The sight of his ankle should have been more than enough to make Dwayne Sandall stop. But the 42-year-old running coach from Winnipeg was too busy training for an ultra-marathon to take time off to heal. Besides, pain seemed like part of the program.
"You need to suffer a bit. It's part of the ultra-marathoners creed," Mr. Sandall says. Last April, he pushed that creed to its fullest as he succumbed to severe tendonitis in his right foot. "It looked like hell," he says. "The side of my ankle looked like somebody took a lemon, cut it in half and stuck it under my ankle bone."
Rather than rest, Mr. Sandall simply avoided the hard ground of the trails he had been running on and instead spent the next few weeks on a treadmill in order to maintain his training schedule.
Many runners will keep pushing themselves even though they are injured, whether it's because they are drawn to the endorphin rush of running or because they are too concerned about following a strict training schedule to take time off. But failing to treat injuries can do significant harm to a runner's long-term prospects.
Douglas Stoddard, medical director of the Toronto Sports & Exercise Medicine Institute, sees many people who will not give up running even though they have suffered an injury.
"Typically they've had a lot invested in some upcoming race and they're often in running groups. They're enjoying it, the camaraderie, the achievement. So it's hard to slow them down," he says. "About four to six weeks prior to a major upcoming race we get inundated with people who are starting to break down."
Some runners may choose to refuse treatment altogether and instead ignore the problem.
"I enjoy being out there running. And the pleasure that running gives me is greater than the pain that I'm inflicting on myself. You're almost thinking, 'Maybe it will just go away,' " says Carole Bonnici, 46, who has had more than her fair share of aches and pains over the course of a long running career, including tendonitis in her shin and a build up of scar tissue in her foot.
While not all running injuries will force people to the sidelines, most exercise physicians and trainers will require runners to adopt new training routines that will avoid hard surfaces but allow runners to stay in shape for race day.
"They're afraid they're going to lose fitness, so we have them cross-train. We have them cycle, we have them running in the pool, work in a rowing machine, so that you're still getting the cardiovascular benefits [of exercise]" says Jack Taunton, a professor of sports medicine at the University of British Columbia and the chief medical officer of the Vancouver 2010 Olympic Games.
As a runner, Dr. Taunton understands why people want to run through pain and injury.
"Part of it is, with running, once you get going, the natural endorphins kind of block the pain. Part of it's in the competitive nature of individuals. They've set a goal and they want to get there despite everything," he says.
But some injuries can cause major, long-term damage. There is a simple way to tell whether an injury is significant enough to warrant a trip to the doctor's office, Dr. Taunton says.
If it hurts to hop after a run, he says, "that tells them this is not just a tendonitis or a shin splint as they may think." Instead, it's a sure sign a runner needs to see a physician.
When Ms. Bonnici suffered a pinched nerve in her lower back in October, she decided to take a break for close to three months as she underwent physio and massage therapy. When she began running again to train for a half-marathon, she adopted a walk-run program to ease the pressure on her legs and feet.
"If you really insist on doing this, then you have to adjust," she says.
Ms. Bonnici, who works in sales and event co-ordination for the accounting firm Deloitte & Touche, believes suffering the injury was a blessing in disguise.
"It's taught me that I really need to be smarter about how I train and do a lot more cross-training," she says. In the lead up to her pinched nerve, Ms. Bonnici was following a gruelling schedule that saw her running 16 kilometres a day, seven days a week.
Runners who are so focused on training for their next race they will continue even though they are injured should consider the long-term consequences of doing so, Dr. Taunton says. Taking some time off now may save your running career.
"You may miss something in two months, but you'll still be running 10 years down the road," he says.