As Miles Pile Up, So Does the Chance of Injury.

any of the runners who utilize the bulletin board I manage online under

the identity InterActiveTraining have as their goal the Chicago Marathon, a race held the second week in October. This is because the Chicago Marathon sponsors the board as a service to entrants in its race, even though runners training for other marathons and shorter races also use it.

It is in August (eight to 10 weeks before Chicago), when a significant number of runners begin to suffer injuries, minor and major. August, not too coincidentally, is also when runners using my novice program increase their long run to 15 miles, their weekly mileage to 30. By the end of the month, they will be running 18 and 36, respectively. This elevated mileage causes a certain number to get hurt, not too surprisingly, since surveys suggest that when you push your training mileage beyond 30 miles weekly, you do increase your risk of injury.

My bulletin board has half a dozen different forums so that questions can be separated by subject. One of the forums is titled “Body Shop” and is dedicated to questions about health and nutrition but also about injuries. Traffic remains relatively light to Body Shop for much of the year, but August brings with it an explosion of calls for help.

I sometimes refer to the injuries runners suffer two months out from the marathon as “August injuries.”

Here is a compilation of August injuries, with questions asked by runners about their ailments during that dangerous month of the year. I include the date the question was asked plus responses by me and other knowledgeable forum viewers, many of whom suffered from the same injuries and who have thus learned from the experience.

SORE QUADS

The Problem (August 1): A runner identifying himself only by the initials K.F. described feeling stiff and sore after starting his longer runs. “Short runs bother my quads even more,” he said, “maybe because of the faster pace.” The runner stretched before and after workouts but did no strength training. “Is there anything else I should do?” he wondered.

The Response: Jon Dikinis of Park Ridge, Illinois, responded: “Those long runs stress the body. It takes a while to recover. A massage might help.” Dennis Ryan of Boston suggested an ice bath. I recommended two quadriceps stretching exercises, both shown on my Web site. The more common one is to stand on one leg and grasp the other leg by the ankle, while pulling your heel up toward your butt. But I cautioned against stretching too aggressively and recommended waiting until after the marathon to start strength training. “Running hilly courses can challenge the quads,” I said, “but eventually, that same sort of training will strengthen them.”

STRAINED HAMSTRING

The Problem (August 6): Steve Blaine of Elmhurst, Illinois, strained his left hamstring but took immediate action to heal the injury: “I iced it, got a massage, took a couple of days off, then tested it with a short run and discovered I needed more rest. Tomorrow will be 10 days since the injury.” Blaine wondered what to do next. “Should I go back to running? Is it too soon?”

The Response: Hamstring injuries vary in severity, so even a skilled physical therapist might not be able to answer that last question. Amanda Musacchio of Villa Park, Illinois, described having a severe hamstring injury, almost a tear, several years before. She recommended: “Lots of ice. Lots of ibuprofen. No fast speed work.” She found that it hurt most the first 20 minutes of a run, then gradually felt better. She could handle long runs, although at a slow pace. Musacchio recovered in time to PR with a 3:46 in Chicago, although five minutes slower than her Boston qualifying goal. Nevertheless, the injury took six months to completely heal. I recommended that Blaine see a physical therapist, adding: “Yes, I know it costs money, but a good therapist who knows where to press and has access to ultrasound equipment can cut your recovery time significantly.” Coincidentally, my son Kevin suffered a hamstring pull about the same time. His therapist recommended cross-training: cycling, swimming, running in the pool, plus leg curls to cure a muscle imbalance Kevin had between quads and hamstring.

KNEE PAIN

The Problem (August 8): “I suppose I’ve learned a valuable lesson,” sighed Anissa Neely of Goldthwaite, Texas. “Don’t do a 15-miler, then ride in a car for seven hours. Not rocket science, I know, but I never would have imagined this would cause such ill effects. It has been almost a week since that workout, and I haven’t been able to run since.” Before posting her message, however, Neely already had visited a physical therapist, who diagnosed an inflammation between kneecap and joint. Neely added: “Continued rest, ibuprofen, and ice should heal things nicely, he said. But when and how do I pick up my training?”

The Response: Bob Winter of New Lenox, Illinois, noted that since the injury had come during a step-back week (when Neely would have run only an 1 1-mile long run), she hadn’t missed that much. “Rest was best,” said Winter. He felt that once the knee healed, she could jump right back into the program, whether to run 17 or 18 miles on the weekend: “But go slow, slow, slow!” I suggested that since Neely was following my intermediate I program, she could compensate for lost miles by shifting down one level to the novice program, with its slightly fewer miles. She didn’t quite do that but did cut back on her pace runs. In the Chicago Marathon, rather than push for a fast time, she decided to run with a friend and finished happily in 5:25.

SORE HIPS

The Problem (August 13): “This is my first marathon,” wrote Sarah Westbrook of Charlotte, North Carolina, “and I’ m going farther than ever before. Running is cool, but by about 14 miles, my hips and knees begin killing me.” Westbrook, who was training for the Marine Corps Marathon, wanted advice for reducing the pain.

The Response: Most of us suspected Westbrook had a classic iliotibial band injury, ITB being the tendon that connects the outside of the hip with the inside of the knee. Cindy Southgate of Kanata, Ontario, recommended checking some yoga Web sites for stretching exercises. “I’m usually a bit achy after a long run, too,” commented Southgate. “Unless you experience severe pain, it’s probably just normal wear and tear.” Icing and anti-inflammatories can reduce pain. Liz Reichman of Columbus, Ohio, added: “Strength training seems to help my hips. When I lift (especially squats), that helps limit the pain.” Proper shoes may help, since the pain may be caused by foot imbalances. So might orthotics. If the pain worsens, I said, a podiatrist might provide a more proper diagnosis and treatment, possibly orthotics.

BACK PAIN

The Problem (August 13): Julie Cagwin from Marion, Iowa, noticed that whenever she got finished running, she would suffer lower-back pain. “Nothing serious,” she reported. “Just a bit achy. It usually happens only after I go more than eight or nine miles.”

The Response: That’s a common problem, I responded, noting that in a recent 10K, I had been running behind a woman who spent most of the middle miles with her hands on her hips, as though her back hurt: “It’s caused by weak abdominal muscles, the core of your body.” I recommended crunches: sit-ups, where you don’t sink all the way back to the floor. Runner’s World frequently promotes cover stories offering exercises so runners can develop a “six-pack,” or “killer abs,” but you can’t beat crunches for strengthening the core. Kathleen Wahlgren of Washington, D.C., seconded the motion: “Work on your abs, and

you’ ll notice a great difference.” Jim Fredericks of South Milwaukee, Wisconsin, recommended frequent massages. We all, however, warned about starting a radical strength training routine during the middle of her mileage buildup.

LEG PAIN

The Problem (August 16): It started with a 5K that Paul Jankowski of Valparaiso, Indiana, ran in April. “I started having sharp pain at the top of my right leg, both front and back,” he wrote. Despite cross-training, the problem continued into the summer but worsened after a 14-mile run. “That’s it,” said Jankowski. “I’m going to a doctor.” The first doctor diagnosed the pain as an adductor and gluteus problem, said take two weeks off, ice, and take ibuprofen. That didn’t work, so Jankowski visited a chiropractor, who offered electrical stimulation, ultrasound, massage, and stretching. With recovery imminent, Jankowski worried about loss of speed because of his enforced recovery.

The Response: I cited research that suggested it takes two days of retraining to regain fitness lost from one day of missed training. “Of course you’ve lost your speed,” I said somewhat unsympathetically. “You lost training time!” Fortunately, Don Pocock of Winston-Salem, North Carolina, had my back, offering more practical advice. Pocock experienced a hip flexor injury before the Marine Corps Marathon the previous year and spent three months resolving the problem. “What got me going,” said Pocock, “was some weight training. My injury stemmed from muscle weakness and was prolonged by scar tissues that built up in the muscle. After a few light workouts, I was able to break up the scar tissue and begin running normally again.” Jankowski recovered enough to run Chicago, albeit in 4:19 compared with the 3:32 he ran the previous year. He attributed the slower time to lack of fitness because of the injury.

OVERTRAINING

The Problem (August 18): “I overtrained,’ confessed Jean Domel of Batavia, Illinois. “With a trainer, no less.” Domel began getting bizarre pains in her body. “Now the pains are gone, but I just don’t feel like working hard again.” Domel reduced her mileage and cut back on speed workouts but still found herself without focus. “Even though I just ran a 5K personal best, it just didn’t thrill me.” She wanted advice to help herself get back on track.

The Response: Alan Ford of Loganville, Georgia, got right to the point: “Stop running! A day, a week, a couple of weeks, whatever it takes. Find new routes. Make each new run an exploration. Have fun. Even if your body feels better, you still have the mental aspects of overtraining to deal with.” I agreed with Ford, suggesting that overtraining was as much psychological as physical, although physical problems can create psychological problems. Melissa Vetricek of Tampa,

Florida, commiserated with Domel. “I’ve been in the same boat for months. I’m even entered in a marathon but have no burning desire to tear up the course.” Vetricek felt that Domel—and she herself—just needed to take time to relax, not always easy for well-motivated runners. Personal trainers, I said, should know better than to push their clients too hard, otherwise, those clients soon become ex-clients, as was true in this case.

PLANTAR FASCIITIS

The Problem (August 23): After a few weeks of pain in his right arch, Russ Bartlett of Salt Lake City began to suspect that he had plantar fasciitis. An article in Runner’s World recommended stretching, icing, and anti-inflammatories, but Bartlett wondered: “Can I ‘run through it,’ or do I need to take a break from my training?”

The Response: Plantar fasciitis is a very common injury among runners who do speed work, run very hilly (uphill) courses, or even run on a tilted treadmill. Getting up on their toes stretches the tendon that connects the ball of the foot and the heel. In fact, piercing heel pain is the most common symptom, particularly at the start of a run. What worked for Mark Felipe of Arlington, Virginia, was to never go barefoot. “The moment you get out of bed,” he advised, “put your shoes on. The minute you get home from work, shift from dress shoes to running shoes.” Paula McKinney of Between, Georgia, recommended inserts and training on soft surfaces. “I cut back on distance,” said McKinney, “but never stopped.” She also found that rolling a tennis or golf ball under her foot felt good. Plantar fasciitis usually proves most painful at the beginning of a workout. Once you get warmed up, the pain begins to diminish. If you can stand the early pain, keep running; if not, see a podiatrist.

SHIN SPLINTS

The Problem (August 25): “I’ve been suffering from shin splints for the last few weeks,” revealed Gordon Booth of Bloomfield Hills, Michigan. “Standard treatment has allowed me to keep running with minor pain at the start, shifting to dull pain, then fading away as the run gets over five miles.” Discomfort when not running, however, forced Booth to skip the [step-back] week after his 18-mile run. He worried whether to cut back on his training or to run the next 20-miler as planned. “I hate not running for a week,” he added.

The Response: We felt Booth’s pain. Shin splints quite frequently are a beginner’s injury, although he was following one of my intermediate schedules. Paula McKinney commented: “Shin splints are nothing to sneeze at. They are a sign that the muscle is weakening and placing stress on the bone. Ignoring them can lead to fractures.” McKinney told Booth to relax, to take time off—and not to panic! She recommended cycling or swimming during the off time. I agreed and

suggested reducing mileage. Booth responded that he would follow our advice, adding that he felt better already. “I sold my bike a few years ago,” he said, “but I think it’s time to get a new one.”

STRESS FRACTURE

The Problem (August 29): A new runner (whose name I will omit) pleaded for help, because of what she identified as “a strain, or sprain, or something.” She wrote: “Toward the end of my 11-mile run, I felt a small pain above my ankle. Within a few days, the pain became intense.” During a midweek five-mile run, the leg hurt so much that she cried. Ice and stretching failed to help, forcing her to skip 15- and 16-mile runs the next two weekends. “What should I do?” she asked. “Financially, I am not able to see a doctor.”

The Response: Several of us considered that unfortunate, because her injury sounded more like a stress fracture than a strain or sprain. Kousik Krishnan, M.D., of Glenview, Illinois, works as a cardiologist. He advised rest from running for a long time. “If you still have pain,” said Dr. Krishnan, “you will need to see a professional or stop training and let whatever injury you have heal, which would likely put you out of this year’s marathon.” I also recommended not starting, saying: “The right sports medicine professional might be able to help, or might