How to Heal from Military Running Injuries: Prevention, Treatment and Back to Running

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Marine Forces Europe and Africa, rush to attack simulated enemy forces.
Marine Forces Europe and Africa, rush to attack simulated enemy forces during Midnight Sun, a battalion force-on-force field exercise in Setermoen, Norway, Aug. 8, 2020. (U.S. Marine Corps/Chase Drayer)

Recently, a doctor of physical therapy joined our local training group and has made a huge impact by educating us on potential injuries and early stage aches and pains, as well as some long-term pain issues, during our high-volume running cycle.

There are many avenues you can take when trying to avoid injury, work though nagging aches and pains, or deal with actual injuries. How do you identify and treat running injuries and still be able to run or take time off of impact activities, then get back into running? Here is some guidance.

Military Running Injury Prevention

Since there are many ways to treat running injuries, the one you select may not be the best course of action for you. Typically, rest and time off are the best healers. That's why preventing injuries is of the utmost importance.

The key to prevention is a gradual exercise progression and ensuring that you are eating and resting enough to recover from your workout.

First, you need to be familiar with the 10% rule, as that is going to guide your exercise progression.

The 10% rule is: Do not increase your running and/or weight-lifting volume, intensity or frequency by more than 10% per week. An example would look like this: You can run 10 miles a week while still feeling healthy and injury free; it's safe and reasonable to add another mile next week or to increase your pace for one of your shorter run days.

Next, keep in mind these prevention tools:

Nutrition: The foods you eat and drink are a significant part of your recovery. Eating a well- balanced diet of foods rich in protein, fat and carbohydrates will allow the body to start recovering immediately from the stresses of working out. The amino acids, electrolytes, anti-oxidants, vitamins and minerals, and water are critical to help you stay ahead of the injury, as well as recover faster when you are injured or ill. Find more information on Fitness Nutrition.

Rest/Recovery: Resting is not just about how much sleep you are getting, it is also about what activities you are doing outside your training routine. A key example is the person who runs six miles in the morning and then works a heavy manual labor job afterward or plays volleyball for two hours in the evening. The stress on your body is cumulative over the whole day. Your nutrition and sleep will matter in how you recover from the day's stresses.

Think of your body like a seesaw, with one end being training, work, physical activity and other stresses in life and the other end being nutrition, sleep and recovery practices (stretching, icing, massage). When those two ends balance out, the body is working to perform at your best and to avoid injury or general overtraining and overstressed symptoms.

Military Running Injury Treatment

Prevention and early intervention are vital for maintaining high performance and function in the long term. It may be useful to implement movements that help indicate your readiness for returning to running. If it is painful to walk or hop with both feet, you are not ready to run. If you can hop on one leg or run in place with no pain, begin adding running back into your routine.

Phase 1: Early Pain Identification and Early Treatment

  • Rest from running/loading 3-4 days at the first sign of injury, or longer if the injury has progressed
  • Ice for 15-20 minutes after any activity or long periods standing
  • Cross-train with low-impact activities (i.e. biking and swimming)
  • Progress training with 10% rule if you feel up to running again
  • Strengthen weak areas to reduce asymmetries
  • Stretch feet, calves and lower extremities as needed

Phase 2: Little to No Pain

  • If needed, reduce running/loading by 50% (volume, intensity, frequency) and gradually progress 10% each week in one of the three listed domains at a time
  • Address gait/running asymmetries
  • General stretching and strengthening of the lower extremities two to three days/week (straight leg calf raises, bent knee calf raises, toe raises/heel walks, lunges, single leg hip thrust, squat, deadlift and plank variations are helpful with running pains)
  • Scale back exercises that cause pain and replace with non-impact cardio options/stretching

Phase 3: Full participation

  • Running and loading progress with no pain
  • Recognize early signs of overuse injury and act early

Back to Military Running

I found that daily massage, ice, compression, foam rolling, lax ball pressure point (soft tissue) and a vibrating massage tool helped speed things up or at least made things feel better. Whether I speed up healing is purely anecdotal by me. Try compression socks when you attempt to run again. If no pain, then keep running within the back to running parameters (10% rule).

The ice and compression sleeves also work well for post-physical activity recovery from inflammation (bumps, bruises, tendonitis, sprains, etc). (See FreezeSleeve.)

Here are my rules for getting back to running:

Do not start back to the volume you were once running when you got injured. In fact, you should back it down a notch and rebuild. Treat yourself like a beginner. If your goal is to run fast for a 1.5-mile timed run, that is easy. Not much volume is needed. If you are preparing for a marathon, your starting point is relative, but the warning signs to decrease volume or stop running are all the same.

My rules on running with pain, no matter what the injury:

1. If it hurts to run, stop running. Replace with non-impact cardio.

2. If it hurts to walk, don't run. Replace with non-impact cardio if possible.

3. If it hurts doing nothing, seek a medical opinion.

Typically, that means pain described as cramping, burning, numbness, swelling, muscular, joint, bone or tingling in the lower leg or feet when sitting or standing. You may need to rest for several weeks from running or other impact activities. But you can reduce painful activity and cross-train (bike, elliptical, swim, row, etc.). However, it is always best to seek medical care if in doubt at any phase of the identification of pain and self-treatment process, as stated above.

For Rules 1 and 2: Ice, heat, compression, elevation and massage are logical starting treatments to the typical aches or pains of running.

My advice is swim, bike, row or elliptical and work the lungs and legs without the impact of running for a few weeks. But test out running every now and then, limiting it to one mile a day MAX. Then, get on a running plan when you are healed and don't start back up where you left off before the injury.

Basic Begin Running Plans will start off with every other day or 4-5 times per week with limited distances.

Start with 3-5 days a week of running but minimum distance and rest days in the week, spreading the 3-5 days into your seven-day week with mobility days or non-impact cardio days in between run days if needed.

Typically, my personal back to running week one is one mile a day, five days a week, plus non-impact cardio. If any pain shows before, during or after running, reduce the frequency of running to every other day with non-impact only on the days in between. The non-impact cardio are typically much longer workouts in the 20-30 minute range, in addition to the one mile a week run workouts.

Week 2 is 1.1 miles a day 5x a week plus 20-30 minutes of non--impact cardio to maintain conditioning.

Week 3 -- Listen to your body. People get injured this week, statistically speaking. Many will often make this a non-impact week.

Week 4 -- Same as week 2

Week 5 -- 1.5 miles a day, five days a week and, if no pain, you can add 10-25% if you are an experienced runner and feeling fully healed. But be smart. Too much distance, too much speed, too many days per week could trigger the same overuse running injury you took months to recover from.

Week 6 -- 2 miles a day, five days a week.

These five runs can be a mix of methods of running, but learning your goal pace for 1.5-mile timed runs is important in the first phase of tactical fitness (getting TO the training). Over time, you can build back up to your normal programming as long as you have no pain and progress logically with 10-15% increases each week.

-- Thanks to Dr. Seth Donelson (DPT) for assistance with this article.

-- Stew Smith is a former Navy SEAL and fitness author certified as a Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association. Visit his Fitness eBook store if you're looking to start a workout program to create a healthy lifestyle. Send your fitness questions to stew@stewsmith.com.

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