While treating an injury is specific to the type injury and background of the runner, many aspects are general in nature and can be discussed in an article such as this. However, don't consider this to be a cure-all, only a first step.  If it works in your case, good.  If not, seek personal and more experienced advice.  But this is a good place to start.

Two things must be considered when treating an injury. First, what caused it and how can that be corrected.  If this first step isn't analyzed and corrected, the injury either won't heal, or if upon rest and treatment it does heal, it is almost sure to return.  The second step is to treat the injury to promote healing.  While it is usually not necessary to completely stop running, it is definitely necessary to reduce effort and mileage.  This limited activity is rest and is very important, but not the only treatment you should consider.  Rest is a must; but, by itself, a slow method of treatment to cure an injury.  Other treatments are a primary topic of this article and are the things I found very few runners employing. They seem to think that some magic will cause the injury to heal.  Believe me, it's just like training - you've got to work at it.  But, before we discuss treatment, let's investigate the cause of the injury to implement corrective action.

Few running injuries occur suddenly.  They start as soreness or a low grade pain that grows worse with time until the runner can no longer stand the pain and/or running is affected.  At this point, the runner reduces or stops running for a period of time.  Some healing takes place, and as soon as the runner can again stand the pain and run, he/she is back on the road hobbling along.  Initially there may be indication of improvement, but soon he is back worse than before with much more scar tissue.  This cycle may repeat several times before the runner seeks help.

What caused the injury?  You may have an imbalance due to a structural problem or it could be due to a muscle imbalance.  Do you stretch the muscles in the rear of the body and exercise to strengthen those in the front of the body?  Is your left and right leg strides the same?  Does one leg or foot function differently than the other?  Watch arm action - are they the same?  If there is an imbalance in the running stride, arm action will not be equal to compensate.  Someone else will have to view your running form to evaluate arm/leg/foot action.  Even the trunk of the body may be compensating due to an imbalance and can lead to sciatica or other lower back problems.  Does the heel of your shoe break down and rotate to the inside or outside of the sole?  All these indicate imbalance due to the body - skeletal or muscle.  Your problem may be caused by shoes overly worn on the sole, uppers that have lost rigidity and support, or the inner cushioning layer of the sole that has become compressed or mushy.  Likewise, did the problem begin when you changed to new shoes or a different pair that you hadn’t used in a long time?  Through time and slow wear, you may have adapted to the wear pattern of the old shoes you are now wearing.  The new shoes are flat and square - shifting your structure, transferring the load bearing points, and moving the forces to a slightly different area of the muscle.  Think back to when the first noticeable soreness or pain started.  What did you change - shoes, training methods, different terrain, more mileage, speed work, running on the opposite side of the road?  Are you flat-footed, have a very high arch, have Morton's toe, have a foot structure that doesn't fit the standard shoe design, have dual ankle joints, one leg longer than the other (check hip joint alignment in a mirror), or an old injury that left a weakness or structural problem.  Also, consider that you may just be over trained or have accelerated mileage, speed, hills, grass or beach running too quickly or have raced too frequently.  Has your normal rest duration been shortened, sleeping less, working harder or involved in another sport? Summer heat often adds stress and disrupts chemical balance. In other words, consider all changes.

Basically, these causes fall into two categories.  A change you made but could not adapt to, or an imbalance due to body (muscle, skeletal or compensation for another or old injury) or shoes.  In the first case, revert back to the same conditions, shoes or whatever, that you used before the injury.  When changing shoes, training, etc., do it gradually.  In the second case, there were many sources of imbalance. Which one or ones caused your problem?  Here are some corrective measures.  Apply those that pertain to your problem source.  Get rid of defective shoes.  Exercise the less active running muscles.  Especially if you have knee problems, strengthen the thigh muscles, and exercise the stomach for sciatica or other back problems.  Stretch and be sure you do proper stretches the proper way.  Read about the subject of stretching.  Done improperly, some are dangerous and can cause injuries.  Experiment with arch cookies and/or heel wedges and even toe pads, dependent upon your problem. You may even need orthotics, but will need professional help for those.  First, though, apply logic and common sense and, as Dr. Sheehan stated, "Be an experiment of one."  Try a cookie; run easy several days; then judge if there is a change for the better or worse.  Make adjustments and watch for change.  When adjusting one function, hold all others constant, i.e. don't add a cookie, then go out and run twice your daily mileage.  Above all, be patient and read your body signs.

How to treat the injury!  If there is swelling, heat (inflammation) in the injured area and/or severe pain, stop running until they are gone and apply RICE (Rest, Ice, Compression, Elevation).  Has the injury or pain caused you to alter your stride?  If so, drastically reduce running or you will create injuries elsewhere and could permanently ruin your running form.   In this case, reduce distance to l/4 daily average and alternately walk and jog the distance until normal running form returns.

For all injuries, take aspirin on a regular basis until swelling and pain while walking are gone. Then take aspirin l/2 to l hour prior to running until pain while running is gone.

If the injury is in a muscle, use a heat rub and massage the muscle four or five times a day.  One time should be l/2 to l hour prior to running.  The muscle will heal quicker if you exercise it lightly (alternately walk/jog) and stop prior to noticeable fatigue.  Do not exercise until pain increases. This is the judgment most use and damage has already exceeded what the next 24 hours of recovery can overcome.  Thus, on a daily basis, the injury will grow worse.  Too much exercise based on the pain level is the single greatest mistake made and is why running injuries become so severe and also why healing is so slow.  Here is a method to overcome this problem.

Go to a track, if available, and jog the straights and walk the curves.  If it must be done on the roads, find a level one and al-ternate walking and jogging each ll0 yards. The track is best because it is level, distance can be gauged accurately, you are always near the stopping point and will be more likely to follow this ritual there.  On the roads the distance to get home when the decision to quit is made is a problem, and all of us hate to have our friends see us walking; so we run when we should walk.  Each time you follow the jog with the walk the muscles relax; thus, strain is less and you can get more exercise as therapy with less strain. Also, each time you begin the next jog you can compare the pain level with the last jog.  Pain should decrease initially.  If it doesn't, terminate jogging altogether and just walk.  If walking is painful or uncomfortable, go home. As long as pain diminishes, keep alternating the jogging and walking.  When this is no longer true, quit.  That's the answer to how far you should go.  The next day do the exact same routine and distance.  At the end, analyze if there was improvement over the previous day.  If no improvement or you are worse, cut back on distance.  If this continues over several days, rest.  If there was improvement, increase mileage the third day.  Make day four the same as day three. Then every odd day increase mileage if there is improvement. Every even day should be the analysis day, same as the previous day.  If you reach a point where improvement is minimal, stop increasing mileage.  If there is ever a degradation, cut back.  In several repetitions, there should normally be noticeable improvement.  Shortly thereafter, progress should become rapid.  When you reach half previous (before the injury) daily average mileage, eliminate every other walk in the mid-half of the workout.  If this is satisfactory, continue to increase mileage and one by one eliminate the walking phases, starting in the middle of the workout, progressing to both ends.  Even after the injury has healed, always do some walking and slow jogging to relax the muscles at warm-up and warm-down.

Unless there is swelling, heat, severe pain or impairment of running form, light exercise as described above is better than complete rest.  There is a good reason for this.  Normal muscle fibers are individual and slide relative to each other.  When injured they are torn, and when healing occurs there is also a degree of lateral bonding between fibers and this is termed scar tissue.  This lateral bonding is eventually reduced by exercise, but lasts well beyond the actual fusing of the tear injury.  The process is a source of internal irritation, causing low grade pain, swelling and additional metabolic action.  It will increase the likelihood of additional or repeated damage to the fibers upon fatigue due to too rapid acceleration of training.  Thus, it adds injury risk.  It is also a pain that hampers running and can cause improper running form, which can in turn lead to other injuries.  Scar tissue pain is confusing to the runner, for while the original fiber damage may now be repaired, pain in the area remains.  The light exercise as described reduces the lateral bonding on a daily basis as healing takes place. Thus, the resultant scar tissue is less and duration as well as risk to recovery is reduced.  However, there is a fine line between therapeutic exercise and the degree of exercise that causes additional damage.  The initial phases are the most critical, but once past that phase, recovery is rapid - much more so than if there was a period of complete rest. Treat the injury before it becomes severe.  Also, repeated setbacks increase scar tissue buildup significantly.  All of you who have experienced a repetitious injury can relate to the slower recovery of each successive setback.

If the injury is in or near a joint, it could be tendon or ligament damage or a combination of both.  The tendon tore due to being the weakest link in the muscle/tendon system. The weakest point is usually near or at the tendon/bone interface or in a joint where a bending action occurs.  The point of pain must be treated, but the tension that caused the tear was a result of muscle tightness, spasms or cramps. Thus, secondary treatment of the muscle must occur to relieve tension from the tendon so that it can heal.  Work on the tendon initially with ice and on the muscle with heat and massage.  Add stretching at a relaxed, low effort when the tendon has healed sufficiently that stretching will not cause additional fiber damage.  Stretching, like exercise, initially must be easy or it can cause rather than cure. Stretching is most effective when you are healthy to prevent injury, rather than as a cure after injury.  Remember to use aspirin and the walk/jog exercise routine.

Ligament damage is harder to heal than muscles and tendons.  They absorb nourishment from surrounding tissue, which is less effective healing.  They do not contain nerves; pain is from secondary swelling or a resulting injury to other tissue at the less stable joint.  Thus, pain is delayed.  You may not feel the repeat damage you are doing to them while exercising - that night or next morning, when too late, you find out.  Also, they bind bones and tendons in place at or near a joint.  When injured, they become stretched or torn; thus, the joint is less stable, adding to the risk of additional or repeated injury even when not running, as the joint flexes for our normal activities. Luckily, bone and ligament injuries are not as frequent in runners.

If you suspect a stress fracture, see a doctor and ask for an X-ray.  Remember, stress fractures often do not show up until they are more than two weeks old.  Dr. Joan Ullyot, in her book, Women's Running, stated that in her first two years of running she had probably five stress fractures, of which only two could be diagnosed by X-ray.  Stress fractures in the foot need not always stop your running.  However, you must reduce workouts and relieve the torqueing action with an insert.  Stress fractures above the ankle should be considered with more care, as it is harder to relieve the pressure that caused it.  Once the stress that caused the fracture is removed, healing is usually rapid and leaves little lingering effects.

In summary, these are the primary points:

..... Analyze what caused the injury and correct it.

..... Use RICE on the injury if severe, swollen, inflamed or continuously painful.

..... Use heat and massage on the injury after it begins to heal and the symptoms above are gone.

..... Use heat and massage on all muscles associated with the injury from the start unless there is significant muscle damage – torn tissue accompanied with inflammation.

..... Use aspirin.

..... Don't force running when normal stride is impaired by an injury.

..... Use the walk/jog routine for recovery and progress analysis.

..... Be patient; use common sense and logic, and experiment.

A wealth of knowledge exists in books, magazines and internet, so read and educate yourself on treatment. If you consult a doctor, be sure he understands runner related injuries. It is very desirable that he be a runner.  Runners are poor patients, and combined with an unsympathetic and over-worked doctor only skilled in traumatic injuries, you will only get more frustrated.  Remember, though, you may have a problem that does require the professional help of a doctor.

Harold Tinsley a lifelong runner, he and his wife Louise have directed the annual Huntsville Rocket City Marathon, one of the nation’s finest, every year since 1977. He is past president of the Road Runners Club of America and served on the Athletic Congress board of directors. At the age of 41 he ran a 2:33.05 marathon and won the National RRCA 10KMasters Championship at the Peachtree10K in Atlanta in 1977. He and his wife edit and publish the Huntsville Track Club News.