This Is Why You’re Still Injured

injured runnerInjuries suck, that’s all there is to it. Oh, but there’s more. Injuries are a big reason as to why an athlete can’t get past a certain performance ceiling. If you’re training improperly as you try to take your fitness to the next level you’re probably going to get injured sooner or later. That injury will not only prevent you from achieving your goal, but now you’ll spend weeks if not months or longer recovering from the injury. Obviously this means you’re going to lose a huge amount of fitness and if or when you return to your sport you’ll be spending a lot of time making up lost ground.

So why do athletes get injured? Of course aside from some unlucky trauma/accident, you suffered an injury because your training formula became imbalanced. Essentially you trained too hard and/or took on more stress than you were able to balance with your rest and recovery. It’s as simple yet as complex as that. Call it overtraining, overreaching, or under-recovered – it really doesn’t matter in the end. An injury is an injury.

You don’t just suddenly become injured. You don’t just wake up one day and step down from your bed and have plantar fasciitis. You don’t just bend over to pick up your pen and throw your back out. These injuries take some time to develop and often there are warning signs and symptoms that are present as your body is letting you know you need to change what you’re doing and chill out or it’s gonna get bad.

Let’s look at five main reasons an athlete becomes injured. These are also the same reasons why an athlete often doesn’t recover as fast and he or she should. These are also in order of importance – in other words, more athletes are injured or not healing properly due to a dietary problem than because of a footwear problem.

meat protein for athletesAn Injured Athlete’s Diet

Biochemical and nutritional problems are by far the main reason athletes get injured and don’t fully recover. Nutritional problems can range from a lack of protein to too much caffeine. Biochemical problems are more due to nutrient deficiencies either from depletion or even free radical damage from too much oxidative stress – often from training too hard and not recovering or eating well.

Protein: I’ve always observed athletes to perform their best when they consume approximately 1.5 grams of protein per kg bodyweight. For those who are injured then around 2.0g if not a bit more may be necessary. This needs to be high quality protein such as eggs, meats, fish, clean undenatured whey protein, and even a bit of dairy if tolerated. Beans and rice won’t cut it.

Fats: Arachidonic Acid (AA) – Though they are given a bad rap for creating inflammation it’s only because those AA fats which do are the ones the body makes from converting omega-6 vegetable oil-type fats (often refined) over to inflammatory AA fats. Naturally occurring AA fats from egg yolks, butter and other high fat dairy sources, and grass fed beef have amazing healing effects when it comes to injuries. There’s a reason these fats are most the abundant fatty acid in our brains. I’ve always told my patients that if they could only take one fat then it should always be butter before a fish oil supplement. More on AA fats here.

Carbs: Speaking of inflammation, cut out most of the carbs if you’re injured. Too many carbs, especially those refined, will lead to too much inflammation. Plus, there’s a link between high insulin levels and gait imbalances in people. That means that if you have too much insulin then you won’t move well and if you don’t move well then you’re at a greater risk of injury and you’ll heal much more slowly. Remember that proper sugar metabolism has a lot to do with joint repair – GAGs – as I discuss here. So chill out on the treats when you’re injured.

Aside from paying specific attention to the protein, carbs, and fats as just discussed, don’t forget that when you’re injured you need more nutrients, often minerals such as zinc, magnesium, and manganese. These are all very individualized so I don’t want to discuss them any further here and I’m not keen on someone taking a multi-supplement. Multis never work as they just keep nutrient imbalances in their imbalanced state rather than correct an imbalance, (if you’re lucky enough to get a good product). Load up on the vegetables when you’re injured, and even as part of healthy injury-prevention program especially when you’re training hard.

athlete sleepToo Much Stress and Not Enough Rest

The harder you train and the more frequent you train, the more you need to rest and recover. This means not just a restful night’s sleep but also lowering daily stress to the best of your ability. Though many trainers, coaches, and physicians like to promote HIIT training as a “quick and effective time efficient strategy” for those living a busy lifestyle, I say the exact opposite. If you’ve got too much going on and live a stressful life, then your exercise should be more aerobic with perhaps some strength tossed in when appropriate. HIIT training at this time is only asking for trouble.
If you’re training mostly aerobically, especially if those training bouts are of long duration, (as you get over an hour for running, for example), you need to balance this with more recovery.

athletes racing hardTraining and Racing Improperly

This one is much like #2 where if you’re training too much you need to rest more but it also considers those training way too often and too hard – or both. There’s a race somewhere close to where you live every Saturday and Sunday; some people even race twice in one day – it can get a bit crazy. Plan your schedule and plan your races. You can’t race effectively and remain healthy if you’re racing hard all year-long. Likewise, you need times when you chill out on the long distance and stay away from the high intensity anaerobic workouts. Don’t get stuck in a rut by doing the same type of training over and over all year-long, only to wonder how the hell you suddenly got injured. You need periods of more steady aerobic work, periods of more strength, and periods of high intensity which are all dependent on how fit and healthy you are as well what your goals are. Every workout should have a purpose and workouts should be changing and developing as you develop as an athlete.

athletes nsaidsOld Injuries Haunting Athletes

For some people, often the ones I see in my office, this is the main reason they are unable to recover from an injury. It’s also the reason why some people get injured over and over. It’s not uncommon for an old ankle injury to still be affecting your gait and next thing you know your knee or hip is injured even though there is no longer any apparent pain in the actual ankle anymore. The problem with these types of injures though is that they’re super difficult to correct since most physicians and therapists don’t know how to identify them and the athlete no longer feels pain or discomfort in the previously injured area – so they go untreated. My best advice here is to make sure you find a good doc and/or therapist when you’re injured to make sure, to the best of their ability, that your injured area is fully functioning, (strength, range of motion) – not just pain-free. Of course if you’re having to wear orthotics or take NSAIDs because of your injury and that’s how you’re getting by then you haven’t corrected anything; you’re just some moments away from the next injury waiting to pop up.

running footwear injuryWrong Footwear, Poor Economy, Your Form Sucks

Some people like to say that the reason runners are so easily injured is that because running is such a repetitious activity. If you’re having a problem in your ankle then landing on that 80-90 times a minute for 30-60 minutes is going to quickly become a much bigger problem. Of course this is true for most sports in general whether you’re swinging a tennis racket (shoulder/elbow) or pushing a bike pedal (hip/knee). If your form is poor then you will eventually develop an injury.

Footwear, as I discussed last month and in many other SockDoc articles, is a major reason why athletes get injured. Orthotics are a big reason why athletes never heal up properly and continue to move with poor form/economy and get injured again (often a new injury) later on. I put footwear as number five on this list because although it is important, there are far more athletes injured because of poor diet, improper training, and just too much stress overall. But footwear is an issue, and for some it is their only issue especially if their shoes are thick and over-supportive.

Change Your Plan

No, you’re not injured because you forgot to stretch or because you forgot to ice before and after your workout. If you need to do these things then you’re already broken and you’re just buying time before it gets even worse to the point where you can’t train at all.

injury therapyIf you’re injured and not healing then don’t keep doing what you’re doing, (assuming that you’ve been injured for a very long time). Undergoing the same therapy month after month with no success will not all of a sudden heal your body. Get a second opinion and seek out a doc or therapist with a different perspective. And going for a second if not third MRI isn’t going to magically heal your injury either.

Consider what you’re not doing right, (per the list above), and what you can change for the better. Sometimes it’s the little things such as tweaking your diet, assessing and treating a specific muscle, or changing how you’ve always done something a certain way that can be the difference between slow or no progress to a fast and full recovery.

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  1. Melissa says

    With regards to the Two Week Test – I have a vanilla whey that is undernatured, grass fed. Think it’s called whey cool. It does have though stevia and xlitol. Should I find a whey that excludes this?

  2. mike mcpherson says

    sockdoc, if you are injured a lot and you say you should boost your protein intake to 2 grams per bodyweight then say i’m 180 pounds that is 360 g which is 1300 calories. If i’m trying to lose weight trying to keep my calorie around 2000 this is over 50% of my calorie count which should be 20 carb 20 protein and 60 percent fat. I’m trying to eat only 3 meals a day like you said to teach my body to burn fat. I would have to eat more often due to your body can only absorb around 40 grams of protein at a shot. I look forward to your book in the spring. Thanks.

  3. says

    I found this post so helpful that I mentioned it in my blog post today! I’m increasing the amount of protein that I eat as I come back from some aches and pains after running the St. George Marathon. Thanks!

  4. Dvir says

    Great article as always. However, as a medical professional (veterinarian) I think that it would be highly beneficial to provide references and sources for the information thoughout the website.

    I have been following the website for quite some time, and have found it to be a great source in my quest for injury free running.

    • says

      Citing references is time consuming and not the big picture behind this site, (and most have already made up their mind with a supporting study), but thanks for the suggestion.

  5. Marten says

    Hello Sock-doc.

    I have pain there the Tibialis Posterior attaches to the foot.
    I have been wearing orthotics because I am overpronating for a year but after reading your website have i SLOWLY started to ditch them.
    I started to feel pain for a couple of months ago and have a program from a physiotherapist (who believes that you can train away overpronation). The problem is that it hurts when i am pulling up the arch off my foot so my feet starts to collapse because the muscle can´t do its job. I think it calls Tibialis Posterior dysfunction and the only solution i have been finding at internet is orthotics. I can shape a nice arch but it hurts. Is it something i can do as you recommend?


      • Marten says

        I have meet a orthopaedic and he thinks and almost sure that i have fused bones in my foot. I am worried about that but skeptic because i can shape a nice arch by pulling my big toe back. I have been very active in bicycling, running and jumping in the woods and i never had any injuries but after starting in athletics was i almost injured every time. Long story short do you think that fused bones in my foot are a problem? I was barefoot almost every day on the summer as a kid. I am 15 now.

          • Marten says

            Ok thank you! I live far away from you so i can´t visit your workshop which i wish that i could. I am surrounded by people who don´t think you can fix any injuries without tape and/or orthotics so your website is my only source to facts and exercises. Thank you so much for this website!

  6. Mike says

    Hi Sock-Doc,

    I have a long history of knee/ankle issues and mainly my knee caps dislocating. Because of these injuries the cartilage on the back my patella is wearing away. Do you believe that cartilage can regenerate itself? And if so what supplements/foods do you recommend to encourage this healing? Thanks

  7. Marten says

    Hello, sorry for asking so many questions. This is a short one and hopefully my last one if I´m lucky! And the question is, how flexible should a foot be. People have told me that I have stiff feet and that i have fused bones in my foot but I´m not convinced. I can shape a nice arch and a neutral foot position. I understand that it´s hard to write a answer but is it something as i can try at home to se if my foot is stiff?


      • Marten says

        I have done your exercises and I am now almost pain free! I´m still overpronating but less than what I did before. Its just one thing and that is that my naviculare bone sticks out. When i pronate my foot as much as possible (and in normal position) does the bone stick out so its looks very abnormal. Is it dangerous or is it just something that some people have. I have looked at other peoples feet and they have absolutely nothing there.

  8. Øyvind says

    Hi sock dock!
    Thank you for making this great website. I have learned so much about nutrition and training, after discovering your site. After changing my diet more towards a Paleo type diet I am loosing weight on a steady pace, and I now understand why taking NSAIDs just made my pain worse. So keep up the good work! :)

    I am fairly certain I have become overtrained or adrenaline fatigued, due to too much stress the last couple of years. My main problem is pain in my wrist, forearm, lower back and legs. My work demanded me to sitt for 8 hours++ every day working on a computer, which I cant do anymore.

    During the last year I have done a lot of trigger point therapy and soft tissiue massage, and I have been adapting to a more Paleo type diet. I can really feel the improvement. I am no longer stiff as a board, and i am able to use the computer for short periode of time without pain. Unfortuntly it seems like my progression has plateaued, and I guess it is because of the sedentary lifestyle I have adapted to due to all the pain. I am slowly starting to walk more and more and my goal are to start running within my HR. In that regard i have som questions:

    1. My legs and feet are starting to hurt. It is a steady ache night and day and it as been going on for a couple of days. Is this just normal DOMS or is there some triggerpoints i need working out? My daily walk is just 30 minuts to one houre.

    2. I would really like to go minimalistic. Should I wait until i have developed some aerobic base or is it ok to just start now?

    3. Do you know of any good aerobic exercice for my hand and forearm muscles? I have done some eccentric training with very light weight, but I wonder if there is some more natural movements which is more effective. I was thinking about bear crawling but I am unsure if it is too much anerobic.


    Sorry for bad spelling. English is not my first language. :)

    • says

      Hi – sorry I can’t give such specific (and detailed) advice on-line. Best I can offer you without a Skype consult is to read even more on this site. Thanks.

  9. alex says

    Dr Steve Gangemi,

    I suffered a calf injure 4 months ago wile training hard on the tread
    mill during my finals,after completing a month of therapy my calf was at the same place when I first got injured,now after a week of starting a new session of therapy with a new Dr, I feel like it is more of the same (not moving forward or easily flare up when I walk exessibly) the injured area,which is on the left side of the soleous on my left leg on the exterior mid side of the muscle has an area that feel stringy and tender,and as you mentioned in your website which I tend to agree with the notion that the constant stretching routine agravete and does keep this injury from healing.
    I do not know what else to do to correct this problem,since I try It all ,will appreciate any advice.

  10. Tom Burr says

    Hey Doc,
    I love your site. I refer people to it all the time and I really appreciate all of the help and insight that you are sharing. I am an avid runner, and I went minimal almost 2 years ago. My daily wear shoes are Merrell Bare Access 2’s and I currently run in Vibram Five Finger Bikilas. I had a painful transition to these from my previous padded pronation “correcting” shoes. Now most of the pain is gone and using your advice on trigger point therapy has done wonders. But now I have 2 reoccurring issues that keep interrupting. 1. 30 minutes after I run (my typical run is 10k distance) I develop severe pain in the top outer area of the 1 metatarsal on my left foot. This pain lingers for days, and I have to take a break from running and let the pain subside over several days. This pain flares up again after I resume my running routine. It’s a vicious circle of running and taking breaks for days to get the pain to go away. I cannot seem to find an answer to this, and I keep interrupting my running routine, which is really upsetting. 2. During the last 2 miles of my run, I start to develop a pain in my lower hip. After the run and for the remainder of the day, this pain increases to a sciatic nerve type of numbing on the back of my thigh. This makes it difficult to walk without hobbling, and once again, I need to take several days off from running. I have 3 chiropractors in my family, and I see then regularly. (My father-in-law and 2 brother-in-laws are chiropractors) Each time I go to them with this problem, the diagnosis is that my sacrum is tipped and causing the pressure and pain in my hip/ leg. After an adjustment and several more days of not running (and more adjustments) the pain goes away. But, once I resume my running routine this problem and/or my foot issue come back again. It is truly maddening.
    I really enjoy running, and have embraced the whole barefoot lifestyle wholeheartedly – I even do toe spacers – but these reoccurring pains are really killing my workouts. Thanks in advance for any advice you could offer.


    • says

      Well it sounds like you need to see why your sacrum isn’t stabilized. Though I too am a chiropractor, I don’t (rarely) adjust bones as it is my philosophy and findings that bones are misaligned due to muscle imbalances. The bones are almost always secondary. The muscle imbalances occur due to some stress, or stressors to the nervous system – all the things I talk about on this site such as poor diet, emotional stress, training, etc…So you stress the nervous system, you create muscle imbalances, and then you create structural misalignments. So the adjustments won’t hold until you fix what’s causing the sacrum to be out of place.

      Only other thing maybe to help you is that the sacrum is stabilized by the piriformis muscles and those are highly affected by hormones – especially testosterone and DHT (prostate).


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