Injured from running? You’re not alone.

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Both recreational and competitive running have become increasingly popular over the last few decades. Due to the vast amount of research, we know more about running injuries than ever before. Despite this, 19-79% of runners become injured each year (Van Gent et al, 2007; Hollander et al2021). It goes without saying that the number one reason to stop running isn’t lack of motivation, it’s injury (Fokkema et al 2019).

For a sport that is considered easy, natural, inexpensive (the cost of a pair of shoes), and convenient – the injuries are anything but that. They are complicated and multifactorial (Taunton et al, 2003) and whilst it can often feel like an injury has come out of nowhere, the reality is that it has been building up without your knowledge for a long time.

A running injury is the accumulation of microtrauma without appropriate healing – there comes a point where you body can no longer handle the load and heal the (albeit small) damage quickly enough. In summary, the tissue load exceeds capacity and injury occurs (Hreljac, 2004; Hollander et al 2021).

What is a running related injury (RRI)?

The definition of a running related injury, in simplistic terms, is when the tissues taking load (such as your muscles, ligaments, tendons, and joints) are unable to handle the amount and/or frequency of stress. The damage overtakes the healing process, and injury occurs. You may have heard that stressing your body helps to strengthen it – this is absolutely true. However, there is an optimal balance of load and recovery that is required to increase strength (Hreljac, 2004). Injury happens when this balance is disturbed and your ‘Running Injury Threshold’ is exceeded.

The Running Injury Threshold:

A threshold is the point at which above the value something takes place, and below the value it does not (Online Websters Dictionary). We can simplify the question of ‘why running injuries happen’ by introducing the concept of the Running Injury Threshold.

Your ‘Running Injury Threshold’ is unique to you. It is reached by adding together all your risk-factors for running related injuries (see figure below). The bigger the ‘risk’ for each element, the closer it takes you towards your running injury threshold. Some factors to consider are:

• Strength
• Flexibility
• Structural Alignment (and physiology)
• Previous Injury History
• Biomechanics
• Training

Consider this example:

Scenario 1:

Olivia normally runs her usual 5km loop a few times a week and a parkrun on a weekend. Olivia doesn’t get injured.

Scenario 2:

After deciding she loves running and wants to do more, Olivia enters her local Marathon. Taking the advice from her friends she starts to follow a training marathon training programme and is running more (often and longer). Whilst she is diligent with her training, nothing else changes. As a result of running longer, and more frequently (thereby increasing her training load), she surpasses her running injury threshold and is burdened with an injury.

Scenario 3:

Olivia takes this information on board and she improves her strength, optimises her flexibility and recovery. She also has a gait analysis to improve her running form and highlight the root cause to her problem, which optimises her rehabilitation programme and treatment for the injury. Now she successfully continues to train for her marathon, injury free.

Whilst this is a fictitious example, it will most certainly resonate with many people in what happens when they mysteriously develop a running injury but no one knows why. The reason is there, but not always obvious.

Running Injury Causes and Risk Factors:

Your risk factors for developing a running injury are usually split into two categories, intrinsic – these are individual characteristics, and extrinsic – these are things that are related to the environment and external from the runner (Saragiotto et al, 2014).

Intrinsic

• ‍Age – As we get older we become more inflexible and are more prone to certain injuries, such as Achilles tendinopathy( Bus, 2003)
• ‍Gender – Females and males have different predispositions to different injuries based on physiological and anatomical make-ups (Taunton et al, 2003)
• Body Mass Index (BMI) – This will impact the loading put on your joints ‍
• Previous injury history (Buist et al ,Taunton et al, 2003)  ‍
• Physiology and anatomical structure – e.g. range of motion, joint alignment etc.  ‍
• Strength & Flexibility – How strong you are and how flexible you are. ‍
• Biomechanics – How you move. This could refer to your joint movements ( Kinematics) as well as the force that you land( Kinetics) (Napier et al, 2019)

Extrinsic (Training)

• ‍Training Errors  - This is the most commonly noted risk factor for injuries and has been proposed to be the ONLY risk factor for injuries bysome authors (Hrjelac, 2004). This refers to your frequency, duration, distance, speed that you train.  Some authors claim that up to 60% of running injuries could be attributed totraining errors (Hrjelac 2004, Van Der Worp et al,  2016). ‍
• Running Terrain – Grass, pavement, trail (Buist et al, 2010)
• Footwear – Do you run in sandals, high heels, or shoes that you’ve been wearing since the 1980’s? There has been less emphasis on this one over the years as our knowledge of shoes, and shoe technology improves. Nigg et al, 2015 has proposed that when choosing the right shoe, the athlete should select one that is comfortable using their own individual ‘comfort filter’. They suggest by doing this automatically reduces injury risk by allowing the person to run on their own ‘preferred movement path’ (Nigg etal, 2015).

 The most common running injuries

The KNEE is the most common joint effected by running injuries(VanDer Worp et al, 2016; Buist et al, 2010; Taunton et al, 2003; Hollander et al,2021).

These are the 4 most prevalent running injuries (Fernandez-Lopez et al, 2020) :

•  Anterior Knee pain / Patellofemoral Pain Syndrome (Knee)
•  Iliotibial Band Syndrome (Knee)
•  Medial Tibial Stress syndrome (Lower Leg)
• Achilles Tendinopathy (Ankle) (Hein et al, 2013)

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Ways you can help reduce your risk of a running injury

Knowing the injury rate for running is so high, what can you do to help reduce your risk of developing an injury? Unfortunately, there is no cookie cutter recipe for how to prevent or resolve an injury. Treatment, rehabilitation, and training are individual, as are the components that make-up each person’s ‘injury puzzle’.

However, here are a few general tips to keep you on the right track.

Here are our 5 top tips on ways to reduce you risk of a running related injury:

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1.  Be wary of training errors

Not many people commit training errors intentionally. If you knew something you were doing was going to give you a running injury, you probably wouldn’t do it. However, when starting a new programme or training for a new distance – it’s easy to get carried away. Always increase your mileage and frequency gradually. This rule applies for changing your training regime but also coming back from injury.

2.      Strength training‍

Studies have shown that strengthening is the main preventative measure you can take to reduce your risk of a running injury (Ferber, et al. 2011). We recommend getting an analysis of your strength first as a baseline to improve on. Aim to incorporate some running strengthening exercises into your workout routines 2-3x per week.

Try these 3 strengthening exercises:

•  Hip Abductor Strengthening – Using a thera-band around your ankles or knees, apply some resistance and move side to side in both directions. Repeat this movement for 1-2 minutes until you can feel your hips working.

•  Single leg knee bend – Standing on one leg, bend your knee. Ensure that your knee stays in line with your 2nd toe and doesn’t dive in towards the middle and your hips stay level throughout the exercise. Repeat this 10x on each side 2x each.

•  Ankle Inversion Strengthening – Using a theraband wrapped around the inside of the top of your foot, slowly move your foot inwards. Ensure that your ankle is the only joint that moves and your knee and hip remain stable. Relax your toes and keep the movement slow and controlled in both directions. Repeat this 15-20x on each foot, 2x through.

3.      Mobility

Stretching is controversial. But joint mobility will help your running movements be easier, less restricted, and give you the ability to run faster . Take up foam rolling or a regular mobility programme to help keep yourself mobile and aware of any imbalanced tightness that could lead to joint restrictions.

Try these mobility and foam rolling exercises

• ‘Windshield Wipers’  (Modified) – Lie on your back with your arms out to the sides. Bend your knees with your feet flat on the ground. Take knees side to side, alternating. Repeat this movement for 1-2 minutes.

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• Foam rolling Quads – Lying on the ground with the foam roller underneath your thigh muscles, roll across the muscle from the knee to the hip, ensuring that you make contact with the muscles on the inside and outside as well, for about 1-2 minutes. Starting out, you can do this with both legs on the roller, as you improve, progress to rolling one leg at a time.

•  Foam Rolling Calves  - in a seated position on the ground, place the roller underneath your calf muscles. If you are new, try doing both calves at the same time. Roll from the back of your knee to your ankle. Keep the movement slow and controlled, ensuring your cover the entire calf muscle. Aim to do this exercise for 1-2 minutes.

TIP: Make sure your toes are relaxed and not pointed upwards throughout – this is easier, but ‘guards’ your muscles making it more difficult to release them.

4. Gait Analysis

How you run is very important in preventing running injuries, as well as helping to get to the bottom of any existing injuries you already have. Ideally, if you can have a 3Dgait analysis this will give you the best possible picture of how you move in the three planes of human movement.

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The benefits of having gait analysis for a runner are well documented (Benson et al 2018) and are commonly used to:

• Diagnose injuries from their root cause
• Direct rehabilitation plans and treatment
• Highlight injury risk areas to create preventative strategies for injuries

More recently, gait analysis assessments are used to improve performance by identifying variables related to efficiency, such as vertical excursion, cadence, and stride characteristics.

The main types of gait analysis are 2 dimensional (2D), using a video camera, or 3 dimensional(3D), using state of the art technology and software.  Whilst 2D gait analysis will be able to give you a good idea of your running, it lacks the accuracy and objectiveness of 3Dgait analysis. Used in research, 3D gait analysis is the gold standard for detecting running injuries, and provides accurate information about your joint movements – Run3D can also do this in real-time using our gait retraining mode to help you pin point the problem AS you run!

Here is an example of a gait analysis report from Run3D

5.      Shoes

Don’t overthink this too much, but make sure you have a pair of shoes that are comfortable for you. If this is a minimalist, zero-drop shoe, great. If it’s a stability shoe, great. If it works for you, that is what matters most.

In summary, whilst runners have a high injury rate, there are some things you can do to keep yourself under your injury threshold. When in doubt, see a specialist to give you advice. The faster you get on board with your injury, the faster you’ll be able to get rid of it. Hopefully for good.

References

Bus, S. 2003, Ground reaction forces and kinematics in distance running in older-aged men, Medicine and Science in Sports &Exercise, Vol. 35, No. 7, pp. 1167-1175.

Hollander, K., Johnson, C., Outerleys, J., & Davis, I.,2021, Multifactorial determinants of running injury locations in 550 injured recreational runners, Medicine & Science in sport & Exercise, Vol. 53,No. 1, pp. 102-107.

Ziga, K., & Sarabon, N., 2017, Common running overuse injuries and prevention, Monten J. Sports Sci Med. Vol. 6, No. 2, pp. 67-74.

Buist, I., Bredeweg, S., Lemmink, K., van Mechelen, W.,& Dierks, R., 2010, Predictors of Running-Related Injuries in Novice Runners enrolled in systematic training programme, The American Journal of Sports Medicine, Vol. 38, No. 2.

Fokkema, T. Hartgens, F. Kluitenberg, B. et al. Reasons and predictors of discontinuation of running after a running program for novice runners, Journal of Science and Medicine in Sport, Vol. 22, No. 1, pp. 106-111.

Hreljac, A. 2004, Impact and overuse injuries in runners, Med Sci Sports Exerc, vol,36. Pp. 845-849.

Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. 2003, A prospective study of running injuries: the Vancouver Sun Run ‘‘In Training’’ clinics, Br J Sports Med, Vol.37,pp. 239-244.

van Gent RN, Siem D, van Middelkoop M, van Os AG,Bierma-Zeinstra SM, Koes BW, 2007, Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review, Br JSports Med, Vol. 41, pp. 469-480.

Van Der Worp, M., WiJer, A., Van Cingel, R., Verbeek, A.,NiJhuis-Van der Sandn, M., & Staal, J., 2016, The 5-or 10-km Marikenloop Run: a prospective study of the etiology of running-ralted injuries in women,Journal of Orthopaedic & Sports Physical Therapy, vol. 46, No. 6, pp. 462-470.

Websters Dictionary – Threshold Definition - Online at: [https://www.merriam-webster.com/dictionary/threshold#:~:text=Merriam%2DWebster's%20Word%20of%20the%20Day%20for%20June%2023%2C%202017,mental%20effect%20begins%20to%20be]

Napier, C., MacLean, C., Maurer, J., Taunton, J., &Hunt,M. 2019, Kinematic correlates of kinetic outcomes associated with running-related injury, Vol. 35, pp. 123-130.

Nigg, B., Baltich, J., Hoerzer, S., & Enders, H. 2015,Running shoes and running injuries: myth busting and a proposal for two paradigms: ‘ preferred movement path’ and ‘comfort filter’, British Journal of Sports Medicine, Vol 49, pp. 1290-1294.

Saragiotto, B., Yamato, T., Lopes, A., 2014, What do recreational runners think about risk factors for running injuries? A descriptive study of their beliefs and opinions, Journal of Orthopaedic &Sports Physical Therapy, Vol. 44. No. 10, pp. 733-738.

Hein, T., Janssen, P., Wagner-Fritz, U., Haupt, G.,&Grau, H., 2013, Prospective analysis of intrinsic and extrinsic riskf actors on the development of achilles tendon pain in runners, Scandinavian Journal of Medicine & Science in Sports, Vol. 24, No. 3, pp. 201-212.

Ferber, R., Kendall, K., & Farr, L. 2011, Changes in knee biomechanics after hip-abductor strengthening protocol for runners with patellofemoral pain syndrome, Journal of Athletic Training, Vol. 46, pp.142-149.

Fernandez-Lopez, I. & Rojano-Ortega, D., 2020, Lowerlimb biomechanical factors related to running injuries: a review and practical recommendations, Strength and Conditioning Journal, Vol 42, No. 1, pp. 24-38.

Benson, L., Clermond, C., Bonsnajk, E., Ferber, R. 2018, Theuse of wearable devices for walking and running gait analysis in the lab: a systematic review, Gait & Posture, Vol. 63, pp. 124-138.

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