If an injury has you on the sidelines, you may need to do more than just take time off. Sometimes an expert needs to be called to the rescue. And whether you have to fix your training program or change your running style, the right advice can get you back on your feet a little faster.
For many runners, the time eventually comes when injury places them on the sidelines. The initial time-off, although frustrating, typically is essential for proper treatment of the injury. For some, the time-off may even provide a much-needed respite from an overzealous training program. However, when an injury persists and treatment options appear to be exhausted, the recommendation of more time-off can become an intolerable and sometimes inappropriate solution for the runner. At this point, prior treatment history should be re-examined to determine whether adequate attention was given to assessing the cause of symptoms rather than just treating the symptoms.

Most running related injuries have some mechanical component tied to the onset or persistence of the injury. If a runner's bony/structural alignment and gait mechanics are not assessed, improper treatment and continued restriction from running can occur. Some individuals have an alignment that genetically predisposes them to injury. You can treat the symptoms of that injury but they will always have problems if you do not address the cause. If the front-end alignment of your car is toed-in, you can change tires as often as you want but the problem will not go away.

Because changing one's bony alignment with surgery is typically not the option of choice, there are often ways to accommodate for the mechanical problem either passively (i.e., orthotics/insert modification, different shoe design) or actively (i.e., gait technique modification, improved dynamic control against faulty movement patterns). Some individuals will have good structural alignment but display faulty gait technique that causes injury. In this situation, changing how the individual runs is a primary focus. Competitive success does not necessarily mean a runner utilizes good mechanics of running. Those that are successful despite faulty mechanics typically have a great engine and are structurally tolerant to repetitive non-optimal loading. Thus, emulating a successful runner's gait may not be in your best interest.

The ideal way to determine if your gait mechanics are faulty is to undergo a gait analysis. This process includes a frame-by frame video analysis of your gait while running on a treadmill. Each detail of your mechanics is scrutinized and a plan is developed to manage the problem. Every gait analysis should include a running related physical evaluation to identify issues that contribute to faulty mechanics. Two runners may have the same mechanical gait fault but it can result from different combinations of structural mal-alignment, joint limitation, weakness, and lack of dynamic control over a movement pattern. As a result, a gait analysis should be a thorough process investigating every crucial aspect of your structure and movement that can contribute to injury.

Thankfully, there tend to be common patterns of faulty gait mechanics that lead to injury. The majority of injuries will typically fall within four to five different patterns. Changing the cause of the injury often relies on making subtle changes in gait mechanics/technique. The transition should occur over a period of weeks so that the body can accommodate. Although the changes are made to decrease strain while running, the body still needs to get used to the new way of moving. Contrary to what you may think, changing the technique of your gait is not difficult. It may feel weird initially but with proper instruction and practice, the changes will become automatic.

When trying to determine the cause of an injury, a runner's training program also should be evaluated. Regardless of whether you are a weekend warrior or an internationally competitive runner, inappropriate progression of running volume and speed-work are the two training program variables most related to injury. I often work with individuals transitioning from the 10K to half or full marathons. The increased training volume required for this transition can exploit an otherwise dormant predisposition to injury. While some runners may never tolerate the training demands of half or full marathon participation, many just need tailored guidance in the development of an appropriate training program. This guidance should not come from your running buddy or local running "hero". Developing a medically-based training program is a critical component of your recovery and requires the expertise of an exercise physiologist or coach specifically trained to understand the complexities of customizing this type of training program. This process requires a close collaboration between coach and athlete if optimal success is to be achieved.

Not all running injuries need the type of detailed investigation I have outlined above. Sometimes a little time off can go a long way. When that doesn't work, don't settle for "just take a little more time-off". Although gait and training program analyses do not guarantee that you will run pain-free, these treatment approaches can help you identify the cause of the pain, which in turn increases the odds that you will be able to establish a game plan to manage the problem.

Timothy Hilden is a physical therapist, athletic trainer and exercise physiologist at the Boulder Center for Sports Medicine.