Doc’s Talk 05-13-2012

Dr. Scaff called this talk “The Beginner’s Guide to Injuries”.

When you get an injury you see a doctor, the doctor tells you what to do, and you spend $80 – $90 in the process, …but 90% of the time you can take care of the problems on your own.

The injuries referred to in this article are not injuries like getting hit by a car or falling onto a curb and breaking a leg.  The injuries in question are cumulative injuries, repetitive stress injuries.  It is important to remember that long-distance running is the only sport where we do exactly the same thing 5,000 times per hour.  In other sports you move back, forth, and sideways, crescendo, decrescendo, etc., and thus get different types of injuries.  In running we are taking 5,000 steps per hour, and it is the repetition that leads to injuries.

First sign of an injury:  Feeling good
Why?  Because when you feel good you tend to go out too fast, or run too much too often.

Injury Phase 1:  Fatigue
The runs do not feel good, your sleeping pattern has changed, you are either sleeping too much or too little; whatever it is, you just notice a change in your general body physiology.  Note:  Injuries progress in intervals of approximately six weeks.  Therefore, after about six weeks in phase 1…

Injury Phase 2:  Soreness
The injury starts to localize and become sore.  Under normal circumstances, you may notice a little soreness at the beginning of a run, but after you warm-up that soreness disappears.  When you are injured the soreness gets worse 20 minutes into your run.  You may not be able to see it, feel it, or touch it, but there is an injury in there.  Six weeks later…

Injury Phase 3:  Tenderness
Where you were sore now you touch that spot and it hurts.  That tissue is starting to really bother you.  There may be swelling.  You’ll notice that you can put your finger on it and you can indent it, whether it is the ankle or knee or some other body part.  Six weeks later…

Injury Phase 4:  Death or tear or rupture of tissue
If you get to the point where you tear an Achilles tendon or one of your hamstrings, those are serious injuries.  They can take up to a year to heal.

The bottom line is, you want to avoid injuries.

Injuries tend to occur more often in the first year of training because you are just starting, although as you get better at running you can certainly damage yourself by over-training.

Nonsteroidal anti-inflammatory drugs (NSAIDs)
If you take a nonsteroidal, like ibuprofen or aspirin, the pain goes away and then you continue to train.  Now you can injure yourself worse because you are numbing the pain.

If you are going to take a nonsteroidal, take it on the days you are not running, and do not take it before a run, …except the day of the marathon, then you can do anything you want because you just want to finish and you’ve got 3 months to heal from whatever disaster you’ve caused.  But do not take NSAIDs up until then.

How do we tell a runner to heal?  First, tell them to stop running.  They can do anything during the healing phase that does not hurt, e.g., ride a bike, swim, etc.  Later they can go out and perhaps train slower if it does not hurt.

You should be able to walk without significant pain before you start running again.

During your slower test run if the pain gets better, you are on the road to recovery.  At this point, Dr. Scaff says you can go out for a 20-minute run, a little bit slower than your training pace, and see how it feels.  If the injury is getting worse after 20 minutes, it’s back to rest and relaxation, walking, or riding your bike.

If the injured area does not hurt after running 20 minutes, rest a day, and then add 5 minutes to your run.  If the 25-minute run feels fine, then rest a day and do a 30-minute run thereafter.  Continue adding 5 minutes to your run until you are again running for 1 hour, 3 times per week for a month, at that slow pace.  When you can do that, then go back to your regular training program.  That should take care of the bulk of the injury.

Some of you are still going to get shin splints, which occur primarily in the first year of training, and then they tend to disappear forever.  Side splints also tend to disappear after the first year of training.

A word on black toenails
Black toenails are an example of a minor repetitive injury.  Black toenails are painless and harmless.  A lot of experienced runners have had black toenails.  A black toenail is the sign of a tight shoe toe box.  If you weren’t wearing the shoe you wouldn’t get black toenails.  Eventually it will fall off and a new one will grow in behind it.

In ultra-long distance running (50K, 50 miles, or longer) black toenails have gotten to be such a problem that some ultra-marathoners have had their toenails permanently removed; drastic, but that happens.

Black toenails are a sign of accomplishment:  If you haven’t had a black toenail you haven’t run enough!  In fact, the Honolulu Marathon Clinic is thinking of coming out with a black toenail polish that will make black toenails look like fashion statements!

For more information on injuries, read the various sections on injuries in Your First Marathon – The Last Word In Long Distance Running, by Jack H. Scaff Jr., M.D., F.A.C.S.M., available for purchase at the Honolulu Marathon Clinic on Sundays and online at:

Coming Attractions
Next Sunday Dr. Scaff will talk about weight and how it impacts performance, and how to lose weight if you can.


For some good reading on nutrition, Dr. Scaff recommends everyone check out the daily postings on Dr. Alan Titchenal’s “Got Nutrients?” web site:

Here is a recent posting:

May 12, 2012
Legumes like soybeans, lentils, and chickpeas produce a class of naturally-occurring protease inhibitors called Bowman-Birk inhibitors that have potential health benefits. These interesting natural compounds are being studies for anti-carcinogenic and anti-inflammatory properties.

Consumer Link
Soybeans Soaked in Warm Water Naturally Release Key Cancer-Fighting Substance

Research Link
J Agric Food Chem. 2012 Mar 28;60(12):3135-43.