Is that pain, or an injury?

How to Know When to Address Pain: Lessons from Hank

This week, I had an interesting conversation with a runner named Hank. He asked a question that many of us have pondered:

"But I’m sore so often from running and mountain biking... how am I supposed to know if it’s something I need to take care of or just power through?"

This is a great question and one that’s harder to answer than it seems. How do you know when something is truly wrong? If you’re an active person, you’ve undoubtedly experienced pain during your activities. But does that mean you should stop doing the things you love whenever there’s pain? Fortunately, no!

The I3 Model: How Overuse Injuries Happen

At Base Camp, we use the Incomplete, Incidence, Injury (I3) model to help determine when to take pain seriously and when it might not be a big deal.

Injuries happen and develop over three phases:

1. Incomplete mechanics or recovery

2. Incident

3. Injury

1. Incomplete Mechanics or Incomplete Recovery

INCOMPLETE MECHANICS:

Imagine trying to do high-level CrossFit, but you can’t get your arms all the way overhead. Or running a marathon when you can only do seven single-leg calf raises. These are examples of incomplete mechanics. While they don’t guarantee injury, they certainly set you on the wrong path in the injury cycle.

INCOMPLETE RECOVERY:

There are three primary domains for recovery:

- Sleep

- Nutrition/Hydration

- Stress Management

If any of these are below 80% (rate yourself on a scale of 1-10), you’re not fully recovering from your activities. It's always a combination of these two factors. Better mechanics can buffer for poor recovery, and vice versa.

CASE STUDY: Hank, runner with Achilles tendon pain

Hank was limited in his ankle range of motion and sleeps an average of 6 hours per night.

2. Incident: Check Engine Light

This is the first sign that something is wrong—the 'check engine light' your body sends to signal that something is off. Incidents include any symptoms or signs of pain and are often the hardest to interpret. Take these signals seriously. Part of why injury prediction is tricky is that the incident may not even be in the area of the actual injury. You may have a shoulder 'hot spot' that turns into a lower back injury or ankle stiffness that turns into knee pain.

CASE STUDY: Hank, runner with Achilles tendon pain

Hank has hamstring tightness that always worsens when he increases his volume.

3. Injury: Limiting

The word 'injury' can be hard to define. Can we call it pain? Well, we’ve all had pain during activity that went away on its own or was just part of the activity itself (looking at you, hill repeats). What about tissue damage? There are millions of people walking around with meniscus tears who don’t even know it and have no symptoms.

Here’s the definition we use at Base Camp: Any time you have a symptom that keeps you from doing what you WANT to do, or HAVE to do, then it is an injury.

- Tingling so bad you can’t carry your groceries in? Injury.

- Knee pain that only starts when you hit 22 km, but you’re training for a marathon? Injury.

CASE STUDY: Hank, runner with Achilles tendon pain

Hank triggered his Achilles pain after a hard hill session.

Take Home Lessons

1. LISTEN TO YOUR BODY. Your body will send you signs that something is wrong, and that you need to do something about it.

2. ACT EARLY. When you are injured, it's late in the game to take action. We can't focus on the incomplete mechanics or recovery until we get the pain under control. It is way more efficient to focus on your mechanics and recovery BEFORE they become an issue.

3. YOU CAN GET BACK TO YOUR ACTIVITY. Injuries suck, but they don't have to limit you forever. Most of the time you don't even have to stop your activity.

CASE STUDY: Hank, runner with Achilles pain

Hank and I are now working to calm down his tendon pain, while he is prioritizing his sleep. Next, we will shift to improving Hank's ankle range of motion, and improving his lower back stiffness (the cause of his hamstring tension). Finally, we will reintroduce volume, intensity, and elevation to his running.

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Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.

Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.

Ready to get back to running PAIN FREE?

Start with a free consult with Dr Mark here: CONTACT

How I fixed my knee pain (and then crushed a 47 km run)

Last year I couldn't run.

In September 2023, a friend and I ran the Juan De Fuca on Vancouver Island. It was an awesome experience. 45 km, 2000 m of elevation and 13 hours.

But in July of 2023... I could barely hike downhill. Forget running.

I was dealing with a long-standing knee injury, that came back when I increased my downhill running.

At the time, we were living up at Silver Star. The trails up there are incredible. They're exciting and flowy, and a true joy to run.

They are also uphill or downhill in just about every direction.

This meant that every single run I was hammering downhill, which is a surefire way for me to trigger my knee pain.

My injury is likely my meniscus. I have an old twisting injury that has given me issue in the past.

It shows up as pain along the inside of my knee that SPIKES with downhill strides. It's sharp, and intense and can often take my breath away.

So... when this came up again, with Juan De Fuca already on the calendar, I took it seriously.

Here is the strategy I used:

1. RESET.

2. RESTORE.

3. RELOAD.

Before we get to that, we need to understand why running injuries happen in the first place.

Whenever we experience a running-related injury, we are dealing with an overuse injury. We did too much too soon.

WE ALL HAVE AN INJURY THRESHOLD.

No matter how fit you are, we all have an injury threshold. For you, it might be 25 km. For the next, it might be 10 km. For another, it could be 100 km.

AFTER AN INJURY…

After an injury, that threshold is lowered. We can no longer handle the same amount we could before we triggered the injury.

Here is exactly what I did to fix my knee pain and successfully conquer the Juan De Fuca in a single day:

Step 1: RESET.

This meant rest... but not complete rest.

I still had to train for the 45 km trail run with almost 2,000 m of elevation gain.

But... I couldn't. Instead, I focused on what I COULD do: flat running and strength training. I focused on continuing to build my leg strength so that when I did return to smashing downhill I was strong enough to do so.

In the CALM IT DOWN phase, my main goal was to maintain fitness and strength, while letting my pain triggers lessen.

Step 2: RESTORE.

The goal of Step 2 was to build my tissue tolerance (the resilience of my knee) up beyond the demands of a 10 hr day.

In order to return to running the distance and terrain I wanted to, I knew I needed to build my strength, endurance and tolerance back up.

Since I had been already working on my leg strength, I was in a good spot.

I added in some specific exercises (in this case step downs, pogos, and adductor planks) to target the muscles and parts of the knee that needed it the most.

Step 3: RELOAD.

Then came the fun / nerve-racking part... running downhill.

Thankfully, I had put in the work and was ready to get back to running downhill with speed.

I reintroduced it gradually, on moderate trails, before turning on the jets.

I was lucky because I didn't experience a single flare-up. I was ready for Juan De Fuca.

Result?

Juan De Fuca was a blast (big thank you for the weather on that one).

Now?

It still bothers me on occasion.

But that is inevitably when I have neglected my rehab exercises. I started to experience sharp knee pain and need to add in a few weeks of consistent strength movements.

Here are the takeaways...

1. When you have pain, take it seriously. Do something about it!

2. When you are injured, you will need rest. Relative rest doesn't mean you can't do anything, it means you need to do less and modify.

3. STRENGTH is your ARMOUR. It's your bank account, your insurance policy, and your treatment. It will get you back to activity faster than anything else.

If you are struggling with​ how manage and treat your injuries, we can help.

-Dr Mark Murdoch

Chiropractor, MS Sports Medicine

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Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.

Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.

Request a free consult with him here: CONTACT

How to Train your Core for Running

I had two conversations with patients last week that reminded me of something that I take for granted.

Most of us have been told we should 'strengthen our core'

Ok...

...but what does that even mean?

And why is it even relevant?

Because you can't fire a cannon from a canoe.

The results of this would be... comical.

Instead, we want to fire our cannons (i.e. our LEG POWER!) from a BATTLESHIP.

The stronger your core, the more stable and efficient your legs can function to propel you forward.

This is why core strength has always been such a popular topic for runners. IT MATTERS.

Not only for performance, but for injury prevention too.

But... where should you start?

My favourite test to put runners through is the Side Bridge Endurance Test.

This test targets the lateral core, which helps stabilize us EVERY SINGLE STEP so that our legs can propel us forward.

It is a common spot that will fatigue, which is why we see so many marathon and Ironman competitors coming across the finish line looking like wet noodles.

I use this test with runners every single week.

STANDARDS

When we set our standards, it depends on what the goals are.

For the general population, just to prevent lower back pain, I like to see a 75-second hold in anyone under 40. We get a bit more lenient in 41+, but shooting for a 75-second hold is a great goal.

For RUNNERS though, I have a high standard, depending on your distance.

10 km: 75 seconds

25 km: 90 seconds

42.2 km: 1 min 45 seconds

50+ km: 2 min+

Here is where it gets tricky... we don't train the lateral core by doing a bunch of long hold side planks... because the core doesn't hold tension the whole time you are running.

Instead, it stiffens and relaxes with every step.

Instead of holding the side bridge for minutes at a time, I have my patients and clients hold it for 10-30 seconds and then repeat with a short rest (2-5 seconds) in between.

This trains not only the core endurance but also the contract, relax, contract cycle.

We also use things like lateral bends, suitcase carries, and step-ups to train the same function.

For my serious runners, some sort of lateral core training needs to be in your program EVERY SINGLE WEEK.

Add this in and you will see some serious performance gains.

-Dr Mark Murdoch

Chiropractor, MS Sports Medicine

P.S. Need to get in touch with us or have any additional questions?
Give us a call at (250)-307-7819 between 8am-5pm Monday-Friday, or email us at drmurdoch@basecampclinic.com

Request a free consult

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Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.

Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.

Request a free consult with him here: CONTACT

Strength Training 101 for Runners

This one is for the runners.

This weekend, the Slay the Dragon trail race kicked off the season at Silver Star mountain resort.

Watching the runners come in, I saw something I always do at these long races: almost no one is coming to the finish line out of breath.

EVERYONE at the end of a 50 km race comes across the finish line limited by MUSCLE FATIGUE, and not cardiovascular fatigue. (Except maybe the top 5%).

What does this tell us?

Distance runners are RARELY limited by their cardio on race day.

Distance runners are (almost) always limited by their strength.

If you’re serious about your running game, you probably already know that strength is the secret sauce for performance and injury prevention.

But where should you begin your journey to becoming a stronger, more resilient runner?

Well, it all starts with calf endurance.

Think of running as a series of thousands of calf raises in rapid succession, as you leap from one foot to the other.

To gauge your calf raise endurance, we use the Single Leg Calf Raise Endurance Test.

Here is how to test your calf raise endurance:

​VIDEO: Single Leg Calf Raise Endurance Test​

How much calf endurance is enough?

Here are some benchmarks tailored to your distance goals:

5 km : 15 reps

10 km : 20 reps

15 km : 25 reps

25 km : 35 reps

50 km+ : 50+ reps

If you're not hitting these numbers, it's time to start working on your calf endurance today.

Trust us; it can lead to rapid improvements in your running performance.

A Comprehensive Approach to Strength Training for Running

But what if you want a more comprehensive approach to strength training for running?

Strength training programs for runners can be complex, but in general, we need to strengthen 4 key areas:

1. Hip Strength

2. Knee Strength

3. Calf Strength

4. Core Endurance

Regularly targeting these areas, assuming you're lifting with sufficient intensity, will set you on the path to building and sustaining your running strength.

If you're unsure where to begin or crave a structured approach to strength training for running, our Run Strong program is your answer. Check out this page to join when the next group starts: www.runstrong.ca

-Dr Mark Murdoch

Chiropractor, MS Sports Medicine

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Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.

Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.

Request a free consult with him here: CONTACT