RUNNING INJURIES & HOW TO PREVENT THEM

Running injuries in recreational runners are often due to poor preparation and always due to overuse of muscle or joints. When you run, you are basically doing the same stepping manoeuvre over and over again therefore small problems become bigger problems when you are doing this tens of thousands of times. But there’s a lot you can do to prevent issues along the way, a lot of things you should NOT do. Let’s get started.

GETTING STARTED

1)     Don’t start off too fast. The biggest problem with someone starting out, particularly if they have played fast action sports before, is that they run too fast! Zipping down the road at full pelt, running out of breath and then wondering how everyone else can run for miles….it’s because we go slower! You start at a pace that you can sustain a conversation, or sentences at least. If you are out of breath, your muscles are going to get full of lactic acid and give up really quicky. Walk-run if you have to, to get your distance up, then you can go for speed if you want to. Your breathing will gradually adjust and be able for more. All you Speedy Gonzales people out there, if you can’t do a reasonable pace, then maybe running is not for you. Period.

2)     Increase your mileage gradually: the biggest cause of running injuries is changing your training dose too suddenly: you’ve GOT to build up gradually, particularly if this is your first time running any distance. Your tissues slowly adjust to the increased load. If you don’t observe this, you are ASKING for an injury. I mean it. Running and walking use a lot more muscle and lung activity than the equivalent distance cycling, so take it easy, OK?

3)     Get comfortable runners that just feel good. If it feels a bit ‘off’, then just don’t buy, regardless of how ‘on trend’ a particular runner is. When something doesn’t feel right at the start, does it ever ‘get right’? In my experience, it usually ends up in blisters and pain -Just don’t go there!

WE all have different types of feet: flat feet, high arches, soft feet, rigid feet – You can get advice and even computerized biomechanical assessment on what suits your foot if you like or just use your instinct. If you have problem feet, then you will probably need orthotics( more of that below). Barefoot runners don’t suit every foot type, so if you try them and they don’t feel good, give up and get more support: YOU CANNOT ARGUE WITH YOUR ANATOMY.

4)     When going beyond 10 miles/20k, it’s really handy to wear compression socks to stop your calf muscles accumulating too much lactic acid so that you recover quicker from runs and don’t end up with tight calves.

5)     Stretch after you run when your muscles are warm: calf stretches, hip flexors, hamstrings and calf muscles all need a going over. You’ll be less sore after the run, I promise.

6)     Try have a good cadence to your running : is the sound of your left foot hitting the ground the same as your right foot? Is one hitting the ground harder, or are you spending more time on one foot compared with the other? Check this out once you’ve got into your stride: if you’ve a lopey or uneven running pattern, try and adjust it – again, you’ll get away with this at shorter distances but it will start to matter at longer distances.

7)     Back to breathing: don’t forget that your breath is what acquires oxygen for your running muscles. If you are breathing in a shallow manner ( top half of lung), you are being very inefficient at acquiring oxygen as most of the oxygen exchange happens in the lower part of the lungs. This will give you neck and shoulder pain from overuse. Try ( for some of your run, at least) to relax the shoulders, and let the lower ribcage do the job of breathing. The softer your breath, the more relaxed your nervous system becomes.

CAUSES OF RUNNING INJURIES

Faulty Foot biomechanics:

Foot biomechanics is not something we choose. It’s due to inherited bony variances, coupled with either rigid or soft ligaments, all of which God gave us! Faulty foot mechanics are really common. In normal life, a lot of us don’t notice any problems but when running distance, it means that our entire leg and pelvis is under extra pressure during the run. To adjust for bony variances, our feet either over-pronate ( taking too much weight on inside of foot), which turns the leg inwards causing foot & kneecap pain, tight hamstrings & hip flexors and lower back problems.  Or,  we stay supinated ( on the outside of the foot) and the problem gets transferred up along the leg. This causes problems at the outside of the knee/ hip/bum and lower back pain,  calf and hamstring problems.

At low mileage, biomechanical problems don’t cause too much problems, but once you increase your mileage, your body finds it hard to compensate without overuse injuries occurring. If your bony variance is mild enough, you might find that a particular type of runner keeps you out of trouble ( e.g. extra arch support) but if you have a more marked bone variance, then you need orthotics. All the strengthening in the world, will not hold your foot from pronating at higher mileages no matter how some physio tries to convince you. And yes, you may only have pain on one side, but your biomechanical problem is likely to be on both sides  - it’s just that muscle weakness on one side may be adding to the equation.

*Remember that orthotics are preventative. Don’t stop wearing them even if you are pain-free, as they are correcting you and making your foot and leg work normally. Some people ( like me) only need to wear them running and not at any other time.

Weakness:

In a perfect world, we would be symmetrical and have the same amount of muscle strength on both sides. But it’s not…and we haven’t. The most common muscles to be weak are core muscles ( lower belly and lower back) as well as hip stabilizing muscles and hamstring/calf weakness. I know, overwhelming, eh? But it makes sense. If your background core and hip muscles are strong, then the muscles that propel your legs forward can do their work more efficiently. If these are weak, you’ll be fine at lower mileages, but problems will emerge once you increase it.

Weak muscles get tight and we all know that tight muscles strain and tear more easily. Get a physio to do a full muscle screening on you off season to include the following:

·        lower back muscles

·        lower belly muscles

·        side muscles (often get forgotten but v important)

·        hip muscles: internal rotators & external rotators; adductors and abductors, hip extensors and flexors.

·        hamstrings and calf muscles: these can be sneaky and hide their weakness easily. If you have tight calves or hamstrings, you probably need to strengthen. Since weak muscles are often tight, so you might notice improvements in flexibility after a good strength programme. (Yoga is brilliant for this, by the way…just saying!)

Hey, all you ladies who have had babies, if there is any urine leakage, go to a women’s health physio for some pelvic floor muscle strengthening. Your pelvic floor health is linked with lower back and hip issues, so don’t forget these.  

Old Injuries and pre-existing stiffness

If you have any old injuries and are carrying any scar tissue in muscles or ligaments, then longer distances will coax these out of hibernation and cause them to re-activate. The problem is that they HAVE healed once upon a time, but in the wrong way. Scar tissue is not as shock-absorbent or flexible as healthy tissue, so all that pounding on pavements and up/down vibration jiggles the scar tissue, causes friction and suddenly your old injury reminds you that it’s there. It’s a great opportunity to get some treatment to address this, and sort it out for good – so get to a physio or sports massage person.

Equally, if you have stiffness anywhere in your skeleton, this will show itself during the long runs, because stiff body parts are less shock-absorbent and can’t adapt to mileage so well. Anyone with a sore neck or back after running, get a physio to check and see if you have spinal stiffness that can be mobilized to give you relief.

Strange running pattern?

You only have to look at a road race to see the massive variety of bodies and shapes that run! Some people are just naturally like gazelles and almost float through the air as they run. Most of this is genetic ability ( schadenfreude from me, I’ll be honest) but lots can be improved upon with the right training. However, looks can also be deceiving: sometimes bodies that don’t look like they are comfortable still can be really fast. Paula Radcliff and John Treacy (I’m showing my age) were two elite marathon runners who always looked like they were dragging themselves around, and yet still they won medals, lots of them. During my first marathon, I remember feeling sorry for this auld geezer shuffling around at mile 5….until that same old geezer shuffled past me at mile 20….a humbling experience indeed. Ok, I had an injury and was walking at this stage, but still….!

About 15 years ago, all the cool kids were learning how to do Chi Running (google it) .This is a form of running based on using the body’s natural momentum to make running more efficient. A lot of the Kenyan distance runners, run naturally like this. When you run using this technique, your body leans forwards at angle, leading from the hips. This uses momentum and gravity to move you forward, with the leg activity being passive (like propellors) instead of using loads of hip muscle activity. I tried learning it from a book ( and failed!), so I’d recommend going a course to learn this properly, if it’s something you want to explore. It helps to have massively long legs to do this too, of which (ahem!), I don’t!

QUICK GUIDE TO RUNNING INJURIES

Injury	Potential Causes	Solution
Shinsplints (pain front of shin) or pain under arches of foot	Flat (pronating) feet Sudden increase in mileage Weakness in hips and pelvis exacerbate this.	Orthotics for feet Strengthening core & hips Keep to low mileage
Pain in forefoot or toes	Stiffness from old injury Foot splaying from poor biomechanics Poor-fitting shoes Weakness in hip/pelvis contributes	Stretching/loosen scar tissue Orthotics Comfortable runners Foot exercises Hip and core strengthening
Pain under heel	Either flat/pronating feet OR high-arched feet with no shock absorbency Exacerbated by sudden increases mileage	Orthotics Gel heel pad can help somewhat Foot exercises Strengthen hips and core Stretch and strengthen calf muscles
Achilles Tendinitis	Too much mileage too soon after being sedentary Middle aged (hormonal) Wrong runners Flat/pronating feet Weak calf muscles	Needs a combination of rest and strengthening Comfortable runners, heel not digging into you. Orthotics for flat feet Eccentric training for calf muscles
Kneecap pain	Flat/pronating feet Tight quads and hip flexors	Orthotics Strengthen hips and core Strengthen quads and hip flexors Eccentric training for quads
Pain at outside of knee/ tight iliotibial band	Cadence unequal Too much running on camber of road Weakness on one side of back or hamstrings Weakness in some of hip muscles	Equalize running cadence Change direction of usual run every now and then Strengthen core muscles and hip muscles
Hip pain (front and side)	Unequal cadence Weak core or hip muscles on one side Poor flexibility of hips ( linked with weakness) Old pelvic injury from childbirth One leg longer than the other	Equalize cadence Strength and flexibility work on core and hip muscles Treatment for any old pelvic injuries Heel raise for shorter leg
Calf pain	Tight or weak calf muscles Increase in mileage too soon Lactic acid build-up Uncomfortable or unsuitable runners Biomechanical foot problems contribute	Strengthen and stretch calves and foot muscles Gradual increase mileage Compression socks Orthotics for poor foot mechanics
Hamstrings tight	Weak core Weak hamstrings Biomechanical foot problems	Strength and flexibility work for hamstrings Strengthen lower back to offload hamstrings Orthotics for feet if req
Lower back problems	Old injuries in spine or pelvic joints Weak core/belly/pelvic floor Weak or tight hip muscles Stiffness in spine ( linked to weakness)	Strengthen, strengthen strengthen: hips, back, belly, pelvic floor, hamstrings, calves. Get old injuries and stiffness treated by a physio
Upper back and neck pain	Weakness lower back so this area overworking Poor breathing mechanics Old injuries in this area	Strengthen lower back, shoulder blade muscles and neck muscles. Get old injuries and stiffness treated

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