Introduction

With new year’s resolutions just around the corner, there may be significant numbers of people looking to running as a one of their resolutions – this article will help to make it as pleasant an experience as possible!

Running can be a mainstay of many client fitness programmes, both as a part of personal training sessions, as well as exercise that a client may do independently. Additionally, you can also check this free guide to running, especially if you aim to train for a 5k marathon.

However, for all its health and fitness benefits, running is not without risk. Lower extremity injury estimates for runners range from 19.4-79.3%, and this increases to 26–92.4% when studies including non-lower extremity injuries are factored into overall incidence.

Common running injuries include:

• Anterior knee pain, most often relating to the overloading of the knee cap;
• Iliotibial band syndrome around the knee;
• Achilles tendonitis;
• Plantar fasciitis; and
• At the hip, you may see injuries including:
  • Proximal hamstring and gluteal tendinopathy; and
  • Medial tibial stress syndrome or ‘shin splints’.

Understanding the key causes of running injuries and strategies to prevent them can help avoid initial injuries, as well as reducing the risk of chronic and recurrent ones.

Injury Risk Factors

There are numerous factors thought to contribute to the risk of sustaining a running injury, including:

• Older age;
• Higher body mass index (BMI);
• History of prior injury;
• Abnormal anatomical alignment and foot posture;
• Training accumulation;
• Shoe type; and
• Training surface.

Injury risk factors may also be sex-specific:

• According to a 2015 review published in the journal PLOS ONE, in which researchers found that age, previous sports activity, running on a concrete surface, participating in a marathon and weekly running distance (48-63 km) were all associated with a greater risk of injury in women than in men.
• A history of previous injuries, running experience of two years or less, restarting running, weekly running distance (32-47 km) and running more than 64 km per week were associated with a greater risk of running-related injury in men.

Despite the numerous, and often interacting, factors at play, the one major risk factor underpinning most running injuries is poor load management (i.e. when a client does more than what their body is capable of handling). There are two factors to consider:

1. Every time you go for a run, you are damaging your body on a microscopic scale; and
2. Many runners do more damage than the rate at which their tissues can recover. This means that instead of the tissues repairing, they gradually degenerate, leading to:
   1. Tendon problems;
   2. Stress fractures; and
   3. Other issues.

Load Management

Inappropriate changes to training volumes are a common scenario in running enthusiasts, and a large proportion of injured runners have done something recently to change their running volumes. This may include:

• Deciding to compete in an event and increasing their training volume to quickly:
  • They may have never run before and build up to quickly; or
  • They may have had some time off running and when they resume it is at the same volumes prior to the injury, and their body has not adapted.

Ensuring proper/adequate load management is a useful preventative strategy that exercise professionals can easily put in place that makes a big difference to injury risk.

A simple rule is to not increase a client’s total weekly training load by more than 10%. Three important elements of load are:

• Volume (or how many kilometres a person has run);
• Vertical (for example, if they are running up steep inclines); and
• Speed.

To make it easier to control these variables focus on increasing just one per week, monitoring how you adapt to the challenge. Exercise professionals should also take an individualised approach to every client:

• Experience;
• Mechanics; and
• Training intensity,

Will all have a bearing on how much each individual can tolerate.

Implementing Well-Balanced Training

1. Strength training:

• Running will build strength, but it should be complemented by a strength training programme.
• Loading up a bar and doing some squats or dead-lifts is a better way of building strength in running-specific muscles, which will then translate over when a client goes for a run.
• In addition, incorporating resistance training into a fitness programme will ensure that the client’s body has the strength to generate force and absorb loads, in turn improving running performance and reducing injury risk.
• This will help build a platform of strength that provides an injury protection barrier.
• As for what regions to concentrate on, you want to ensure you have a holistic programme that targets all major muscle groups:
  • The calves;
  • Quads;
  • Hamstrings;
  • Gluteal muscles; and
  • Core.
• If possible, you also want to address the specific muscle deficits of the client and hone in on them with targeted exercise.

2. Mix up the intensity:

• Cross-training is a useful principle to avoid repeatedly loading the same tissues and muscles.
• You also want clients to be running frequently enough to produce the desired conditioning, which is protective against injury.
• A lot of people fall can fall into the ‘grey area’ of training where it is not enough to elicit a high training response yet it is not enough to allow them to recover.
• For most runners, around 20-25% of their training volume should be high-intensity, and the remaining 75-80% should be easier, recovery-type running.
• Clients who are serious about improving their running ability should aim for two intense running sessions a week, balanced out with some recovery-based training sessions.

3. Stability Work

• Working on hip and pelvis stability is another useful tactic in injury prevention.
• This essentially involves exercises on one foot. For example, walking lunges, bicep curls or lateral raises with a light weight while standing on one foot. Ensure that proper footwear, such as high performance sneakers are used.

What about Running Retraining?

While retraining biomechanics sometimes requires a collaborative approach between a physiotherapist, a personal trainer and a running coach, there are a few things for exercise professionals to encourage in clients:

1. Preventing Over-striding:
   1. Giving the client a running cue of taking shorter, faster steps will usually lead to a reduction in how far they land in front of their centre of mass, and therefore the impact forces and load going through the tissue.
2. Relaxed Arms and Upright Posture:
   1. Ideally we want an arm action that looks relaxed, with arms that are not crossing the mid-line of the body.
   2. Posture should be upright, because trunk lean can lead to a shorter stride length and prevent proper hip extension and gluteal activation.
3. A Natural Foot-strike:
   1. A Harvard study of endurance runners found that those who habitually rear-foot strike have around twice the rate of repetitive stress injuries.
   2. However, instructing clients to forefoot strike is not the solution; if they are doing this and over-striding, it can lead to injuries like stress fractures.
   3. Runners should land in a way that feels natural to their body, and most find that as their running speed increases, they will (naturally) move to a mid forefoot strike.

What about Treadmill Running?

While running can be done outdoors on trails, parks, paths and roads, the treadmill is the obvious go-to for most exercise professionals working in indoor settings.

However, the repetitive nature of treadmill running can increase the risk of overuse injuries. With a treadmill there are no corners, traffic lights or stepping off curbs, so even road runners get more of a break to their stride.

It is recommended to advise clients to mix up the type of terrain they run on, and to ideally cap treadmill running sessions at 30 minutes. Exercise professionals should consider breaking up client running sessions into smaller increments.

If you wanted someone to run 5 km, you could do five lots of 1 km rather than 5km in one go. Therefore, you might consider performing a 1 km warm-up run, then jump on the bike, then do some weights, then come back and run another 1km, and repeat that five times.