With the marathon season fast approaching, no doubt many of you are starting to ramp up the miles. The majority of you will have no problems at all and will be lucky enough to avoid the physiotherapists treatment couch, however, this is often the time our physiotherapists at physio-form start to see a rise in running related injuries. Hopefully in this short piece you will gain an understanding of why we might get injured and how to prevent it happening by following sensible advice. For more information please see one of our running specialist physiotherapists.

Most of the time runners end up getting injured by doing too much too quickly and putting extra strain and load on tissues such as bone, tendon and ligament ,which, simply cannot cope with the sudden increase. When we start out on a running programme our tendons, joints and muscles will all adapt and gradually get stronger. With the correct balance of training, recovery and time those structures will build the strength they need to be able to tolerate the demands a runner wishes to place on it, whether that be completing a 10km or completing 5 marathons in 5 days!

However, a sudden increase in mileage or intensity in training without adequate rest will lead to loads that the body just cannot tolerate and ultimately lead to INJURY. Muscles may respond to fatigue by getting tight and achy like those dreaded tight calfs. Tendons respond to overload by getting swollen and painful and develop tendinopathies such as achilles tendinopathy and bones respond by developing stress reactions such as shin splints otherwise known as medial tibial stress syndrome. Exercise improves joint health but overdo it and they can become inflamed and painful.

Other Factors that runners need to consider in conjunction with training load are the extrinsic and intrinsic factors. Extrinsic factors are things like footwear, running surface and even things like the camber of the road which can place repetitive loads on tissues. Intrinsic factors such as a persons own biomechanics, especially after injury, their own capacity to cope with demands of running, running style and fatigue also play a significant role in running related injuries.

How To Avoid Injury Part 1:

LOAD MANAGEMENT: The most important strategy to prevent injury is to manage our load placed on our tissues! We need to think about training in terms of volume such as weekly mileage, intensity simply how hard you train, frequency how often and how much rest you have and type, whether you run a speed session, a hill session or long slow endurance session.

Volume: Increasing your mileage is one of the most common ways to cause injury. As a useful guide if we stick to the 10% rule and only increase our total weekly mileage by no more than 10% this will allow a gradual increase with less risk of injury. In some instances this may even be too hight - quote evidence. This rule is flexible however if you're currently only running short distance for example your longest run is only 5 miles, you may be able to cope with increases of up to 20-

30%. It may also be useful to schedule in recovery weeks where you train with a steady increase for 3 weeks then having a recovery week where you reduce total mileage by about 10-20%.

Intensity: Doing too much speed work for endurance runners can lead to injury. Generally the rule here is to stick to the 80:20 ratio. That is 80% at low intensity and 20% at high intensity. For the majority of us this will probably equate to either 1 speed session per week or 1 hard hill session per week. If you want to do more of this type of sessions they would need to be gradually introduced over a period of weeks and also taking into account all the other above factors into consideration.

Frequency: Frequency and volume are often related as the more often you run the more mileage you will do but you must also think in terms of recovery. The more often you run the less time the body has to recover. So Frequency needs to be built up gradually. Always bear in mind total volume too when increasing sessions. Volume will go up as frequency goes up so you may need to slightly reduce the miles in one or two of your sessions as you start to add in another run and then gradually increase the miles again.

How To Avoid Injury Part 2:

The Video above shows the runner overreaching with each stride in front of the body, which in turn is causing the gait to narrow and the foot to land on the Lateral (outside) area of the foot placing excess strain on the foot, ankle and lower limbs.

RUNNING STYLE AND RETRAINING:

Running retraining can play an important part in the treatment and prevention of many common running injuries, particularly patellofemoral pain, ITB syndrome and tibial stress fractures. From the literature it is clear that strength training alone does not improve running mechanics. Willy and Davis (2011) showed that a hip strengthening programme improved hip abductor strength and single leg squat mechanics but did not change running mechanics.

If we view running as a coordination skill then running gait retraining focuses on altering the skill of running. Noehren (2010) showed that gait retraining using feedback on a treadmill in 10 individuals with patellofemoral pain resulted in a significant improvement of hip mechanics that was also associated with a reduction in pain and improvements in function.

As running specialist physiotherapists at physio-form one of the most common faults we see is over striding (landing with the foot too far in front of the body). This can be caused by tight or overactive hip flexors (muscles at the front of the hip) , weak gluteal (buttocks) muscles, poor trunk control, slow running cadence and certain footwear. This type of gait can lead to a number of structures being put under excess stress such as the knee joint, patello-femoral (knee cap) joint, low back, hamstring and gluteal tendons, and achilles to name but a few. Studies have shown that when we reduce over stride and increase step rate there is a reduction in ground reaction force, a reduction in braking force and reduced ground contact leading to a reduction in force going through the body. Simply taking smaller quicker steps can help to reduce this over striding pattern, however - A WORD OF WARNING - any changes you make to your running style need to be done gradually and you need to make sure that if you start to change your running mechanics you may start to load up different structures which don’t have the capacity to cope with this new load. If you think you could improve your running mechanics then consult a specialist physiotherapist or trainer in running who can guide you in the most appropriate changes you need make.

Running Retraining is not enough on it’s own to make substantial improvements and reduction in injury in the long term. You also need to improve the capacity that the muscles and tendons can cope with.

IMPROVE THE CAPACITY IN OUR MUSCLES, TENDONS TO TOLERATE MORE LOAD:

There is clear evidence now to suggest that introducing strength and conditioning into your programme will not only reduce the likelihood of running related injuries but also improve your performance. Beattie et al. (2014) in systematic review looking at strength and conditioning on performance of Endurance runners showed that runners improved time trial performance at 3km and 5km, improved VO2 max, improved running economy and improved muscle power. Programmes should be specific to individuals and what they are trying to achieve. Resistance training needs to be introduced gradually and there should be at least 48 hours recovery between sessions although certain neuromuscular training can be done on a daily basis. It is generally considered that 2 sessions are better than 1. See advice from a qualified practitioner who will guide you appropriately.

TAKE HOME MESSAGE:

1. Make any increases to Volume, Intensity or frequency of running very gradual.

2. Introduce strength and conditioning into your programme at least twice a week.

3. Address running mechanics as part of your overall training programme.

References:

Willy, R.W., Davis, I.S., 2001. The effect of a hip strengthening program on mechanics during running and during a single leg squat. J Orthop Sports Phys Ther 41, 625-632.

Noehren, B., Scholz, J., Davis I., (2011) The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. British Journal of Sports Medicine 45 (9) 691-696.

Beattie, K., Kenny, I.C., Lyons, M., Carson, B.P. (2014) The effect of strength training on performance in endurance athletes. Sports Medicine 44 (6) 845-865.