How to heal injuries as quickly as possible

The worst thing about being a committed runner is injuries.  They sidelined us for doing the daily activity that we love, and they throw plans for races in turmoil or ruin them completely.  The key question is

 "How to heal injuries as quickly as possible?"

Quick Personal history and context

Since I've got back into running five years ago I've struggled with injuries of various sorts, each year my training mileage and racing has suffered.  This year has been my best in terms of consistent mileage and getting PB's in every race I've run, the key has been getting better at spotting injuries before them become too serious and then mostly doing the right things to heal them quickly so that interruptions to training have been minimized - over the last five years I've learnt from others, blogs, academic research and from my own mistakes.  With this post I'll collate the various bits of wisdom that look to be helping me, and perhaps go some way to answering that key question.

"how to heal quickly?" is particular relevance to me right now - two days ago, on Saturday morning, during a 21 mile long run my calves, left one in particular, began to progressively more painful.  Unfortunately there was no easy opt out from the run, I had to complete the return leg nursing an injured calf.  To ratchet up the stakes I have a the 41 mile River Ayr Way Challenge (RAW) to run this coming weekend, which gives me just 7 days to heal up and be ready to race.

Injury prevention

Prevention is far better than cure, if I had been more sensible I would have chosen to listen to my body before my run. I awoke with slightly sore calves, something I was surprised by as I had done three easy days of running prior to my long run, normally plenty of time for my body to recover from the tempo run that I had done on the previous Tuesday.  Prior to me long run I did consider  choosing a half marathon route instead of 21 miles to avoid risking over stressing my pre-fatigued calves, but I had in mind using the long run as a race pace rehearsal for the RAW so just stuck to my original plan.  In hindsight this was foolish.

Lesson to learn : Listen to your body, not plans or ego.

Injured, what to do next?

Staying the right side of training hard enough to adapt and get stronger and faster, but with enough recovery to avoid injury, is hard balance to get right consistently.  When you do get it wrong, injure yourself you then have to do everything you can to heal quickly and fully so you can get back to training and racing.

What should you NOT do?

Research into injury prevention and rehabilitation has provided some surprising findings that go contrary to years of practice, but once you understand the physiology of healing it actually makes sense.  The following items have been found to reduce symptoms of injury - like swelling and pain but harm the healing process as they reduce the very damage markers that immune system uses to signal that it needs to repair flesh and bones:

1.  Icing/ice baths - reducing swelling and pain, but hampers recovery but switching off the some of the immune response.
2. Pain killers - reduce discomfort levels but make it's more likely you over stress damage tissue before it's ready to bear full weight.
3. Anti-Inflammatory drugs - doubly wham of immune suppression and fooling you into pushing too hard too soon.
4. Anti-oxidants like vitamin C and E have been shown to reduce damage markers and discomfort but at the cost of also suppressing the immune response that uses those markers.
5. Caffeine - stimulants like caffeine don't compromise the immune response but they do suppress pain which can lead to over stressing the body.
6. Stretching.  Part of the immune response to injury is for the muscle fibres around the damaged area to shorten to take the load off the damaged so that it can heal - this is why muscles often feel tight after an injury.  The worst thing you can do is fight this protective mechanism by stretching the muscle fibres back apart as you then expose the damaged fibres to stress and can easily create even more damage to them.

What SHOULD you do?

To repair muscles back to full strength as quickly you must listen to your body, work with the immune system, stimulate it and support it. How can you do this?

1. Sleep well, heal well : Growth hormone is one of the key tools the immune system uses to stimulate repair of tissue and bones.  Growth hormone naturally peaks during sleep and this is when the majority of injury repair will happen. This means you should get as much good quality sleep as you can.
2. Avoid stress : Cortisol is one of the hormones the body uses to release energy for the body, and in particular the brain, to use.  However, Cortisol tells the body to start breaking down muscle proteins for fuel use which obviously runs counter to what we want when repairing muscles. Cortisol naturally goes up and down through the day and during exercise and as long as it's balanced by adequate Growth hormone they body will find a balance.  If you are exposed to lots of physical, mental or emotion stress then one can be exposed to chronic levels of Cortisol that aren't balanced and the body steadily breaks itself down.  So it's import you avoid stress during injury rehabilitation.  If you can't avoid stress then make sure you can relax as soon as possible to get your Cortisol levels back down.
3. Eat well - eat plenty of good sources of healthy fats, proteins, whole fruits and vegetables for their macro-nutrients and fibre and complex carbohydrates to support the bodies immune system and reduce stress on the body.  Animal proteins are the most complete and effective at supporting muscle repair, in particular grass fed cattle, oily fish, eggs and fermented dairy products like hard cheeses and yoghurt.
4. Don't ever stretch tight muscles, listen to the body when it's tight and avoid loading tight areas.  Gentle movement, massage and heat is the best way to relax up muscles.
5.  Massage : initially you want to employ gentlw massage on the injury area, for the first few days avoid intense massage as this can just cause more damage.  As the pain subsides and area starts to loosen you can help stimulate the immune system and blood flow by massaging the area more deeply.  As it heals massage will become less painful, but don't over do it - listen to your body and learn how it naturally relaxes once the worst of the damage is repaired.
6. Get outside into the sunshine and expose your skin, ideally for at least 30 minutes each day.  The skin creates Vitamin D when exposed to sunlight, and this Vitamin is crucial part of keeping the immune system active and balanced.
7. Active recovery beats full rest.  You want to keep you body moving during rehabilitation, both moving the rest of the body and the injured area.  You have to gentle and progressive and listen to the body - if it hurts then stop and do some other activity or rest, if it's just a dull pain that eases off as your exercise then it's safe to continue.  Walking and swimming can be great ways of getting the muscle working in a gentle way that doesn't overload any areas.
8.  Re-introduce running progressively.  If you can walk without pain then it is probably safe to try a few running steps.  If you find a few steps of running painful then stop immediately. If there is dull ache then proceed with caution, if the pain starts increasing stop and walk immediately.  The best places to run/walk will be out in nature on well kept trail - listen to the birds, the wind, relax and enjoy the time out in fresh out.  If you do this then you'll get some exercise and be relaxing at the same time.  
9. Be patient, let the body heal itself and listen to when it's ready.  If you body isn't ready yet relax, enjoy taking life a little slower.  The less you stress about getting back to training/racing the quicker you'll heal.

If I spend longer pontificating I could probably come up with more do's and don't, please feel free to add any further pearls of wisdom in the comments section.

How well is working for my calf? 

After the problematic long run I've had two days off running, and instead did a 15 minute walk yesterday, and 35 minute walk today in the sunshine.  My calf is still a bit tender when walking up and down stairs but definitely improving.   I've been using a foam roller several times each day and am seeing lessening discomfort here too.  I've occasional felt the urge to stretch but have avoided it so far, it's a hard habit to break, but as my calf is already less tight then it was is a good indication then stretching isn't required at all, just a bit of patience and listening to the body.   The danger zone might be feeling too good and running too soon, so tomorrow no matter how good the muscle feels or how lovely the day looks I'll stick to walking.

The progress made so far is really encouraging and looks like there is every chance after five more sleeps I'll be good to go.  With this progress I'm feeling really positive about being able to chase another PB at next Saturday as we run from the source of the River Ayr down to the coast.