It is that time of the year again when us “Minnesotans” begin to slowly increase our outdoor activities as the warmer weather approaches. Whether you have been running all winter long or hoping to start a running program, injuries are a common occurrence. Some resources have reported that the annual injury rate for runners is as high as 66%. What can we do about this?
These tips are widespread in who they can help. We recommend these to folks who are dealing with chronic aches and pain related to running. Also, to those who are looking to begin a running program in hopes to prevent injury from occurring.
First, let’s debunk a myth.
Running is not “bad” for your knees or hips. As a recreational runner, or maybe semi-competitive (participate in 5K’s, half or even full marathons), the risk of knee or hip arthritis is LESS than that of a person who is sedentary.
What injuries are most common?
Injuries that occur most commonly are anterior knee pain, hamstring strains, lateral hip pain, medial tibial stress syndrome or “shin splints”, achilles tendinopathy, patellar tendinopathy, calf strains, and foot pain.
Why do these injuries happen?
The majority of injuries during running are due to overloaded tissues. What that means is the muscle or tendon has a specific capacity to the amount of stress or load it can take. When the tissue stress/load to tissue capacity ratio is too high for too long, the tissue can become painful (i.e. injured).
How can we measure and track running stress to decrease running injury?
Load can be measured and tracked using different methods: external and internal stress. External stress is the application of mechanical load such as volume (i.e. miles per week) and pace (i.e. 7 min/mile vs 9 min/mile). Internal stress is a physiological effort such as rate of perceived exertion (i.e. 0 to 10 scale, “how hard was that run?”) or heart rate.
It is important to track both or combine the two forms of external versus internal stress/load. For example, combining miles of a single run with the rate of perceived exertion (RPE). Real life example: 7 mile run that was a 7 on the RPE scale would have a total stress level of 49. It is important to vary these training sessions throughout a week such that 2 runs per week are more intense, higher number, and 2-3 runs per week are less intense, or a lower number. Tracking these metrics can help you monitor your training loads to keep you injury free.
Gear to Help Track These Metrics
Smart watches that track miles, heart rate, heart rate variability (essentially a recovery score for your body) are a great addition if you’re serious about tracking your health and injury status. We’ve had great experiences with the Apple Watch; Garmin series such as the Fenix, Forerunner, or Vivoactive; or Coros Pace or Apex series.
Other factors to include to prevent injuries while beginning or continuing a running program?
Strength and Plyometric Training
Every runner can benefit from a strengthening program performed 1-3 times a week at 30-60 minutes per session. Our favorite strengthening exercises for runners include lunges, squats, calf raises, and deadlifts. These exercises should be performed with heavier weights at 3-4 sets of 6-10 reps. Building strength in your legs will significantly reduce your risk of running related injury.
It is also important to add in plyometric training, or jump training, to help load the muscles and joints of the lower body to increase power. This power and loading helps prepare the muscles to tolerate miles of running. Running is essentially hundreds and hundreds of single leg jumps each session. Examples of plyometric exercises that we love include: box jumps, single leg box jumps, jump squats, and jumping rope.
Example of 4 week strength progression from PRO Therapy:
Online resources to get started with strength training before injury:
Core Performance Endurance by Mark Verstegen is a great resource with multiple weeks of programming to help improve your strength and plyometric training.
CLE Sports PT and Performance also has a great resource that is friendly to those runners who have not returned to the gym in the COVID-19 time period.
Utilize a Dynamic Warm Up
Warming up for any sport is important, it should be the same for running. We all know it is tempting to throw the shoes on and head out the door or hop on the treadmill, maybe start at a slow jog and then work into your pace.
However, dynamic warm ups are worth the time investment to improve running and muscle efficiency. It has been found that a plyometric dynamic warm up may improve total running distance, improve time to exhaustion, and improve leg stiffness during running (more on that below).
Example Dynamic Warm Up (~ 8 min):
2 Rounds (all performed with band)
Standing Hip Abduction x 10 each
Side Plank + Clamshell x 10 each
Standing March x 10 each
Strength and Plyometric
Reverse Lunge with Overhead Reach x 10 total
Heel Raise x 15
Squat Jumps x 15
Deadbug (Alternating) x 20
How Do I Fine Tune My Running Form?
A great start for this is to run lower and increase your cadence. In other words, “keep your body as low to the ground as possible without slouching to reduce bouncing when running.” Then, “increase the number of times your foot hits the ground by 10%.” Recent studies have found that the application of these two parameters can reduce the amount of force absorbed to your feet and legs while you run.
When increasing your cadence, a metronome app can be very beneficial to helping you stay on track with your training. During your run, utilize the metronome at the beginning for 1-2 minutes to find your cadence. Then turn off the metronome and restart it 3-4 times for 1-2 minutes at a time throughout your run. This way we’re training and then reminding the body of a new cadence throughout the training session. We recommend utilizing a step training app (Cadence Trainer is a great option for $2.99) or free metronome app to do this.
Wondering why running with the correct form is important? We’ve previously discussed foot strike importance and ways to modify that aspect of your running form. Reduced force at our joints = Reduced injury rate.
Load Management/10% Rule
Studies have shown that when we keep weekly running progressions around 10% our risk for injury significantly reduces. The 10% rule helps manage running volume and gives a recommendation on how to increase your mileage over weeks to months.
Here is what this means. Let’s say last week I ran 1 mile on Monday, 2 miles on Wednesday, and 1 mile on Friday for a total of 4 miles. This week I should only be progressing by 10% of those 4 miles (0.4 miles). I will have an extra 0.4 mile I can add somewhere into my training program. At the start of the spring when runners tend to start getting back outside, it’s important to keep in mind this rule and not overstep your body’s limits. For example, week 1 you run 5 miles and then week 2 you run 20 miles (300% increase).
This 10% rule can also be applied to the external/internal stress calculation that we talked about above.
The typical runner should replace their shoes when they are worn out (around 400-500 miles). The biggest wear in shoes comes in the first 100 miles. The research for footwear based on arch height and injury risk is inconclusive, meaning we don’t think it plays a large enough role to consider as a large factor when choosing footwear. Recent 2020 research states that wearing a shoe that prevents excessive pronation (ankle turning inward, see photo below) may help reduce foot/ankle related injuries. Custom foot orthotics can be an option to help prevent excessive pronation leading to injury of the foot/leg.
All in all, while the pronation limited shoe may be beneficial, the largest factor continues to be comfort. If a shoe is comfortable to you, continue to use it for your running and training purposes.
All this to say…
There are many aspects of being a runner that can contribute to running related injuries. Overall, running injuries tend to stem from a few variables: load management, running form, decreased use of strength training, lack of a proper warm up, and/or footwear. Injuries can come from one or a multitude of these variables which helps dictate our treatment plan.
Have more questions about running? Have you been dealing with pain while running that doesn’t seem to get better with rest, ice, stretching, etc.? Need help getting started with a running program? PRO Therapy is happy to meet in person or chat on the phone with one of our Doctors of Physical Therapy to help get you ready to run!