reducING running injuries
By far the most common running injuries seen in clinic are that of the overuse injury. They account for approx 80% of running related injuries. On this page I’ll be focusing on how you can reduce overuse injuries.
Overuse injuries are mostly caused by:
Load (Changing too much too soon) – Increasing mileage, speed work, hills, time you run for surface you run all can cause issues if you increase or introduce them too much too soon.
Sudden changes in gait and footwear – Similar to the above, changing your gait or running shoes suddenly for example forcing yourself to forefoot strike or barefoot running can lead to loads being pushed through parts of your body that aren’t ready for it as can suddenly changing shoes.
Psychological factors - Perfectionism, support form social network and family, relationships with coaches, negative stresses in life (Martin et al, 2021)
Capacity (strength) – Your soft tissues just not being strong enough for the demands of the sport.
Overuse injuries are mostly caused by:
Load (Changing too much too soon) – Increasing mileage, speed work, hills, time you run for surface you run all can cause issues if you increase or introduce them too much too soon.
Sudden changes in gait and footwear – Similar to the above, changing your gait or running shoes suddenly for example forcing yourself to forefoot strike or barefoot running can lead to loads being pushed through parts of your body that aren’t ready for it as can suddenly changing shoes.
Psychological factors - Perfectionism, support form social network and family, relationships with coaches, negative stresses in life (Martin et al, 2021)
Capacity (strength) – Your soft tissues just not being strong enough for the demands of the sport.
Avoid sudden changes and spikes in training.
"TOO MUCH TOO SOON"
Generally, overuse issues are sustained after a period of increasing things a little too quickly and this is often really easy to do without even realising it! This then results in an injury due to our soft tissues (muscles, tendons, ligaments or bones) not being able to adapt fast enough to the increases. It might also be that some of your soft tissues didn’t quite have the capacity in the first place.
Increases are usually in the form the following key variables:
Frequency - How many times a week you run
Intensity - How hard you run
Time - How long you run for
Type - Type of training (speed, hills, fell)
Try not to increase any if the above too much too quickly. One of the best way to do this is to have a good quality coach or to at least plan your training.
Sudden changes also relate to running shoes and definitely with gait changes! Look out for the drop on shoes to ensure you're not drastically changing things and if you really want to transition to a very different shoe, do it gradually alongside another pair that you're used to. Running gait analysis is becoming very fashionable but this means it's being used by many who either aren't trained to carry it out properly or are using it to sell you something (useless insoles are a common sales pitch!). The key risk other than a dent to your wallet is sudden changes to your gait can be detrimental to your risk of injury. (CLICK HERE for my full guide on buying running shoes and gait).
Increases are usually in the form the following key variables:
Frequency - How many times a week you run
Intensity - How hard you run
Time - How long you run for
Type - Type of training (speed, hills, fell)
Try not to increase any if the above too much too quickly. One of the best way to do this is to have a good quality coach or to at least plan your training.
Sudden changes also relate to running shoes and definitely with gait changes! Look out for the drop on shoes to ensure you're not drastically changing things and if you really want to transition to a very different shoe, do it gradually alongside another pair that you're used to. Running gait analysis is becoming very fashionable but this means it's being used by many who either aren't trained to carry it out properly or are using it to sell you something (useless insoles are a common sales pitch!). The key risk other than a dent to your wallet is sudden changes to your gait can be detrimental to your risk of injury. (CLICK HERE for my full guide on buying running shoes and gait).
Progressive, structured and flexible training
One of the very best ways of keeping injuries away is to gradually increase your training and be aware of the 4 key variables mentioned above and how much you are changing them in a given time frame. A good structured and progressive training plan is your first defence against running injury. It’s probably your best way to reduce your chances of picking up an overuse injury.
Have a flexible approach to training to allow for days when you're feeling down, tired from work or life in general. I often say to athletes, be confident to change sessions. If you're feeling great push hard but if you start a session and feel really lethargic then swap it to an easy run.
There is also research coming out that indicates that psychological factors also can increase the risk of overuse injuries. This can include training behaviour, perfectionism, response to training and healing and negative stress from life. Working with your coach if you have one can be really effective. Be open and honest with them about how you're feeling and if you need a break. So if you’re feeling fatigued or flat then switch to an easy run, but when your feeling good have confidence to push hard.
Have a flexible approach to training to allow for days when you're feeling down, tired from work or life in general. I often say to athletes, be confident to change sessions. If you're feeling great push hard but if you start a session and feel really lethargic then swap it to an easy run.
There is also research coming out that indicates that psychological factors also can increase the risk of overuse injuries. This can include training behaviour, perfectionism, response to training and healing and negative stress from life. Working with your coach if you have one can be really effective. Be open and honest with them about how you're feeling and if you need a break. So if you’re feeling fatigued or flat then switch to an easy run, but when your feeling good have confidence to push hard.
STRENGTH TRAINING
This is the next thing to include in the top ways to reduce injury is a good simple but effective strength programme.
This addresses soft tissue capacity. By incorporating a strength training programme, you can increase your muscle’s, tendon’s, bone’s and ligament’s ability to withstand the load you put through them with increased training. It also brings about performance gains in increase efficiency and time trial time.
Implement a simple strength plan in to your diary. It does not need to be complicated! Squats (they don’t need to be deep), calf raises, deadlifts, lunges and resisted hip abductions (crab walks) are all great and simple. The important thing is to try and lift heavy! You want a weight that means you can only do a max of 12 repetitions. Some heavy books in a bag will do. I’ve even prescribed squats holding a toddler before! If you don’t have any weights then repeat until you fatigue.
Aim for 3 - 4 sets and try to complete these 3 times a week.
The ideal is to complete a 12 week strength and conditioning programme before you start your running specific training. You can then complete your strength training just once a week to maintain the strength you've gained.
CLICK HERE for specific strength training advice for runners and endurance athletes.
This addresses soft tissue capacity. By incorporating a strength training programme, you can increase your muscle’s, tendon’s, bone’s and ligament’s ability to withstand the load you put through them with increased training. It also brings about performance gains in increase efficiency and time trial time.
Implement a simple strength plan in to your diary. It does not need to be complicated! Squats (they don’t need to be deep), calf raises, deadlifts, lunges and resisted hip abductions (crab walks) are all great and simple. The important thing is to try and lift heavy! You want a weight that means you can only do a max of 12 repetitions. Some heavy books in a bag will do. I’ve even prescribed squats holding a toddler before! If you don’t have any weights then repeat until you fatigue.
Aim for 3 - 4 sets and try to complete these 3 times a week.
The ideal is to complete a 12 week strength and conditioning programme before you start your running specific training. You can then complete your strength training just once a week to maintain the strength you've gained.
CLICK HERE for specific strength training advice for runners and endurance athletes.
"STRENGTH tRAINING can not ONLY INCREASE TISSUE CAPACITY AND REDUCE RISK OF INJURY IT CAN ALSO INCREASE PERFORMACE"
Rest, Recovery & SleeP
This is often hugely overlooked and arguably the key element to success. It’s the not so glamorous bit that the elites don’t put on social medial. After all it wouldn’t be that interesting watching Mo Farah sleep for 12 hours + a day. If we put it really simply, training is where you stress and slightly breakdown your body. We do this to elicit a response from the body to adapt and get stronger, fitter and there for faster and more efficient. Well, the adaption that we are trying to drive only happens when we rest, recover and mainly when we sleep. It’s why I always so to my patients “sleep is where the magic happens”. Fatigue is also a potential for injury risk (vishuran et al 2019). It’s been shown that fatigue can increase risk of lateral ankle sprain, patellofemoral pain syndrome and hamstring injuries.
This means really keeping an eye on the balance between how much you’re training and how much you’re sleeping and recovering. An example maybe that if you know your sleep is going to be reduced then perhaps reduce your training load temporarily.
This means really keeping an eye on the balance between how much you’re training and how much you’re sleeping and recovering. An example maybe that if you know your sleep is going to be reduced then perhaps reduce your training load temporarily.
"SLEEP IS WHERE THE MAGIC HAPPENS"
"You can only benefit from the training you recover from"
WARM UPS
Warm ups are probably something we probably all remember from PE at school. However you probably see the same sort of warms up applied today as you did all those years ago. Unfortunately there is no solid evidence that suggests warm ups reduce injury. However no evidence is not evidence that they don't work. When we look at other sport such as football there is good quality evidence to say that a structured warm up significantly reduces injury. These warm ups however are long and specific including balance and proprioceptive work. I would suggest this type of activity would be best done during your strength sessions. The other type of warm ups that have been shown to be effective are plyometric drills (Wei et al, 2020). Plyometrics being bounding and jumping like activities.
Essentially a good warm up should prepare your for the activity you're about to do. It can simply be an easy run or running easy at the beginning of your run.
If you're going to be doing an intense speed session you might want to include some other movements such as body weight squats, lunges, leg swings, jump squats and pogo jumps (quick jumping on the spot with very short time touching the floor).
CLICK HERE for a more in depth look at warm ups.
One thing we know for sure is that warm ups should NOT include any static stretching as it can reduce power output and therefore hamper performance. Warm ups also do not need to be 30 minutes long for endurance sport. I have genuinely seen some running groups complete a warm up in the same time its taken me to warm up and do a session!
Essentially a good warm up should prepare your for the activity you're about to do. It can simply be an easy run or running easy at the beginning of your run.
If you're going to be doing an intense speed session you might want to include some other movements such as body weight squats, lunges, leg swings, jump squats and pogo jumps (quick jumping on the spot with very short time touching the floor).
CLICK HERE for a more in depth look at warm ups.
One thing we know for sure is that warm ups should NOT include any static stretching as it can reduce power output and therefore hamper performance. Warm ups also do not need to be 30 minutes long for endurance sport. I have genuinely seen some running groups complete a warm up in the same time its taken me to warm up and do a session!
"a good warm up should prepare your for the activity you're about to do"
"warm ups should NOT include any static stretching"
Stretching & foam rolling
Lot of us feel compelled to grab the foam roller or increase stretching to prevent injury or even to treat injuries. However this might not be a worthwhile activity. Foam rolling and stretching do not reduce running injury and actually in some cases can aggravate niggles considerably.
What don't they do.
Neither foam rolling or stretching have any direct effect on muscles or fascia. They don't release anything and they certainly don't break down 'adhesions'. They also have no effect on long term flexibility or muscle length (Behm D & Wilke J . 2019). Stretching can effect flexibility but first only of done for hours and hours every day but most importantly as runners we don't actually want to be super flexible. Our bodies need stiffness to be efficient during the running gait cycle.
So what do they do?
Foam rolling can help to reduce the sensation of delay'd onset muscle soreness (DOMS). It can also make you feel a little less stiff (Wiewelhove, T. et al., 2019). It's probably more effective than stretching which ultimately has no positive effect on runners in terms of injury prevention.
My take on both foam rolling and stretching is this: If you love doing it and genuinely believe it helps you then carry on. BUT if you dread doing it and are only doing it because you think you need to do it to stop getting injured then absolutely stop!
What don't they do.
Neither foam rolling or stretching have any direct effect on muscles or fascia. They don't release anything and they certainly don't break down 'adhesions'. They also have no effect on long term flexibility or muscle length (Behm D & Wilke J . 2019). Stretching can effect flexibility but first only of done for hours and hours every day but most importantly as runners we don't actually want to be super flexible. Our bodies need stiffness to be efficient during the running gait cycle.
So what do they do?
Foam rolling can help to reduce the sensation of delay'd onset muscle soreness (DOMS). It can also make you feel a little less stiff (Wiewelhove, T. et al., 2019). It's probably more effective than stretching which ultimately has no positive effect on runners in terms of injury prevention.
My take on both foam rolling and stretching is this: If you love doing it and genuinely believe it helps you then carry on. BUT if you dread doing it and are only doing it because you think you need to do it to stop getting injured then absolutely stop!
sports Massage
This one is very similar to the foam rolling and stretching above.
There are lots we used to think massage did that we now know it doesn't do. I was one of them, as I did my massage courses years ago before I became a Physio.
Massage for some has great effects on feeling better and definitely can be of use during hard training and after races.
However again sports massage is most certainly something you shouldn't be getting to treat an injury or to prevent injuries occurring.
Sports massage is a great way to reduce DOMS and sooth tired legs that are training hard. But as long as you're not spending out on something you believe will stop you getting injured, it just doesn't work like that.
There are lots we used to think massage did that we now know it doesn't do. I was one of them, as I did my massage courses years ago before I became a Physio.
Massage for some has great effects on feeling better and definitely can be of use during hard training and after races.
However again sports massage is most certainly something you shouldn't be getting to treat an injury or to prevent injuries occurring.
Sports massage is a great way to reduce DOMS and sooth tired legs that are training hard. But as long as you're not spending out on something you believe will stop you getting injured, it just doesn't work like that.
Massage guns / 'theraguns'
Again very similar to foam rolling. Except there is a huge amount of money going into marketing these at the moment and it's working.
Massage guns can, like foam rolling and massage, reduce DOMS but there is absolutely nothing to make us believe from a science and evidence perspective that they help with injury prevention whatsoever.
If you have the spare cash and want something to play with then go for it, they're quite cool BUT please don't stretch yourself financially or get one if you're doing so to stop yourself getting injured or to treat an injury.
Massage guns can, like foam rolling and massage, reduce DOMS but there is absolutely nothing to make us believe from a science and evidence perspective that they help with injury prevention whatsoever.
If you have the spare cash and want something to play with then go for it, they're quite cool BUT please don't stretch yourself financially or get one if you're doing so to stop yourself getting injured or to treat an injury.
REFERENCES
Martin, S. et al., 2021. Psychological risk profile for overuse injuries in sport: An exploratory study, Journal of Sports Sciences, 39(17), 1926-1935, DOI: 10.1080/02640414.2021.1907904
Verschueren J. et al., 2020. Does Acute Fatigue Negatively Affect Intrinsic Risk Factors of the Lower Extremity Injury Risk Profile? A Systematic and Critical Review. Sports Med. 2020 Apr;50(4):767-784. doi: 10.1007/s40279-019-01235-1. PMID: 31782066.
Wei, C. et al., 2020. A Plyometric Warm-Up Protocol Improves Running Economy in Recreational Endurance Athletes. Frontiers in physiology, 11, 197. https://doi.org/10.3389/fphys.2020.00197
Behm D & WilkE J . 2019. Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review, Sports medicine (Auckland, N.Z.), 49(8), 1173–1181.
Wiewelhove, T. et al., 2019. A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery. Frontiers in physiology, 10, 376.
Walther, M. et al., 2005. Verletzungen und Uberlastungsreaktionen im Laufsport [Injuries and response to overload stress in running as a sport]. Der Orthopade, 34(5), 399–404. https://doi.org/10.1007/s00132-005-0790-0
Verschueren J. et al., 2020. Does Acute Fatigue Negatively Affect Intrinsic Risk Factors of the Lower Extremity Injury Risk Profile? A Systematic and Critical Review. Sports Med. 2020 Apr;50(4):767-784. doi: 10.1007/s40279-019-01235-1. PMID: 31782066.
Wei, C. et al., 2020. A Plyometric Warm-Up Protocol Improves Running Economy in Recreational Endurance Athletes. Frontiers in physiology, 11, 197. https://doi.org/10.3389/fphys.2020.00197
Behm D & WilkE J . 2019. Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review, Sports medicine (Auckland, N.Z.), 49(8), 1173–1181.
Wiewelhove, T. et al., 2019. A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery. Frontiers in physiology, 10, 376.
Walther, M. et al., 2005. Verletzungen und Uberlastungsreaktionen im Laufsport [Injuries and response to overload stress in running as a sport]. Der Orthopade, 34(5), 399–404. https://doi.org/10.1007/s00132-005-0790-0