To train or not to train… that is the question?

For many runners, once they are bitten by the running bug, there are suddenly a whole host of complex reasons why they run, in some cases twice a day and in many cases every day of the week. The forces that drive people to miss out on social engagements, pretend that they really like salad and wholemeal pasta dishes, go for orange juice and soda water in the pub, are powerful indeed. And sometimes the drive to improve and to succeed can become too powerful. Sometimes we are driven to train when it is certainly not the best thing to be doing.

sick-runnerSo the question is, how do you know when you should most definitely not be training and when you can safely push on through?

Actually I don’t know that there are any hard and fast rules. For me, as with so many things in running, it comes down to experience and intuition.

Listen to your body?

Runners often advise each other (and probably themselves) to ‘listen to the body’ but I think that this is too simplistic. Sometimes the body is sending messages that should be heeded, whilst at other times it should be completely – and I would suggest – aggressively ignored.

But how do you know which is which?

There are times when all runners, indeed all athletes, feel pretty low. Fatigue, over-training, a slight cold, a niggle here or there. But in many cases, the problem is not significant enough to warrant stopping training altogether. But other times a cold can become a chest infection or a pain in the knee can develop into serious tendonitis that takes months to heal.

My experience is that the longer I have been a runner, the tougher I have got. Whereas when I first started running I would heed every cough and sniffle or twinge, now I tend to get myself out to do something, even if that is not the session that I had planned. So far, touch wood, I have not had a twinge turn into anything more serious and colds have abated without morphing into pneumonia.

What advice can I offer?

I know that intuition and experience is not very useful, so here are my top tips for working out if you should HTFU and get out there, or take a rest day or two and get better first:

Illnesses
  • If you check your heart rate and it is hammering, then your body is fighting some bad-dude germs and you should give it a chance to win. My resting heart rate (that is measured as I wake up before getting out of bed) is around 42-44 BPM. I measure it once every couple of weeks. If I wake up feeling rough and my heart rate is in the 50s I give it a break.
  • If your illness is affecting your respiratory system, i.e. you’re really coughing or your lungs are sore, don’t go for a run. Breathing hard in those circumstances is a bad idea.
  • If you have diarrhea or vomiting, especially if you are dehydrated as a result, take some rest and drink electrolytes to replenish the fluids and minerals lost.
  • If you have a tickly throat or a bunged-up nose, wrap up warm and get out there, even if you only go for 20 minutes easy, you’ll often find that the run clears the symptoms of the cold.
  • Hungover? No sympathy. Get out for a run and stop feeling sorry for yourself.
Injuries – this can be a more difficult area and these are only my rules of thumb. I’m no medical expert!
  • If you have a sore spot that eases up once you’re running, it is probably tightness rather than an injury, so get your run done and remember to stretch well when you finish
  • In my opinion if you have an injury that persists or even gets worst when you’re running, stop running. If you can’t at least be pain free after 10-15 minutes running then your injury is chronic and needs to be dealt with
  • Upper limbs don’t count. I ran races – including the New York marathon – two weeks after an operation to pin a broken bone in my wrist. Provided you’re not off your head on pain-killers you will be fine. Just don’t fall over.
  • If you don’t know what your injury is, figure it out. There are some things that cannot and shouldn’t be run-through. Check out the Running Injury Oracle or a physio for diagnosis
  • Accupuncture works… fast! Nonsteroidal anti-inflammatory drugs, such as Ibuprofen work… but they don’t fix the problem so don’t abuse that route
  • Change your shoes if you have knee/ankle problems and see how you get on before you confine yourself to your bed for a week

Timing

There is something to be said about timing – if you are two or three weeks out from a key race and you pick up an injury or an illness, the most important thing of all is getting well as fast as possible. I promise you that any fitness you loose by not training in the last 14-21 days before a key race will pale into total insignificance in comparision to how you will feel and perform if you try to train through and allow whatever it is to get it’s teeth into you. Stop training, rest and rehabilitate in the most appropriate way so that you have a chance of getting to the start line in decent shape.

If you get ill or injured with a month or more to go, the trick is to assess whether you do need to rest and rehabilitate or whether you can afford to take your foot off the pedal and simply train through whatever ails you, whilst keeping some training going. This is not, however, the time to give yourself a week off because you’re tired or have a little cold. If you are in the 16 weeks-to-go zone, you really need to be training as much as possible.

Final advice

The main thing to focus on is getting well again. Remember that for most of us (and I’ll assume everyone reading this) running is a fun activity. Sure, it is wrapped up in self-worth and how we define ourselves. But you’re not a contestant in The Running Man. So be smart – if you’re just feeling a bit tired, ill and daunted by the prospect of training, do something else, but DO get out and do something.

If you are unlucky enough to end up with a proper illness or injury, deal with that first and then get back to training. You won’t loose anywhere near the amount of fitness you fear you might and if you’re clever, you’ll be back and ready to regain your former fitness and more in no time at all.

 

“The only antidote to mental suffering is physical pain” Karl Marx

When I started running, pain was something that I understood would be inevitable, but assumed would be temporary and periodic. However as I progressed my training over the years increasing my mileage as well as the intensity of my sessions, I came to realise that pain could be a pretty constant companion. At the moment, as I am logging regular 65-70 mile weeks, I wake up every morning with a very tight, sore right ankle. Following my easy morning run and after an hour at my desk my right knee twinges. By lunchtime there is a pain in my lower back. And before I set out for my session in the afternoon my IT Band feels like a tensioned steel cable. These niggles are a part of being a marathoner.

The regular companionship of mild pain or discomfort has, however, made me think about what it is like for other runners and especially 100+ mile-per-week elite athletes.

Elite runner, elite pain

In Charlie Spedding’s brilliant autobiography, From Last to First, he describes how, when he was training full time, pain was something he had to deal with constantly. This was especially true for his Achilles tendon, thanks to which he almost died after a negative reaction to an operation he was having.

Ben Moreau
Scott Overall

So what about contemporary elite athletes? I had the opportunity to ask Ben Moreau, an aspiring Olympic marathoner, Scott Overall, whose 2:10:55 at Berlin in 2011 secured him the first place on the Team GB marathon team and Alyson Dixon who is also hoping for a place in the Olympic marathon for Team GB.

When I asked Ben about whether he deals with constant pain he said that, thankfully, he doesn’t. However Ben went on to tell me that he has trained through pains that have lasted for weeks and that in fact at the moment – with 13 weeks until his shot for a place on the Olympic team at the Virgin London Marathon – he has a hamstring issue that has been going on since early December (that is for around seven weeks). Ben said that this pain has meant that he has reduced intensity of training somewhat but that his volume of training has remained constant.

Scott Overall was similarly sanguine about pain when I asked him, telling me that

I think the aches and pains that athletes have are natural as I think its quite un-natural to be running over 100 miles per week, week in and week out

and he went on to say that in his experience a pain is often a sign of a problem away from the site of the discomfort. In his case calf pain was due to hip issues:

once I had a calf problem but the cause of this was because my pelvis was out of alignment and the pain was showing itself at the weakest part of the chain. No amount of stretching or icing the calf would help it because the root of the problem was with my pelvis, and it was this that needed to be corrected.

Alyson Dixon

Last weekend I was at a marathon training conference in Brighton and had the opportunity to run with Aly Dixon, who is looking to take the third and final place in the Team GB  Olympic team for the London Games. When I asked Aly about managing pain she laughed wryly, after all Aly has only recently returned from injury having run last year’s World Championship marathon in Daegu with a the double whammy of fracture to the distal phalanx (big toe) and sessamoid (ball of the foot) that she thinks started when she ran the Great South Run in 2010.

Aly is reported as saying that she was in pain during that race “but thought it was because I needed to change my shoes as they were worn out.” Aly went on to tell me that because the pain was intermittent she assumed it was a natural part of having increased her mileage and that it was something she just had to manage. In interviews Dixon described how the physios at Team GB in Korea did a great job at managing the ‘niggle’ to allow her to run after which they discovered the broken metatarsal.

Pain is inevitable. Suffering is optional (according to the Buddha)

So we have established, from some of the best runners in the UK, that with hard training comes pain and niggles. There is of course, quite a challenge in telling the difference between natural soreness or tightness and the start of an injury. So what do the experts say? Well Scott Overall told me that

Elite athletes tend to be very in tune with their bodies and would know why something is sore, it might be my calves are sore because I did a session on the track the night before, or my Achilles is sore because I’d stupidly been walking around in flip flops the previous day. A lot of the time there is a reason for the pain and you can generally narrow it down to what’s caused it.

and Ben Moreau gave me tips on how he manages the inevitable discomfort:

  1. if I feel like I’m changing my running style to accommodate it [the pain], I’m on a hiding to nothing and so will have to rest
  2. if it is getting worse constantly, that’s a bad sign, so I’ll rest
  3. assess rest vs healing and see if a reduced training amount now will impact the end goal vs possible benefits

Aly Dixon, now something of an expert in dealing with pain and recognising (or ignoring) injury, told me much the same as Ben – that she tries hard to recognise when pain is constant or worsening and affecting the way she is running and then decide whether, with a goal in mind, rest is possible and appropriate or whether she simply needs to push on and manage the issue.

How does that affect me?

To summerise, it seems that pain is an inevitable part of being a marathon runner and to avoid all pain would mean that the runner was not able to train enough to really reach his or her potential. The challenge comes when the pain is not a niggle but actually an injury. Scott Overall advises that

It’s important to nip these niggles in the bud before they get anymore serious. Keeping on top of things and getting regular physio and even massage can really help – if those things are not an option then just simply stretching or getting a foam roller to massage yourself.

One thing I have learned from talking to Ben, Scott and Aly is the importance of getting to know your body and recognise the difference between a niggle and an injury. Obviously being overly sensitive will mean that one doesn’t run enough whilst not being sensitive enough means that a serious injury could develop whilst the runner stubbornly refuses to acknowledge it.

I think that my advice would be that if you feel sore before you run, get out of the door and go for a 10 minutes warm-up. If after that the pain goes then it is fine to carry on (but get a physio to check out the area of pain anyway) but if the pain really remains or worsens, go home and immediately book an appointment with your favourite physio!

To conclude this ramble about pain, I think that my coach Nick Anderson of runningwithus, gave me some great advice this morning. We were out running together and I mentioned my sore ankle. I told Nick that the pain subsides within a couple of minutes of waking and goes completely once I have been walking or running for a minute or two. Nick said that this meant that the problem is manageable at the moment, but with three months until my ‘A’ race – the London marathon in April – I should get the ankle checked out by a physio now to avoid problems later as the volume of training continues to increase. I think that this is pretty good advice for all you marathoners out there so please let me know what you think and what you are doing to be the best runner you can be despite the pain!

 

 

Looking for a needle in a haystack

Injuries can be funny things. By this I mean they can sometimes seem to come from nowhere and be resistant to all the common treatments whilst at other times their arrival can be well announced and then they respond perfectly to icing or stretching or massage or whatever else is prescribed.

However with trickier injuries it is often a lack of clear solution that results in the injury worsening and become a real season-interrupter. My first brush with a persistent injury that resisted treatment was also my first experience of acupuncture and I learned a lot from both the injury and the treatment.

The injury was diagnosed as patella tendonitis or what many runners refer to as runner’s knee or jumper’s knee. Basically this is inflammation of the patella tendon which is found at the front of the knee connecting the knee cap (or patella) to the top of the shin bone. It is a classic over-use injury which often comes on when the runner increases milage and/or intensity and possibly doesn’t increase stretching to compensate.

In my case I had stubbornly kept running even though I was acutely aware of the pain in the front of my right knee. The pain continued to worsen until it was continuous and especially painful when I was running. And then I hit my knee with a pallet-lifter…

It was the Wednesday before the Milton Keynes half marathon and I was having a particularly difficult conversation with a client on the telephone. I had decided to take my phone and continue the conversation with the client while I took a walk from my office to the factory on the ground floor (I worked for a commercial printer at the time). I was mindlessly pushing and pulling a heavy industrial pallet trolley around whilst listening to the client when WHAM! the handle came down on my right knee. I was in agony (although I managed to avoid yelping and scaring the crap out of the client). By the time I got home that night my knee had swollen up and the tendon was incredibly sore. In desperation to run the race four days later I went to see Gavin Burt at Backs and Beyond who had dealt with my previous injuries. He decided that acupuncture was the best course of action.

Despite being rather nervous, I trust Gavin and so I tried to relax on the treatment table and see what acupuncture could do for me.

According to Gavin – in his typically straightforward manner – the idea behind acupuncture is this:

“If you have a splinter in your finger your brain sees it as a foreign object which may be infected and dirty, and certainly shouldn’t be under the skin so it mounts an immune response and an inflammatory response against it, involving white blood cells and inflammatory substances to disinfect the area and to get rid of the offending splinter. exactly the same process occurs when you have an acupuncture needle in your skin, except this time it’s the damaged Achilles tendon or muscle tear that the needle is inserted into that gets all the good healing stuff that the brain sends down there. so the acupuncture needle is used as an antenna to direct the brain’s attention to damaged tissue to help it heal….. simples, no?”

My experience was that after the initial very, very mild discomfort of the needles being deployed (acupuncture needles are typically made of stainless steel wire and are very thin) there was a sensation not unlike warm water rushing down my leg and around my knee. Gavin and I then chatted for a while – it might have been 20 minutes – before he removed the needles, which was totally painless, and I hopped off the treatment table.

The result was remarkable. My knee felt instantly better and I walked out of Gavin’s practice rooms with significantly less pain than I arrived with. Gavin suggested I ice my knee and rest for a couple of days, which I did. And on the day of the race I was completely pain free – no bruising from the pallet-lifter incident and no patella tendon pain.

The cynical amongst you may well suggest that the ice and rest had the effect of reducing the swelling and resolving the patella tendonitis. I guess there could be some truth in that.

However I am absolutely sure that the acupuncture had a significant effect – not least reducing the pain immediately after the treatment in the way it did. I must admit that I can’t rationalise how acupuncture can help people stop smoking or cure baldness, but I am a convert to the type of acupuncture that Gavin uses at Backs and Beyond. I have been back to Gavin with a few injuries and on the occasions where he has used acupuncture it has worked brilliantly so I would recommend that for those of you suffering from an injury that is not responding to the treatments you are using, find a practitioner that you trust, lay back and see what a bit of ancient Chinese medicine can do for you.