Don’t “Pick The Scab” Off Your Overuse Running Injuries

Have you ever suffered from Achilles Tendonitis, Runners Knee, a Stress Fracture or ITB Friction Syndrome?

These are just four examples of common overuse injuries suffered by runners, and they are caused primarily by doing more running than your body can cope with.


Do overuse injuries need a rest from running?

No. At least, not for any sustained period of time. You might need a few days, or even a few weeks, to let an acutely inflamed overuse injury settle down, but as soon as you can perform all of your normal daily activities with no pain, then you should be able to ease yourself carefully back into some running.

Prolonged rest often makes overuse injuries worse. Partly because rest causes you to start losing the hard-earned tissue strength that you build up as a runner. But also, because most runners don’t look after themselves when they are injured. Diets often deteriorate, and stretching and strengthening routines go out the window as the depression start to set in.


How much running should you re-start with?

Building volume too quickly after an overuse is the biggest mistake that runners make. The most common advice I have heard is that you should “run until it starts hurting, then stop and walk back home”. Unfortunately, if you run to the point where your pain returns, it is already too late. You will have stirred up your injury enough to need another window of rest to let the acute symptoms settle down again.


Don’t keep picking off the scab!

Imagine you have just cut your arm. Quite a deep cut that requires some butterfly stitches to hold the wound closed. You leave the butterfly stitches in place for 10 days until the wound has closed over, a scab has formed, and it has started to heal. You leave it a couple more days just to be safe, then you pick the scab off to see if it had healed.

No surprise - it splits open again, and you have to reapply the butterfly stitches to hold it closed for another 10 days.

If you return to running with a run which is long enough to bring back your pain, you have effectively picked off the scab and inflicted more rest time on yourself.

Instead of picking off the scab, imagine instead that you had given the scar a very gentle massage. This helps to break away and soften some of the superficial layers, making it a little bit smoother, and improving the elasticity of the skin around the scar. Each day it will tolerate slightly more massage.

If you don’t touch the scar at all (the equivalent of prolonged rest for an overuse injury), the skin around the scar can become hypersensitive, and the scar can heal jagged and raised.

The scar healing rate improves with the regular gentle massage, just like an overuse injury will recover better and faster with the right dosage of running at the right time.


How much running will massage your scar?

This varies a lot from injury to injury and person to person. It depends on a huge number of variables including your age, injury history, the severity of your symptoms, your biomechanics and more.

It is best to always err on the side of caution. Start with a very small amount which you think would be unlikely to reaggravate your symptoms, and aim to build gradually from there. You are much better to start with too little than too much.

Include walking breaks in every run for the first few weeks.  Overuse injuries are often exacerbated by the tension that builds up in our body as we continue to run. If you include regular walking breaks, that tension dissipates, so when you start running again, it is almost like your body is starting from scratch.

It is not uncommon for runners to successfully manage rehab intervals of Running 2 minutes / Walking 1 minute for 30 – 40 minutes total without any increase in symptoms (massaging the scar), versus running for 15 minutes non-stop and the symptoms return (picking off the scab).

Even though walking breaks can be frustrating, this type of return to running will maximise your total volume and help to minimise the risk, allowing you to build up your fitness and strength faster. This is the quickest method to make a return to full running.

This RETURN TO RUNNING article has a table you can follow with gradually progressing walk/run intervals which will guide you all the way back to your normal running volume.

Our official 10-Week Return to Running Program - includes everything you need to do to make a full recovery from your injury, including running technique lessons and access to our online coaching group.

If you have been off running for 3 months or more, and feel like you are almost starting from scratch, then our Zero to 5K training plan is another option that will help to get you back on track. It uses walk/run intervals over an 8-week period to build you back to 5km continuous running.