Running Injury Prevention

It is that time of year when most runners starting to think about the upcoming race season.  In Upper Michigan, it is also a time for just being proud to "get out there" and log some base miles as the temperatures and conditions make it tough to do any real training.  As you look back at last year, and look forward to this year, it is a great time to think about running injuries and what causes them.  An ounce of prevention is worth a pound of cure!

Let me first say that I am not a medical doctor. What I am is a veteran runner who has been coached by the best; I have read dozens of books on running and training; have logged thousands of hours running and had just about every type of injury along the way. I understand how to apply the fundamental principles of training to achieve the desired result and maximize the ability of any runner. I have also successfully coached many runners of all levels.

Let’s first start with definitions.

An INJURY is a physical problem severe enough to force a reduction in training. Did you know that scientific studies show that about 60-80%* of all runners will experience an injury resulting in significant loss of training time (more than three days) during an average year? When compared to other endurance sports, the risks associated with running are higher. Injuries can have varying degrees of severity. The best source for grading these injuries is described by Bob Glover and discussed in "The Competitive Runner's Handbook." These grades are useful when describing the severity and knowing when to take corrective action.

• Grade One: Minor aches that aren't noticed until after a run.
• Grade Two: Some discomfort is felt, possibly during the later stages of a run but does not affect performance.
• Grade Three: Severe discomfort and pain which may alter form and limits training performance
• Grade Four: Pain is so intense that running is not possible and you are forced to rest until it pain subsides

Being SORE or experiencing SORENESS after a strenuous workout, a time trial or a race is normal. You have just stressed your muscles beyond the limit of your regular workout and your body is reacting. Scientifically, soreness is your body's defense mechanism responding to tiny tears in muscle fibers as a result of the workout. After your muscles recover, they actually should be stronger. Tearing and repairing is the process of raising your fitness level and allows you eventually to run further and faster. Swelling is a side effect of your body trying to repair these fibers and may contribute to stiffness in the muscles. This process usually peaks within 48 hours after exercise. For this reason, you are sorer on the second day after a hard workout but for the same reason you are able to work out hard two days in a row (DOMS). Being sore, stiff or fatigued does NOT mean that you are injured.As Hal Higdon suggests, "If you want to become a runner, you may need to accept some soreness as a natural part of the conditioning process." Running is a process of repeatedly stressing your muscles to become faster and stronger, so some pain or soreness is to be expected.

Running injuries are quite common among amateurs and professionals, beginners and veterans. Although a recent study in the Archives of Internal Medicine (Archives of Internal Medicine, vol. 149(11), pp. 2565-2568, 1989) has determined that injury risk can be linked with inexperience. The study pointed out that individuals who had been training for less than three years were more likely to sustain injuries when compared with runners who had been running for longer periods of time.

A similar study by Dr. Murray Weisenfeld concluded that most injuries occur when running mileage starts to climb over 40 miles per week. That means that if you are training for a half or a full marathon, you are putting yourself at additional risk, even if you are able to limit all other factors.

Most injuries are caused by training errors with very few injuries occurring as a result of a single factor. Injuries do not occur suddenly, but more gradually, elevating up the scale as mentioned above. Of the many things that you need to know in order to avoid time limiting injuries is the ability to recognize the difference between normal soreness and possibly progressive injuries. Knowing your body and understanding when you have stressed it too much and when to back off is very important.

Injury causes

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Improper form and/or poor biomechanics
This is listed first because it is something that you can do very little to change. You may choose proper footwear to correct pronation or study video of your running form to help make minor corrections, but in the end, your natural form may limit your ability to run without risk of injury. Some people may have a great desire to run and be competitive but do not have the basic genetics to support anything more than running for basic fitness. You can tweak your form, slightly improve your vo2max and your running economy, but as my long time running partner Marty Clarke has been quoted in saying, "You had all of the ability to run the day that you were born."

General overuse
This is a blanket category for running too much. This is the most common factor leading to injuries and means not backing off in training when the initial signs of an injury are felt. It simply means that you have stressed something repeatedly without adequate rest to allow for the rebuilding process as discussed above.

Equipment related
This is mostly related to footwear, though can also be improper apparel for the conditions. If you are wearing shoes that are not designed for your foot then you are putting yourself at risk when you take your first step. Going through a formal fit process, having an expert analyze your form to properly recommend the right shoe for you is vital. Since your feet strike the ground 90 times per minute per foot, it all starts with your feet and works up from there. Typically shoes need replacement after 300 to 500 miles and it is smart to begin to rotate in a new pair of shoes after 200 miles on the first pair. Not allowing your footwear to properly dry out after wear is the number one cause for them to break down and reduce their life.

There are no ways to truly avoid injuries, but you can do your best to lower the probability that you experience one that will set back your training. This is in no way a complete list, but here are things that you can do to improve your chances of staying healthy.

• Build mileage at an increasing rate of no more than 10% per week, reducing mileage every 4th week to permit recovery.
• Follow the hard – easy rule, scheduling a day of rest or easy running following a hard workout and before the next hard workout.
• Don't do too much, too soon, too often, too fast, too hard, with too little rest.
• Listen to your body. When it says to back off, take an extra day of rest, knowing that you can’t skip all of your hard workouts or you might consider a less aggressive plan.
• Be sure to be properly hydrated and taking adequate nutrition, before, during and after your run. Carbing up is important to provide proper fuel before the run, during the run to help sustain longer efforts and immediately after to help the recovery process.
• Incorporate stretching into your routine, after muscles are warm and after activity subsides.
• When needed, leverage recovery tools such as message, icing, compression, elevation and rest on aching muscles.
• Try to vary the type of surface that you do your training on, knowing that a softer surface such as trails are easier on your joints and will prolong your running career than daily pounding on concrete and blacktop.
• Add strength training to your program, especially in the building phase toward your goal race.
• Keep your weight in an acceptable range for your height and gender, eating as healthy as possible. Being on the heavier end of the ranges may cause joint (especially knee) pain.
• Obtain proper rest during your training and understand that as your volume of running increases, so must your hours of sleep.
• Warm up before each workout and follow it up with a proper cool down. This will help to ease into the workout before introducing stressors to cold muscles.

So what does all of this mean? Soreness is inevitable and while injuries are likely for endurance running athletes (based on studies and the law of averages), you can take steps to reduce your risk factor. Training too hard too often may lead to injury, while not training hard enough will lead to underachieving and failure to achieve goals; there is a fine line between these two. Training is about finding your limits and learning how far you can push yourself without getting hurt.

While there is proven theology behind these methods and they are applied with the utmost attention, there is no guarantee that they work unilaterally across all runners. This is because no two runners are alike and each person responds differently to training. When I am coaching runners, I do my best to instruct runners on how to train properly, give them the best chance to succeed while teaching them to run and remain healthy for the long term. If they follow our properly designed training program which incorporates the principles discussed above, listen to the advice given and listen to their bodies, they have the greatest chance of success.