Prevention of Running Injuries
There are quite of number of common causes of injury but even when the individual’s problem is understood it can be challenging to correct. Prevention is definitely preferable.
Important factors are:
1. Previous Injury
2. Muscle imbalances, weakness / fatigability and shortness
3. Poor technique or form
4. Overtraining
5. Poor stability and coordination
6. Poor equipment
7. Congenital factors such as hypermobility and skeletal orientation
The first in the list are, in my opinion the most common and important for most runners. Programs for prevention and rehabilitation must identify and correct these problems.
Corrective exercises should be challenging but able to be performed correctly. I frequently choose from the multitude of corrective exercises available for a movement problem by testing and having the runner perform them. If they can't perform it at all with proper form, it is too advanced and requires something more stable better feedback, flexibility or less force to work up to the initial exercise. If they are challenged but can perform 3 to 10 reps it is probably useful. If over 12 to 15 quality reps are easy, I add force or speed, change posture, challenge stability or look for a different exercise. A few may remain useful for ongoing issues and can be incorporated into your warm up or cool down.
In the end, all this has to be translated into good, safe performance. Even plyometrics / NMR and agility training only partially transfer to actual performance so gradually increasing work with a coach is best.
Previous Injury: The reason that a history of previous injury is first in the list is because it has the strongest correlation with future injury; so strong that I bolded it.
The reasons for the strong correlation appear to be that the cause may not have been corrected and that the injury may not have been fully rehabilitated. If you are, like me, dumb enough to cycle in heavy Houston down town rush hour traffic and be hit, you may well be dumb enough to be hit three more times in nine months. The first injury was highly predictive of those that followed. (I eventually gave in and purchased a car.) You may also be structurally compromised or not have corrected your technique errors. You may also have become out of shape and training too advanced during recovery.
Once tissue is injured, the healed tissue is rarely identical to the original. It may have scar tissue connecting torn tissue and be stretched, shortened or stiffened. The innervation may be damaged and decreased with altered input and therefore altered output coordinating the muscles.
Muscle Imbalance: If you did not fully rehab your movement patterns, stability, endurance, strength, speed of contraction and technique or if your therapist just missed something, you are at risk. Occasionally, people are simply too badly injured to recover well enough perform as before.
When your form fails it is time to end the training session. After this point you will only train poor form, risk injury and weaken the quality of your next training session. When a muscle is weak or tired, your body substitutes others and does things differently in order to keep going. This changes your gait which stresses the joints, ligaments, tendons and muscles resulting in the repetitive stress injury and pain. It can result in more catastrophic injury such as ACL tears, sprained ankles or falls when function is compromised.
An important cause of imbalance is when an athlete trains too frequently to the end of their endurance. At that point they are substituting alternative muscles for the proper movers. This also occurs when an athlete is beginning a new sport or going from sprint to endurance racing. Also if they are training up too rapidly without consolidating their technique.
Muscle imbalances often occur due to overstretching a joint. This is especially important with regard to short deep muscles which are the main controlling and stabilizing muscles. They may actually be strong in the stretched position but not in their shortened position where they perform to coordinate joint position. When this occurs, many of the larger / longer muscles crossing the joint may then be used to stabilize and become over-stressed, tightened and shortened, further complicating matters.
On the other hand, when a muscle is not stretched back to its normal operating length after being heavily exercised it can become shortened. If a muscle becomes chronically shortened the opposing muscles become inhibited and weakened. An example would be your hamstrings and hip flexors which will shorten if you run and then work at a sedentary job which places them in their shortened position. These then inhibit their opposite muscles, your gluteus maximus and quadriceps. In addition, this forces you into compensatory low back extension which tightens the extensors and weakens their opposing abdominal muscles.
Similar muscle imbalances can also occur when an injury causes chronic protective tension. Reoccurring muscle tightness may be due to residual muscle splinting. When you are injured, your long superficial muscles spasm to stiffen and protect the joint and this pattern may continue after you recover.
This is another reason that proper rehabilitation after an injury is so important.
One of the best tests is to observe the runner before and after fatigue, noticing the changes and test for muscle weakness and tightness that could cause these changes. The simplest test is often to have the runner perform simple movements and look for loss of form, weakness or restricted movement. Examples of these tests are overhead squats, single leg squats, single leg dead lifts, lateral hops and single ankle toe ups (Don't let them sprain their fatigued ankles during hop testing.) Notice any instability, knees drifting inward, ankle pronation, mid foot collapse etc. If you can't stand still on one leg with your eyes closed, how can your leg be solid at foot strike during running without starring at the ground, especially if it is uneven.
Poor technique can be difficult for the average runner to identify and correct. It helps to run with, and observe experienced runners and trainers but you have to remember to ask for help and work on the corrections. There are also clinics that are set up for more elaborate evaluation and correction but it has a price tag. Learning a bit and having a friend video you with a regular camera that can be slowed and carefully viewed can be quite illuminating (sometimes better than information from treadmill running that is used for accurate capture. Treadmills are not roads and you are not really moving.)
Increasing your running speed moves your center of gravity forward over your contacting foot which often decreases a variety of problems. Running faster usually trains improved form so interval strides or sprints have their place.
Don't try to change too many things at once. It is hard enough to focus on one thing at a time and if a change causes trouble you want to know which one did it. Try counting backward from 100 by 7s and see if you can keep running as fast. That should demonstrate how concentrating hard on anything else slows your running speed.
Over-training can also be difficult to identify. You want to extend yourself to a point where your body has to compensate by strengthening during the recovery period. If you fail to rest sufficiently, you begin to progressively break down instead weakening and developing repetitive stress injuries. On the other hand if you rest too much or fail to provide enough stress, you fail to progress as fast as you could. You will not be able to tell what is helping or hurting if you change too much at once. How can you identify and manage the balance? You have to pay attention, have a good plan and be sensitive to changing needs.
The Sports Backers training has built in an undulating progression that pushes you and then backs down for recovery weeks. The problem is that we are not all the same and some like me at 72 require more recovery. The only way I know is to try the program and if you are losing sleep due to pain, not as alert /clear thinking or catching more colds; provide more recovery. Shorten your distance and increase more gradually or train less intensely on hills or speed / intervals, substitute a day of cycling or swimming for running. Almost always get more sleep. Athletes need 8 to 11 hours of sleep. I do well if I get 8/night and nap. I try to nap for the same duration that I ran whenever my run exceeds an hour.
It takes experience to learn what your body responds best to and in the beginning you need to rely on the advice of others. Just don't do anything so foolish that you break yourself permanently in the learning process and you will be fine.
Some training technology allows you to measure heart rate variability, which may prove helpful but I think it is best to be aware of your responses to all your life demands as well as the running..
Cross-Training is too broad a term. Are you performing alternative aerobic activities like cycling, to rest running tissue? Are you performing weights, 3-4 sets of 10 rep max, to increase or maintain muscle mass? Are you training for power for toughness? We need to be more specific about what systems we're training, so we can look effectively track results.
Running burns muscle mass along with glycogen and fat. You need to maintain your strength through cross training. If you belong to a gym and your technique is good, one or two circuit training sessions per week can work wonders if you simply add on a few pull-ups and increase the weight to a level that you can only perform less than 12 reps. Be certain you have good form with each exercise and stop when your form goes. Careful not to become too sore to run well. If you are running sore after lifting, try to ease into it with a slower, longer warm up. During the winter, I prefer to run less frequently and perform more sessions of hypertrophy training to replace muscle and strengthen tendons and ligaments.
Equipment: The shoe debate continues. I have noticed a number of people injured due to improper shoe types. If you develop aches and pains with new shoes try going back to your old ones. If the problem improves bring both pairs to road runners, Fleet Feet or one of the Trisports stores for recommendations. Sports docs may also have input on this, matching any idiosyncrasies to your shoe requirement. Unfortunately, the same model may be totally different next year even though the name remains the same. It would be nice if you could buy a bunch once you find your favorites but the foam ages just sitting on the shelf. This goes for old models purchased online as well.
Minimalist shoes are not the same as running barefoot and may not accomplish what they intend but they do protect your feet from rocks and glass. There is usually increased impact. They may help train away from heel striking but often do not. If you are heel striking, first simply try to increase your running speed, training with strides. Increasing speed places your body forward and off the heel.
If you are relatively new to running get advice on lacing and fitting as well as selecting a shoe that matches your physical structure and mileage. Be cautious about trying to correct everything from the bottom up with heavy duty stability models. You may find that you simply move the compensation elsewhere. Try to identify the fundamental causes and fix them. Usually feet are just part of the problem and may not be the origin. Stress from poor hip control will then produce knee stress if denied foot / ankle compensation.
Look at any callouses and such as signs not only of poor fit but of poor stability, flexibility or technique. For instance, if your calves are too tight or you stretch them with your foot not straight ahead it may force you to externally rotate your foot which will create callouses on the bottom. It can also force your foot to bend in the midfoot instead of the ankle.
Congenital or developmental factors are just for you and they can be good or bad but usually are a bit of both. We are all different but certain variables are known to create extra stresses.
One of the problems I frequently notice is hypermobility syndrome or sometimes just more mobility along the normal continuum than is good for distance running. To deal with the repetitive stress of distance running you need to have collagen that is strong enough. If not, it will break down or inappropriately transfer forces causing pain and degeneration. Collagen also has to be able to store and return energy like a spring. If it is not stiff enough you will have to push yourself along with excessive muscle contraction which is inefficient and bound to go wrong at some point. You also have less neurological input regarding joint position and ground response which creates more sway and stress.
A fair number of patients show up with joint angles that are simply not aligned well enough for the repetitive stresses. Their hips / femurs may be torsioned internal or external to where they have to be at the end of their range just to aim the knees straight. Angles producing bowed or knock-knees can greatly increase stresses. Femoral acetabular impingement (FAI) occasionally causes problems but since we don't run in a squat, the problem is generally due to squatting at home or possibly cycling. High arches and foot anomalies can often be dealt with with selecting appropriate distances, shoes and training.
Many of these people can continue running with some corrective exercises and/or shorter distances, 5K as opposed to Marathons for example.
Important factors are:
1. Previous Injury
2. Muscle imbalances, weakness / fatigability and shortness
3. Poor technique or form
4. Overtraining
5. Poor stability and coordination
6. Poor equipment
7. Congenital factors such as hypermobility and skeletal orientation
The first in the list are, in my opinion the most common and important for most runners. Programs for prevention and rehabilitation must identify and correct these problems.
Corrective exercises should be challenging but able to be performed correctly. I frequently choose from the multitude of corrective exercises available for a movement problem by testing and having the runner perform them. If they can't perform it at all with proper form, it is too advanced and requires something more stable better feedback, flexibility or less force to work up to the initial exercise. If they are challenged but can perform 3 to 10 reps it is probably useful. If over 12 to 15 quality reps are easy, I add force or speed, change posture, challenge stability or look for a different exercise. A few may remain useful for ongoing issues and can be incorporated into your warm up or cool down.
In the end, all this has to be translated into good, safe performance. Even plyometrics / NMR and agility training only partially transfer to actual performance so gradually increasing work with a coach is best.
Previous Injury: The reason that a history of previous injury is first in the list is because it has the strongest correlation with future injury; so strong that I bolded it.
The reasons for the strong correlation appear to be that the cause may not have been corrected and that the injury may not have been fully rehabilitated. If you are, like me, dumb enough to cycle in heavy Houston down town rush hour traffic and be hit, you may well be dumb enough to be hit three more times in nine months. The first injury was highly predictive of those that followed. (I eventually gave in and purchased a car.) You may also be structurally compromised or not have corrected your technique errors. You may also have become out of shape and training too advanced during recovery.
Once tissue is injured, the healed tissue is rarely identical to the original. It may have scar tissue connecting torn tissue and be stretched, shortened or stiffened. The innervation may be damaged and decreased with altered input and therefore altered output coordinating the muscles.
Muscle Imbalance: If you did not fully rehab your movement patterns, stability, endurance, strength, speed of contraction and technique or if your therapist just missed something, you are at risk. Occasionally, people are simply too badly injured to recover well enough perform as before.
When your form fails it is time to end the training session. After this point you will only train poor form, risk injury and weaken the quality of your next training session. When a muscle is weak or tired, your body substitutes others and does things differently in order to keep going. This changes your gait which stresses the joints, ligaments, tendons and muscles resulting in the repetitive stress injury and pain. It can result in more catastrophic injury such as ACL tears, sprained ankles or falls when function is compromised.
An important cause of imbalance is when an athlete trains too frequently to the end of their endurance. At that point they are substituting alternative muscles for the proper movers. This also occurs when an athlete is beginning a new sport or going from sprint to endurance racing. Also if they are training up too rapidly without consolidating their technique.
Muscle imbalances often occur due to overstretching a joint. This is especially important with regard to short deep muscles which are the main controlling and stabilizing muscles. They may actually be strong in the stretched position but not in their shortened position where they perform to coordinate joint position. When this occurs, many of the larger / longer muscles crossing the joint may then be used to stabilize and become over-stressed, tightened and shortened, further complicating matters.
On the other hand, when a muscle is not stretched back to its normal operating length after being heavily exercised it can become shortened. If a muscle becomes chronically shortened the opposing muscles become inhibited and weakened. An example would be your hamstrings and hip flexors which will shorten if you run and then work at a sedentary job which places them in their shortened position. These then inhibit their opposite muscles, your gluteus maximus and quadriceps. In addition, this forces you into compensatory low back extension which tightens the extensors and weakens their opposing abdominal muscles.
Similar muscle imbalances can also occur when an injury causes chronic protective tension. Reoccurring muscle tightness may be due to residual muscle splinting. When you are injured, your long superficial muscles spasm to stiffen and protect the joint and this pattern may continue after you recover.
This is another reason that proper rehabilitation after an injury is so important.
One of the best tests is to observe the runner before and after fatigue, noticing the changes and test for muscle weakness and tightness that could cause these changes. The simplest test is often to have the runner perform simple movements and look for loss of form, weakness or restricted movement. Examples of these tests are overhead squats, single leg squats, single leg dead lifts, lateral hops and single ankle toe ups (Don't let them sprain their fatigued ankles during hop testing.) Notice any instability, knees drifting inward, ankle pronation, mid foot collapse etc. If you can't stand still on one leg with your eyes closed, how can your leg be solid at foot strike during running without starring at the ground, especially if it is uneven.
Poor technique can be difficult for the average runner to identify and correct. It helps to run with, and observe experienced runners and trainers but you have to remember to ask for help and work on the corrections. There are also clinics that are set up for more elaborate evaluation and correction but it has a price tag. Learning a bit and having a friend video you with a regular camera that can be slowed and carefully viewed can be quite illuminating (sometimes better than information from treadmill running that is used for accurate capture. Treadmills are not roads and you are not really moving.)
Increasing your running speed moves your center of gravity forward over your contacting foot which often decreases a variety of problems. Running faster usually trains improved form so interval strides or sprints have their place.
Don't try to change too many things at once. It is hard enough to focus on one thing at a time and if a change causes trouble you want to know which one did it. Try counting backward from 100 by 7s and see if you can keep running as fast. That should demonstrate how concentrating hard on anything else slows your running speed.
Over-training can also be difficult to identify. You want to extend yourself to a point where your body has to compensate by strengthening during the recovery period. If you fail to rest sufficiently, you begin to progressively break down instead weakening and developing repetitive stress injuries. On the other hand if you rest too much or fail to provide enough stress, you fail to progress as fast as you could. You will not be able to tell what is helping or hurting if you change too much at once. How can you identify and manage the balance? You have to pay attention, have a good plan and be sensitive to changing needs.
The Sports Backers training has built in an undulating progression that pushes you and then backs down for recovery weeks. The problem is that we are not all the same and some like me at 72 require more recovery. The only way I know is to try the program and if you are losing sleep due to pain, not as alert /clear thinking or catching more colds; provide more recovery. Shorten your distance and increase more gradually or train less intensely on hills or speed / intervals, substitute a day of cycling or swimming for running. Almost always get more sleep. Athletes need 8 to 11 hours of sleep. I do well if I get 8/night and nap. I try to nap for the same duration that I ran whenever my run exceeds an hour.
It takes experience to learn what your body responds best to and in the beginning you need to rely on the advice of others. Just don't do anything so foolish that you break yourself permanently in the learning process and you will be fine.
Some training technology allows you to measure heart rate variability, which may prove helpful but I think it is best to be aware of your responses to all your life demands as well as the running..
Cross-Training is too broad a term. Are you performing alternative aerobic activities like cycling, to rest running tissue? Are you performing weights, 3-4 sets of 10 rep max, to increase or maintain muscle mass? Are you training for power for toughness? We need to be more specific about what systems we're training, so we can look effectively track results.
Running burns muscle mass along with glycogen and fat. You need to maintain your strength through cross training. If you belong to a gym and your technique is good, one or two circuit training sessions per week can work wonders if you simply add on a few pull-ups and increase the weight to a level that you can only perform less than 12 reps. Be certain you have good form with each exercise and stop when your form goes. Careful not to become too sore to run well. If you are running sore after lifting, try to ease into it with a slower, longer warm up. During the winter, I prefer to run less frequently and perform more sessions of hypertrophy training to replace muscle and strengthen tendons and ligaments.
Equipment: The shoe debate continues. I have noticed a number of people injured due to improper shoe types. If you develop aches and pains with new shoes try going back to your old ones. If the problem improves bring both pairs to road runners, Fleet Feet or one of the Trisports stores for recommendations. Sports docs may also have input on this, matching any idiosyncrasies to your shoe requirement. Unfortunately, the same model may be totally different next year even though the name remains the same. It would be nice if you could buy a bunch once you find your favorites but the foam ages just sitting on the shelf. This goes for old models purchased online as well.
Minimalist shoes are not the same as running barefoot and may not accomplish what they intend but they do protect your feet from rocks and glass. There is usually increased impact. They may help train away from heel striking but often do not. If you are heel striking, first simply try to increase your running speed, training with strides. Increasing speed places your body forward and off the heel.
If you are relatively new to running get advice on lacing and fitting as well as selecting a shoe that matches your physical structure and mileage. Be cautious about trying to correct everything from the bottom up with heavy duty stability models. You may find that you simply move the compensation elsewhere. Try to identify the fundamental causes and fix them. Usually feet are just part of the problem and may not be the origin. Stress from poor hip control will then produce knee stress if denied foot / ankle compensation.
Look at any callouses and such as signs not only of poor fit but of poor stability, flexibility or technique. For instance, if your calves are too tight or you stretch them with your foot not straight ahead it may force you to externally rotate your foot which will create callouses on the bottom. It can also force your foot to bend in the midfoot instead of the ankle.
Congenital or developmental factors are just for you and they can be good or bad but usually are a bit of both. We are all different but certain variables are known to create extra stresses.
One of the problems I frequently notice is hypermobility syndrome or sometimes just more mobility along the normal continuum than is good for distance running. To deal with the repetitive stress of distance running you need to have collagen that is strong enough. If not, it will break down or inappropriately transfer forces causing pain and degeneration. Collagen also has to be able to store and return energy like a spring. If it is not stiff enough you will have to push yourself along with excessive muscle contraction which is inefficient and bound to go wrong at some point. You also have less neurological input regarding joint position and ground response which creates more sway and stress.
A fair number of patients show up with joint angles that are simply not aligned well enough for the repetitive stresses. Their hips / femurs may be torsioned internal or external to where they have to be at the end of their range just to aim the knees straight. Angles producing bowed or knock-knees can greatly increase stresses. Femoral acetabular impingement (FAI) occasionally causes problems but since we don't run in a squat, the problem is generally due to squatting at home or possibly cycling. High arches and foot anomalies can often be dealt with with selecting appropriate distances, shoes and training.
Many of these people can continue running with some corrective exercises and/or shorter distances, 5K as opposed to Marathons for example.