Rub Some Dirt On It Epilogue

Last week I tackled the following question:

“How can you tell when an exercise injury should be rested rather than rubbing a little dirt on it?”

I also shared that I was actually having to answer the question for myself as I was dealing with a strained calf muscle with a race approaching.

I’m happy to say that I was able to “rub some dirt on it”, and not only finish, but win the Madison Duathlon from Ennis to Virginia City! In my case, the appropriate analogy was more like, “I duct taped it together.” The day before the race, my calf was still quite tender, and I was having some doubts. On race morning, I used a combination of KT tape and a compression sleeve to give my calf some extra support—hence the “duct tape.” After a 13-mile mostly uphill bike, I had to run eight mostly downhill miles into Virginia City. I really didn’t know how my calf would feel until I started running. But other than getting a little tight around the middle of the run, things held together and I was able to get to the finish line relatively unscathed! This week, I’ll give it a little extra TLC and hopefully ease back into my run training, as I have a marathon to be ready for in 16 weeks!

Me at the finish of the Madison Duathlon with my #1 fan. Note the duct tape job.

Rub some dirt on it

Today’s ask-a-wellness-question features one of our favorite sport/medical sayings:

“How can you tell when an exercise injury should be rested rather than rubbing a little dirt on it?”

Excellent question, and one which we all will most likely face several times throughout our lives, especially if we exercise regularly, and/or still participate in recreational sports. In fact, I’m facing this very dilemma currently—but I’ll tell you more about that when I wrap up the article. First, let’s try answering today’s question with a series of questions.

  1. How intense is the pain? It’s good to be in touch with your body. Pain is the body’s way of telling us that something isn’t right. The more acute and intense the pain, the more you should lean toward total rest and recovery. If the pain is more general and mild, you may be able to work through it. Some people have a higher tolerance for pain, but just because you have a high pain threshold, doesn’t mean you shouldn’t rest an obvious injury. If you listen to your body, often times you can treat/rest a potential problem before it turns more chronic. Speaking of which…
  2. Is the pain from an acute injury, or overuse? Acute injuries are sudden and often more traumatic. You know when you do it: rolled ankles, pulled hamstrings, torn ligaments, etc. Most of the time this is an obvious sign to stop doing what you were doing and go seek some medical treatment and diagnosis. Continuing to “play through” an acute injury increases the risk of further tissue damage and potentially making the injury worse (more on that in a bit). For today’s question however, I’m assuming most of us think of those more nebulous injuries, many which stem from overuse. Like when we wake up in the morning, roll out of bed and realize our foot/knee/back/fill-in-the-blank doesn’t feel right. Or same thing when you begin exercising, which leads us to:
  3. Does exercise change the pain? If the pain intensifies and worsens when you begin exercising or during exercise my suggestion is to shut it down. Find another type of exercise that doesn’t hurt, or just take a rest day and treat the injury. If I have an injury that only bothers me while I run, then I could still bike, swim, lift, hike, or walk. If the injury hurts no matter what I do, then I rest. However, if the pain subsides during exercise, or a tight area loosens up, then it may be a matter of pain tolerance and working through it. But still consider the final two questions…
  4. Does exercising make the pain better or worse post-exercise? So you’re tough, you rubbed some dirt on it, and you made it through your session. Great job! If the pain is unchanged later that day and the following day, then you may try again, starting back at question #1. But if the pain is worse after exercise, this is when you listen to your body and rest! You are in dangerous territory here, where the injury has a high potential to get chronic. I once had a bad case of Achilles Tendinitis where for months I went through a cycle of: rest a day or two, it feels better, go run, it’s trashed again, rest a day or two, go run… I would’ve done myself a favor by getting more rest and treatment at the onset of the injury, but instead I kept hammering it until it was chronic. Alas, I was young, impatient, and unwise. Now I am old, impatient, and slightly more wise.
  5. Finally, by not resting, do I have the potential to create a more devastating injury? Let me give two examples of professional athletes in recent situations. First, Kevin Durant injured his calf during the NBA playoffs in May. If you don’t follow basketball, Kevin Durant played for the Warriors, and he is really, really good. KD took a month off, and only came back when his team was down three games to one in the NBA Finals. He played 11 minutes in that game, and then ruptured his Achilles Tendon. Sadly, he will most likely miss all of next season. Now, hindsight is 20/20, there was a championship on the line, and he gets paid an awful lot of money to play basketball and win championships, but given the result, it’s pretty obvious he wasn’t ready to come back from his initial injury. Here’s one more that happened just this week. Megan Rapinoe plays for the US Women’s National Team and is one of the best soccer players in the world. She sat out of the World Cup semi-finals because she tweaked her hamstring in the previous match. Perhaps she could’ve rubbed some dirt on it and played? I have no doubt about her mental toughness. But by playing she also would’ve, like Kevin Durant, been risking a more serious injury, perhaps taking her out of the World Cup Final if they won, which they did. Instead, she rested, and now hopefully Megan will be able to give it a go in the final on Sunday. You are most likely not a professional athlete. You are not getting paid and there’s no world championship on the line. So what’s your hurry? If you think you have a minor injury but it could be made worse if you push it, then rest.

In summary, listen to your body! And if you’re unsure, it’s probably always better to err on the side of caution, rest the injury, treat it with RICE (rest, ice, compression, elevation), and if you think it’s serious or chronic, then go get medical diagnosis and treatment. It’s best to have a long term outlook—in this case, health becomes a priority above fitness. Don’t sacrifice your health for fitness! A few missed sessions won’t hurt you that bad in the long run, but a serious or chronic injury can. Or, best case scenario, find an exercise you can do pain-free, while you treat and rest the injured area.

I alluded to actually being in this situation in the beginning of this article. Last Saturday I was running when my right calf had a sudden, deep, acute cramp. I stopped running immediately. I walked for a while and stretched (this was my attempt at rubbing dirt on it) then I tried to run again. My body (via sharp pain in my calf) said no. Run over. Here’s where lies the complication—I’m supposed to race this upcoming weekend in a duathlon. Fifteen miles of biking and seven miles of running. So, let me take my own advice, and answer these questions for myself. Should I rest or rub some dirt on it and continue my training?

  1. How intense is the pain? It’s intense. It’s in one spot. It’s deep tissue. I’m aware of it when I’m walking. I feel like it would hurt if I ran. Verdict: Not running.
  2. Is the pain from an acute injury, or overuse? I have not gotten this injury diagnosed, so I’m not entirely sure, but it feels like it’s more acute.
  3. Does exercise change the pain? I already ruled out running in question 1, but I biked Monday, and it was fine. The pain didn’t get worse. So I can bike.
  4. Does exercising make the pain better or worse post-exercise? No change, maybe felt a bit tighter after riding, but didn’t feel like it hurt or worsened the initial injury.
  5. By not resting, do I have the potential to create a more devastating injury?Yes, I don’t want a torn calf muscle, so I rest and treat it.

So here’s the final verdict. Based on the initial injury I suffered last Saturday, and listening to my body, I have not been running this week, and I don’t think I will. I biked Monday, and now I’m taking a couple of days completely off before biking again. The pain and tightness has subsided a bit each day, but I’m still aware of it, so it’s not totally healed. I felt that my best chance to actually race and finish this Saturday would be to maximize rest and treatment. Will I sacrifice a little fitness? Perhaps, but not much. The risk of “rubbing some dirt on it” and trying to continue my normal routine in order to not lose fitness is much outweighed by the reward of resting. I’d rather feel rested and as healthy as possible to begin the race. So I’ll take the max rest, treat the area as much as I can, and see how I feel on race day. At that point, I’ll go back to questions 1, 3, and 5, and listen to what my body says!

Fingers crossed,

Neal

P.S. For more on the subject of injury treatment and prevention, you can go to our MUS Wellness Webinar page, and check out these three webinars: Pain Management; Ask an Exercise Question: Mobility, Injury Prevention, & Recovery; and The Amazing Foot & Ankle Complex.

P.S.S. Have a safe and happy 4th of July!