Despite our best efforts, injuries can creep into our lives from time to time. So, what do we do? Go to the doctor, take anti- inflammatories, and don't run for three to four weeks. But for many of us, this is not an option (already bought plane tickets for the Chicago Marathon, etc.). Running injuries are "overuse injuries" rather than "traumatic injuries". Traumatic injuries are usually the result of a single, large force causing acute trauma, like a sprained ankle. These usually cause an immediate halt of activity and a long limp home.

Overuse injuries come on more slowly and are due to repeated "microtrauma". Running produces approximately 1500 footfalls per mile, at a force of three to five times your body weight. This repetitive stress on our tissues can overcome the body's ability to recover and injury occurs. Overuse injuries typically begin with pain towards the end of, or up to several hours after your longer runs or more intense exercise bouts, such as speed sessions. As you continue to exercise, the pain is present more frequently, lasts longer between training sessions and begins to affect your ability to train. Examples of such injuries are plantar fascitis, shin splints, IT band friction syndrome, and runner's knee.

In this author's humble opinion, if you go to a "sports medicine specialist" for treatment of your sports related injury, they should provide you with alternative forms of training while reducing direct stress on your injured tissues. This "active rest" has proven to decrease the deconditioning which accompanies cessation of exercise, and has been shown to speed healing of the injured area. Such training options will provide the following:

1. Enable you to maintain your aerobic base (keep your wind up) while your tissues heal
2. Help prevent you from returning to training too soon, risking re-injury
3. Provide the steps necessary to return to activity, with consistent feedback, thereby reducing the risk of re- injury
4. Cross training exercises stabilize the assisting musculature, creating better balance throughout your body, which can lead to greater running efficiency
5. Provide a stress release valve, which will maintain your sanity and the sanity of the ones you love

Consider all the activities listed in the chart below as a continuum that can be used to return to running. You can gradually work your way up to a 30 to 45 minute session. At that point, use that activity as a 10-minute warm up, then do intervals (2 minutes/2 minutes) of that activity with the next higher number in the chart. As you progress, decrease the time spent in the lower # and increase the time in the higher # (activity), say 3 minutes/1 minute. Continue to progress up the chart until you're back to running.

Notice I did not say anything about the time between progressions. This varies with the individual patient, and with my big doctor brain, I have devised an intricate system called trial and error. We try to push the envelope in getting someone back to full activity ASAP without injury recurrence, a medical term known as "tweakage". We also take into account the patient's individual goals and the time frame for a particular event.

1. SWIMMING

HR Intensity - 40 to 60% of your maximum
Pros - Works the entire body as well the core musculature without stressing the joints or other tissues
Cons - Inconvenient; Not specific to running; Requires skill or massive frustration; The chlorine messes up your hair
Conditions - Safe for everyone, except people with shoulder issues

2. POOL RUNNING

HR Intensity - 60 to 85%
Pros - Less pounding on tissues; Specific to running motion; Uniform resistance throughout range of motion both forward and back
Cons - Inconvenient; Not specific to running speed which will effect neuromuscular recruitment patterns
Conditions - Safe for everyone

3. BICYLING

HR Intensity - 60 to 85%
Pros - Works hips, knees and ankles without the pounding; Same sagittal plane (forward/back) movement of running
Cons - Does not train the core muscles enough for running; Can be rough on people with lower back and neck pain
Conditions - Plantar fasciitis, Runner's knee (raise the seat), IT band syndrome, Shin splints

4. ELLIPTICAL MACHINE

HR Intensity - 60 to 85%
Pros - More specific and uses the same muscles as the running motion without the pounding; Can work arms concurrently
Cons - May not prepare the muscles of the lower leg to withstand the pounding of running; May bother runner's knee
Conditions - Plantar fasciitis, Shin splints

5. WALKING

HR Intensity - Yes, walking! Pros - Specificity similar to running, without the pounding; Used intermittently with run intervals to retrain tissues
Cons - Less stress on the aerobic system (less cardiovascular training)
Conditions - Safe for everyone, except people with acute shin splints and plantar fasciitis

Dr. Ken Sheridan is a local road and trail runner who enjoys competing in a variety of events, from marathons to duathlons. He practices at Active Care Chiropractic and Rehab in Golden. To ask him your injury questions, call 303-279-0320.