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Welcome to part 2 of our 4 part series focusing on everything to do with running. Back in part 1, we looked at the history of running as well as the key differences between running and walking and the many health benefits of running. We also had a quick look at some of the drawbacks from the high impact nature of running. Part 2 will take a further look into the many types of injuries common to running and how you can best avoid them.

Running - An Injury Prone Exercise

Running, with all its benefits could almost be counted as an extreme sport with the amount of injuries that occur every year. It is estimated that 30-70% of all runners will suffer a running related stress injury each year. A mind blowing number when you consider the sheer amount of runners there are. While the injuries are usually not considered as serious as other sporting and exercise injuries, many of them are debilitating enough to warrant a week to a couple weeks rest. What is more surprising, is that this level of injury amongst runners has not seemed to decrease even with improvements in running technology and knowledge over the past 40 years. So is running just a sport inherently prone to injury or are we just not taking the advice?

Running - Common Injuries

Running in all its forms can result in a whole host of musculoskeletal injuries. In general, the most common type of injuries to runners are what are termed stress injuries, which occur as a result of constant and similar movement patterns (eg. running around the same track every day for the same amount of time). These movement patterns apply large amounts of stress to our bones, ligaments, muscles and other tissues. Other causes of common injuries include the high impact nature of running, poor running technique and poor strength of musculoskeletal tissue in the leg region. Following is a list of some of the most common injuries in running:

  • Patellofemoral pain – Pain in the knee region.
  • Iliotibial Band Syndrome – A special connective tissue injury in which the outer side of the leg hurts anywhere from the hip to the knee. This type of injury is exacerbated with foot striking on the floor.
  • Shin Splints – An injury affecting the lower part of the leg.
  • Pulled Muscles (strains) – Especially of the hamstring, groin and glutes.
  • Twisted Ankles – One of the most common running injuries.
  • Stress Fractures - Injury affecting the integrity of the bones.
  • Inflammation – Of the connective tissue including plantar fasciitis, patella tendonitis and archilles tendionpathy.

Running - Preventing Injuries

Prevention is better than cure. An age old saying, but definitely an accurate one. With running, taking the proper precautions can prevent many of the above injuries. Here is a list of the top 5 things you can do to help you run injury free.

1. Vary Environment

One of the main ways to prevent injuries is to vary your running environment. As stress fractures are caused by constant and similar foot strike movements, varying up the environment of running allows for a better and more appropriate distribution of stress, effectively reducing your risk of stress injuries. The best way to alternate your running environment include changing:

  • Running Routes
  • Running Distance
  • Running Speeds
  • Running Inclines
  • Running Surfaces

2. Overpronation

Everyone runs differently and there is no one universal correct way to run. However there are ways to run which can help prevent injuries from occurring. Many of the most common injuries are caused by foot strike issues with one of the major foot strike mistakes being overpronation. Overpronating your foot is when at contact with the ground, your foot rolls greater than 15 degress. That is, your inner ankle is pushed more inwards with the outer foot pointing more outwards. This results in more pressure on your big toe as you lift off again. Overpronation is often a cause of a substantial amount of injuries listed above.

If you are not sure if you are overpronating, the best way to check is to have someone look at you running from behind. If they see a lot of side to side movement of your foot placement, then most likely you are overpronating. You can also check by examining an old pair of runners. If there is less padding near the big toe and also at the heel of the shoe, you could be an overpronator. People with flat feet also tend to overpronate moreso than people with higher arches.

Overpronating is quite natural and changing your foot strike can be difficult for some to adjust, however will be useful in preventing future injuries. To correct for overpronation, a pair of motion control or stability shoes may be helpful. For more information on shoes, check out Part 3.

3. Heel Striking

Unlike elite runners, your average runner generally runs by landing on their heels, instead of their forefoot and midfoot. This poses a problem because whenever you land on your heels you are effectively applying on a brake to your movement. Not only is this detrimental to your performance, but it can also create an area where injuries occur.

Analysis has shown that heel striking can attract up to 5 times more pressure than if you land on your forefoot or midfoot. This essentially puts on a lot more force on all your joints and other body tissue. Furthermore, aside from musculoskeletal injuries, foot striking is also a notorious culprit in destroying your red blood cells. Landing on your heels in particular is much more destructive due to the greater impact forces. As with overpronation, heel strike is quite natural to most people and takes a substantial time to correct. Investing in a shoe with greater support or considering barefoot running every so often can help lower the risks of heel striking injuries. It has been shown that many runners switching from shod (shoe wearing) running to barefoot running generally return to midfoot striking patterns.

4. Listening & Pay Attention

Another main cause of running injuries is fatigue and not paying attention to your environment. As simple and obvious as this sounds, you need to listen to your body in terms of pain. While strenuous running often results in releases of both adrenalin and endorphins into your system, often masking pain, any sharp pain or injury which prevents you from running properly should mean an immediate cease in running.

When you are fatigued, such as in an endurance styled race, with repeated sprints or through dehydration; your running technique changes and generally not for the better. The more your form breaks down, the more at risk you are of injuring yourself. So if you are feeling exhausted, stop, start walking and have a drink before continuing. While finishing a race may be important, risking injury to do it is not the best choice.

You don’t drive blindly, so don’t run blindly. Always be aware of your environment, especially on off road running. Rocks and tree roots are common culprits and if you are on the road, watch for footpath edges and cracks, not to mention other runners. This may sound obvious, but so many runners seem to be blissfully caught in their own world during running.

5. Resistance Exercise

Running is rather like weights, there’s constant contraction and relaxation of your muscles. This is why after a long run or even an intense run, your muscles will feel sore due to the healing process of microdamages caused by these contractions. Regular resistance exercise will not only help by strengthening up your muscles, but also help your tendons, ligaments, bone and connective tissue get used to large forces to prevent impact force stress injuries.

Running - Treating Injuries

So now you know about how best to avoid injuuries. But what if you’ve done all you can and still get an injury? Well, you need to know how to treat it, so that you can get back into training as quickly as possible. While there are hundreds of remedies for all types of aches, strains and injuries, the most common ones include:

1. RICE – which stands for Rest, Ice, Compression, Elevation. While several variations exist, the original RICE treatment is the most well known and popular treatment for soft tissue injuries and sprains and strains. It was originally a first aid treatment invented to slow internal bleeding and to provide comfort to injuries. However, RICE treatment has exploded in the last few years as the number 1 recommended treatment for running injuries. However, while the principle is correct, many people are miseducated when applying RICE to their injuries. For example, it’s important to remove the compression prior to elevation. And when icing, it is best to ice with crushed ice for 10 minute bouts and avoid direct skin contact. An ice bath, while impractical for most is often used by coaches due to its ability to help with injuries without masking it. Ice baths can help by temporarily restricting blood to the painful areas. After getting out of the ice bath, there is a rush of blood throughout the body, which is helpful in providing nutrients and removal of metabolites to the injured muscle; an important factor promoting faster recovery.

2. Massage – A method employed by physical therapists as a way to prepare an athlete for competition and enhance athletic performance, massage is also used as a way to aid in injury rehabilitation. While the studies are equivocal and generally point to a lack of efficacy of massage in helping with injuries, massage is still one of the most commonly used injury treatment methods.

3. Movement – Moving around with a sprained ankle or a pulled muscle is counterintuitive, however, movement is crucial for the healing of an injury. Movement allows blood flow which helps with the healing process as mentioned previously. Movement should be non strenuous, non painful and restricted to short bursts. Depending on the injury, performing daily movement exercises in a swimming pool is an excellent option as the buoyancy helps to make it easier.

4. Medications – Many running injuries are associated with a level of inflammation which itself comes with pain. Taking some anti-inflammatories can help ease any pain and swelling, but never forget that they are not to be taken to mask the pain so that you can get back into training. By doing this, you are doing more harm than good.

5. Specialist – If the injury is particularly bad, persists or you are unsure of where the pain is coming from or where the injury is, it is best to consult with a trained professional such as a physiotherapist; who are trained to find out the root cause of injuries and the best way to get you rehabilitated.

The Immune System and Running

While most people consider musculoskeletal injuries as the main type of injuries associated with running training, many people forget that the immune system is also often affected by intense or chronic training. Whenever we train quite intensely or over long periods of time, our immune system can actually become suppressed making us more susceptible to infections, which can put you off training for a substantial amount of time. Part 4 of this series will look at nutrition and supplementation to boost your immunity to prevent this exercise induced immunosuppression.

Running & Injuries

Running will always be an injury prone exercise. Because of its simplicity and everyday nature, many people avoid reading up or learning about running before diving straight into training. However, knowing some essentials about running and prevention and treatment of running related injuries, you can dramatically improve your training whilst avoiding the risk of injuries. Simple things such as investing in good footwear, changing your running environments and practising your running technique will keep you running at 100% so that you can make the most out of your training. Stay tuned for Part 3 which will look at some of the training methods you can employ to have your running faster and more economically.

1. Hespanhol Junior LC, Costa LO, Carvalho AC, Lopes AD. ‘A description of training characteristics and its association with previous musculoskeletal injuries in recreational runners: a cross-sectional study.’ Rev Bras Fisioter. 2012 Feb;16(1):46-53.
2. Yeung SS, Yeung EW, Gillespie LD. ‘Interventions for preventing lower limb soft-tissue running injuries.’ Cochrane Database Syst Rev. 2011 Jul 6;(7):CD001256.
3. Proske U, Morgan DL, Brockett CL, Percival P. ‘Identifying athletes at risk of hamstring strains and how to protect them.’ Clin Exp Pharmacol Physiol. 2004 Aug;31(8):546-50.
4. Herbert, R. D.; Gabriel, M. (2002). "Effects of stretching before and after exercising on muscle soreness and risk of injury: Systematic review". BMJ (Clinical research ed.) 325 (7362): 468. doi:10.1136/bmj.325.7362.468. PMC 119442. PMID 12202327.
5. Herbert RD, de Noronha M, Kamper SJ. ‘Stretching to prevent or reduce muscle soreness after exercise.’ Cochrane Database Syst Rev. 2011 Jul 6;(7):CD004577.
6. Fields KB, Sykes JC, Walker KM, Jackson JC. ‘Prevention of running injuries.’ Curr Sports Med Rep. 2010 May-Jun;9(3):176-82.
7. Walsh NP, Gleeson M, Shephard RJ, Gleeson M, Woods JA, Bishop NC, Fleshner M, Green C, Pedersen BK, Hoffman-Goetz L, Rogers CJ, Northoff H, Abbasi A, Simon P. ‘Position statement. Part one: Immune function and exercise.’ Exerc Immunol Rev. 2011;17:6-63.
8. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. ‘Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.’ Br J Sports Med. 2007 Aug;41(8):469-80; discussion 480. Epub 2007 May 1.
9. Bleakley CM, Glasgow P, MacAuley DC. ‘PRICE needs updating, should we call the POLICE?’ Br J Sports Med. 2012 Mar;46(4):220-1. Epub 2011 Sep 7.
10. Telford RD, Sly GJ, Hahn AG, Cunningham RB, Bryant C, Smith JA. ‘Footstrike is the major cause of hemolysis during running.’ J Appl Physiol. 2003 Jan;94(1):38-42. Epub 2002 Aug 9.
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