Running Injury and how our body heal.

I had a difficult time trying to put a proper title to this blog post. First thing first. Disclaimer: I am not a doctor/podiatrist/biomechanist/etc, what you see here are compilation of information from what I've read, and researched upon. I tried not to get too technical but anatomy being anatomy, there are terms which I would recommend you to read up on. Take this post as a platform for you to launch yourself into understanding your body more. This was posted because I just basically want to share some info about injuries as well as how our body deals with it to the runners out there.

A lot of us out there have the misconception that if you're injured, we should rest. I don't blame you nor am I saying it is wrong, since this is what we have been taught by our doctors, parents and friends. Well, a lot of you out there will be surprised that not all injuries get better with rest. In fact, some even get worse apparently. How is that so? Well it depends on the type of tissues in our musculoskeletal that was injured. Does anyone know how many types of tissues are involved? Don't you wish you've been paying attention during your science class now? lol

Ok ok, here's the list. They’re:

1.    Bones

2.    Tendons

3.    Ligaments

4.    Muscle

5.    Cartilage

You see, each of the above have different properties, ranging from how they get their nutrients to how they react to stress and etc. Below are as quick a summary as I can make it

Cartilage:

Cartilage are the springy white stuff at the end of your bones which prevent bone to bone meeting while also acts as shock absorbers for the bones (yes it's the one some of us tend to chew off our chicken wings). Cartilage mainly gets its nutrient from the Synovial Fluid just like the tendons and ligaments. It has to be noted that distribution of the Synovial Fluid comes from compression, decompression and movements, so who says running is not good for your joints? (Subject to wear and tear of course) Cartilages do not have pain nerve so you will not feel any hurt or pain from damaged cartilage. The bad stuff only comes when it's already down to bone to bone grinding.

Ligaments:

Ligaments are the tissues that attach bones to bones. What, we ain’t got no super glue attaching our bones together ok? Ligaments do not have much give and they attached bones together at an optimal distance, not too loose, not too tight, juuuuussttt nice. Ligaments are oriented to resist tension a long a very specific direction, so they don’t tolerate nonsense like slipping sideway (shearing), which is the major cause of ligament tears.

The cool thing about ligaments is the fact that it gets its nutrients from the fluid inside the joints (Synovial Fluid). Ligaments can't contract like muscles but they can, and do get thicker and stronger with exercise and training. They are one of the tissues that do not heal 100% after injuries, only up to 97-98%. That’s why for those that have sprained ankles before, you’ll realize your ankle will not be as strong as before and need to be strengthened by additional training and exercises.

Bones:

Guess what. There are actually 206 bones in our body, and their main duty is not just to provide our body with the structural shape, but also to provide anchoring points for us to move our body via other tissues. Contrary to what many believes, bones are not rigid, but are actually flexible and can display slight bend/flex when you exert force on it, kind of like a thick cane. There are actually 2 parts to our bones.

2 parts to bones:

Cortical: This is the hard outer layer of our bone. It is compacted and made up 80% of our skeletons.

Cancellous: This is the inner part of bones, which provide scaffolding (looks kind of like sponge) to the bones. It is also where majority of the tissues are replaced. The Cancellous area has good blood supply with blood being pumped in by dedicated arteries through the surface of the bones. Yes bones have blood flow inside too. How do you think we get our red blood cells?

Bones are constantly growing and will adapt to the optimal load placed on it. How they do so is by constantly breaking down bone for calcium (as per the requirement of the bodily function) and the laying down new minerals for increased integrity, a process called Osteoclast and Osteoblast. In other word, you’re constantly breaking bones to make them stronger. How freaky is that?

Tendons:

The tendons are the rubber band tissues of your body. This is the magic stuff which makes us so adept at running. How they do so is by storing energy upon impact/compression and returning it as free energy at the next phase of running. One of the most popular tendons in our body is the Achilles tendon, no thanks to a certain Ancient hero's weakness :P The tendons are also the tissue that sits sitting between the bones and the muscles.

Tendons have very little blood flow to them and gets nutrients mainly from a covering or sheath around them that contains Synovial Fluid. Growth and repair of the tendon is via a process called Fibroblast (the manufacturing of elastic cells), and also by improving the density and structure of the tendons via exercise and Trigger Point Treatment to break up scar tissues for realignment.

One particular thing that I would like to point out is that, apparently, tendons are not capable of inflammation. So, any doctors that want to give you anti-inflammatory shots for your inflamed Tendon or Tendinitis should be avoided. The cause of the inflammation is actually by tissues surrounding the affected area, acting as a splint and a message to the body to repair the affected area.

Muscles:

These tissues are the powerhouse for the body and are responsible for the majority of the movements or the generating of force/power that we require. The muscles are tissues that have a very active supply of blood. Muscles can be trained to generate more power via 2 methods.

1. Hypertrophy and Hyperplasia: (to put it simply, an increase in size in the Muscle cell and division of Muscle cells). Hypertrophy typically takes 6-8 weeks to develop; and 
2. Nerve control: Improved control of your musculature via increased nerve firing.

In human, there are 3 type of muscle fiber, Type I or Slow Twitch, Type IIa or Intermediate Fast Twitch, and Type IIx or Fast Twitch. There is actually a fourth type called Type IIb which is present mainly in small animals and is a Fast Twitch Fiber (this is how we get our White Meat). This can be confusing so I'm gonna put in a table with the individual features for easier reference.

Feature	Type I (Slow Twitch fiber)	Type IIa (Medium fast twitch fiber)	Type IIx (Fast Twitch fiber)
Twitch Rate	Slow	Fast	Fast
Myosin ATPase Activity (How fast power can be generated)	Slow	Fast	Fast
ATP Synthesis	Aerobic	Aerobic	Anaerobic
Myoglobin Level (How well oxygenated the muscle can get)	High	High	Low
Glycogen Store (Fuel)	Low	Medium	High
Fatigue Rate	Slow	Medium	High
Color	Red	Pink	Whitish/Pale Pink

The ratio of Muscle fiber type is fixed in each individual and no matter how much training we do, we cannot gain additional Type I/IIx Fiber. We CAN however train Type IIa to work similar to Type I with aerobic/cardio training. Note that it takes almost no training to get Type IIa to work like Type IIx. It should also be noted that Mitochondria (a component which is important for aerobic metabolism) is readily available in Type I and Type IIa in high concentration but not that much in Type IIx Fiber.

As you can see from the above, majority of our tissues actually require activities to get their nutrients. So what does protracted rest actually do to our specific type of tissues?

Cartilage - Swelling occurs and binding agent weakens.
Ligaments - Decrease it's strength and holding power.
Bones - Weakened due to breakdown of collagen structure and mineral density.

Tendons - Decreases strength and causes disorganized collagen similar to scar tissue.

Muscles - Weakens muscles, Atrophy of muscles.

So what should we do?

Exercise within means of course. That's why Physiotherapy is so important after any major injuries. The initial rest period is for your body to start the healing process. Exercise is a very important part of the healing process that a lot of people actually skip or do without, thinking that rest will fix all things. What type of exercise is beneficial to the specific type of tissues?

Bones > Slight compression and vibrations. Simulated in running, jumping and etc.

Cartilage > moderate loading within comfortable range of mobility.

ligaments > Controlled, comfortable loading of stress along the natural line of force.

Tendons > Eccentric Strengthening via loading of tension to improve organization of collagen fibers

Muscles > Aerobic exercise to induce Type IIA adaptation.

I've included Wiki links to some of the more bizarre lingo in this post to help people understand more about what some of these things are. If you have any question, do post a comment and I'll try to answer it to the best of my ability. Most importantly, DO NOT, I repeat, DO NOT use this post as a self diagnostic to how you can heal yourself. Always consult your doctor and heed their advise. Use this post as an added knowledge so that you can get better faster. Clear any activities/exercise you would like to do with your doctor before hand.

Happy running people.