The runners survival guide

You miscalculate your distance from a curb, land on an unstable rock, or trip over your own feet (hey, it happens). Suddenly, your ankle bends unnaturally underneath you and you’re in a world of pain. First things first: Whatever you do, do not try to “run it off.” “This old idea is fraught with peril—you could make tendon or ligament damage worse,” says Marc Leavey, MD, primary care physician at Lutherville Personal Physicians, part of Mercy Medical Center in Baltimore, MD. Walk carefully, and if it’s quite tender, use what you have—your running belt, your shirt—to apply compression and provide support. Once you’re home, Leavey says to use good ole RICE: Rest, Ice, Compression, Elevation. But skip ibuprofen or other NSAIDs for the first day or two. “I recommend taking Tylenol for pain first because anti-inflammatories will suppress the body’s healing process, which includes inflammation,” he says. And if the swelling is pronounced or there’s a lot of bruising, seek medical attention to be sure you didn’t break or tear something.

Running injuries can be tricky: One moment, all feels fine and the next, yowch! If you can’t pinpoint a specific trauma to your side/hip/knee/ankle/foot, a sharp pain could be a simple muscle cramp, or could indicate an overuse injury gone suddenly worse. In the moment, stop and apply compression if you can. “It may go away in a few minutes or later that day or the next,” Leavey says. “But if it doesn’t, see the doctor.” The bottom line: as already mentioned, Leavey isn’t a fan of running through the pain, since it’s the body’s way of telling you to stop whatever it is you’re doing.

That shortcut across the field seemed like a good idea at the time. “A single sting is annoying and won’t hurt you if you’re not allergic, unless it’s in a delicate area, like the mouth, tongue, eye, or genitals,” Leavey says. In that case, or if you’re unlucky enough to have disturbed a wasp’s nest and you’re really stung up, get to an ER ASAP. Removing the stinger will reduce the swelling, and the best way is to use a credit card like a scraper across the site, rather than picking at it with your fingers. Once you’re home, antihistamines can help ease any reaction. A bee sting is defined as a puncture wound, so if you haven’t had a tetanus shot in a while, you now have a good excuse to do it. And if you know you’re allergic to bees, never leave home (not even—no, especially, for a run) without your epinephrine shot.

The long-distance runner’s biggest physiological fear: running out of gas with just a few miles to go. As the body uses up its supply of ready glucose and stored glycogen, reaction slows, the body feels sluggish and heavy, and the brain can even play tricks on you in the form of hallucinations (sadly, that floating cheeseburger isn’t real). “Assuming you’re not diabetic, when you have a sugar low, you need sugar,” Leavey says. If you’re not a fan of gels or other running-specific quick carbs, he recommends packing a small pouch of jelly beans in your shorts pocket or waist belt. Don’t have anything on you? Take a walking break. “Your body has a mechanism to compensate for a sugar low—your liver will make sugar out of fat—but it takes time,” he says. You then should then be able to continue, albeit likely at a slower pace than before. If it happens a lot, re-think your pre-run nutrition (you may not be eating enough) and see your doctor to rule out diabetes or other health problems.

More common on summer days, heat exhaustion causes muscle cramps, dizziness, excessive thirst, and muscle weakness and general feeling-like-crap-ness. “If you feel it coming on, get the hell out of the heat,” says Leavey. Remove restrictive clothing to let skin breathe, and get into air conditioning, seek shade, fan yourself, or get wet (with a water bottle, hose, swimming pool…) to reduce your body temp. “Ice on the skin in sensitive areas, where the blood vessels congregate, can also cool you off fast,” Leavey says. (Think the sweatiest areas: armpits, small of back, groin, and back of the neck.) Next, rehydrate with water or sports drinks, but steer clear of caffeine and (duh) alcohol, which both have a dehydrating effect. If you throw up or your skin feels hot and dry and you stop sweating, these are signs of heat stroke, which is a medical emergency; call 911 and get treatment immediately.

Whether he bounds after you or you run by just a leetle too close, a ticked-off canine can quickly turn a good run very bad. If a pooch lunges, go rigid and don’t make eye contact, which can make an angry pooch angrier. “They say you shouldn’t try to run from a dog because he’ll outrun you, no matter what,” says Leavey. Don’t put your hands out where they can be bitten. Use your sneaker-clad feet to kick. “It sounds cruel, but you’re being attacked.” Once the fight is over, try to get the owner’s info. Rinse out any open wounds with water (and soap, if you have it), apply direct pressure (in a pinch, Leavey suggests using your shoelace to tie your shirt over the wound), and get thee to an emergency room for a tetanus shot and possibly rabies treatment. Even with no puncture, the dog’s jaw clamping can leave a “crush wound”—internal bruising that may also need medical attention.