4

A 4-

A 4-Step Guide to Beating Injury This guide and plan aims to provide you with a logical, safe progression to significantly reduce

the turnaround from injury. I want you to reduce your chance of long term injury so that you

can train more consistently.

Without consistency, you can’t improve; you can’t get faster. The purpose of this guide is to

supplement the 30-minute video seminar (available at RunSmartOnline.com).

You’ll find the “ladder test,” as described in the link below, along with a more detailed

explanation of key concepts.

The protocol, outlined in this guide has been developed across thousands of treatments

sessions with my patients who love to run.

I hope you find the same success that my patients and I have found by executing this protocol.

Best of luck,

Steve Gonser PT DPT

Physical Therapist

RunSmartOnline.com

Steve Gonser PT DPT

Physical Therapist

RunSmartOnline.com

KEY ARTICLES TO

READ, KNOW, AND

PRACTICE

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STEP ONE: Admit You’re

Injured

It’s the age-old question, “When should I just tell my body to be quiet and when should I listen?” If only the answer was clear cut, distinct, and easy. I’m a firm believer that most runners lack the discipline and patience to avoid long term injury. We feel things pull, tweak, (and) or ache. While most are unable to conclude if the feeling is ‘a usual ache and pain’ or something more serious, there are some rules that can help you determine if you should keep running or not.

The verge and inspiration for this article is founded not only by multiple user requests, but my own experiences wheeling and dealing with injuries. Remember, every runner experiences some wear and tear, some just more than others. The slope to the bottom is slippery. Runners underestimate the seriousness of a gradual ache or pull. That ache or pull could be nothing, sure, but it could also be a warning shot. Your body may be telling you there’s worse on the horizon. Navigating the storm is confusing and rarely the same. I plan to link my patients and my past experiences with injuries. For

some pain is only present while running while others suffer during daily activities (stairs, squatting, etc.). Your pain may oddly improve as you run while others can pinpoint to the mileage of symptom onset. This article is intended to be a blueprint to identifying the difference between a warning shot and a typical everyday ache.

Most runners are delusional, literally running on a prayer (Whoaaaa, oh! We’re half way there. –couldn’t

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resist.) A mixed bag of emotions circles the run. You’ll convince

yourself it’s all in your head or ‘not that bad,’ but knowing when to circle back for home or call for a ride is extremely important. The structural damage that can accumulate within a few minutes is horrifying. Most of my patients have heard me say, “When you have that ‘should I still be running?’ thought, STOP. Rounding out a mile or finishing the last few driveways can offset a weeks’ worth of rehab.”

Deciphering Between Pushing Through or Pulling

Up

Even in the most stubborn of individuals, I believe all runners know when it’s time to bag a workout. Deciphering between every day ache and impending doom can be tough, yes, but it’s not impossible. It really comes down to proceed with caution or a stop ASAP. Here are few things to think about when you start to translate the old tongue of injury prevention:

Proceed with Caution

You know your body best, but don’t let that be a loop hole in protecting yourself. General aches and soreness, especially new ones, should draw your attention, but feel free to keep running. Most minor aches, pulls, and pains resolve mid run and you certainly don’t want to overreact every time you feel a tweak. Heck, if that were the case most of us would never run again. Discomfort that you feel during any run should 100% resolve when you stop or shortly thereafter. The pain shouldn’t be sharp, stabbing, or burning. Dull ache is generally a caution sign. The symptoms shouldn’t persist across multiple runs, either. You’ll feel it one run and then it’s gone the next.

Seek Shelter!

On the flipside, any sharp, stabbing, or burning pain is generally a sign of inflammation or damaging of tissue. Every step will create further damage and more intense symptoms. Finishing or bagging your run quickly is important. Every step can and will create further damage.

For some their lucky enough to be at the tail end of their run, for other’s you may be miles from home. If catching a ride isn’t an option you’ll want to make sure you keep running. Stopping for water, to walk, or for a bathroom break will cause your symptoms to magnify. You even might end up walking home. As soon as you can, douse your injury with ice. AVOID HEAT! Ice will help manage tissue breakdown and inflammation.

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If you failed to bail on the run for whatever reason (stubbornness, denial, or you’re too far from home), you’ll still need to apply ice and quickly. An injury is usually marked with symptoms that intensify post run. You’ll notice trouble squatting, walking, or negotiating stairs. The pain may present as being sharp, burning, or overly tight. If you experience tightness, burning, or sharp pain with daily activities you likely sustained an injury. (Note: I did not mention a dull ache.) Feeling symptoms at rest or with daily activities will be a red flag for you.

If you’re disciplined enough to stay off your feet for a few days post injury and perform the right corrective exercises your injury should heal quickly. This article will lead you through the opening stages and a quick recovery. For most, a sensitivity accompanies most runs after a recent injury. Generally dull aches will come and go, while a true injury only intensifies. Don’t be fooled by a pain that improves as you run, either. Read here why your pain may improve while you run.

Remember, most runners know they’re hurt, but conjure up ideas that it’s “not that bad” or “all in their head.” Don’t freak out about missing training time (easier said than done). Pushing through or being stubborn with an injury will only fail you in the long run (pun intended). Fix the problem, whether it’s your training, run form, or anatomy.

STEP TWO: Test Your Readiness to Run

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The injury rehab water is murky. Most runners forego seeing a doc altogether. After all,

who wants to be told to stop running? Those two words (stop running) have bred a

distrust for doctors within the running community. Runners have sought asylum in the

confines of Google searches and the forever “valuable” phone a friend option. The

obvious trouble lingers on both sides of the latter options. For one, doc’s are

stereotyped as running haters, all spewing the same “stop running” treatment option.

The flipside offers little hope too, as your friend is likely affirming what you read on

Google (which is where they found their answer).

The distrust for the medical community is real—I know that. Timid runner’s visit me

every week hoping those two austere words aren’t mumbled from my mouth. “Please

don’t tell me to stop running,” they interject. Luckily, I’ve built my brand as being

“runner friendly.” Mostly because I’m a runner and how infrequently I murmur the

forbidden words.

Whenever I’m working with an injured runner, the number one question is “when can I

start running again?” Through my work and own injury experience, I’ve developed a

protocol of sorts. The purpose of this article is to pass on a piece of my injury rehab

protocol. It precedes my “10 Minute Feeler” article that discusses the importance of

keeping a short run on your first outing. Using the repeatable and rather simple test,

I’ve built to answer to the ultimate question: “CAN I RUN?”

I’ve used the test outlined below for nearly every runner I’ve seen since its inception

two years ago. It’s worked nearly (but not always) flawlessly when determining the

burning question on every runner’s mind. The test is my own little bearer of bad (or

good) news. It’s easy for a runner to infer that they are/aren’t ready to run.

The test mentioned below is on the tail end of my return to running protocol. It’s part

of the madness that is my treatment. It won’t tell you what you need to fix, how to fix

it, or much in the details of your injury, but it will tell you if you’re ready to run.

Whether you’re dealing with a banged-up knee, sore Achilles, or a forever lingering hip

injury, this test can make the “am I ready” conversation an easy yes or no answer.

The Ladder Test

Running through this test is simple,

requires no equipment, and is easy to

score (pass/fail). The primary goal of

the test is to determine if the body is

ready to accept impact. It will test the

injured tissue in multiple planes of

motion, insuring that some degree of

healing has occurred.

If you fail the test, it becomes

incorporated into treatment, which I

discuss in the video below. If you pass

the test, you’ll simply move on to the

next phase of my injury rehab protocol:

the 10-minute feeler. Check out the

video below to learn how to check your

body’s readiness to run:

(Click Above to Watch the Video)

Remember, there are multiple steps that

precede this test. Those steps are injury

and patient specific (me saying I really

can’t give them to you). A simple rule: if

you’re not functioning without pain in

your daily activities, then you likely have

no business attempting the test.

If you pass this test: On to running!

Learn about your first run after injury on

the next page.

If you fail this test: You should

continue lower impact and functioning

activities specific to correcting and re-

loading your injured tissue prior to

attempting the test.

IMPORTANT: Zero to Five Scale

I use the scale outlined below daily with my injured runners. This scale works for nearly

every injury. The image above is a scale that is likely burned onto the whiteboard in my

office.

A professor in college drilled into our brains that: a tissue, is a tissue, is a tissue. For

those with no medical background, it equates to the underlying fact that a tendon injury

in your ankle will likely respond the same as a tendon injury in your shoulder: a tendon

is a tendon.

The same rationale can be said for joints, ligaments, and the like. In my work with

running injury rehab, I’ve developed a protocol/system that is based on the “a tissue is

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a tissue” method. My patients have likely heard this at one point or another. Although

rather simplistic, the rule applies to nearly all running injuries and is rooted on a

foundation of tissue resilience and the ability to accept load, which are two very

important principles if you’re looking to successfully run after an injury.

Load acceptance and loading until failure reaches far beyond injury rehab. Engineers

know this well. For example, a bridge can accept a certain load before buckling. An

elevator cable can withstand a specific weight limit before straining (or breaking). The

same can be said for your (insert your running injury here). It can withstand so much

load until re-injury.

My simple scale can help you better understand the threshold breakdown for your

injury. I’ve used this thousands of times in practice and developed it when dealing with

my own injuries (yes, I too get injured).

The Scale: 0 to 5, How Much Does It Hurt?

Zero (0): “I don’t feel anything.”

Zero is easy. This is typically the point you’re thinking yourself, “hey, maybe this is the

time it won’t hurt?” It’s usually a subconscious Hail Mary that your (insert injury here) is

finally gone for good.

One (1): “I think I feel it?”

A one rating is that “is this all in my head” question. You’re running and you think you

feel it, but are typically unsure. This isn’t anything to fret, keep going (not that you

were going to stop anyways).

Two (2): “It doesn’t hurt, but I definitely feel

it.”

Ok, so at this point you’re positive you’re not crazy. You feel it. A “two” on the scale can

go either way. It can loosen itself up and retreat to a “one” or “zero” or can progress.

This is where you ideally stay close to home. You can keep running, but the street signs

now read “proceed with caution.”

Take home from zero to two:

As you can see, I’m not telling you to stop running. I equate the sensation of “feeling”

your injury or “being aware” to loading tissue that is simply not fully healed. News

flash, it can take up to six months for tissue to fully remodel (heal back to normal).

The zero to two stage can (but not usually) last months. Just proceed with caution and

patience.

Three (3): “It hurts a little, but I can run

through it.”

There’s no doubt that this thought has crossed your mind when attempting to return

running. Crossing over from a two to three on my running scale equates to the

beginning stages of breakdown.

The “slight pain” you feel may be manageable, but it’s a sign that your injury is failing.

The bridge is beginning to buckle.

Four (4): Pre-Limp – “I probably shouldn’t be

doing this.”

Although you shouldn’t be running, you’re likely still putting one foot in front of the

other. At this point every foot strike is shredding, tearing, and destroying your injury. It

doesn’t matter than you only have a few minutes left of your run.

Think of it this way: the average runner hovers around 80 steps a minute. An additional

10 minutes of running exposes your injury to 800 additional repetitions when it’s

already sending signals to stop. If you had a sore arm, would you lift a weight 800

more times? (Please say no)

Five (5): Limping

So by now the pain is fairly strong. You can’t hide your limp and it’s clear you

shouldn’t be running. You’ve gone overboard at this point. Plan on resetting your injury

clock a few weeks or even back to day one.

Progressing Through the Scale

Most runners will progress from a 0 (“I feel nothing”) to a 3 (“It hurts just a little”). The

progression of symptoms is a clear indication that your injury is failing to withstand the

barrage of foot strikes. If you start at “three” within 30 seconds you’re not ready to run

(sorry).

Don’t run on denial. It either hurts or you feel it. Black and white. Once you’re at the

“it’s about to start to hurt” pull the plug. Walk. It doesn’t matter that you’re only a block

away from home. Every foot strike is damage.

With time, you’ll slowly watch your time to symptoms or pain onset increase. What

started at five to 10 minutes is now 30. If you continue to run with patience, you’ll

avoid becoming a patient.

STEP THREE: Perform a Trial Run

The first run after injury is crucial but often butchered by most runners. Your first run

sets the table for a full recovery or destroying what you thought was healed injury. The

internal dialogue starts to weigh the fact that you can walk and negotiate stairs without

pain. Essentially every aspect of your life is pain free and seems to have resolved within

a week (or two) of rest. Most of you have lived the story, some of us hear it every day

(me!). You think you’re healed–you’re fine. You lace up and head for the door.

Confidence shortly begins to fill with self-doubt. Symptoms go from nonexistent to

negligible climbing to ‘not that bad’. Continuing that trajectory, your pain worsens until

you’re at a perfect, yet damaging, distance from your car. You refuse to walk back and

decide that running is your only option. Sound familiar?

Overdoing it seems to be hardwired into our DNA. It hinders healing, which eventually

causes further damage to our confidence and psyche (oh yeah and body!). Remember,

we all get hurt and injured. That’s not the point of this article. It’s more important to

discuss the steps required to resume running. As stated, that first run is so crucial. Most

athletes analyze runs comparatively. “Well I’m used to running 5-8 miles so 3 miles

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should be an easy gauge.” You’ll need to ditch that mindset if you want to fully recover.

Often a first run will tolerate less than 10 minutes. Ten minutes you say? Who cares

about 10 minutes? Well, for one, your injury certainly does. We’re not looking to

increase fitness with a short, simple run, but simply “feel it out.” You’ll want to grasp

how your injury bodes before jumping off the deep end.

The All Important 10 Minute Feeler

Clinically speaking, I will always begin with what I like to a call a ‘10 Minute Feeler Run’.

Ten minutes is an easy gauge that allows you to assess symptoms with minimal chance

for aggravation. It’s set in stone, too. Ten minutes doesn’t mean 10:15, or 10:45. Ten

is ten. I don’t care that you don’t feel anything or feel like you could run forever. Ten is

ten.

Ten minutes allows us to assess your tissues immediate and latent response to load.

Symptoms can be felt during the run or within minutes of stopping. For others, the

effects might not be felt for 24 hours. I’ve had patients experience zero symptoms in

their ‘10-minute feeler’ with symptoms drastically increasing the next day. Imagine if

said individuals were to keep running. The effects of stretching a run longer could cause

a setback measuring weeks to months.

Other Considerations:

Before making that crucial decision to start running, you’ll need to be able to function in

daily life without pain. That means walking, negotiating stairs, squatting, etc. If you

can’t function at lower level activities, how do you expect to fair at higher ones

(running)? If you can’t do these

activities, then unfortunately, your

answer is rest. Rest can equate to 24

hours, 7 days, or even longer depending

how much damaged occurred.

The key here is catching it early. You’ll

know something is wrong. Burning or

sharp pain is always a dead giveaway

when it comes to injury identification.

Symptoms may be experienced mid-run

or once you stop. You know your body

best. Don’t talk yourself out of an injury.

The best thing is to start the rest cycle

paired with ice immediately.

Progressing from 10

Minutes

No one wants to lace up for a 10-minute

feeler, especially in the colder months.

You’ll spend more time getting dressed

than running. Warming up on an

elliptical or bike can help get the blood

flowing and transform the experience

into a workout. Remember, motion is

lotion and may help you complete 10

minutes successfully. Once you’ve

completed 10 minutes without

symptoms, it’s time to progress. Every

other day is your best bet. I’m guessing

less than 1% will listen to what I just

wrote, so please don’t go three days in

a row. Fill the in between days with spin

classes, strengthening, and the elliptical.

These activities can serve to minimize

fitness loss, keep you sane, and not re-

injure yourself. You’re looking for small

gains early. Literally one run to the next

might yield 90 seconds of gain, but take

it. Ninety seconds turns into tens of

minutes quick. You’ll see progression

every few runs, but you’ll need to

patient.

It’s so important to avoid the mental

trap. Going out for an ‘easy 3’ is no way

to test an injury. Does it make sense to

throw 20-30 minutes at a recently

injured tissue? It shouldn’t. Ten minutes

has served me well and quickly grows to

tens of minutes. It allows a safe gauge

and shows improvement in a short time.

Work the process, remain patient, and

stay in control. You will run again… why

not make it sooner rather than later?

STEP FOUR: Progressing to 40 Minutes and Beyond

As you begin to gain confidence with your ability to run, it’s easy to rush the process. This is a huge (and common mistake). Below you will find an example schedule of how to progress your runs. The process is not the same of everyone and every injury.

What about speed work?

As you build your mileage you should be avoiding excessive hills (up and down) and speed work. Plan on getting 1-2 weeks of solid running under your belt before adding harder running.

Example Return to Run Schedule:

XT = Cross Train, Bike / Elliptical. Rest Days are interchangeable

ST = Strength Train (BaseSix Bootcamp Preferred)

XT = Acceptable on Run Days PRIOR to Run

Week Day of the Week

S M T W Th F S

1 10 min XT, ST 10 min XT, ST 15 min XT, ST 15 min

2 XT, ST 20 min XT, ST 20 min Rest 30 min XT, ST

3 30 min 30 min Rest 40 min XT. ST 40 min 20 min

4 ST 40 min XT 40 min 40 min Rest 30 min

5 50 min Rest 40 min XT, ST 40 min 30 min 50 min

6 Rest 40 min XT, ST 50 min 50 min XT, ST 60 min

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EX