury.

If you look to do these things and none of it helps you at all, then ok, it didn't help as much as you wanted. But it is definitely not unwise to try and figure out what is wrong and try to improve it.

[Steve Morrin]

I definitely agree with your concept of increasing mileage slowly and waiting til you are ready to increase again. I have seen firsthand the effects of too much mileage too soon. My team captain was actually injured for the whole track season, so instead of being great, he was only good because his injury from overtraining hampered him.

[Christi]

Sasha- Thanks for taking the time to type these helpful ideas.  After being on the blog for a year I have read some of these tips from you before.  However, it is motivating and a good reminder to read again.  I am guilty of a couple things that lead to my current foot injury- being inconsistent on vacation then expecting too much mileage the week I began a new job and MOST of all putting over 500 miles on my favorite shoes.  But I've been listening to my body and its getting better day by day.  I'm making sure to put in some cautious "active" recovery miles and its slowly working. 

[Steve Morrin]

Just talking about the amount of mileage on shoes. I have two pairs of shoes that I switch between every day. Is it true that you can put more mileage on the shoes because you only use them half the time? I heard that letting the shoes "recover" for a day helps the cushioning last longer.

[jtshad]

As far as shoe mileage, 500 miles is a general guideline, but it holds pretty true.  Last week I was running on a pair of shoes that had reached about 550 miles and I started having sharp pains in my achilles.  Jon Allen reminded my about my mileage on the shoes, so I changed to new ones and the pain immedidately went away.  I think that you do need to rotate your shoes (at least 2 pair), but the 500 miles is true assuming this rotation approach and you won't get too much more beyond this (at least my personal experience).

[Steve Morrin]

Alright. I hope I remember what mileage is on my shoes. :-)

[Sasha Pachev]

I've put as many as 5600 miles (yes, that's right, it is not a typo) on a pair of shoes with no adverse effects other than feeling the ground through a hole. Recently I've put over 500 miles on a pair of Crocs and retired them because the hole was too big for my comfort, and over 500 miles on a pair of Five Fingers, and they are still in good condition. I think they will make it to 2000 miles, maybe more.

I did not even know you were supposed to change shoes after 500 miles until I had run for 12 or 13 years. I remember overhearing somebody say something about it, and then asking Golden Harper in disbelief - "really, you are supposed to change your shoes that often?"

I think overtime your body can adapt to putting quite a bit more than 500 miles on a pair of shoes if you start young and run consistently.  In Russia back in the 80s  we could not afford to change shoes that often, and we've had a lot fewer injuries than the American runners who change shoes every 500 miles do. Also think about all those Kenyan boys than run to school and back barefoot. I am willing to bet they get injured a lot less than your average shod American runner.

[Josse]

I agree that you don't need to change your shoes after 500 miles.  I put double or triple that on a pair of shoes and I am hoping more now that I am barefoot running. 

[ghethco]

Thanks Sasha, some good recommendations for sure.

I'd like to share some of my experiences in the hopes that others will benefit.  I'll start with the punch line for the benefit of those without the time or patience to read the details.  Here are two things that I heard from experienced runners when I was starting out:

   1. "You can run up to twice your normal mileage as a one-time thing without hurting yourself" --  Simply not true.  Not if you're 45 at least.  Maybe the 20 year olds can get away with this.  In my experience this is a sure fire way to get an injury started.
   2. "Running is the best training for running.  Throw in a little cross training if you need it." -- Again not necessarily true for everyone.  Strength training the lower body is needed to maintain balance and good body mechanics while running.  Cross training in other sports is not a bad idea, but is no substitute for strength training the lower body for running.

It took me several years to arrive at these two fundamental truths.  I'm not saying these two things will be true for everyone.  They probably will be true for most runners over 40 however.  If you're still interested read on.

I few things I learned, slowly and the hard way :-)

   1. Icing sore/injured areas after running.  Icing any area where you have an inflammation starting -- tendonitis, bursitis, etc.  will help tremendously.
   2. Using a foam roller when sore is also very beneficial.

I started running at age 45.  Part of a mid-life crisis of sorts, I'm probably not alone in that :-)  I built my mileage slowly, following the 10% per week mileage increase rule.  I spent several sessions with a trainer, who went over everything with me including shoe selection, form/posture and so on.  I got fitted for shoes at a specialty running store by a guy who was very knowledgable and experienced.  I tried different shoes and he watched me run on a treadmill.  Everything went fine and I built up to doing 10 mile runs without any problems.  Then I ran a half marathon.  Decent time (2 hrs something) but within a few hours of the finish, my knees hurt so bad I could barely walk.  I couldn't run again for several weeks, and in the following months my knees never fully recovered.  I had soreness in my knees and right hip after every run.  These problems nagged on for over a year.  I tried lowering my mileage, taking longer breaks, but the pain and soreness kept coming back.

Like many of you I'm sure -- I love to run.  There are few things I enjoy as much as running a fast 100 yard dash.  Feeling your body pushing you, feeling strong, I'm sure many of you know what I mean.  I really didn't want to stop running for good.  I was afraid that if I continued I would be putting myself at risk for long-term injury and maybe even disability of some kind.  So I saw a sports physician.  He sent me to a physical therapist attached to his practice.

The sports physical therapists I saw opened my eyes to a lot of things.  They see people every day with sports injuries, including a lot of runners.  The first thing she observed is that I'm flat footed.  I knew that, but noone had ever mentioned it as a potential problem.  Neither the personal trainer or the guy who fitted my shoes caught this.  Granted I probably should have realized it could be a problem myself, but after 45 years with flat feet, I don't think about it too much :-)  She recommended orthotics (Superfeet) which I now use religiously.  These would probably benefit most people with low or flat arches.

She had me lie down and tested the strength of my lower body.  She said I was weak in a number of important areas.  She stated flatly that the non-running exercise (not much) I was doing was totally inadequate.  She said I needed to spend at least one session strength training for every run that I did.  Here's the program she recommended for stretching and strength training:

   1. Calf stretches - 3x 30 sec
   2. Toe touches (knees together) -- 10 with toes elevated one inch, 10 with heels elevated one inch
   3. Warm up on treadmill, elliptical, or dynamic warm-up -- 10 minutes
   4. Stretches (lower body -- hamstrings, quads, IT band, torso twist, etc... the usual stuff)
   5. Bridge on exercise ball - 10 times, 10 sec
   6. Hamstring curls on ball, 2x 10 reps
   7. Step up on 12-16 inch step, 3x 10 reps each leg
   8. Dips on same step, 2x 10 reps each leg (good posture is to stick your butt out as much as possible)
   9. IT band -- using a stretch band around the ankles, walk sideways with knees bent, 30 feet in each direction
  10.  Superset - backward lunges and bridge on ball - 2x 10 reps each side

I usually follow this with some abs and upper body work if I have time.  Following this regimen and icing / foam rolling any sore or injured areas, I have had no further problems and I've built back up to 5 mile runs three times per week with no problems.  I'm also following the 10% rule religiously, no more than 10% increase per week in per-run mileage or weekly mileage.  Never.  Ever.

Gary

[Benn Griffin]

What about us overpronators though? I know I'm not built to be a runner with the feet I have and at 6'2" and about 170 I wear my shoes out even WITH my orthotics. Shouldn't I stick to the 350-400 mile range per shoe?

[Steve P]

In high school I used to put 1200-1500 miles on a pair of shoes consistently and fortunately never got injured. I just couldn't afford to buy them more frequently and it worked for me. I always thought it was a pact between the running shoe companies and Runner's World to get you to buy more shoes. Kind of like Jiffy Lube telling you to change your oil every 3000 miles even though it's probably not necessary in most cases.

Now that I'm 32, I might have to reconsider. We'll see.

[Benn Griffin]

My problem is that I blow out shoes so quickly. I really like the Asics 2110s and 2120s, but at 90+ bucks a pop I cannot afford to buy them. Also I used Brooks Addictions last year and they are heavier, but much more roomier for my flat feet then the Asics. I'm thinking I might go back to them, but they are 90-100 bucks a pair there. I find I can't get much more than 350 miles out of a pair of shoes before they're completely shot. Why don't they make running shoes more durable?

[Paul Petersen]

Benn - try ebay. I used to get Brooks Addictions on there for $50, usually last year's model.