"What Caused My Running Injury"?

Training errors are responsible for far more injuries than any other factor

In the past couple of weeks I have found myself suffering with right lower leg pain and it has stimulated me to reinforce a common topic I discuss with many patients and admonish myself for making the same error despite knowing better.

Most runners present to our clinic with their various aches and pains with some thought as to what has caused their injury. Often people are worried about their running technique, or the surface they are running on or the shoe they are running in. Many have been told, or read – rightly or wrongly – that if they improve their cadence (step count), or run more on their forefoot, or get stronger in their gluteals, or get their pelvis more stable, then that would solve their problem.

Now all these things can be factors, and I use all these variables to some extent in management of runners, from both a treatment or preventative stand point but in my experience nothing influences injuries more than training errors. This can manifest itself in many ways, all of which result in tissue overload. Running is an extremely repetitive activity with high peak loads on our tissues (muscles/ tendons /bones) and therefore requires us to gradually load and adapt these tissues to ensure they can tolerate the load we are putting through them. Some forms of running put more stress on our tissues than others, and this is where we often make errors and where I fell down recently.

Running faster or up and down hills puts higher stress on our body than slow gradual running. When we see runners who are new to running this is often where they fall down. Each time we load tissue it under goes changes in its physiology and we need to give it time to adapt to that change. Rest and recovery are very important parts of any training program, and one that is often neglected leading to maladaptation to tissue load and therefore injury.

When considering load it is not just the external loads associated with running such as increasing either frequency, distance or intensity too quickly but internal loads that come from workloads, lack of sleep, other daily activities you may undertake and family stresses.

With our current Level 3 restrictions associated with COVID 19 over the past 6 weeks I like many found myself running more but also working very long hours with considerably more stress. This stress results in inferior adaption to tissue load and combined with poorer sleep leads to generally poorer recovery to training. So when I get home from a long stressful day and think I am going for a run to unwind it is nearly opposite to what my body needs. Add on top of that running a bit harder than I have for a long time and it is no surprise that I broke down.

The great success in improvement in performance when it comes to running is consistency of running without interruption from injury. A big part of that is the ability to listen to your body. It is a great talent, and takes enormous discipline, to run well within yourself when you feel like your body hasn’t quite adjusted to the recent loads that you have put it through. Running well within yourself and giving yourself at least 72 hours between any harder running sessions, where your perceived exertion is 7/10 or more, is more likely to keep you running injury free. The invention of the Garmin and the many other apps that can now track our performance may have contributed to this over training in that we don’t tend to want to have a very easy slow recovery day appear on our Strava feed etc. The end result can be running harder, more often and injury.

Running with others is always great as it is easier to get motivated and certainly assist you to run faster or longer than you otherwise would but it is also a potential source of overload. In groups there are always runners of various standards and if you are training with people clearly better than yourself, you tend to find that you may always be running at a higher intensity than the better runners. If you do this regularly and don’t allow your tissues time to absorb and adapt you have a higher risk of injury.

Especially when we are younger we tend to fall into the habit of running hard all the time but in reality we should only do focused intensity session (perceived exertion >7/10) a couple of times per week ( maybe 3 for the more conditioned athlete) and focus on volume for the remainder of the week. Even some of that volume should be very slow running – for example if you are a 3 hour marathoner you may do a lot of easy running at 4 hour pace to help minimise injury risk and maximise tissue adaption from the harder running.

A focus on increasing volume through more frequent and longer running is the safest way for a new runner to start building up running. It is often said that you need to get fit to train. That basically means develop great fitness by just doing more slow easy running before introducing faster running. You will initially get great physiological improvement just from increasing your volume. When the body has adapted well to this and your improvement plateaus then you may look at adding a bit more intensity into a training session.

While treatment of running injuries is all based around science, the construction of a running program is often referred to as a lot more art than science. Every runner is different and adapts to the varying stresses of running in different ways and at different rates. It is a bit of an art form to be able to read your body and prevent yourself from pushing a tendon or a bone beyond its tolerance levels. If in doubt always take the easier option. Obviously this becomes harder the fitter and better you get as running becomes far more performance based which means you have to take a few more risks but the most successful are still those who are able to have less breaks in training through injury.

So always give a lot of thought to what you are trying to achieve with each run and what else you may have done that may be influencing how you feel and how your tissues may adapt to the stresses you are about to put them through. Add that art form to the science of having the most efficient running style you can have and improving the strength of your running muscles and you will give yourself the best chance of enjoying uninterrupted running for longer.

Rob O’Donnell

SSPC Physiotherapist