Clinical Commentary: Can I Race While Injured?
By Matthew Klein
This week we address a common question we get both at DOR and as clinicians. Running injuries are common and many runners want to know whether it is safe to continue their normal training but also to participate in their goal race. Matt does his best to explain the nuances of this decision and some thoughts that may help you make good choices for you as an individual
A common question runners have when they are injured is "Can I continue running?" The other common variation on this is "can I do my goal race with this injury?" Running injuries are common, impacting up to 70% of runners each year (CITE). They typically result from too much training (intensity, volume, etc) performed too quickly with inadequate time for the body to recover and adapt. Additional things like stress, sleep, nutrition and personal factors can positively or negatively influence this, continuing to suggest that running injuries are multifactorial. It is not uncommon for runners to experience aches and pains towards the end of a training cycle just before a race as their body finally tells them that they didn't have enough time to recover or adapt. Getting better and preparing for races often requires pushing our boundaries, which also means an inherent risk for injury. That doesn't mean you should not train hard, it just means that injuries do happen and you have to be able to decide what is the most appropriate way to approach them.
Before the Start Line: How Bad is It?
There are certain injuries that are an easy no for attempting to continue training or racing. Stress fractures, muscle or ligament ruptures or post-operative surgical conditions (not a small superficial surgery but repairs, arthroplasties, etc) are non-negotiable. Any training, let alone a race, will not only further damage the injured tissue but will also cause significant damage to other structures. These injuries are severe and require several weeks to heal from then additional time to rehabilitate from. A return to running program should only be started months out depending on the injury.
There are other injury types that may be negotiable. Chronic injuries that have been going on for a while that a runner has been able to train through without making much worse may be something that a race could be tolerable for. If the injury is acutely irritated, there needs to be enough time for it to calm down before the race. This can take 1-2 weeks depending on the injury and any runner attempting a race needs to understand the race itself may flare it up or irritate it more. This may require additional recovery after the race with the additional risk of a complete cessation of running for a while, which could have been avoided if the race was skipped. Different people will have different goals. Injuries in the later stages of healing may be able to tolerate a race but the same risks and consequences still apply if the workload from the race is high enough.
Making the Decision
Types of injuries that may be acceptable to race through include minor or low severity/low irritability injuries. Mild strains and sprains are normal and often heal within a few days. Some tendinopathies may be fine if they are non-symptomatic or have low irritability. Tendinopathies tend to improve as things warm up, but may worsen over longer periods as the tissue irritation increases. More severe muscle strains are challenging because muscles tend to get irritated more with repeated use. Optimal footwear should be utilized to not irritate these pathologies, which can be used to strategically reduce load to get through training or racing efforts. However, if symptoms continue to increase beyond tolerance, runners should reconsider continuing onward or initiating participation in a race.
The major signs that a runner should not race include not being able to tolerate any weight, compensating enough that there is an obvious gait deviation, a post-operative condition or pathology where rigorous activity is contraindicated or an injury that gets increasingly worse with more intense and longer efforts. For those who choose to race with injuries, know that finish time is no longer a major factor and finishing the race may be the best goal. However, given the unknown and potentially negative long-term consequences of pushing through injuries, we generally suggest not racing while injured, letting the tissue heal appropriately, rehabilitating the injury and returning to running safely to avoid complications and further injuries.
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NEXT: The Challenge of Zero Drop Shoes on the Trail