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Stay Injury Free this Season

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What to do when you are injured

by Steve Manning

Injury is a normal part of being a runner. Runners average between one and two injuries each year that are severe enough to force a reduction in running. On top of that little niggling pains come and go as you push your body to its limits.

Three major questions you need to ask are:

  1. How do you decide if you have an injury or a niggle?
  2. What should you do when you become injured?
  3. When should you seek expert advice?

The first thing you need to do is to rate the severity of the injury and to consider the injury history.  Identify if it is an Acute injury related to some kind of trauma or a Chronic injury related to overtraining. If you have turned an ankle or pulled a muscle during a run then this is very different to if you woke up sore the day after a long run or race.

When does it hurt? Is it from the first step running? Or does it hurt at the end of a run? Perhaps it warms up after running a few kilometres, or only hurts after you stop. Does the injury actually stop you from continuing running? Perhaps it makes you change your running style. Does it hurt you during the day while you are not running or make it hard to go to sleep? What are the other symptoms? Is there swelling or redness? Is there an open wound or general feelings of illness?

Injuries need appropriate treatment for them to resolve safely.  Niggles will resolve with a few days of rest and some self treatment.  Both severity and duration of your symptoms will determine whether you have a niggle or a more significant injury that needs a treatment plan.


Once you have determined how bad the injury is you need to make an initial diagnosis. The goal is to identify the location and type of tissue involved.

Try to reproduce the pain without causing any more damage. See if you can find a single point of pain or if it is in a general area. Identify if there are multiple sights of pain and if one site precedes another. Understanding some basic anatomy can then help to identify the types of tissues that may be affected. Push on different structures and see which ones hurt. If it is a joint then move the joint to see what position hurts most. Bones, joints, ligaments, muscles and tendons, nerves, blood vessels, skin and connective tissue can all be isolated so that you know what is actually injured. This is very significant to help you decide what to do next.


PROTECT:  The first step with an injury involves protecting the injured area so you do not make it worse.  If you reinjure yourself the damage is usually much worse the second time.  This can be with strapping tape, a brace or even crutches.

REST:  You will find most injuries will resolve with rest from the aggravating activity.  Sometimes that means reducing running duration or intensity.  It may involve keeping to flat smooth surfaces.  Stopping running completely may give a niggle the chance to resolve in a few days.  Extended activity may prevent some injuries from healing properly.

ICE: If in doubt use ice. Ice works as an anti-inflammatory to reduce pain and swelling. It is able to do this by numbing the pain receptors and causing vasoconstriction (contraction of the small blood vessels).  It also reduces tissue metabolism.  This results in a reduced inflammatory response that can aid in a quicker recovery. Ice packs are appropriate for large muscles but will not work as well over bony prominences.  Immersion icing works better for feet and heels by cooling evenly around smaller areas.  You can use direct ice massage but need to avoid icing too long on one spot that could damage skin and superficial nerves.

COMPRESSION:  Compression with tape or bandages may reduce the amount of swelling while supporting the veins to help blood flow back to your heart.  Compression socks or leggings are better to use for extended recovery times.  

ELEVATION:  Elevation of the injured area may reduce swelling by preventing the accumulation of fluid in response to trauma.  Ideally, the injured area should be elevated above your heart level.  This can be achieved by resting the injured limb on a pillow while lying down.

REHABILITATION:  The final step in treatment is often skipped as pain and symptoms have subsided.  However, it is the most crucial in ensuring that you are back running safely and reducing the risk of reinjury.  The earlier you can start rehabilitation the better and usually, it will begin around 3 days after an acute injury.  You might start with non-weight-bearing mobilisation exercises and conclude with functional tests proving the return of full function.

4. SHaM Treatment:

There are a number of treatment options to avoid that can increase the damage from an injury and significantly increase the time to resolution.  When people have hurt something the first reflex is to stretch it.  Stretching is not a panacea for all injuries and will often cause more trauma and increased spasming.  If you cut yourself you would not try and pull the wound apart.  Muscle tears are like an internal would and the same principle should apply.  You can turn a simple muscle cramp into a tear by aggressively stretching the muscle.  Heat will increase the bleeding and swelling around an acute injury like a sprain.  It may be appropriate in Chronic injuries to use a heating modality as part of your treatment plan but it will make the inflammatory response worse in acute injuries.  A massage is a form of stretching where an external rather than internal force is applied. The same factors apply with massage as stretching with regards to an acute injury although massage may help in recovery for sore muscles after an intense effort and will help identify problems earlier for chronic injuries.


Once the symptoms have resolved you need to look further at your biomechanics, foot structure, training, footwear, muscle balance and flexibility. The injury may just come back as soon as you start running if you do not do something about the underlying factors that led to the injury in the first place. Often the cause of injuries has multiple factors that all may need to be addressed.  It is much harder to identify the cause of an injury than to make a diagnosis.  An accurate diagnosis is critical to implementing the best treatment protocol but understanding the causes is critical to preventing re-injury.  This will often require a thorough check of your training diary, the wear on your shoes and your foot structure and function.

6. WEEK 50% RULE:

With any type of treatment that you are doing there needs to be a significant improvement in symptoms beyond what would happen if you had done nothing. You do have to give it an adequate trial but two weeks is enough for most injuries to get 50% better. If this has not happened, then you need to try something different or you may have made the wrong diagnosis. Remember also that rest is not always better. Too much rest can make an injury chronic and entrenched which will take much longer to resolve completely.


If you think you have a good idea of what is injured and it is not too severe then you can begin to treat it yourself using the above suggestions.  If you are not sure what is wrong or if it prevents you from running then you might be better off seeing a sports medicine Podiatrist or Physiotherapist at the intraining Running Injury Clinic.