Reducing Running Injuries



By Southampton Physiotherapist, Phil Coleman

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I have been a club runner for 35 years, competing on road, cross country and track.   I am a physiotherapist with a specialist interest in running and I have no injuries and my knees are perfect (thought I would get that one out of the way!)  I have contributed to magazine articles such as Why Cheetahs Don’t Stretch in Frontline and Power up Your Hamstrings in Athletics Weekly.

Running injuries are very common, but rarely serious, with up to 80% getting injured every year.  Running can be stressful on the body with impact forces of 2.5 times body weight with every step. This increases further with fast and downhill running.  The body takes time to adapt to this stress. New comers to running are more prone to injury than experienced runners.

Quite simply, most running injuries are caused by overloading the body’s tissue more than they can tolerate. Therefore, the strategy should be to minimise the loading and strengthen the body.  A warning sign that the body is being overloaded is stiffness and/or pain after running, especially the morning after. This needs to be respected.

Therefore a key tenet of avoiding injury is having the correct training plan.  Physiologists recommend 80% of running should be at easy pace, with the remainder for threshold or VO2 max pace. I see a lot of runners who do mainly “steady” running – hard enough to get injured but without maximising performance.

Running injuries can be divided into volume (too much running), loading (too much quick running) and range of movement (restricted movement).

Thus ITB syndrome tends to be a volume issue, Achilles tendinopathy loading and low back pain range. Some are a mix such as patellofemoral pain syndrome (PFPS, pain around the knee cap). Therefore training can be adapted accordingly.

Running injuries can have confusing titles such as “shin splints.”  This is not a diagnosis but an umbrella term. A good physiotherapist should be able to differentiate for correct diagnosis and treatment plan. The common form of shin splints is medial tibial stress syndrome (MTSS) but it could be a stress fracture (both loading injuries).

Common Running Myths

  • Running wears out your joints, especially the knees. How many times have I heard this! Actually, research tells us that runners tend to be less prone to osteoarthritis than non- runners.  It appears that runners develop stronger joints and thicker cartilage, and healthier spinal discs.
  • Stretching before and after running reduces the risk of stiffness/injury. Lots of research has been done on this subject but with little evidence to its efficacy. Stiffness is due to soft tissue damage hence the need for recovery between runs.  However, a warm up is recommended but this should be dynamic (running is dynamic) such as a lunge matrix, hopping and skipping.
  • There is a universal “right” shoe to wear. We are all different and have different preferences/needs. Comfort and fit are probably the most important factors.
  • Running on hard services increases the risk of injury. Again, research does not show a strong link, but it’s probably best to run on a variety of surfaces as this varies the loading pattern.

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