Running injuries are horrible. They seem to sneak up on you just as you are starting to feel good with your running. At first you just keep going because you rationalise that it’s probably nothing more than a niggle that will settle on it’s own. But then it doesn’t. You try to rest it and it seems to settle temporarily, but comes back as soon as you try and run again, or run a bit faster or harder. You may look to online help or ask a social media forum what you should do and you receive a myriad of advice – because everyone has had that issue before 😬.
Did you know that 50% of runners will have some form of injury in ANY given year?! That means that for all of you that run, you are more than likely to have an injury caused by running at least in the next couple of years. Hence why so many people seem to have had the SAME injury as you. But they haven’t because, well, you are you. Everyone’s situation is just a little bit different. So what should you do?
Wouldn’t it be great if there was a way to (potentially) prevent or limit the occurrence of injuries in running.
It has been said by Phil Glasgow (team GB head physio, researcher and all round good guy) that LOAD is the cause and the cure for (nearly) all sporting injuries. However understanding this term LOAD and how it applies to the individual can be really tricky. That’s where we come in.
Common running injuries
Lower limb injuries are the frustration of the runner. There is a significantly higher rate of injury in running when compared to other common forms of recreational aerobic fitness exercise (walking, cycling and swimming). The most common lower limb injury is anterior knee pain (knee around the knee cap area) followed by problems with the foot and ankle (plantar fasciopathy, Achillies tendinopathy etc) and then the shin (bony stress injuries), this is then followed by the thigh (hamstring, ITB) and the hip (gluteal tendinopathies). Women have a slightly higher rate of injury than men. You can read more about tendinopathies here.
Running is very different to walking. With walking there is always one foot in contact with the ground. Running has a distinctive ‘flight’ phase. This is a period of time where both feet are off the ground. Because of this flight phase there are large forces that the body has to manage/attenuate each time a foot comes back in contact with the ground (foot strike).
Newtons 3rd law says that for every action there is an equal and opposite reaction. When the foot strikes the ground, the ground exerts and equal and opposite force back up through the foot. This is know as the ground reaction force. The actual force is determined mathematically taking into account the weight of the person, the speed they are travelling and gravity. Modelling has shown that this force is up to three times body weight at every foot strike. Think about how many foot strikes you have on the average run. Each minute should be around 160-180 (90 each leg). Half hour run would be 4800-540 (total). One hour would be 9600-1080 (total). that’s huge! That ground reaction force comes back up through the body and needs to be attenuated efficiently so as not to cause excessive strain and potentially injury on a structure.
This force attenuation is an important role of our muscles and joints through our lower body. It requires our muscles to be adequately strong especially around our foot and ankle, knee, hips and pelvis. If one or more of these structures are not strong enough for the amount of running you are doing, problems can occur.
With the exception of traumatic injuries and some disease processes, all running injuries are caused by doing TOO much or going TOO hard, TOO soon.
It may be that you are strong enough to (say) gently jog 2-3 kms a couple of times a week. But then you decide that you would like to try ParkRun – a free, full timed community running race every Saturday morning. Instead of running gently for 2-3 kms you add in the Parkrun and you run as hard as you can. That is a significant sudden increase in your weekly running load (you’ve increase the total amount of running by 80% plus you’ve added speed). Initially it seems ok but after the 3rd or 4th week you notice some soreness developing in your knee. This is because you have OVER loaded too much and your body has not been able to adapt adequately. Suddenly your knee is not able to attenuate the ground reaction forces effectively and soreness has developed.
Hormones also play a role in the frequency and type of running injuries. Women approaching menopause (peri menopause) have decreasing amounts of the hormone Oestrogen in their bodies. Oestrogen is an amazing hormone. It is responsible for puffing up our skin giving us the youthful look. It helps us build and maintain muscle and aides in the resilience of our tendons. So as it declines we often find that it’s harder to build and maintain muscle and we are more susceptible to tendon injury. In this case we need to be extremely careful and mindful of the loads we place on our body when we are running.
Running with friends is a great way to pass the time. It is also a fabulous incentive to get out and run when you have an accountability running buddy or group. Sometimes though there can be a downside of running with friends or in a group and that is that not everyone will have the same or complimentary running style. Some people are taller, some have longer legs, some people are younger and fitter. What that can mean is that one person is running much ‘harder’ than another person. This can lead to them over striding or losing their quality running form. Unfortunately this can sometimes lead to injury.
Running Physiotherapy at Vital Core
Our first piece of advice is to please come in as soon as you start to experience discomfort with running. For most running injuries, the earlier we can assess it, the quicker the recovery – particularly if it is a tendon injury. Patients are often hesitant to come in because they assume that the physio will immediately say they have to stop running. That is rarely the case. Most often the advice is to initially decrease the load (speed, distance, frequency) down to a level that is comfortable.
The first part of any good physio assessment is finding out what the patients’ goal is. From there is important that the physio has a good understanding of running/ exercise history and previous injuries as well as general health and nutrition – both of which can have a significant influence on the running body. There are often questions that are particularly important for women who have just had a baby or for those hitting the middle years of life particularly in relation to the pelvic floor. There are other questions specific to teenage girls and boys about their growth and development to better understand the varying demands and potential for bone injury issues.
Once the physio has a good picture of the runner with an injury infront of them they will perform an assessment. This assessment will vary depending on the patient. For some it will consist of basic posture and movements others it will be far more challenging and functional. It all depends on the person and where they’re at in terms of pain and dysfunction.
All this information helps the physio to clinically reason what is going on, They will explain this ‘diagnosis’ to the patient and what the prognosis looks like. Then together the physio and patient work out a treatment plan including a realistic recovery timeframe based on the best evidence available to get the patient back running again and achieving their goals.
Strength training for running
As well as managing the actual running loads, strength training is really important for runners in injury prevention and management. Often the runner with an injury will have strength deficits around the injured area. This means they are not able to use that muscle or group of muscles effectively to attenuate the ground reaction forces. This can lead to ongoing issues. We encourage you to watch this interview Physio Beck did with local fitness leaders and runner Anna Liptak recently about strength training and runners.
We recommend that you perform at least two strength sessions every week. This is also recommended by the Australian department for health. If you are wanting to get better at running we recommend that you work on the areas of your body that you need to be strong to attenuate those ground reaction forces more effectively. It doesn’t matter where you exercise. It could be at home, in a gym or even a park. However exercising in a group with like minded people doing the exercises you need to do specifically for running whilst being supervised and supported by an expert is fabulous. That’s what RunFit is.
RunFit is our Vital Core 8 week progressive strength class designed specifically for runners by runners. It is suitable for all levels and abilities and can tick the box for one of your strength sessions each week.
RunFit runs through out the school term on Monday and Tuesday evenings. You need to register in advance and if you haven’t been to Vital Core recently then you will likely need an assessment first. But that’s easy, just call our helpful reception team to make an appointment.
Next time you have a niggle start from running we encourage you to call up, make an appointment and let the team at Vital Core Physio help get you back out running again.