The Chicken or the Egg

The Situation:  M has a frayed tendon after running in the St. George Marathon last October.  She was in a walking cast for 12 weeks.  She can feel the twinge of the injury still, but can run pain free for three miles now.  Her ultimate goal is to qualify for Boston at the next St. George Marathon.  Her short term goal is 13.1 miles in April at an 8:30 pace.  Her current pace is 9:20.  Can she get there?  And if so, which comes first mileage or speed?

Opinion from a Podiatrist:  Chris Funk, DPM, Tucson, AZ
The whole issue is whether the damaged tendon is able to withstand the stresses of running again.  Pain free running does not mean freedom from stresses on the frayed tendon.  Having said that, I know how "devoted" runners can be when it comes to putting the miles in.  As long as patients understand there is a risk of re-injury from something not quite healed, I usually recommend increasing distance rather than increasing intensity.  Increasing intensity uses more energy in a shorter period of time, and that really pushes the tissue to the limits.  Try to get up to the distance desired, and don't even think about the pace until everything is stable.

Opinion from a Coach:  DeeAnn Smith, USAT Level II Coach, CPT Carlsbad, CA
I agree volume before intensity (and I think her PT would also, a good question for her to ask her PT).  You must progress slowly and stick to the 10% per week rule like glue.  Be sure she is giving you comments on each workout regarding pain from injury so you can adjust or delete workouts accordingly.

Opinion from Another Coach: Gail Leveque, USAT Level II Coach, Dallas, TX
I agree with the volume before intensity for sure. Especially if it is an Achilles issue. Intensity is just asking for trouble.  I may be wrong in assuming that it was her Achilles, but if it was, coming back too soon or too hard could leave her with a chronic issue that will cause her a lot more trouble. Is she willing to try water running? That is a great way to keep working the run with no impact and will really give you an idea of how serious she is about taking care of her injury.

And from Runner's World March 2010:
You used to run 30 miles a week, you got injured, now you want to get back to your old routine as quickly as possible.  Don't.  Take your time.  The same applies to that upcoming race - if you missed some training time, don't accelerate the pace and distance of your remaining workouts in an effort to "catch up."  Instead, adjust your goals as needed.  Try balance training, shortening your stride, RICE (rest, ice, compression and elevation) and stretching the back of your legs with dynamic (not static) stretching.