I suspect I'm not alone when it comes to self-diagnosing illness and injury. Let's just say that as a doctor, I'd make a good journalist.
When it comes to illness, which happens very rarely to me, I tend to err on the side of caution and assume I'm in death's grip. For example, my editor was very lucky to get this blog, filed as it was from the self-imposed exile of my bedroom (struck down with what feels like Ebola, one can never be too careful). Fortunately for everyone, after a couple of days the mystery virus revealed itself as the common Aussie flu. The family may have suspected this all along, but then they weren't negotiating with the Grim Reaper, were they?
Running injuries are different, though. The hypochondriac in me cowers as a tough guy steps in and says "it's just a little niggle - soldier on!". So I do (gotta achieve those mileage targets), and then of course I find myself on the physio's table.
It's not easy for anyone to know when they are injured, versus carrying a simple niggle that will settle. It's a vexing issue, as these aggregated answers from a bunch of dedicated amateur runners I questioned last week demonstrate:
What is a niggle?
"Something that causes you to wince and maybe slow down but not stop; does not stop me from exercise; can still run, but can feel it; doesn't impact on my running form; may be uncomfortable but not painful; a low-grade injury that doesn't really warrant seeing the physio for."
What is an injury?
"Is painful, limits my ability to run normally and may also cause pain post-exercise; more acute and prevents exercise; causes me to stop; makes you run with different form to normal."
Your most common niggles (listed in order of popularity)
"Tight calves, quads, knees, glutes, heel, achilles, hip, age and mental problems." (At least these guys are honest!)
"Massage, stretching, anti-inflammatory topical gels, compression gear, rest, ice, magic Chinese spray, painkillers pre-run, a good program to keep core muscles strong and in alignment."
"Ignore niggles at your peril."
Indeed. The price to be paid for misdiagnosing a niggle can be very high - hands up anyone who's finally got an entry into a marathon, bought the tickets and booked the accommodation, only to train themselves into an injury and out of the race?
So why is it hard to know when to pull back on the training and when to soldier on?
Older equals more niggly
One reason is that the criteria for definition changes with age. What could be treated as a niggle in your 20s cannot be ignored in your 30s and beyond. Your body simply doesn't have the same healing capacity.
Physiotherapist, ultramarathoner and ironman triathlete Mark Green from Sydney's The Body Mechanic says that as we get older, we become less elastic. "You get more collagen tissue and less elastin tissue and as that happens, little niggles that might have gone away in your 20s take a bit longer in your 30s and a bit longer again in your 40s."
Basically, the older you are, the more intelligently you have to manage your body.
Green, who's back racing the 60km Kepler Challenge in New Zealand after a 15 year break, says his training volume is similar to what he was doing in his 20s, but his management strategy is completely different. "I eat better food, I'm a lot more sensible about getting sleep and do a whole lot more stretching. If I didn't do that I couldn't do the training."
He also recommends cross-training to achieve the training volume required for a big event if you're struggling beyond certain distances. "Above 50km of running a week, add a couple of hours on the bike. That way you are getting a bit more endurance but not giving your body such a hard time."
Two key management strategies
The Body Mechanic team has two strategies for runners managing the niggles-versus-injury issue.
One is "little and often", which works on the rule that the body copes better with training in small amounts regularly, rather than large amounts infrequently. "For example, it would be much easier for your body to cope with 5 x 4km runs in a week than 1 x 20km run. If you've got a niggly calf, this is a good way to still train but not make it worse and have to stop and rest it completely."
The other strategy is "prevention is better than cure".
"People who sit at desks for work are becoming tight whether they like it or not," says Green. "Sitting is one of the things that our body likes the least, especially for running. It's one of the things that causes the most harm to our body in terms of our ability to run pain-free."
The Body Mechanic team has compiled a video series of prevention exercises to do daily, some while at work.
"If when you are running, the level of pain starts off at a one or two out of 10 (10 being excruciating and zero being pain-free), and over the course of a week of running it stays at a one or two, I'd say that's a niggle and that's OK," says Green. "But if it sneaks up to three, four, five or six then I'd say you're getting an injury if it's not one already.And here is a (subjective) self-diagnosis tool:
"After a week if it's still a two out of 10 I'd get it looked at because by then most niggles should've gone away. Definitely get it looked at sooner rather than later if it gets higher."
There are other approaches to niggle management aside from training. Nutritionally, there are theories around at the moment that sugar and gluten can cause inflammatory changes in your body, so a diet high in processed food and refined carbohydrates could make it more difficult to get rid of a calf niggle, for example.
As for compression garments, they are helpful for getting over a long, hard run, but Green believes wearing calf guards or socks while training can also can make a big difference to your ability to maintain your running program, especially if you're prone to calf issues.
"Most niggles if addressed early enough can be treated successfully," he says. "It's something we deal with daily. We tend to notice that the more injured athletes have been in the past, the more aware they become of what is a niggle and what is an injury."
How do you balance training volume and injury management?