You start training for your first marathon with full enthusiasm. After a month you feel some twinges in your knee, ankle or foot. You do some stretches, some colleague or veteran/ expert in your running group gives you some tips to recover from those aches and pains and you pop some pills to keep yourself running- this is a very common scenario. After a few runs maybe 50 or 100, you are back on your couch with an icepack on your knee. Even with the advancement of technology related to running shoes and researches related to form, running surface, muscle strength and biomechanics as many as 79% of runners take a break from running because of injuries.
There can be many reasons why runners get injured, we will discuss them one by one. Also, you will receive tips on how to avoid running injuries.
1. Poor running form or technique
Running for shorter distance is fairly easy you just lace up your shoes and walk at a fast pace. But when it comes to running long distances, things become complex. Proper running is all about good mechanics which in turn depends on flexibility as well as strength of the muscles, these help you to maintain a good posture. In simple words, better the form, easier it will feel while running and there will be fewer chances of injury. Running is not only about the lower body, but there is also a full-body involvement right from head to toe and you use the body machinery in a very efficient way. Having said that every body's mechanics is different here is what you can do to achieve a proper running form.
The most common mistake that people do that they run with their heads in front of the body. The ideal position is to keep your eyes on the horizon not down at your feet so that your ears are aligned with your shoulder.
As the run goes on it is common to have tight shoulders but hunched shoulders are a 'BIG' no while running. Shoulders should be pulled back and the shoulder-blades gently squeezed together. To get rid of stiffness you can consciously loosen your shoulders, shake your arms or you can shrug your shoulders for some time and then relax. This will save you a lot of energy while running.
Arms & hands
Your elbows should be bending at a 90 degrees angle and it should be closer to your torso, your hands relaxed as if you are holding a potato chip with your thumb and index finger. Also, arms should not cross the torso while running as that results in loss of momentum.
Core training / Torso
While running or doing any fitness activity the core works as an energy house, it forms a connection between the right and left side of your body and it also helps in using momentum to drive your body forward. Most commonly people bend their back due to a weak core or mobility issues and it results in loss of energy which is gained from ground reaction or momentum. So keeping your core engaged and your spine tall is the key to minimize the chances of injury to your back.
When you see an ideal running posture, the torso is always slightly forward than the lower body and this should be bought by hinging the hip rather than bending the back. This helps in using gluts muscle efficiently.
Knee & leg
The knee of landing foot should not cross your toes and it should always be in line with your second toe. Avoid overstriding or taking bigger steps.
Feet are the most important piece of this whole act. When you are landing always try to land on the ball of your feet, it does two things- one it disperses the ground reaction force and second, it helps in using that force to propel you forward. Landing on heel or toes can lead to injuries.
2. Bio-mechanical imbalances / Body asymmetries.
Biomechanical imbalances or asymmetries can be understood as the difference of strength and mobility between either side of the body or when compared with baseline normal. The human body is built asymmetrically and it is normal to have some asymmetries in our body as we use the left and right side of our body differently and over time there are strong differences between the left and right side.
During running, your body is pushed to its limits and small asymmetries are suddenly magnified. Muscle weaknesses that were never noticed during walking can now cause big problems and weak muscles can fatigue easily. As soon as a muscle is under fatigue, it stops working properly. This forces other muscles (muscles that shouldn’t be working) to step-up, take over and do more than they’re supposed to. That’s what eventually leads to injuries. Similarly, when there is less mobility around some joints it leads to either overuse of joints, muscle, and other soft tissue or it causes improper loading of these structures and over some time leads to their failure resulting in injury and pain.
Hence, the body is more prone to injury when it doesn't work in a co-ordinate way or body movement is asymmetrical. These asymmetries can be sometimes visible, e.g difference in limb length, knock knees or flat foot and sometimes may not be that appreciative e.g hip being slightly forward or increased curved around your low back.
To explain this further we will take a few examples of the pronated foot (foot is not flat but while standing on one leg arch of the foot collapses and becomes flat). Somebody who has pronated foot is more prone to injury in ankle, knee, back, neck & shoulder as shown in the image below
Similarly, somebody who has tight hip or weak buttock can compensate with their back by arching it and can cause back injuries like prolapsed disc/ slipped disc, spondylosis, back muscle spasm, piriformis syndrome, etc. Weak quadriceps muscle and tightness of Gluts ITB and calf can lead to several knee injuries like ITB or Iliotibial band pain syndrome, Patellofemoral pain syndrome or PFPS also known as runners knee, bursitis, degenerative meniscus injury and in some cases, it can lead to Osteoarthritis of the knee.
Stiffness in the mid back area can cause the head to move forward with torso putting increased load on neck and shoulder muscles and causing Shoulder pain, neck pain, and limited shoulder mobility. To correct these bio-mechanical imbalances first step is assessment, a runner has to undergo a movement screening with a physiotherapist, who will identify all the imbalances. Once the problem area is identified your Physiotherapist can prescribe exercises including specific muscle strengthening and stretching exercises.
3.Too much too soon.
Increasing distance/ speed or running for a longer time is another most common cause of injury in runners. Lets first understand how does your body adapts and gains strength after you run or exercise. When you run or train you break your body down through rigorous workouts thus forcing it to adapt, our body responds to this stress of increased activity when it is allowed to recover. Recovery time varies from person to person but usually, it takes 24 to 48 hours post-training where the body regains their strength and becomes stronger than before. But, without sufficient recovery, the body will not be able to adapt to the stresses of training and performance will not improve. Insufficient recovery leads to fatigue and can be detrimental to achieving training goals and may lead to injury.
5 signs of overtraining.
Low energy level: Running too much can lead to extreme fatigue and the body will feel lethargic and tired.
Muscles feel weak and sore: As your muscles don't recover they don't rebuild and it results in added fatigue. So, even if you are doing the exercise your muscle is getting weaker.
Disturbed sleep: Fatigue and imbalance in hormones in your body can lead to disturbed sleep.
Mood swings: Exhaustion, hormonal changes, and sleep disturbances can cause mood swings.
Decreased appetite or digestive issues: Exhaustion leads to digestive disturbances because of exhaustion, the body is trying to keep other systems running.
4.Weak knees & hips
Knee injuries are the most common while running. Injuries like PFPS ( Patellofemoral pain syndrome) or runner's knee, ITB pain syndrome, Chondromalacia patella, Anterior cruciate ligament, and meniscus injuries are the most common ones.
Weakness around knee and hip can be the reason for these injuries. When you don't train properly you may develop weakness in your gluteus medius, gluteus maximus, and imbalance around thigh muscles. One part of the quadriceps called VMO also goes for weakness. This may be caused by an injury, but often it happens for no apparent reason. It is thought that tightness in your hip flexor muscles in the front of your hip may lead to weakness in your gluteus medius muscles in the back and side of your hip. This is called as dormant butt syndrome or Gluteal amnesia.
When these muscles become weak, it abnormally allows your thigh to rotate and pull inwards. This abnormal position of your thigh puts excessive stress and strain around your knee joint and kneecap (patella). The collapse of this kinetic chain (chain of muscles which function in synchrony to bring movement) can also lead to anterior cruciate ligament (ACL) injury. When athletes run or jump, their knee collapses (possibly due to weak glutes & other imbalances), and the knee-buckling causes tearing of the ACL.
Movement screening is a thorough evaluation and assessment of your walking, running, lower extremity strength (including knee and hip strength), flexibility, and range of motion. Movement screening helps your physical therapist to provide the proper strength training program targeting specific hip and knee muscles, which further help in treating as well as preventing injuries.
5. Running on hard and uneven surfaces.
Which surface is best for running? This is another most common question from runners. Choosing a running surface can depend on the individual as some runners love trails, some like grip of roads and some like running on grass. But as a rule, runners need to vary their running surfaces as this helps in improving strength and balance and further helps in avoiding injuries.
Every running surface has its pros and cons. Like running on the road gives you a lot of consistency and uniformity but as it is hard it jolts the joints because of ground reaction forces. Similarly, the ground reaction force on concrete is harder than running on the road. The grass is softer on the joints but it doesn't provide stability. Your foot and knee can turn inwards putting more load on muscles and joints. Same as grass, trail or wood chip surface put less impact on the joints but running on an uneven surface can lead to injuries.
Science says during running, the brain is constantly trying to judge the hardness of the surface—using data from previous running experience and stride—and 'tunes' how strongly the leg muscles will contract before the foot landing. So when the trail gets softer, muscles in the legs get stiffer, and the net impact on the lower body is approximately the same. It’s how well the body maintains the overall stiffness of the surface/shoe/leg combination and it’s the reason why running on softer surfaces doesn’t necessarily result in a lower rate of injury. The overall impact on the leg remains virtually the same whether running on trails, a beach or concrete.
But there is a catch- We know how the body adjusts to different surfaces in the short term, but what we don’t know are the long term consequences of running on a particular surface.
So running on different surfaces is the key to avoid running-related injuries. Runners need to vary their routes to avoid doing too much uphill or downhill running and this needs to be balanced with some flat runs. In addition, do strength training to help your body take on the challenges and demands of various terrains.
6.Misfit/wrong running shoes
Shoes are the most important piece of equipment for runners. A good shoe can reduce the risk of injury as they alter the repetitive forces applied to the body. If you wear a shoe which matches your foot type and feels comfortable will put less strain on joints and muscle, minimizing wear and tear due to repetitive movement.
Flat-footed runners (and pronators) should buy stability shoes or motion control shoes with support. Those with high arches (or supinators) and heavy runners should use shoes with good cushioning and arch support. Others can buy neutral shoes.
There is no conclusive evidence that minimalistic shoes prevent injuries. Like any other shoe it can fit people with leaner built but can be a misfit for heavier individuals.
Insoles can work if you have a pronated or flat foot. Customized insoles work better than over the counter ones. We at Synchrony can help you in finding the shoe that is best for you and suits foot shape and biomechanics. If we do that, we can minimize the role of a shoe causing injury. Physiotherapist/ orthotist will ask about your training, look for wear patterns on your old shoes, examine and measure your bare feet, and watch you run in a few pairs and do the screening of your movements, accordingly they will recommend you the best shoe for your feet.
It is recommended that you replace running shoes, after every 1000 - 2000 KM depending on your running style, body weight, and the surface on which you run.