The path to injury.

vigorously training injury-free requires both pushing and listening to your body. Learn to recognize and carefully monitor minor aches and pains before they take you off the course, court or field for weeks at a time. There are four stages to the development of a full-blown overuse injury. Let this overview of running injury progression help you stay alert to troublesome situations before they do real damage.

Stage 1

Symptoms: Pain noticed only after running, sometimes hours after or the next morning.

Prognosis: 1- to 2-day recovery possible with proper treatment and elimination of the cause (e.g., replacing worn shoes).

Treatment: Ice, compression, elevation and massage.

Stage 2

Symptoms: Discomfort or tightness--but not pain--felt while running. Normal running and racing still seems possible.

Prognosis: 4- to 7-day recovery possible with proper treatment and elimination of the cause.

Treatment: 2- to 4-day rest or a non-exacerbating alternate activity (e.g., deep water running if impact stress is causing or contributing to the discomfort). Also, ice, compression, elevation, massage and anti-inflammatories. Do not exercise while using anti-inflammatories. These medications mask pain and can mislead you into making the injury worse. If after 7 days you see no improvement (or symptoms are worse), visit your general practitioner or a sports medicine physician.

Stage 3

Symptoms: Pain while running. You feel compelled to reduce training or racing frequency and intensity.

Prognosis: 2- to 4-week recovery possible with proper treatment and elimination of the cause.

Treatment: 4- to 7-day rest or a non-exacerbating alternate activity. Additionally, ice, compression, elevation, massage and anti-inflammatories. Seek professional help if you see no improvement or are worse after 7 days' rest and treatment. Return to running only after you feel no pain during runs. You may require physical therapy as part of rehabilitation.

Stage 4

Symptoms: Severe pain. You cannot run.

Prognosis: 6 weeks of recovery or longer.

Treatment: Seek professional help immediately. This stage requires both professional treatment and therapy for rehabilitation. Return to running only when you feel no pain on activity.

You can take steps to prevent injury before discomfort strikes. First and foremost, expect to get injured; this will keep you attuned to injuries in the making. Next, keep paper cups of frozen water at the ready for ice massage, and ice cubes in freezer bags for general application. Immediately ice (for 10 to 20 minutes, then allow to warm) any area that doesn't feel right after running. Repeat this throughout the day if you can. Take a day of rest at this stage; it can save you from extended time off later. After treatment, gradually return to running. Don't try to get from zero to your previous level of training any sooner than the total amount of time you were off. Finally, admit to yourself that injuries are caused by specific factors that you must unearth if you are to ultimately avoid them.

(Adapted from Team Oregon Running Tips, wY'east Consulting and Team Oregon, www.teamoregon.com; personal corresp. Warren Finke, Team Oregon & Portland Marathon Clinic)