This article is Part 1 of a series on running injuries and how to prevent it. The series will deep-dive into the types of injuries and scientific solutions to address them.
Only the disciplined ones in life are free. If you are undisciplined, you are a slave to your moods and your passions – Eliud Kipchoge
When it comes to performing at optimum level in sports and life, it all boils down to desire, direction, dedication and discipline, but one more thing that differentiates a top runner from others is INJURY. Top performers dedicate themselves and avoid injuries. Throughout his career, Eliud Kipchoge has been extremely disciplined to his training and avoided injuries.
Now, the question arises that almost 70% of the runners are prone to injuries, ranging from minor to serious, some injuries only require rest and some require medical intervention. As per the study conducted by Dr James R White and Dr Joseph Ellis in 2013, of 10,754 runners, around 75% men and 80% women runners suffered at least one injury that was serious enough to halt their running temporarily and half of them needed to seek professional advice. Compared to other sports, running has high injury rate. But the running community is rapidly growing and many elite and recreational athletes are taking this up.
These recreational runners, mostly in their 30s or above, have either ran in school, colleges or had not run at all but due to the simplicity that running brings in, they think that anyone can run. Christopher McDougall’s Born to Run is an interesting book which talks about our innate quality of being a great runner and believed that humans as a species are born to run. But in reality the story is different and in my view as humans – we are not born to run, we get adapted to running. Just like we adapt to crawling, walking, or speaking while growing up. So all those who just started their running journey and never primed their body or adapted it for stress and strain which comes with running, have a higher chance of injuring themselves. We need to answer this adaptation process.
Running being a simple exercise, it is assumed anyone who walks can run, which remains true to just being a thought as running adaptation involves two phases of body getting adapted, one at the cardiovascular level and another one at musculoskeletal level. Now, the point to consider is both these adaptation of body happens at different rates. Generally, cardiovascular adaptation happens faster than musculoskeletal adaptation. That is the reason why a novice runner feels confident after doing 2km non-stop and goes on to run 2.5km or more and achieves higher distances over a period of time. There is a simultaneous adaptation going on at the musculoskeletal level. At some point, the musculoskeletal system is not able to sustain the increasing load on it and starts giving signals for rest and recovery to prevent injuries. Beyond this point, if the body is pushed further, it leads to injuries.
Understand this with an example, you cannot put a jet engine on a paper plane. Similarly, cardiovascular adaptation should match musculoskeletal adaptation equally.
Earlier running injuries were considered as overuse injuries, as the activity of running engages specific muscles repeatedly and therefore, continuous stress on those muscles leads to the injury. A large proportion of injuries happen due to overuse, but over the last two decades, studies conducted by scientists have enlightened us on the various factors that are equally responsible for injuries, like biomechanics, footwear, running gait or style, genetics and so on.
Addressing Running Injuries
With regards to running injury, most of the time the advice is to take rest and the injury will be taken care of, which is not true. RICE approach should be the first approach while dealing with any injury, yet it only treats the symptoms and doesn’t take care of the cause. I personally would prefer PRICE instead of RICE – which can be elaborated as below:
PRICE leads to protection of the injury site along with rest and using methods of icing, compression and elevation to reduce the swelling. As most symptoms are taken care of by PRICE approach, recreational athletes never delve deep into the causes and treatment of the injury.
Understanding Running Injuries
Running injuries can be categorized into acute or chronic; acute, where injuries are not debilitating and a runner continues running, albeit with pain and injury. It creates discomfort, but the runner can still go on. On the other hand, chronic injury is the pain and injury that prevents the runner from running, and he/she cannot continue running without an intervention.
The first step is to avoid progressing from an acute injury to a chronic injury stage. Also, a comprehensive approach should be taken to address the injury instead of addressing just the symptoms. The root cause needs to be identified and treated.
Moreover, there is anatomical and specific pathology involved in the injury as per the type and site, which needs to be treated. Women and men have different type of biomechanics and that leads to different types of loading in the body and different types of injuries.
A study conducted and published in The Journal of Sports Science and Medicine (2018) 18, 21-31, which consisted of 36 studies done on running injuries and involved prospective, retrospective and cross-sectional analysis showed that only 5,362 of the 13,182 runners availed medical intervention for their running injuries. It is noted that more than 70% of injuries occur below the knee level, of which, it affects 78% men and 75% of the women. Therefore, a strong strengthening program is needed to address and avoid these injuries.
Detailed chart of running injuries as per anatomy given below:
|Anatomical Running Injuries||Overall (%)||Men (%)||Women (%)|
(Area between Knees and Ankle)
|Hip and Thigh||14||15||18|
Top 10 injuries as per specific pathology is listed below:
|Top 10 Injuries||Total (%)|
|Patellofemoral Pain Syndrome||17|
|Achilles Tendon Injury||10|
|Medial Tibial Stress Syndrome||8|
|IT Band Syndrome||6|
- Most of the running injuries can be prevented or corrected with understanding, treating and at best avoiding them.
- Building cardiovascular and musculoskeletal systems go a long way to help us run longer and stronger.
- The good part is that most of the running injuries can be treated fully and very few are serious enough to disrupt your life or end your running career.
So, if you are listening to your body, its signs of fatigue, overuse and taking timely action to rectify them, you will outrun and outlast the runners who try to go all out.
Word Of Advice
One of my students asked: Sir, what is the best way to avoid injury?
My answer was simple: Don’t get them in the first place. Be intelligent, work on your body.