I have to admit I’m a little embarrassed writing this. Here I am, a Physio with his own website on managing and preventing running injuries about to defer on a marathon because I’m injured. The truth is though that sometimes it really is the best choice to make. So how do you decide whether to push on or pull out?
When we train for a race it’s a big investment of time and energy. We sacrifice things to fit in the mileage. Gone are Sunday morning lie ins, boozy nights out and half of my toe nails. It’s a juggling act squeezing in runs home from work, justifying a pub walk as ‘cross training’ and balancing family and relationship commitments. It is hard. Any runner whose partner doesn’t run will have heard their loved one ask, “you’re running again?!” and had to justify their fourth/fifth/sixth run of the week.
So deciding that after all this training and sacrifice that you won’t run the race you’ve worked hard for is painful. What makes it worse, certainly for me, is knowing what you’re about to miss out on. I loved Brighton Marathon last year. I still buzz thinking about it. I’m gutted to know I won’t run it this year. I pass the road signs each day saying “road closure for Brighton Marathon April 14th” and my heart sinks.
It’s a surprisingly emotive topic missing a race and that can persuade us to make bad decisions and just “run through it”. This is also sometimes the advice you’ll get, especially from hard-as-nails blokes who champion the phrase Man the F**k Up! Don’t be persuaded by this macho rhetoric, you have to make you’re own choice…
Coming to a decision
When deciding if to defer there are a few factors to consider;
- What’s actually wrong with you? – some conditions will may flare up briefly and settle quickly, you’ll need some guidance from your Physio on this. Every individual situation is different. Many conditions though may experience a long term deterioration if you ignore your pain and race. Tendinopathy, for example, may progress from a reactive tendon (which usually recovers well with rest and a little rehab) to a tendon with structural changes or degeneration (which often requires lengthy rehab). For some things racing is an absolute no go, if there is any suspicion of stress fracture for example then don’t race and get properly checked out.
- Advice from health professionals – a key point here is see a Physio or health professional experienced in sport. In-experienced or non-sporty physios are more likely to air on the side of caution and just say, “don’t run” even when not necessary. I’ve met people who have been out of running for a year after a simple calf strain because their GP insisted they shouldn’t run. Personally I don’t think as health professionals we should be telling people not to run. Our job is to tell people the risks, the pros and cons and let the athlete make an informed decision. So, if you haven’t already, seen an experience health professional and ask their opinion. In many situations they’ll find a way to help you run if you can be fixed…
- Can you fix it? Now ‘fix it’ is probably the wrong phrase – we aren’t like cars, just stick a new fan belt in and away you go! That said, sometimes with the right input things can improve significantly. I’ve seen quite a few runners hobble in a couple of weeks before a race and yet make it to the finish line unscathed on the big day. Often the right advice during the taper period can really help and sometimes taping techniques can be effective in offloading healing tissue for a while. In many cases it comes down to resting from running completely for a short while and making your priority being injury free not squeezing in more miles or ‘testing’ an injury (more on this in while…)
- How much time is left? Time is a great healer and I’m often surprised how well the body will heal itself if you let it. For some races you need to defer well in advance but for some, like Brighton Marathon, you can wait until the last few days before the race. Give yourself as much as time as possible before making the decision. Healing times for injuries cary considerably. A sore overworked muscle might settle in a few days or a couple of weeks. With an actual tissue tear though it is much longer and will vary depending on severity. Very roughly speaking muscle injuries heal in 6-8 weeks, tendons and ligaments take longer at around 12 weeks. It may take longer to reach a level where you can run a race, especially long distance events.
- Are you really going to make it round? I say to myself that I could run this marathon, it’d hurt but I’d get round. In reality though I can’t run across a road at the moment without pain! I haven’t ran more than 4 miles in 5 weeks 26.2 is out of the question! You have to ask yourself whether you really could do it, and more than that, could you enjoy it? Is it really worth a lot of pain just to ‘get round’? Part of this question is also are you fit enough? You’re injury might hold up but will all the missed mileage take its toll?
- What are your goals? If your main aim is to beat a PB then you probably won’t achieve that running injured. If however you just want to experience the race and the atmosphere and you think you could find a way of comfortably plodding round then it should be possible.
- Likely impact of running the race – think short term and long term. In to short term you’ll be sore, how will that effect you? Would you have to miss work? Can you see someone to help you? Is it likely to settle quickly – how has it been after running recently? In many ways long term impact is more important. In my case running less than 4 miles aggravated my pain for 5 days (in fact it still hasn’t settled). Running the whole marathon might aggravate it for weeks or even months taking it from a fairly simple reactive tendinopathy to something more long term. Most injuries are treatable and will recover but do you want to face missing running for some time and a lengthy period of rehab. If there are likely long term implications then deferring is the most sensible option.
- Your running plans and race schedule – for some a race might just be one of many races in their calendar. Missing it might well mean being fit for other events. For other runners, especially those tackling marathons or raising for charity, the race might be the Big One – a once in a lifetime challenge. If this is the case and you have no plans to run soon after the event then you have a little more freedom to take risks. That said, this should always be just part of your decision!
Once you’ve made a decision be prepared to review it. Things do change but be careful not to jump to any rapid conclusions! Just because you feel a bit better for a day or two doesn’t mean you’re suddenly fit to compete!
When the dust has settled and the decision is made it’s important to reflect on how you got injured to learn from it and stop it happening again.
Honest reflections on my injury
My injury is my fault. I haven’t been unlucky or cursed I’ve just been a bit careless. I’m not beating myself up about it though as it’s an easy and common mistake to make. I was trying to beat my PB of 3:12 for the marathon and this meant pushing hard. In doing this we tread the thin line between peak performance and injury. Sadly I crossed that line.
This is why…
Taking on too much - FMG and I bought our first home in December and we’re getting married in September. This is all fantastic however it has meant that while training for a marathon I’ve been renovating our home, planning a wedding, working 2 jobs and building the website! This makes planning 4 runs a week very difficult. I’ve had to run home from work carrying my stuff in a heavy back which is part of what aggravated my hamstring. It’s also been pretty stressful and I’ve realised that, in future, I need to strike a better balance.
Inadequate preparation - moving home meant virtually no running in November and December. I dropped to 10 miles per week which meant a massive step up to 34 miles in my first training week.
Neglected strength and conditioning - In all my training I did just 2 strength and conditioning sessions! Partly this was due to lack of time but I should have prioritised and cut out a run or two instead.
Overconfidence - most of 2012 I spent running up hilly trails. I felt like I’d toughened up my legs and marathon training on the flat would be fine. My first training run, scheduled as a slow, flat 7 miler, I ran off road on huge hills. Oh and I did 10 miles rather than 7. By the end of my first week my hip hurt! I ran every run slightly faster than my schedule suggested, just because I could.
Changed too much, too quickly – as a natural progression from overconfidence I did far too much without really thinking. In a rest week of reduced mileage I decided I’d hit the hills again for the first time in 2 months. I did all 4 training days on hills and even did a speed interval of 1.5 miles all up hill. 3 days later I ran home with a heavy pack (faster than I should). The next day, carrying a niggle, I ran a 10 mile tempo (again faster than recommended) and then couldn’t walk after.
Didn’t modify my training enough - you’d think carrying a niggle I’d have slowed down a bit!? No, still did the vast majority of my runs at less than 8 minutes per mile.
Didn’t rest enough - I ploughed on through niggles as in the past they’ve always just gone away. I should have just had a few days rest.
Focused on squeezing in runs lost sight of bigger picture - because I was a bit of ‘schedule slave’ I became a bit obsessed with not missing a training run. Because of this I’ve missed about 25…Oh and the marathon.
You’d think having written this advice out many times before on RunningPhysio I’d have learned! It goes to show really, knowing what to do and actually doing it are two very different things! It’s all very good knowing the theory but you have to put it into practice!
There are positive things to take from an injury – I’ve learned important lessons to stop it happening again. Next time I’m training for something I’ll be more sensible, progress slowly, rest more, strengthen up and absolutely smash the race!
Final thoughts: choosing to defer is a tough choice. Sometimes though it’s better to think long term, rehab properly and come back stronger. There will always be other races!
If you’re injured and are considering deferring a race see your Physio or health professional for expert advice. As ever on RunningPhysio if in doubt get checked out!