Injury for runners is pretty much guaranteed at some point which is why there's so much research done on it and so many theories bandied about as to what causes runners to get injured. Working out the REAL cause, however, not just Googling and hoping for the best is like wading through treacle. This blog post much like all my blog posts are here to help you think things through for yourself and to hopefully avoid the dreaded running injury.
A week ago I asked my Private Facebook Group (I Run Strong) what they thought the top three causes of running injury were. These were the quite brilliant responses I got back...
In no particular order then:
So these were the responses I got in my group which we'll explore in more details. And these are the top three supported by research:
Not stretching, not warming up, shoes and so on aren't supported by research per se. Now, I'm a research loving individual. I think it's important. HOWEVER I do not think it's the be all and end all. Typically running research looks at a particular type of runner, say male and aged between 18 and 25. How does that then translate to female aged 45-50? It's also very difficult to control for the reseach because all bodies are different. So although I am a big fan of research I also use my common sense when listening to any client with a running injury and spend some time digging deep to work out what's going on.
So looking at our list then, here goes.
Poor running technique
For me as a running coach and movement therapist, this is a big one. HOW you run IS important. It just has to be. If we argue that form is important when you're lifting something heavy because it has the potential to cause injury, then your form when running (because it too is a stress on the body) matters.
How do you change your running technique? This is a tricky subject because it depends on what you're trying to change. How you run, like how you move, has developed over time based on how you move the rest of the time, how much you sit, stand, the shoes you wear, how you feel, other injuries or muscle imbalances and s o on, so saying to someone change how you run might work in the short-term, but the body is likely to go back to what it was doing before. There are things you can tweak like cadence and terrain which mean that you have to run differently, but moving better overall is the key to improving your running economy. Running is a skill. It is a skill like any other which needs to be practiced and honed and doing running specific drills will help you groove some new movement patterns.
Ooh controversial :) I love being barefoot and I've spent a lot of time transitioning to minimal shoes and strengthening my feet and everything connected to them. What happens if you go out running in a minimalist shoe without any prep... injury! How do I know... that's exactly what happened to me. Moving away from the barefoot stuff then, what about trainers and all the marketing bullshit that comes along with them. Apparently it's all waffle. According to the research the support shoe, the neutral shoe and so on are all much the same i.e. they don't do much for your running economy. There is some research that suggests that trainers are actually causing injuries. Therein lies the dilemma with research... one says tomato, one says tomahto...
What to do? Don't run barefoot or in a minimalist shoe unless you know what you're doing and have spent some time sorting your feet out! Beyond that, find a running shoe that fits and is comfortable. There's some scope for rotating shoes as well to give your body and feet some variation, much like running on different terrain and so on which I'll get to below.
Over-training / Insufficient rest and recovery / too many miles
Yep. Below are the three main researched causes of injury and training error is right up there. Too much too soon, a change in pace, volume, distance, speed, cadence etc. all take their toll. Over-training is most common. You go out running, you feel amazing, you do something daft, like a few sprints or some bounding... how do I know? Because I've done it... and the result was an injury. When you're doing something that you like doing, you feel like you're getting somewhere, you feel awesome and strong, then you're likely to want to do more of it. You go too fast, too much, too soon, with little rest and hey presto you're knackered. It definitely pays to have a plan and to stick to it.
Not enough different types of runs
Remember these points come from my clients/group members. I could interpret this a number of ways. In essence, yes, it comes back to training error. Running harder and faster is not always better and in fact the 80:20 rule is useful here. 80% of your runs should be conversational and easy, with maybe 15% medium and 5% tough.
Not balancing running with other types of exercise (especially restorative exercise)
This is a tricky one. I can see the point - let's do more exercise that isn't running in an effort to keep the potential damaging efforts of running to a minimum. Restorative exercise, particularly as I teach it is there to improve your body moves. Unfortunately even restorative or corrective exercise as it's known can only go so far because it's still 'exercise'. Ideally if you want to be a better runner, then you need to run more (that doesn't mean run daft, it just means you need to practice that which you want to improve). Restorative exercise might feel good, but ultimately it isn't going to save you from poor patterns, lack of strength and learning the skill of running.
Whilst cross-training with bike or swimming is usually recommended to an injured runner, if that runner is anything like me they'll run a mile. I don't want to swim, I don't want to bike, I want to run! That's it. Running! Cross-training is designed to keep your heart and lungs fit whilst you do less mileage. The only reason you'd need to do less mileage is if you hadn't built up to it and allowed your body to adapt and therefore kept getting injured OR you fall into the camp that believe that running is ultimately bad for your joints and tendons and so on. Actually running is briliant for your joints and other soft tissues, including the discs of your spine if... go on, have a guess... you do it well and don't do too much too soon blah blah and let your body adapt. Can you see a theme here?
Lack of warm up and stretching
Another controversial one which I cover more in depth on the vid. No amount of warming up is ever going to save you from running more miles than you should or quicker than you've adapted to.
Stretching... that's a whole other blog post, which I'll get to at some point in the not too distant future. Stretching on the whole doesn't appear to be, from the research perspective, particularly injury-proofing. I would argue that all the clients I've seen as a therapist with muscle tears, however would go some way to proving that a 'tight' (again, another blog post all of its own) muscle is more likely to tear.
That brings us to static versus all the other types of stretching and they all have fancy names like proprioceptive neuromuscular facilitation... wah wah wah. So? Well, again, it depends. What does it depend on? You! You're an individual. What works for one person, won't work for another. I'm on several running groups and I was contributing to the gait analysis of a female runner. She was very spongy in her running and having spent the last 12 years around various body types I could tell that she was a bit more bendy than the average bear. That meant when somebody suggested she do Yoga and more stretching, I had to wade in and flex my biomechanical pec muscles. Actually I just suggested that this lady in particular might benefit from MORE stiffness, not less. WHAAAAAAT!?!?!?! you want me to be MORE STIFF? Again, a whole extra blog post awaits, but imagine a slinky oozing down the stairs, it's not bouncy, it's just floppy and malleable. Then picture a spring that's rusty and jammed shut. Neither of these are going to bounce about. Then imagine the pogo stick spring, bouncing about merrily zinging its way about the place. Which muscle/spring type do you want for running? I think I'll choose the pogo please, Bob.
Lack of knowledge of your own body
I especially liked this response. I agree. I think (myself included) that we rely too much on what other people tell us (myself included) instead of being able to 'know' in our deepest being what's right for our bodies. Guess what? Yep there's another essay in there waiting to happen, but it starts at school. We are taught to ignore what our bodies NEED and instead to do as we're told. Anybody ever look after a toddler who you've begged to sit still? Me neither, I can't think of anything worse, but the point remains, they're slippery little buggers, always on the go, into everything and designed to NOT remain still. But given enough training they'll do what their parents and teachers tell them instead of what feels right and good in their bodies and sit still for hours at a desk, sit properly at the kitchen table, stand up straight and so on and so forth. Eventually you have lost all connection with your body, how it should move, wants to move and indeed thrives on moving and instead we take it to the office, sit for eight hours and then take it to a dimly lit soul destroying building on an industrial estate which we drove to, to then make it do depressing repetitive movements on various pieces of plastic shite whilst we plug ourselves into various media distractions to blank out the feeling of our life force draining away through the sides of our very expensive Nike Air Max trainers... Oops, sorry, did I just type that our loud?
This is my life's work. I spent my twenties and thirties being told that I over pronate. Pronation is the movement your foot goes through to absorb impact. It's completely natural. As yet, no one has been able to hand on heart say what constitutes 'too much'. Back when I didn't think about what I was being told, I completely bought into the hugely expensive orthotics I was sold that were going to control my over pronation when I was running. Well, when you think I am a natural forefoot strike runner, then those orthotics that wrapped around my heel and midfoot were controlling absolutely bugger all! Grrrr!!!!! I have a lot more to say about pronation but it will fill a book, so I'll keep weaving it in as we continue our journey together. Any specific questions about your feet, feel free to get in touch. I LOOOOOVE feet!
Not tapering training if you are doing a bigger run. I did a half marathon (16 years ago now! ) and was ill afterwards so more or less stopped running for a while. The result was a nasty case of plantar fasciitis.
Plantar fasciitis is another real favourite of mine. It's a very painful condition where it feels like you're walking on glass, particularly first thing in the morning or after you get up and walk after a rest. PF is a loading issue. It is the quintessential too much, too soon injury. One of my clients managed to develop it after signing up to a charity baking day and found herself stood for six hours on a stone floor in someone else's kitchen. It's common in beginner runners whose feet aren't used to the load, but ultimately it's not a tapering issue per se, other than you could argue that by not tapering you were doing more than your body could handle.
Lack of strength training
And last, but by no means least, my personal favourite. I spoke briefly about cross-training above and some people do view strength training as a form of cross-training. I disagree. I believe with all my significant movement experience that strength training IS PART OF your running training and if it isn't then you're doing your body a massive disservice. The stronger your muscles, joints, ligaments and various other tissues are, the more resilient your body will be as you pound the concrete or hit the trails.
Ultimately the reason why I named the group I Run Strong is because strength training is missing not just from runners' training but from women's training in general. And before you start shouting at the screen, BodyPump, the lat pull down/leg extension/pec deck workouts at the gym are NOT strength training :) I can feel another extensive blog post coming on.
So what do I think of the three researched reasons for injury? Well, we've already discussed training error above. High BMI, well, that makes sense if you're a beginner - your tissues have a lot more load to deal with if you're carrying too much chub. However, I would question that one from an experienced runner's perspective. It's like starting running and then starting to wear a weight vest or carrying a back pack because you'll need to for your event... your body adapts. But, yes, in the beginning phase if you're deconditioned and also overweight, then your tissues aren't going to thank you for bouncing up and down on concrete too much.
That brings us to the final researched injury cause - previous injury. I can definitely vouch for this one. When I make the training errors above I get similar injuries. Those injuries are very different to 10-20 years ago when I didn't move as well as I do now, when I didn't know what I do now. So if you've gone over on your ankle, pulled your achilles or calf, developed plantar fasciitis, then the chances are you're gonna feel it again if you're not careful. By careful I mean make sure you address the 'cause' of that initial injury so you can rehab it, strengthen it and make sure it doesn't repeat itself.
As always, I exist to save the world from running injuries, leaky bladders and movement misery, feel free to get in touch and pick my brains :)
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