Updated: Nov 9, 2020
Running is one of the oldest sports in the world with ever-growing popularity today. Who doesn’t love the freedom and ease of running? All you need is a pair of shoes and socks and you’re good to go!
Travel a lot? It’s a great way to get exercise, see an area, and pack light!
Tight on time? Great workout and easy to squeeze in!
Overall, the benefits you get from running are boundless. Studies show running can lead to 25-40% reduced risk of premature death, and on average runners live up to 3 years longer. (1)
That's amazing and worth pushing yourself for, right?!
But if it's so great, then why do so many people get injured running?
A recent study reported 9 out of 10 runners experience a running-related injury or illness during 1/2 or full marathon training cycles (2)
Does that mean running is bad for you? Not at all. But like all things, it carries risk and potential for error.
A vast majority of these issues are overuse/stress injuries that come from increased load without adequate time for the body to adapt.
Running injuries can be influenced by so many different factors including biomechanics, how much you’re training, how hard, how often, athletic background, cross-training, genetics, stress, diet and nutrition, and hydration.
That list is not exhaustive either. There’s really a lot going on.
SO, THE MILLION-DOLLAR QUESTION: HOW CAN WE 100% PREVENT INJURY?
The answer is that I am not sure we can. But we can REDUCE risk.
We reduce injury risk by understanding how the system works together, addressing weaknesses, and having a well-balanced training load and cycle.
Understanding the System
The human body is built for running and totally capable of handling the stress put on the system.
So let’s talk about a few key structures that make us so strong:
Our Skeletal System
1. Bones are our deepest framework. The bones themselves play an important role in the attenuation of shock as well as serve as attachment points for our various tendons.
Bone is constantly reforming and breaking down. Bone metabolism is a key consideration in managing the running athlete, particularly with bone stress injuries. This balance between bone breakdown and restoration is maintained by numerous factors including age, hormones, other health conditions, sleep, and nutrition as well as physical activity. Participation in sports in childhood can also be a key factor in bone strength and size in adults (3)
2. Tendons serve as the connection point between our muscles and the bone.
We have grown to understand that tendons play an active role in running. They allow for energy storage and release - essentially behaving like a spring under impact. This helps to give us power and explosion which is key in athletics and is crucial for agility and performance.
Tendons, like bones, are also common areas of overstress injury.
***Sidebar- NO, it's not because you didn’t STRETCH enough. Stretching doesn't necessarily aid in tendon rehabilitation and in some cases can actually be more irritating than it is helpful.
3. Our muscles are the workhorses that generate the force needed to propel and control our landing.
Muscle groups behave differently depending on where we are in the running cycle as well as how fast we are running. (4) Weakness in key muscle groups such as the calf complex not only potentially increases the risk for injury but also plays a large role in performance. Understanding muscle performance can help us tailor training focus to help build tissue capacity within the muscles.
The Contribution of the Brain and Heart
In endurance sports, the musculoskeletal system is ultimately subject to what’s happening with the brain and heart. Theories dating from the late 19th century cited neurological control as a primary cause of fatigue. These early theories postulated that fatigue was produced within the brain as protection from potential harm with maximal exercise.
Over the following decades, thoughts shifted to a more cardiac biased theory, stating that demand from peripheral muscles exceeded the heart's ability to supply blood. A simplistic mechanical theory doesn’t seem to account for emotional components that clearly seem to affect performance such as motivations and competitive drive. Neurological theories have made a modern resurgence citing that fatigue is an emotional response that is multifactorial.(5)
There seems to be merit here in that most athletes are familiar with changes in performance with stress, poor sleep, competition, incentive, etc. Either way, we can’t oversimplify the musculoskeletal system as the only factor in an injury. We must also consider how the brain is interpreting and responding to the stress of exertion if we want to mitigate injury and maximize performance. This is a commonly overlooked step within training plans that can often lead to training error and injury.
Balancing the load
Training capacity is a crucial concept for all athletes from recreational to elite. In order to improve performance, we have to slightly exceed our capacity in a slow and systematic way so that the body adapts, getting stronger and more capable. If we exceed capacity too much, injury often follows. If we don’t challenge capacity enough, performance can suffer and we are ill-prepared for sport.
There’s really no one specific running plan that works for everyone. There are so many variables that makeup one’s capacity for running. Capacity is multifactorial considering athletic long term training ability and fitness level as well as countless other variables that could make an athlete more or less tolerant of training load.
10% of training changes have long been suggested as the ideal “golden training rule”. Research shows that it's more of a “guideline” than a “rule” as some people may be able to tolerate greater loads, particularly for individuals with greater fitness levels or a long history of consistent training volume.
Avoiding sharp spikes in training as well as a rapid decline in training volume can be key. Most people are familiar with increasing too quickly, but a rapid decline in training can also affect the risk of injury. Doing too much or too little too quickly can lead to an increased risk of injury. (6)
So, is it worth it?
Yes, there's a chance, if not a likelihood, you may incur some injury. However, the gains you get from running are vast, and injuries heal, especially when treated by those who understand the demands of this sport.
Ultimately, the greatest takeaway should be this: Running is great for you.
There are so many resources you can utilize to make yourself a stronger and more resilient runner.
Just because you may have struggled with pain or injury from running in the past, that doesn't mean that you shouldn't be a runner!
Most injuries are very treatable, and working with a specialist who can diagnose what went wrong and exactly what to do to correct it can get you back to hitting the pavement with renewed strength and vigor.
If you have struggled with injury, please know it's not the end of the road.
Are you worried that pain is going to end your love of running?
Are you frustrated with being slowed down by nagging injuries that never seem to fully heal?
Do you wish you had a PLAN that an expert could walk you through to get back to pain-free running?
Treating injury and helping runners navigate how to stay active for a lifetime is what we specialize in, and if you're nervous about having to quit running because of an injury, we can help. Our bodies are built to run, and we can help you keep running for a lifetime.
If you're ready to take the next step in making sure that you're doing the right things to keep you running pain-free, click here to get access to our FREE Pain-Free Running Guide where we share our Top 5 Tips to reduce your risk for running injuries.
Sara Michael, PT, DPT
1. Running as a Key Lifestyle Medicine for Longevity https://www.sciencedirect.com/science/article/abs/pii/S0033062017300488 2. Running themselves into the ground https://www.jospt.org/doi/abs/10.2519/jospt.2019.8473 3. Previous Sport Activity During Childhood and Adolescence Is Associated With Increased Cortical Bone Size in Young Adult Men https://www.ncbi.nlm.nih.gov/pubmed/18767931 4. Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance https://www.ncbi.nlm.nih.gov/pubmed/22573774 5. Fatigue is a brain-derived emotion that regulates the exercise behavior to ensure the protection of whole-body homeostasis https://www.google.com/search?q=Fatigue+is+a+brain+derived+emotion+that+regulates+the+exercise+behavior+to+ensure+the+protection+of+whole+body+homeostasis&ie=UTF-8&oe=UTF 8&hl=en-us&client=safari 6. Debunking the myths about training load, injury and performance: Empirical evidence, hot topics and recommendations for practitioners https://bjsm.bmj.com/content/54/1/58