Running injuries expanded

Expanding on running injuries (and some admin)

Yesterday, Jonathan did a post looking at running injuries and specifically the common training error made by runners who tend to move from one injury to the next in their training! He raised the the guideline that a 10% increase in distance from one week to the next is probably about the limit of what most people can aim for before they start running (literally) into injury territory.

And the post got some pretty good comments and discussion going, and it struck me that the whole concept of injuries in runners (and in other sports, cycling and swimming especially, since our focus is on endurance) is a topic that we have never really tackled here.

And since it's so prevalent - studies suggest that about 2 in 3 runners will be injured every year - it seems like a topic worth delving into in a bit more detail in the coming months!

Of course, it's a vast, enormous topic, and much like our Fatigue Series, it's probably too big to be discussed adequately in a nice, packaged series of three or four posts. So rather than introduce it as a series, I think I'll put forward that we will start giving a lot more thought to some posts that follow on from yesterday's post and the resultant suggestions, and then roll those posts out a little less frequently than we would in a dedicated series. But just be assured, it's on the radar screen!

So just a couple of ideas around injuries in running:

1) Running technique and injury

First, a couple of people raised the issue of running technique and injuries, which is a pretty common thought these days. I honestly don't believe that running technique, at least in the form that it's been "packaged" and then sold to runners, has a great deal of importance for injuries. I'd go with the theory that if a runner is injured, look first at training, second at training, third at training, fourth at strength and flexibility imbalances, and fifth at training. Maybe at number six, you can consider running technique.

All this is obviously within reason, and as one reader (Cassio) pointed out, there are obvious technique related things that can easily be addressed, like very obvious overstriding. So sure, in that case. But the case that is made for subtle changes is really overdone and overmarketed, in our opinion.

The issue of technique is however one that we have covered in great detail, and so this is not a debate we need to have right now - it's been had! You can read our series on running technique here for all the discussion of those ideas.

2. The inter-relatedness of it all

Of course, at this point, we must make a very very (very) important point. Nothing in your running (or cycling or any sport) can ever be looked at in perfect isolation. In otherwords, training may well be the cause of most injuries, as we've said, but there is a substantial interaction between the training you do and other variables which act externally to affect your unique response to that training. A 55 kg Kenyan might go from no running to 120 km in a matter of months, and be racing competitively in less time than that. Another person will be bed-ridden in weeks with stress fractures! Why? Because their unique physiology, anatomy and response to training means that "not all training is created equal".

So I am firmly of the belief that if correct training principles are adhered to, then any athlete can train without injury - the level they reach and their success as a runner is of course dependent on numerous other factors. But the problem that we land ourselves in is that we "train by numbers", and try to fit all athletes into the same mould. So the concept that training is simply run from a template doesn't work, precisely because we are not all average.

So the truth is, training might make up the first three areas of concern for an injured athlete (in my opinion), but you can't look at the athlete's training without considering things like flexibility and strength balance (as Sean has pointed out) because they MODERATE the athlete's response to training. That's why I'm in agreement that the athlete must address strength, flexibility and balance.

Now, if we want things to get really tricky, then we start talking about flexibility - can you be TOO flexible? I think when asked in that way, the answer is quite obviously "Yes". But what if it's asked a little differently: Should runners be stretching? Because now all of a sudden, the answer is "Maybe". And once again, we have a case where "one size does NOT fit all". There is, in other words, evidence that stretching can CAUSE injury, not prevent it. And excessive strength too. The key then is balance, and that's a topic worth getting into in the future as well

3. The influence of intensity - critical

Then lastly, the other variable in your training programme is the intensity. Yesterday, Jonathan touched primarily on VOLUME, and raised that guideline (not a rule, remember) that 10% increases are usually the limit. What that doesn't deal with is intensity, so we have to discuss the impact of increasing intensity.

What often happens is that a runner will very patiently and methodically build up VOLUME, because it's much easier to measure - time or distance. What they neglect, and it's more difficult to quantify, is intensity. Because my experience, and theory, suggests that a 5% increase in intensity is NOT the same as a 5% increase in volume.

In other words, if you increase the intensity very slightly, the volume has to drop quite a lot more in order to keep the OVERALL load the same. And so what often catches runners out is that they ramp up the volume by 5 to 10%, but the intensity goes up by 5% too, as they get fitter, or push a little harder. The net result is that the overall training quality increases too much, and they break down.

This is also why the biggest danger period for any runner is that moment when they start to add in the high intensity training to the programme. They finish base training, and suddenly start to do the odd track workout, some fartleks, or the like. But if they don't manage a reduction in volume, the combined effect can be damaging.

So that's another topic worth discussing

One final point - no research available

One thing that we must make clear right up front, is that as we tackle this topic on and off over the coming months, there is very little scientific evidence on this, and so we rely instead on theoretical insights, experience and "bald assertions". Studies often look backwards at injury, and work out after the fact that X, Y and Z are the likely predictors for injury. For example, we know that if you've had a previous hamstring injury, then you have a many-fold greater chance of a hamstring injury! (hardly rocket science...)

But scientific studies that look at the long term effects of different volumes and intensities of training are, for many reasons, just about impossible to do effectively, so it's looking backwards that reveals the evidence.

But, that's no reason not to discuss it, and we'll welcome any comment or feedback. So keep an eye out for those injury posts!

Ross