In 2018, The American Journal of Sports Medicine published a study on overuse injuries in recreational runners. During the course of the 2-year study, 66% (199/300) of participants sustained at least 1 injury, including 73% of female runners, and 62% of male runners. 66% of runners is an alarming statistic. What’s also alarming is that 56% (111) of injured runners, sustained an injury more than once. The good news is that there are many strategies to reduce the risk of running injuries.
Most running injuries occurs due to overuse rather than trauma. There are three factors normally associated with running injuries:
- Training error;
- Equipment and environmental factors.
Other factors including age, sex and weight may also play a role.
When to Stop Running
Most runners are aware that risk of injury is part of the sport of running, however, it is important to know when to stop training and seek treatment. Generalised muscle soreness is common and not unusual after a run. You should stop running if you experience localised pain greater than 3/10 (mild to moderate), or if you notice your running gait changes to due to pain.
For novice runners, overuse usually means too much load (km’s) without allowing adequate time for recovery and adaptation. Overtraining occurs when the body is unable to adapt to the load applied during repeated training sessions. Experienced runners can suffer injuries as a result of training errors as well. As well as increased load, factors such as training frequency, intensity, speed, environment and equipment may cause tissue structures to be overloaded resulting in pain and injury.
Common injuries such as iliotibial band pain, patellofemoral pain and medial tibial stress syndrome (shin splints) have been linked with specific running biomechanics. For example, increased hip adduction, narrow step width, increased knee valgus and certain foot strike patterns may increase injury risk.
Equipment and Environmental Factors
Barefoot shoes have received a lot of attention in recent years as a more “natural” style of running. Unfortunately there is minimal evidence to back up this claim. Barefoot or minimalist shoes have been proposed to better distribute impact forces by shifting to a forefoot strike. Forefoot strike pattern may reduce load on the hip, knee and shin, but will consequently increase load to the calf, ankle and foot, increasing risk of injury to these areas. A prospective study published in 2016 aimed to address the question of whether barefoot runners experienced fewer injuries than their shod counterparts. The study found that the barefoot runners did experience statistically fewer overall musculoskeletal injuries than the shod runners, however, the barefoot runners ran on average just 24km/week compared to 41km/week in the shod group. Barefoot runners sustained a statistically greater number of injuries to the plantar surface of the foot and the calf, but a lower number of knee and hip injuries. Authors concluded that barefoot running is associated with fewer overall injuries per runner, but similar injury rates occurred in both groups. The injury rate was not statistically different between the barefoot runners and the shod runners due to a significant difference in kilometres run between the two groups.
Evidence backed ways to decrease running injury risk
- Following a training plan allows you to schedule the intensity of workouts allowing adequate time for recovery, avoiding excessive load and monitoring changes in volume over time.
- Monitoring perceived exertion, pace, heart rate and training zone helps to avoid over-training.
- Practicing running specific drills improves biomechanics and running economy. Supervised gait retraining and running specific drills reduce injury risk by as much as 60%.
- Complementing your running with targeted strength and proprioceptive training I can reduce overuse injuries by up to 50%.
It’s clear from the research that running-related injuries are multi-factorial in nature. Two things are certain though:
- Running-related injuries are incredibly common across all levels of runners; and
- There are proven ways to reduce the risk of sustaining a running-related injury.
For runners with a recent injury, or history of injury, a detailed running assessment that includes analysis of training load, biomechanics and equipment is a great way to understand, treat and prevent injury.
At Restore Function Physiotherapy we do specific running assessments using a treadmill and slow-motion video analysis to identify biomechanical risk factors.
Altman and Davis. Prospective comparison of running injuries between shod and barefoot runners. British Journal of Sports Medicine. 2016
Chan Z et al. Gait retraining lowers injury risk in novice distance runners: a randomised controlled trial. The American Journal of Sports Medicine. 2017
Lauersen JB et al. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine 2014; 48:871-877.
Oestergaard Nielsen et al. Training Errors and Running Related Injuries: A Systematic Review. The International Journal of Sports Physical Therapy; 7(1); 2012.