Friday, January 6, 2012

When Rest Doesn't Help You

We all know that rest is important in any training program.  The rest period during the week is when you get stronger as your body restores itself from the stress of training day in and day out.  But there also comes a point is most people's training where they start getting a pain in one or more parts of their body.  Often times, the advice of RICE (Rest Ice Compression Elevation) is given to people for any host of pain, injury, niggle, etc.  You see it everywhere as if that is some magic formula for getting better.  And in the short term, it is.  But I've also observed people who stick with the RICE principle for weeks/months.  Well I want to tell you that RICE is not necessarily the magic formula people think it may be.  This isn't to say that RICE is a bad thing - there is surely a time and place when it can be effective.  For example, when an injury is in the acute phase. But doing RICE over a long duration doesn't serve you well as a stand along treatment and can be a waste of your time.  Let me explain.

The Situation

Let's paint a typical picture of a runner and call him "Fred" (sorry if you're name is Fred, I mean no harm to you!).  Fred has been having this ache in his calf for a few weeks now and despite his best efforts to make it go away, he is left with no other choice but to stop running due to the pain it is causing him.  Pretty typical if I do say so myself and for many people, you can just insert calf for some other body part, muscle, tendon, etc and say that you've gotten to that point in your running before where a pain became chronic to the point where it forced you to stop.

Now, I'd first like to point out that Fred likely went through the five stages of grief already as it relates to injury:

1) Denial - This is just an ache that will go away if I avoid it, right?  Yea, nothing to see here, move along...

2) Anger - Often times, this isn't impacted through running, but more through the home life or job.  Typically, Fred has a shorter fuse than normal and seems to be a bit snappy at things out of his frustration that running isn't going so well right now.  But nonetheless, he carries on...

3) Bargaining - I'll just keep up with only 3 workouts a week instead of the usual five, so that I give my calf enough time to recover.  I can still train on 3 days of running, right?

4) Depression - This sucks and doesn't seem to be getting any better.  The calf still hurts, I'm running less than I was initially, and who knows if I will even make it to the startling line?

5) Acceptance - Well, I guess I'm an injured runner and need to do something about this, because whatever I'm doing doesn't seem to be getting better.  Hi, my name is Fred, and I'm an injured runner (Hi Fred).

Don't tell me this doesn't sound familiar.  I think pretty much everyone has gone through some set of these phases before.  Maybe not as clearly defined, but when something starts bothering us, we typically do follow a similar path till we get to the point of not being able to continue with "x" activity.

What To Do?

So with that said, our running friend Fred has a busted calf that has become chronic.  Read most advice, and they'd tell Fred to go with the RICE principle and just stay off running for an indeterminate amount of time (a day, a week, a month...who knows), at which point he should be able to get back into running.  In fact, some doctors may even give this advice!  But let me tell you that you won't resolve anything and will just kick the can down the road by doing so.  Assuming Fred follows that advice and takes a month off (he no longer feels tight in his calf now that he isn't doing anything to aggravate it), he gets back to running and is so relieved to have "solved" his calf issue.  Except there is one problem - Fred didn't solve anything.  He simply "rested" till the issue went away and came back.  Well, once he gets back into the swing of training again, his calf problem will undoubtedly crop up again, thus forcing another period of downtime.  And thus the cycle repeats and/or Fred just gives up on running and moves onto something else (how do you think so many people have become triathletes!), because he says "his body isn't built for lots of running".  But that's where he's wrong.

RICE is just fine for a niggle here and there and for acute injuries, but when we start talking about chronic issues (ie problems that last weeks into months), all that does is make the problem go away for the time you are not doing said activity, only for it to come back sooner or later, because you didn't fix the underlying issue.

So that brings up the next piece of the puzzle - what is wrong with Fred's calf?  Well it could be a whole host of issues, but my point is that so many people think they are making a problem go away with rest or some combination of RICE.  But in reality, they aren't doing anything other than wasting time that could be spent figuring things out. 

Notice I haven't mentioned self massage yet.  The reason is because while self massage will likely prolong the amount of time Fred can run, due to working out any number of knots in his muscles, that still doesn't solve the reason for why he has such a terrible issue in his calf.  So while you may think self massage is the secret sauce (I do think it is completely beneficial and perform it nearly daily), if you are suffering from a chronic issue, there is something else going on downstream or upstream in your body from where the problem is.  Massaging those areas will help manage the pain/tightness, but it will not prevent the soreness from happening in the first place.  General tightness that can be resolved through self massage is normal, but if the tightness is at the point to where it is limited your activity, there is something else going on that needs fixing.  Extreme pain/tightness is not normal, no matter what the activity.  And despite your best intentions to stay the course (you are probably still in denial), your best bet is to solve the issue before it becomes a problem.  Doing so ensures a long term solution to the issue, rather than dragging it out over the course of a few months or even years.

In order to solve this issue, Fred would need to strip away the immediate issue of the calf and look more holistically.  This may involve a visit to a PT to see if there are any functional issues going on or perhaps something else.  Based on common sources of running injuries, his calf pain is likely caused by some form of weakness or imbalance that may or may not be as result of his form, his training approach, his shoes, lack of hydration, etc.  It could be any of them or a combination of a lot of things.

Conclusion

So the next time you are dealing with a chronic pain, don't just decide that RICE is the long term solution to your troubles and take a week or however long till the pain magically goes away.

- Take immediate steps to look at EVERYTHING (weaknesses, form, approach, history, shoes, diet, etc)
- Don't wait till you hit the Acceptance phase to take action
- Treat acute injuries with RICE, but if you don't see improvement after a few days, seek alternative methods
- At the first onset of an issue, go into problem solving mode to find a solution, not band aid

I've found that more often than not, most issues can be nipped in the bud long before they become chronic.  And on the brighter side of things - if it is something that requires significant rehab, you just saved yourself weeks, months, or even years of torment from trying to grind out painful miles on your bum calf while you were stuck in denial that you were suffering from anything.

Trust me, you can thank me later for being so proactive in helping to manage your pain.

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