Runners are a unique breed. I am fortunate to treat many local runners. They are motivated, and they need to run to feel whole. Most runners are fairly predictable as well. Many will run the same pace, the same trails each week. Because of their predictability many runners will return to the office with some very common running injuries. Most of these common overuse running injuries are avoidable.
You have a race which is rapidly approaching. You are running harder and longer. Your training ramps up. With it will come the risk of developing one of many common overuse injuries. Many overuse running injuries should be perceived of as training errors.
With 4-6 weeks left to train for the NYC marathon is when I see the most severe forms of overuse injuries. “Catching Up” is a bad training concept. This post will start with some of the training issues which might contribute to developing running injuries. Further down in the post we will discuss the most common running injuries and how to avoid them.
Training Considerations/Risk Factors for Running Injuries:
- We see some of the most common injuries in the novice runners… novice runners become very excited at the thought of running the marathon and they put everything they have into training. Many do not even know about the 10% rule and go about training a bit too aggressively.
- The fastest, most successful distance runner in the world has no idea how fast she runs during training and does not train to a certain pace. She runs by how she feels. No watches, no apps… just her sneakers, her breathing and the road. As you know, your bodies ability to handle a certain run will vary day to day. Some days you have an easy time completing a training run, and some days you feel like a sloth and everything seems to ache.
- The 10% rule is quite simple. You do not increase your mileage, (cadence and/or speed) more that 10% per week in the months leading up to a race. There is a reason it takes most more than 4 months to prepare for most races more than 10k.
- Running requires strength and stability. Do your planks, strengthen your hips, thighs and posterior chain (hamstrings). This will diminish your risk of injury and make you a better runner.
- Cross training… yes, I know most runners hate it. But the science is clear. One bike ride/week will make you a better runner and possibly decrease your risk of injury.
- Follow the 80/20 rule. Most runners train too hard. 80% of your training runs should be at a conversational pace, or a heart rate that is below 75% of your maximum heart rate.
Foot Strike Pattern: The debate about where your foot should strike the ground rages on. Many favor mid-foot strikes to soften the blow, while some claim that low drop shoes and a heel strike with distribute the stresses more naturally. The literature is not firm on this, but as noted below … mid-foot strike might not be as soft of a landing as we once thought.
A slight forward lean, through the ankles will not only improve your pace. It has actually been shown to decrease the force of running and the pounding your knees take.
- low drop
- typical – heel elevated
- Bottom line .. Find the proper shoe for you. This post will help. Science shows that choosing the right shoe easier than you think.
- Take your recovery weeks seriously. Sleep is your number one recovery weapon. Respect your need to rest a day. Much of your training should be done in zones 1-3. Very little of our training should be performed in zone 4. This post covers how the intensity of your run is a more important variable then the pace your are trying to adhere to. Adhere to the 80/20 rule to minimize your risk of over-training, improper recovery and being prone to injury.
The most common running injuries are :
- Stress fractures
- Metatarsals (foot)
- Medial Tibial Stress Syndrome (Shin Splints)
- Achilles Tendinopathy
- ITB Friction Syndrome
- Runners Knee : Anterior knee pain syndrome
Stress fractures occur because you have exceeded the amount of force that your bone can take. The internal scaffolding of our bones actually becomes thicker when exposed to stress. If you follow the 10% rule, then your body will be able to manufacture new bone and repair any damaged bone before any problems set in. IF you try to push too hard, the scaffold inside the bone will begin to falter and break. That break will become larger and larger unless treatment is started, and the excess stress eliminated.
Most stress fractures can be managed with a change in your activities. Some stress fractures, particularly those around the hip require urgent attention and might require surgery.
Medial Tibial Stress Syndrome (MTSS)
There is so much written about medial tibial stress syndrome or MTSS, and much of it is wrong :-(
MTSS occurs due to the irritation of the attachment of one of your calf muscles (soleus) to the lower, inner portion of your tibia or shin. Similar to stress fractures in the bone, the tissue that attaches this muscle to the tibia will thicken and strenghten its attachment over time. The bone will also adapt in the same area. If you over achieve, you might stress the tissue or bone … and it can be VERY painful . Other factors can contribute, but they are very complex. Over-pronation might be more common in people with MTSS, but it does not appear to be causative. There is a lot of interest in impact reduction to diminish the risk of injury. Some “experts” favor a mid-foot strike, while other “experts” suggest the use of “low-drop” shoes. The jury is out, but some papers suggest that low drop shoes might be better and impact force reduction than a mid-foot strike.
Medial tibial stress syndrome will get better for most everyone — with rest. I know, you have a marathon to run, etc, etc… unfortunately you need to get over that :-( Many docs might give you orthotics, boots, etc… but the literature shows that rest is as good if not better than any other treatment for medial tibial stress syndrome. Here are exercises for those who suffer from medial tibial stress syndrome. Surgery for medial tibial stress syndrome is nearly never necessary.
The achilles tendon has brought down mythical warriors and many runners. This recent post goes into depth on diagnosis and management of achilles tendinopathy. Most of you who are suffering from achilles tendinopathy or achilles tendonitis are guilty of a training error. That means you might be training to hard, or too fast and your achilles tendon can function as a training barometer.
Stretching is generally beneficial for many. Static stretching and eccentric stretching are both useful, depending on how painful your achilles is when you start a recovery program. Unfortunately, achilles tendinosis can be a recalcitrant problem that keeps coming back. And sadly, PRP injections, etc are not beneficial in this area.
Ilio-Tibial Band Friction Syndrome
ITB Syndrome is a very common cause of pain on the outside of your knee. You will find it very tender to touch as well. ITB Syndrome is caused by the ITB tendon on the side of our leg popping over the side of our femur repetitively. Physical therapy, foam rolling, rest, NSAIDS, and perhaps an injection will usually nip this in the bud early. See the article in this blog for more in-depth information.
A runners knee is also referred to as anterior knee pain syndrome (AKPS). The term runners knee has been mis-used to describe anything that bothers a runners knee :-). However, it is a very common and distinct entity unto itself. It is characterized by pain in the front of the knee. It can be mild or severe. The actual cause is unknown. All patients with a runners knee have weak HIP musculature and poor pelvic and core stability… but that does not mean that weak hip muscles are the cause of AKPS. I go into far more depth on AKPS in this post and this post as well.
Most of you with a runners knee will respond very well to a program to improve your core stability (planks, etc), and a dedicated hip strengthening program hitting all the muscle groups.
Hats off and congrats to all of you who plan to run the NYC marathon this coming November. This will be a busy time in my Hawthorne office in Westchester County. Feel free to stop by… sooner rather than later if you feel you might be suffering from an overuse running injury or if you feel you are at risk for one.