June 1 is global running day, and many people will take this opportunity to start or enhance their running career. This should be encouraged. However, like all exercise, there are sensible ways we can begin a sport and there are common risks to consider. This article aims to point out some common sense for runners so that they can have a long, sustained running career and avoid injury. It is also useful for those returning from injury.
Running injuries are exceedingly common, with studies ranging from 19% to 79% injury rates when participants are tracked for 18 months. In other words, on the low end of things, 1 in 5 runners will be injured in the next 18 months; on the high end, 4 out of 5 runners.
What are the risk factors? Most injuries occur around the knee. Other risk factors for running related injuries are a history of a prior injury. Women have a higher incidence of hip injuries. Furthermore, there is a strange paradox: long distances run per week are both predictive of injury; yet protective of injury. How can this be?
There is evidence to suggest that chronic work loads (consistent training) protects athletes. However, sudden increases or spikes in training load are a recipe for an injury. This has been discussed in the British Journal of Science and Medicine as, "The training—injury prevention paradox: should athletes be training smarter and harder?".
What can be done about this risk for injury, and how can you be sensible? Fortunately, you live in the age of technologically. GPS systems allow runners to track their total extrinsic training load over a period of time. A running watch that tracks your weekly kilometers is a great investment for both novice and beginner runners. These account for the important "extrinsic" load factors.
It's not the whole picture though. There is another, hidden factor in training load. There is the "Intrinsic" factor. The intrinsic factors are one's perceived effort. For example, consider Runner A, who is a trained 5K runner who has consistently trained for 6 months and participates in a 5K Parkrun. Compare the efforts to Runner B, someone showing up for a 5K Parkrun who is only beginning their running career. While runner A and runner B have the same extrinsic workload, their intrinsic workloads might be vastly different. This intrinsic factor is very important at predicting injury. Track some of your perceived efforts. Ask yourself, how hard was this training session? Rate it on a scale of 0 to 10.
A good coach can help you make sense of these training loads. There are different philosophies in coaching, so finding the right fit can take time. Speak to other runners, and consider joining a club.
Avoiding too much, too soon is a great starting point. But what happens when in your running career, nagging injuries come about? Well, there are some things that we know work quite well. But there is also a lot of hype and speculation. So avoid extremes, or gimmicky tricks that may or may not be beneficial.
Having your injury assessed and diagnosed by someone familiar with running injuries is a great start. For example, there are many myths that persist about running. (IE, contrary to common belief, long distance running is NOT a cause of osteoarthritis and you can choose the best running shoes yourself simply based on comfort, not price or prescription). Furthermore, running injuries need appropriate history taking, diagnosis and treatment; some injuries will improve with rest alone; however, if the cause is a biomechanical one, many injuries need to be addressed with more exercise (albeit, very specific exercises). This is called load management. For example, rehabilitation of tendons has changed dramatically in the past few years. While there may be a tendency to rest it, or a lure towards expensive injections, the evidence for these therapies is often very weak, and the mainstay of treatment should be specific loading exercise, such as Heavy Isometric Loading or Eccentric Loading. Appropriate, professional advice here is crucial, and most sports minded doctors, physios and chiros will be up-to-date with similar recommendations from the scientific literature.
Beyond the active, exercise components, there is some evidence for passive manual therapy for many running related conditions. However, the mainstay of treatment should be advice and active exercise for appropriate load management. For example, a patient with knee pain may present, and there is often tenderness around the knee. However, many times, knee pain may be caused by a weakness in the hips/gluteal muscles. So you can see any guru treating your knee with taping, dry needling, mobilisation, soft tissue...they may prescribe orthotics, release restrictions or perform miraculous incantations, however, without appropriate rehabilitation, this issue is likely to persist.
Sometimes the rehabilitation must include running technique modification. Recent evidence highlights the effectiveness of gait retraining for some chronic conditions that do not respond to other modalities. Gait retraining, such as ENHANCE Running, or from a local legend, Keith Bateman may be available. There is currently some evidence (low quality) to suggest running technique workshops are beneficial for, "iliotibial band syndrome; plantar fasciopathy (fasciitis); Achilles, patellar, proximal hamstring and gluteal tendinopathy; calf pain; and medial tibial stress syndrome." However, the evidence is emerging and treatments are not universal fixes. The recent review in the BJSM recommends, "Tailoring approaches to each injury and individual...to optimise outcomes." One area that there is good evidence for the use of running retraining is "for the immediate biomechanical effects, including evaluation of step rate and strike pattern manipulation, strategies to alter" how the hip functions. This is one of the better solutions for many common knee pains, which as mentioned before are high in runners.
- Running is a great form of exercise
- Injury rates are high in running. Get a coach and an appropriate healthcare professional.
- Monitor your extrinsic load with a running GPS
- Monitor your intrinsic load by rating the difficulty of your run 0/10
- Maintain consistency with running, increase Kilometers slowly, avoid big spikes
- Knee pain is very common with runners, but running does not cause osteoarthritis
- Gait retraining programs can be effective for the treatment of chronic problems; but technique changes should be tailored towards the individual's specific needs