Running injury - common mistakes made and tips to help avoid them.

Running injury - as I see it and live it

Prevention ; ‘the act of stopping something from happening or arising’

You cannot prevent injuries from happening. In any sport, if you are training regularly (or more to the point irregularly), you run the risk of injury. However, what you can do is train a bit smarter (not harder) and reduce the risk of injury as you get stronger and faster. Actual figures of injury risk in runners are shady at best but it’s certainly high enough to have a blog post on the issue.

When I see people in my sports injury clinic with running injuries, I like to ask some questions first and try to get the backstory(aka - doing my job). Most people will be very quick to blame their new running shoes (which can be a factor, more on this later) but more often than not the problem lies in the training, or even before that!!

Let’s run through a few scenarios.

Example conversation A:

Me: Can you give me a bit of your running history just so I know where you are at right now?

CLIENT Y: Well, I did a lot of running when I was younger. I haven’t run a lot in the past few years but I took it up again recently and ran a lot the last three months including a half marathon. Now I have desperate pains in my knees.

Example conversation B:

ME: Can you give me a bit of your running history just so I know where you are at right now?

CLIENT Y: So I would usually run about 2-3 times a week, short distances mostly about 5k, but I signed up for a marathon and started adding in some longer runs. My right hip is very sore for the last week or so.

ME: How many runs per week now and how long are we talking about for these runs?

CLIENT Y: Probably 4-5 runs and I am trying to hit 40k every week now

Example conversation C:

ME: Can you give me a bit of your running history just so I know where you are at right now?

CLIENT Z: I have been running for years, fairly consistently, maybe on and off a bit but still quite regularly. I am training for an adventure race though so in the last two months I have added in some hill work and now my calves and heels are really sore.

ME: How much hill work?

CLIENT Z: Probably twice a week.

ME: Would the intensity be quite high running the hills? Would you say you are breathing hard going up the hills?

CLIENT Z: Of course.

Obviously these are not exact conversations that have happened in my clinic but these are the stories you hear from people suffering with running injuries. Each conversation represents the most prevalent cause of running injury. TRAINING ERROR.

Training error is thought to be responsible for up to 70% of running injuries (Nielsen et al 2012). Increases in volume, frequency and intensity being the major mistakes most people make.

Like CLIENT A, going from zero to hero with their running volume. CLIENT B increased both volume and frequency together which brough total weekly volume up by over 100% on the previous week. CLIENT C increasing the intensity of the sessions with harder terrain was without doubt going to cause some strain, even for an experienced runner.

Typical training errors;

Running too hard too often. Without getting into the science too much, runners need to know that the vast majority of your running should be EASY. Basically the recovery time needed for easy runs is much quicker. We can get more running done this way and continue to build the aerobic system (which is the point). Some runs of course should be harder, but much less than people think or practice in training.
Increases in training volume far beyond the capacity of the runner's ability. Just because you ran 50k a week last year, doesn’t mean you should jump right back into that volume when you decide to get back to training. The 10% rule is a useful guide, but not applicable to every situation.
Lack of a training plan. This used to be my biggest problem. Run for 4 days in a row, take 3 days off for no reason, back for 1 run, 2 more days off, 5 runs in a row with 2 of them as long runs. Madness. Even if you are a weekend warrior (the bulk of your training is done at the weekend) you need some structure to the weeks and months or you run a high risk of injury.

What might be even more glaring as a non factor for most runners is the lack of a strength program. Even the more experienced runners will opt for extra runs rather than spend some time strengthening the legs. There is fairly overwhelming evidence at this stage to support strength training as a function to reduce injury in sport. Running is no different. You can reduce overuse injury caused by running by up to 50% with a strength program to go alongside your running program (or triathlon program). That’s before we even consider how strength work will help with your running economy (how efficient you are basically), hormone levels, range of motion, recovery, balance and coordination.

I don’t want to get overly technical writing about research papers and statistics of different running injuries. However, I think it is worth examining the risk factors beyond training error and lack of a strength program that might make some sense of it all.

Previous injury. Unfortunately, if you have previous injuries you are far more likely to suffer more injuries. That is a hard pill to swallow for anyone like myself who suffered a few injuries in their youth. It’s not so likely that it definitely will happen, but if you fall subject to some of the training errors outlined above then it’s quite likely.
Changes in footwear. This is definitely NOT as dramatic as it’s made out to be(or as shoe companies make it out to be). Typically it’s only if you change from a shoe with lots of support to something with very little support that you would be subject to injury from new shoes. If you have issues with your feet however, the change in footwear is much more likely to cause injury. Some people are very adaptable between different shoes and make a point of doing so to stay that way. These are usually the same people that do their strength work regularly and don’t take the piss with changes in their run programs.
Advancing age. Yeah, that’s just life I suppose. Although, if you stay strong and change your program relative to your current fitness levels you will continue to reduce the risk of injury. It’s not a guarantee you will get injured just because you are getting older. The flip side is that if you continue to train throughout your life you are likely to get injured and then you are exposed to point number 1, previous injury. Can’t win ‘em all.
Psychosocial factors. ‘ Those who reported worse mental-health related quality of life and more negative affective states, such as being jittery, irritable, and nervous, were more likely to sustain overuse running injuries’ Messier et al. (2018) . Now you could write an entire book on that point alone so I won’t elaborate too much on this blog but I did feel it was an interesting enough risk factor to note. The body doesn’t decipher too well between internal stress and external stress. So if we are stressed and further stress ourselves through training….. That’s a lot of stress. Some stress is good, too much is bad, like anything.

There are a lot of common misconceptions about running injury. Like having poor posture or some form of alignment issue with your hips. There is very little evidence to support this. If it were true, then everyone would be getting injured all the time. Nobody, including top end athletes, has ‘perfect posture’ and alignment. Usain Bolt has scoliosis (his spine has a magnificent bend where it is normally straight) but it certainly didn’t keep him on the injury list for the Olympics. Of course there are going to be issues with posture and alignment for some athletes in some situations but I feel they take the spotlight in advertising and social media.

At this point I would like to note that while I have referenced a few articles, (most taken from the wonderful Running Repairs course by Tom Goom - The Running Physio) there is a lack of high quality evidence when it comes to running injuries. There are gaps in the evidence and the evidence is forever changing, (thankfully) so things we thought were gospel 10 years ago are no longer practised as I am sure will be the same in 10 years time. Sometimes you can tick all the boxes, do everything ‘by the book’ and still get injured. Lot’s of grey areas when it comes to injury. Hopefully this can shed some light on some of the main causes of injury for the running community.

Take home points. Use a training plan or get a coach to provide you with one. Do your strength training. Enjoy the process, it’s supposed to be enjoyable. Train smart, stay FITFORLONG.