To Train or To Not To Train- What To Do When Sick or Injured.

“So, what’s the rule about exercise when you’re sick?” I can’t count the number of times I’m asked this question during the winter, when colds and flu abounds. Die hard runners are wanting  to push through coughing fits to get in training mileage for upcoming races, triathletes have been know to swim a 50, then hang on the edge of the pool trying to recover as they suffer from the flu. And everyone gets a little grossed out by that one guy in the gym who seems to be coughing all over every piece of equipment he touches.

The same can be said for injury, and I hear this question all the time: “I’m hurt but still want to train- can I run anyway?” Just think of the runner who still has that high ankle sprain, yet insists she’s “Ok to tough out a recovery run” while literally limping along the trail. Or the triathlete trying to push through yet another bout of plantar fasciitis grimacing with every step.

Unfortunately, there isn’t a hard and fast rule. The answer to both questions really is, “It depends.” Not the answer that most want to hear. This conundrum is real: take too much time off, and risk loosing fitness you’ve worked so hard to gain. Take little (or NO) time off, continuing to train and risk the injury or illness taking too long to heal, and loosing fitness anyway.  It’s not an easy answer. However, there are a few things to help narrow it down and ensure you’re able to keep maximum fitness, while allowing the body to fully recover.

ILLNESS

But before working out the first questions I ask myself is “WHERE do I feel ill?” Ask yourself, “Does it hurt in just my head, or is it anywhere below?” Minor head colds, sinus pressure, etc. are usually ok to work though according to most medical professionals. In fact, getting the body moving helps to improve circulation and break up some sinus pressure. In addition, exercise releases ‘feel good’ endorphins, which contributes to feeling better after a workout when you’re feeling under the weather. However, major chest congestion, persistent sore throat, stomach pain, etc. signals that something more serious is going on and rest should be the goal for the day.

My second questions is: “Do I have a fever?” Most times, a fever indicates the body is already working overtime to fight against an illness of some nature. Overly taxing it with an additional expenditure of energy will almost certainly end poorly. Don’t risk even a “light” workout when you’re running a fever. Best to rest up and consult a Doctor. 

Finally, I ask If I’ve got a cough. Coughing usually indicates that the respiratory system is compromised in some way. It could just be mild sinus drainage, or something more severe such as bronchitis or pneumonia. Either way, If I’m coughing, I don’t want to do anything that will tax my cardiorespiratory system in any way. I may switch the workout to some some very light traditional strength training, without any high-intensity bouts. However, more often than not, I choose the rest option. 

INJURY

Let’s say you’re ship shape with the immune system, but you rolled your ankle recently. Or have some IT band issues flaring up. Or you’re super sore from the weekend bootcamp, crossfit workout, or long run. Or maybe you’ve got some tennis elbow or plantar fasciitis. When do you lay off the workouts and when do you suck it up and push through? Again, the answer is the same as with illness: It depends.

For me, the injury question boils down to origin of the pain: If I can answer the questions, “How did this happen” and “where do I hurt”, I usually know what to do.  If the condition is chronic, meaning this is something that flares up on a regular basis, such as nagging knee pain or DOMS (delayed onset muscle soreness), then I usually continue with my workout regimen, but alter subsequent workouts as to allow for minimal impact on the affected area. For example, If my legs are super sore from a strength session, I will change my planned long run to a swim workout which engages the body aerobically, but limits direct impact on the legs. The increased circulation from the full-body movement helps pump oxygenated blood into the legs and helps remove toxins from the sore area. Usually in a day or two, I should be fine to resume my original training schedule.

However, if the injury is acute, rest (and an appointment with the PT or sports chiropractor) is usually the first course of action for me. For example, if while doing some speed work on the track, I feel a twinge in the hamstring followed by acute pain that does not abate, this is an signal telling me to stop as there is something acutely wrong, probably a muscle strain (pull or tear). Typically, an acute injury needs time to heal, in addition to rehab, so refraining from regular training impact on that particular area is best initially. In this example, I might stop running for a week or two, but under the supervision of a good PT, continue rehab work and moderate cycling and swimming.
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As a general rule, anytime I exercise when I’m hurting or feeling sick, I always modify the workout, changing up duration, intensity, and/or volume to make the workout easier. If you’re going to train when you’re not feeling well, make sure to treat it like a recovery day. Sometimes that means taking the day off, and sometimes it just means slowing down a bit