A question I often get asked is, ‘can I keep training with this injury?’. Many of my patients are passionate about their fitness pursuits, and the thought of missing a week or more of training is upsetting to them.

 

I can sympathise with this because I love to train too. I am currently training for an ultramarathon, and during my plan, I have had three niggles that I was convinced would stick with me until the race.

 

Well, thankfully, the short answer is, ‘yes’, you can train through injury. In my case, I made a few adjustments to my plan, and I was able to keep up with my weekly mileage whilst the injuries recovered. I am now back to running injury-free and I didn’t take any rest.

 

Before we get into it, I want to make a little caveat to this article; the advice here should be taken carefully. Some injuries should be rested, and I do advise this from time to time. I will try my best to explain how to train through pain, but if you are ever in doubt, seek advice from a professional.

 

With that said, yes, you can train through (most) injuries. The reason for this is that science is starting to realise that recovery from injury largely happens in the brain. There are cellular changes that need to happen locally in a damaged tissue, which is facilitated by the nervous and immune systems, but the way the brain processes what has happened and how it coordinates the body in response to the injury is perhaps a more important factor in one’s recovery.

 

When you are training, you are sending information up to the brain that helps it reconfigure your movement patterns, and this also helps coordinate the response from the immune system.

 

The other important benefit of continuing to exercise is that you are staying strong. Strength (or lack of it) is the number one predictor of one’s risk of injury. It’s important to note that strength is task-specific, so if you are a runner, it is important to stay ‘running strong’, and the best way to do that is to run!

 

The way I think about problems in the body is that if we are taking two steps forward and only one step back, we’re winning. So the goal when training is to not aggravate the system so much that you’re taking two steps forwards and two steps back.

 

If you are injured, I have a few rules to follow which should help you win the battle:

 

  1. Try to find a way to adapt your training to not aggravate the injury. With gym work, this is easy because you can always take out the movement patterns that aggravate the pain. For example, if you have a shoulder injury that doesn’t like overhead press but can cope with bench press and pull-downs, you can keep training your shoulders by avoiding the overhead press movement. Often, strengthening the joint with planes of motion that don’t cause pain will help the plane that is struggling.

    You can play with other variables too. Reducing the load, the speed and the range of motion can activate the muscles and joints in a way that is safer. Over time, you can increase these variables back to their original levels.

    With running, this can be a bit trickier. One of my injuries was a foot problem which caused stabbing pain in the ball of my foot each time it hit the ground. This isn’t ideal as a runner because my feet often need to hit the floor! I found a way to manage it, though, by changing my gait to more of a ‘waddle’, running on trails instead of roads and reducing my speed. Although this was a much slower run, I was getting the miles in, which helped me stay on track for the ultra.

 

  1. Pay attention to the first few minutes of your session, and things should get easier. If they progressively get worse, that is probably your body’s way of asking you to stop. Most problems get a bit easier when you are warmed up, and this is a sign that you can continue, but listen to the language of your body and stop if you need to.

 

  1. Get treatment and do the rehab. Getting a good diagnosis, hands-on treatment, and personalised exercises from a professional can help accelerate the recovery process. The body is a healing machine, and anything we can do to enhance the body’s natural power will increase the likelihood that an injury will recover even if you are training on it.

 

Are there any times that you shouldn’t exercise through injury? Yes, of course! Everything I have spoken about above involves adapting your training in a way where you manage the pain to prevent it from getting worse. This often involves reducing the intensity significantly to find a level of training that works for you.

 

Sometimes, however, this isn’t possible. This is why I often advise my patients to avoid matches, races and team events where the intensity is out of their control. It’s one thing to train on your own in an intelligent, controlled way, but another to ramp up the intensity and put your body at risk.

 

If pain and injury are holding you back, we can help in this clinic. We also like to discuss lifestyle factors, not just to get you out of pain but to live a healthy life with well-being as a priority.

 

Runner’s Knee can affect runners of all abilities and can be one of the more frustrating injuries. Confusingly, Runner’s Knee is a term that refers to one of two problems; iliotibial band friction syndrome (ITBFS), or patellofemoral syndrome.

ITBFS is where the lower part of the iliotibial band, a connective tissue that runs down the side of the thigh, can become irritated by the repetitive nature of running. Patellofemoral syndrome is an irritation to the joint between the kneecap (the patella) and the thigh bone (the femur).

You can easily tell the difference because ITBFS is found on the outside of the knee and patellofemoral syndrome occurs at the front of the knee. Both problems typically build up gradually and occur the more you run, they don’t normally come on suddenly. They also don’t click or lock, so if you have knee pain that came on traumatically, or if it clicks or locks, the advice in this article is probably not for you.

If you have one of the runner’s knee problems though, there are a few things you can do to help it.

What Are The Causes of Runner’s Knee?

Both problems are most commonly caused by having too much movement in something we call the ‘frontal plane’. This is the side-to-side motion of our body. When our foot hits the floor in walking and running, our knee bends a bit and it drops inwards a bit. This dropping inwards is known as ‘frontal plane motion’. It’s entirely normal to have frontal plane motion in walking and running, but it can be excessive on one side, and this is what causes problems.

There are two main reasons why this might be happening; firstly, if the foot is overpronating as it hits the floor, it drives the tibia (the shin bone) inwards, thus driving the knee in. Secondly, if there is weakness in the lateral glute muscles behind the hip, that causes instability of the femur, which also allows the knee to drop too far inwards.

Diagnosing Runner’s Knee

As with all pains in the body, it is best to see a professional to help you understand what is causing your problem because sometimes it is tricky to see yourself! If however, you have quite asymmetrical feet and one rolls in much more than the other, it may be likely that the foot is the culprit. Or if you feel unbalanced or weak in certain leg exercises, maybe it’s the hips that are at fault. Sometimes, the problem may only show up when running. In the clinic, we film people running outside with a special app on an iPad, and this is the way we can diagnose where the problem is coming from.

Exercises To Help Runner’s Knee

With all that being said, the exercises I’ll outline below will help most runners, whether you have pain or not. The only group of people that may not want to do them are those I mentioned earlier who have clicking, locking or a traumatic onset of knee pain.

Movement is hard to put into words, or at least it’s hard to put into a few words, so I will let the picture do most of the talking. I have also made a video with more explanation, which you can view here on our YouTube Channel.

If you are suffering from Runner’s Knee, it is helpful to keep the quadriceps (the muscles at the front of the thigh) stretched and the ITB treated with a roller. You may also find strengthening the glutes to be helpful. There are many ways to do this, but using a resistance band can be a useful tool because it leaves no hiding places for the glutes – they can’t ‘cheat’! Here I show a basic hip extension exercise and a standing ‘fire hydrant’ exercise (imagine a dog peeing on a fire hydrant!).

By keeping the tissues supple and the hips strong, this can help to mitigate the problem.

Why Did I Get Runner’s Knee?

In many cases, stretching the area and keeping it strong is enough to reduce symptoms, but an osteopath’s favourite question is ‘why?’. Why did it start in the first place? Why were the tissues tight? Why was the knee dropping in? Why were the glutes weak? Why does the foot overpronate?

If you try these exercises and the pain persists, it may help you to see an expert where we can help to answer the ‘why’ question and give you a personalised plan for recovery. Read more about knee pain here or book an appointment online.

And in the meantime, keep on running!
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