Time to recovery following a running injury

When you are sick you always want to know how long until go are going to get better. The same when you come down with a running overuse injury. The answer to the question of ‘how long’ is somewhat of a loaded one, as if you keep on doing exactly what caused the injury, then the answer is probably ‘never’ and if you have a total rest, then the answer could be as short as a ‘few days’. In between ‘never’ and ‘a few days’, there are so many variables involved. In some injuries short term measures to reduce load can give immediate symptomatic relief, so full training can still be done; in other injuries, short term load reduction strategies are not as effective (or even have the opposite effect!) and training loads need to be reduced while the medium to longer term strategies are put in place (see: The Key to Preventing Overuse Injury in Runners is Load Management and Why do overuse injuries occur?). This means that you can manipulate the time to recovery by manipulating the loads. Just how far you go in this will depend on the injury and just how important what magnitude of training loads need to be maintained. In that context, this caught my eye this morning:

A Prospective Study on Time to Recovery in 254 Injured Novice Runners.
Nielsen RO, Rønnow L, Rasmussen S, Lind M.
PLoS One. 2014 Jun 12;9(6):e99877.
OBJECTIVES:
Describe the diagnoses and the time to recovery of running-related injuries in novice runners.
DESIGN:
Prospective cohort study on injured runners.
METHOD:
This paper is a secondary data analysis of a 933-person cohort study (DANO-RUN) aimed at characterizing risk factors for injury in novice runners. Among those sustaining running-related injuries, the types of injuries and time to recovery is described in the present paper. All injured runners were diagnosed after a thorough clinical examination and then followed prospectively during their recovery. If they recovered completely from injury, time to recovery of each injury was registered.
RESULTS:
A total of 254 runners were injured. The proportion of runners diagnosed with medial tibial stress syndrome was 15%, 10% for patellofemoral pain, 9% for medial meniscal injury, 7% for Achilles tendinopathy and 5% for plantar fasciitis. Among the 220 runners (87%) recovering from their injury, the median time to recovery was 71 days (minimum  = 9 days, maximum  = 617 days).
CONCLUSIONS:
Medial tibial stress syndrome was the most common injury followed by patellofemoral pain, medial meniscal injury and Achilles tendinopathy. Half of the injured runners were unable to run 2×500 meters without pain after 10 weeks. Almost 5% of the injured runners received surgical treatment.

This study was a further analysis of a dataset that I previously discussed: Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe (?) that got a lot of mileage in social media.  It found that “overpronation” was not a risk factor for running injury after they eliminated those who “overpronated” who were at the greatest risk for injury …so of course the found that the overpronators left in the study were not at any greater risk for injury! I still have not comprehended or understood why they did that, let alone claim that they ‘exploded a myth’ in a press release. So the above study needs to also be interpreted in the context of those who they eliminated from inclusion in the study.

In the above analysis 254 of the 933 (ie 27%) sustained an injury. This is yet another study that puts the injury rate down under 30-40% which is way down on the 80% from just one study that the fan boys like to keep parroting!

The most common injuries in the study were:
Medial tibial stress syndrome 15%
Patellofemoral pain 10%
Meniscal injury 9%
Achilles tendinopathy 7%
Plantar fasciitis 5%
Soleus injury 5%
Iliotibial band syndrome 4%

No surprises there, except that patellofemoaral pain syndrome is down somewhat on what many other studies are reporting and meniscal injury are higher than other reports.

What was surprising was the time to recovery. The median time to recovery for all injures was 71 days (min=9 and max=582), but if you look at the days (min/max) to recovery for the above most common injuries:
Medial tibial stress syndrome 72 (16/582)
Patellofemoral pain 77 (28/399)
Meniscal injury 87 (16/362)
Achilles tendinopathy 82 (21/479)
Plantar fasciitis 159 (51/308)
Soleus injury 31 (15/115)
Iliotibial band syndrome 88 (22/398)

I seriously question the quality of care and/or advice that was given to these runners to manage their injuries if they got one in the course of a study. Plantar fasciitis is the one I know most about … The median recovery was 159 days (minimum of 51 days and maximum of 308 days)…. as my 7yr old daughters would say “Seriously?” – even though only a few of them got treatment; why did they put  up with it for so long if it was enough to interfere with running (the definition of an injury in this study). As far as I am concerned if you have not fixed most of cases of plantar fasciitis within a month or so, then you really doing something very wrong. There is no need for plantar fasciitis to be managed for that long! I will have to defer to others who know more about the knee to pass judgement on the median times for injuries there.

As always, I go where the evidence takes me until convinced otherwise and I not sure what to make of this. The study did eliminate the high risk “overpronators” and those median recovery times look really high to me and may reflect the nature of the way that the injuries were managed by those in the study.

Nielsen RO, Rønnow L, Rasmussen S, & Lind M (2014). A Prospective Study on Time to Recovery in 254 Injured Novice Runners. PloS one, 9 (6) PMID: 24923269

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