Mind How You Go

The mental agony of an injury can often be worse than the physical pain - here's how to deal with the psychological hurdle of being sidelined

Posted: 6 May 2008
by Jj

It's a truth universally acknowledged that a happy runner in possession of a good few miles under his or her belt must at some point be in need of a physio. Between the first shuffling steps of the self-conscious beginner and the confident cadence of the sub-3:00 marathon runner there is frighteningly large potential for problems and a whole world of pain.

But pain is far more than physical. A worn cartilage or sprained ligament can bring us up short with a shout and an emergency call to the home-based rescue service. But that can just be the beginning. Because it's then that runners are reminded - or in the case of someone who's not been running long, it's a dawning realisation - that being a runner is a key part of their life, their very identity. And when injury threatens that identity, that raison d'être, it's important to acknowledge the effect and then to do something about it.

It’s impossible to say who suffers more when they’re struck by injury: the 100-miles-per-week club star or the back-of-the-pack plodder. A runner’s reaction to injury depends on their individual psychological make-up, but sports psychologists acknowledge that the extent of the downturn of a runner's mood will affect not only their life in the short term, but also their response to the injury itself. And a runner's ability has no bearing on that.

Running as therapy

The Runner’s World community is a slice of running life. Visitors and contributors to the forums – not just the Injury section – will soon see that injury and its psychological effects form a huge proportion of discussions there.

Whatever a runner’s ability, they use their running time as therapy, to lift their mood and in some cases, treat depression. They use it to escape, whether it’s from screaming children or a stressful desk job. They use it for self-improvement, from losing a few pounds to beating a PB; there’s nothing like it for boosting your self-esteem and giving you a sense of achievement.

Injury takes all that away. As soon as a runner feels a pain, the fear begins. Fear that their fitness is going to take a nose-dive and take with it all those feelings of contentment, self-esteem, control and escape. Often the fear is greater than the fact - the flaring agony of a twisted ankle can actually settle quite quickly, but not before thoughts of doom and gloom take root. It sounds extreme, but grief is a very real emotion when a runner hears that he or she will be off the road for weeks, or even months.

Regular forumite Mrs Pig posted recently that she was at the 'panicky stage' of injury. She took up running because she needed an outlet, and found the way blocked when she developed a stress fracture. "I’m absolutely gutted," she says, "I recognise it's trivial in the grand scale of things, but I'm angry that I have it.

"Running calms me, gives me time and space away from pressures of family, work and life. Now I'm worried about gaining weight and how hard it will be to get back to fitness."

Patience is a virtue

Thankfully, as Mrs Pig realises, there is light at the end of the tunnel – but you need patience and an open mind. If you can’t get your 'high' from running, try other forms of exercise, which will also keep your fitness up when you’re ready to hit the road again.

Forumite TR has learned this lesson. He describes himself as 'a fit bloke who runs a bit', managing a 1:06 10-miler off not much training and getting close to his goal of a sub-3:00 marathon. Last June he was out for a run when he slipped and smashed his knee on a concrete wall. "I damaged my medial knee ligament with the slip and then smashed the bone," he says. "The knee was really swollen for a while, but almost immediately I was swimming and biking on it to try and get it moving again. Icing also helped reduce the swelling."

TR took advice from a physio, then eventually started running slowly, while cycling or swimming most days. He dropped out of some key races, but knew that he should hold back. "I finally ran a race in November and then picked up the running to six days week for the London Marathon," he says "Now my knee is slowly getting better."

TR’s background in other sports, and willingness to cross-train, has helped his recovery. "I'm not a person that has to run everyday, so I was happy to find other ways to keep fit.”

Help Yourself

Unless you're very lucky, or very cautious, or both, then injury will strike at some point. But watching out for the warning signs and following a few tips could prevent the worst psychological effects and help get you back on the road a bit quicker.

  • Discomfort is normal; sudden or increasing pain isn't. Be aware, and be prepared to stop. Our experienced and knowledgeable sub-3:00 marathon runner is just as likely as our determined but naïve beginner to tough out the pain, but both will end up on the bench.
  • If self-treatment (rest, ice, painkillers or anti-inflammatories) doesn't work after a few days, seek professional help. A good sports physio is ideal, but don't be put off by the negative press that a few unsympathetic GPs have had. Most are keen to help.
  • Keep things in perspective. It's probably not terminal. By all means get angry and fed up - and if it was overtraining that led to the injury, learn the lesson! But there are other things in life. Do them for a while.
  • Cross-train. It's unlikely that your running injury will stop you doing everything physical. Walk, swim, go to the gym, cycle. Vast numbers of triathletes go into the sport because they were injured for a time.
  • Continue to set goals in whatever you do. Achievement in anything is a mental boost.
  • Don't go back to training too early. Listen to advice, including your own. Would you advise someone else to do what you're about to do, when you take a sneaky jog around the block 'to test it out'?

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Discuss this article


I have been running now for just about a year in parallel with a much healthier diet including giving up smoking... A year on I have managed to lose 2.5 stone, I recently ran a 44 minute 10K and 1hour and 36minute half marathon and setting my self up for a full marathon later in the year October'ish and doing another 10K and half marathon between now and then. Running has done marvellous things for my body frame, mental health and self esteem. Just over a week ago now I came down with a full blown cough and cold and had not been feeling my self for a good couple of weeks prior to my cold taking hold. I took each day at a time but I decided to stop all exercising so that I could concentrated all my energy on fighting the virus/cold and to be honest the way I had been feeling running would not have been a good idea as I felt it could have led to exhaustion. It’s been eight days since I stopped and I feel just about ready to go back to running. I need to get back to training for my 10K in four weeks time. My question is do other people stop al exercise when they get a cold? And am I going back to early? My coughing has ceased and today is the first day that I have felt my chest clear even though I am still feeing a bit tiered.
Posted: 16/05/2008 at 15:00

Like you, I avoid running when I have a cold. As you say, the body needs to save energy to fight off infection. Running with a cold or 'flu is, in my humble opinion, an act of folly. Better to rest, consume plenty of fluid and a moderate amount of easily digestible healthy food.

Interestingly, running provides signs of an oncoming cold for me before physical symptoms appear in the form of a slight but noticeable drop in stamina.

I'd wait until your energy levels come back up, then try a short run at easy pace, and see how it goes.

Get well soon!

Posted: 16/05/2008 at 17:12

Soujnds like you've thrown yourself into running - good for you.  Watch out though, colds and the like can be a sign of over training.  I have managed three half marathons now and have been ill the month before all of them, largely due to not taking enough rest days.  I'm just Reading Hal Higdon's "Marathon" and he talks about rest, over training , illness and injury in almost every chapter:


My advice would be to take more rest and don't worry about the 10k too much - the other thing that comes with overdoing it is injury, and that can take a lot longer to get back to normal.

Posted: 16/05/2008 at 17:50


I've been in bed all weekend with a very bad cold, cough and sore throat and rather unusually haven't run through this cold - normally, I would run through a cold!  It must be a pretty bad one or I am still in my over cautious stage having had pelvic stress fractures and 3 and a half months off running at the beginning of this year.  This cold seems to be persisting longer than usual and I have quit the running!.    

What I was going to say is don't worry about having time off, particularly for the 10K distance.  When I had my first pelvic stress fractures, which took over 6 months to diagnose and 18 weeks to heal, within 4 months of returning I set a PB at every distance I did from 1 mile to a Half Marathon.  I think what you feel mentally is important.  If your really into your running and then you wake up one day thinking "I don't feel like it", then your body is saying it's time to rest!         

If you have been feeling fatigued and have a marathon coming up in October, I would rest up for a while or you might be mentally tired by thetime the marathon comes.  The second time round I started training for the marathon too early, hadn't had a holiday/rest for awhile and was feeling mentally tired.  Then hey-ho double pelvic stress fractures!

Hope you get better soon - you can afford the time off now!

Posted: 18/05/2008 at 18:16

Thanks everyone. I slowly but surely got back to running after my cold. It's very hard to stop running I am totally addicted to the buzz. I must admit I still think I went back a bit to early as my cold seemed to linger 'on & off'  for a couple of weeks whilst running again. I'm still not sure if you should be 80, 90. 95 or 100% recovered before you start running again. I meet some runners (military) who say they run through their illnesses, in any case it is difficult for me to judge if I am 100%, I will cross that bridge again 'if' I ever get a cold again. In the mean time I,m all fired up for my 10K this weekend and I am feeling stronger and fitter than at any other point in my life.
Posted: 09/06/2008 at 15:39

I recently got back into training as a way of staying fit. I already regularly work out on rowing machine and go cycling too. 4 weeks into a 6 week training program for my 5k race on 7th September and at the end of my run I was in agony. Now looks like I have stress fracture although A&E weren't much help, didn't offer me so much as a paracetamol let alone a support bandage and it's taken two further trips to my GP surgery to be referred for X-rays as a matter of urgency, only to be told by X-ray dept. that there are no appointments until Monday. Completely incapacitated, can barely walk and my 5k is going out of the window! I completely underestimated how much I enjoy running,even though at times I hate the not being able to run another minute without getting completely knackered! I love that feeling at the end of my run when I say to myself "I did it!". You can't beat it! So far I've been told if it hurts, don't do it... which is just about anything at the moment. Now completely devastated and fed up! I only hope that I will be able to get back into the running... and soon!

Posted: 30/08/2008 at 16:35

I haven't run for nearly 8 weeks, so can empathize, Sara. The story goes like this: I start running on coastal paths to give my knees an easier time. Unfortunately, this has resulted in a ligament injury, caused by lateral movement of the knee, as it struggles to cope with an irregular surface!

 My GP was sympathetic, but there was little he could do. I've been eating well and supplementing my diet with chonditrin/glucosamine sulphate, which seems to aid the  healing process, or at least gets rid of the inflammation and discomfort.

 I'd forget about running until you're healed. You can get the endurance kick from other sports that use the upper body. For me, that's sea kayaking. For you, it may be something else. Get well soon.

Posted: 31/08/2008 at 16:39

I only started running back in April on and off and didn't really start doing it more seriously until November of 08 in preparation for my first marathon in Edinburgh in May. Over Xmas had an old back injury return and it put me out of action for only 3 weeks. But in that time I am finding it really hard to enjoy my runs again. Every step is hard work and all I want to do is stop, I am too tired. Yet before Xmas I was doing well. I guess I am becoming very aware as to how impatient I am, which is affecting my running! I am forcing myself to go back to my running club tonight because I am dreading it, when before I was starting to see progress. There is nothing wrong physically with me now, it is trying to learn to get my confidence back and feel that buzz again that I seem to have lost in replacement of negative feeling about my progress. Never thought it would effect me this much so can empathise with anyone having to stop running due to injury!
Posted: 21/01/2009 at 10:35

Hi Luch, sorry to hear about your injury, but glad to hear you're back on your feet again.  Three weeks isn't too long to miss and you'll probably find it comes back quite quickly, but there are a few things to watch out for.

Firstly, take it easy to begin with - lots of people come back from time off and go straight back out and injure themself trying to pick up where they left off.

Secondly, if you are tired, what's the cause?  Sleep is too obvious an answer, but are you eating properly? Lot's of people on diets this time of year.  You need fuel to run and if you haven't filled up on carbs you'll use fat, which is a good thing to train yourself to do for a marathon, but it's not as efficient as burning carbs and is hard work.

Thirdly, have you had / do you have a cold?  Viruses can make you feel much more sluggish and impair performance.  You'll probably find your heart rate elevated significantly and would have to slow down to accommodate.

Don't overdo things, but keep at it whilst listening to your body - easy running should come back quite quickly.

Posted: 21/01/2009 at 10:52

Hey Roger, thanks for the advice. Yes, am on a diet, but a very low calorie diet, you may have heard of it cos it is quite contraversial! Lighter Life. So I don't eat carbs, my body is burning them off as I want to lose about 3 more stone in weight to get to my target. Have done it before and never had a problem so am wondering if it is something to do with this horrible winter thing! Just want to go to bed and wake up in April!

And I think you are right about overdoing it, I will keep listening to my body and stop when I really can't do anymore!

Posted: 21/01/2009 at 15:21


I think that's why you are tired. 

I'm not sure about the sense in repeatedly running without eating carbs, but I'm erring on the side of it being a pretty bad idea.  Not having any carbs and running will, at best, put you off running, but I suspect it is a good way to get ill, injured or both.  You can do it occasionally to help your body learn to burn fat on long runs, but not every time.  You do have to take what I'm saying with a pinch of salt as I am no expert, but I'm pretty sure you're taking a risk.

If you are dead set on losing weight that way, I'd keep the mileage down.  But as you are aiming for a marathon, I'd eat a sensible diet, with the majority of calories coming from complex carbs, low fat protein and loads of veggies, and work on your mileage.  As your long run builds (10% a week) you'll find the fat comes off naturally.  I am 40 in a couple of months, am 13.5 stone and training for the London Marathon, my first.  I've been at it for a month or two, am up to ten mile long runs and have just been reaquainted with my abs after a ten year absence (in a friendly mirror when the light is just right).  I am moderately careful about what I eat, but the key has been doing my long runs whilst keeping my heart rate around 65%, which keeps you in the fat burning area.  My weight has reduced a bit, but not massively, as muscles have grown too.  However, my belt is two notches smaller than it was. 

This said, I have a mate at work who lost ten pounds in a few weeks on the Atkins so I believe there's something about it all that works.  But I wouldn't combine it with marathon training.

Posted: 21/01/2009 at 15:58


 a quick Google gave me this....


might explain your lack of buzz.

Posted: 21/01/2009 at 16:13

Oh man! What do I do! I read that article and was about in tears. I never thought for a minute that not eating carbs would affect my running. Due to my diet, my glycogen store is always depleted.  I have been grumpy as hell and feel like signs of depression setting in, wanting to sleep lots, not wanting to go out, being really down on myself etc.

Guess I am scared that I won't lose any weight if I go onto any other form of eating (other than abstinence in a controlled way!) and all I want to do is get past that stage of feeling like a fat woman trying to jog and become a healthy person running!!! Don't suppose getting divorced helps my mood and self esteem much though!

So thank you so much for your help and I will keep you posted as I am running on Friday again.


Posted: 21/01/2009 at 18:11


all is not lost I'm sure.  Does your diet give you any ideas of how much weight you might lose in a couple of weeks, say?  You could keep the running on stand by, just do a few miles a week, until your weight is down a bit and/or you're ready to pick up the Marathon training programme, at which point you could switch to a diet including carbs.

But, bear in mind that if you are training for a Marathon, you'll be logging at least 20 to 30 miles a week when your programme is in full swing, and more at the end.  For most people, that's 2000 to 3000 calories, and for a lump like me its 3000 to 4500 calories.  A pound of fat has about 3500 calories, so your running, when combined with a sensible diet, should allow you to lose a pound a week, more or less - a sensible rate.

Also, why not visit a sports nutritionalist?  Try a Google search in your area - you can quite often find them associated with sports injury clinics / physios etc.  They will give you some sound, well informed advice about combining training with weight loss and tell you some of the ins and outs about avoiding feeling hungry  and bingeing (my weekness: I'll starve for hours, get home and pig out, when I should snack on lower calorie foods that keep my blood sugar at the right level to keep hunger at bay). 

This might be useful:

Q+A: When I run I eat more. How do I lose weight?By Sarah SchenkerOur experts answer real-life questions


<!-- Weight management Increased volume training --><!-- Title: Q+A: When I run more I eat more. How can I lose weight? Standfirst: Our experts answer real-life questions Author: UAN: RW issue: jun02 Keywords: weight -->

Q I’m planning to run a marathon, but I’m also trying, unsuccessfully, to lose weight. When I run, my appetite increases, and I find that I eat more and put on weight rather than lose it. What can you suggest?

A Perhaps surprisingly, losing body fat and training to achieve faster times do not always go hand in hand. As a rough rule of thumb, a 10-stone runner burns 100kcal per mile. However, during low-intensity training, your body uses a high percentage of fat, and less glycogen. As the intensity increases, the amount of fat burned decreases only very slightly, but the glycogen use rises sharply on top of that.

Unfortunately, using up your glycogen stores with hard training sessions can leave you ravenous, and the potential is there to overeat no matter how healthy the food is. However although five miles at a hard pace may leave you starving, five slower miles will burn the same amount of energy and should leave you less hungry.

The bottom line is that if you take in more energy (calories from food) than you have used up, the excess energy is stored as fat, making weight loss impossible. From what you’ve said, it sounds as though your diet is pretty healthy and well balanced, so just use your willpower to make sure your portion sizes aren’t too big.

Dr Sarah Schenker, British Nutrition Foundation registered sports dietician

Posted: 22/01/2009 at 09:32

Roger, it's funny that you should suggest what you did because after alot of soul searching that was what I decided to do. When my friend said I should chose between running or staying on this programme to lose 3lbs per week, then I couldn't make a choice, I wanted both! So I will do what you suggested, run smaller amounts so that it doesn't affect my glycogen store, but run more often so that I am keeping the miles to about 18 per week until my weight goes down by about 2 stone and then switch to a diet that I will arrange with my dietician! Then I will start serious training in March. I don't want to be an athlete on my first marathon, just to be able to run most of it within about 4 and a half hours! Thanks for all the help getting my head sorted Roger!


Posted: 22/01/2009 at 10:31

Good on yer Luch - and good luck

Posted: 22/01/2009 at 10:35

I have been training for my first Reading half marathon since 2008 but because more serious October 2008 increasing by 1 mile until i hit 12 miles 2 weeks before xmas. I developed a big toe injury because of how i position my toes while running. Took 2 weeks off to recover and on my first day back, I decided to take another 1 week off due to tiredness. 3 - 4 weeks after my break, I found out that i completely lost my fitness and have struggled to maintain 10 miles until last month. Unfortunately, I have been in and out of cold - everytime i think i have recovered and go back training, I end up staying home all week resting or using the weights and treadmill (running less than 50 mins or do interval speed runs) to maintain basic fitness. Today i felt i needed to get back to training as soon as possible to hit sub 2:15 target but i feel feverish and cold - guess another week dedicated to resting! Also i feel pain on my soles when running. Kindly advice cos i feel i won't be ready for the race i have so looked forward to since last year. Thanks George
Posted: 10/02/2009 at 18:54

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