Recreational running sees strong rates of participation in Australia. The benefits for general health are widely known and there is an increased number of organised events for runners to strive towards in their training. High rates of participation in recreational running mean we also see high rates of running related injuries. The common risk factors that contribute to running related injuries include previous injury, changes to training characteristics (frequency, intensity, and programming), less than three years of running experience, and footwear.
You may have experienced the frustration of getting to the final stages of your running/training program only to have injury prevent you from achieving your goal. This article attempts to provide some strategies to help reduce some of the risks associated with running related injuries. The most commonly diagnosed lower limb soft tissue injuries caused by distance running are iliotibial band syndrome, tibial stress syndrome, patellofemoral pain syndrome, Achilles tendinopathy, and plantar fasciitis. In order for our bodies to be better prepared and fit to run, we will discuss some strategies that may go a long way to prevent these injuries from occurring. Preventative strategies are most often multi factorial – as are many intervention strategies. In this article with will look at some of these preventative strategies including strength, biomechanics, and neuromuscular control, combined with training and load management.
Strength, neuromuscular control, and biomechanics
On average, if you are a recreational runner you are likely to have experienced an injury at some point in your running life. A therapist may have given you a diagnosis and prescribed strengthening exercises as part of your rehabilitation. The therapist may look at your movement patterns and biomechanics whilst performing functional activities and devise a treatment plan based on returning to full activity. Often this is where it ends, once the athlete has returned to running again it’s ‘job done’ – however, strengthening has an important role not only in rehabilitation but in preventing injuries occurring in the first instance. Programs should be performed on a weekly basis and target specific muscle groups which require strength, power, and endurance – not all programs require pushing heavy weights and increasing body mass.
Commonly running related injuries present to the clinic as athletes who have reduced body awareness (neuromuscular control), strength and altered biomechanics to meet the demands of long distance running. An individualised prevention program would likely incorporate combinations of strength and neuromuscular control. Not only is there evidence for these being good prevention strategies, but together they can also be beneficial in improving running efficiency and performance.
Evidence supports the use of strength training for middle and long-distance performance, mainly through improvements in running efficiency, maximal power, and maximal strength. Most often a strengthening program will first target the gluteal muscles in order to benefit pelvic stability. Other important target areas for muscular strengthening include gastrocnemius (calf), soleus, quad, and hamstring. Studies have, however, indicated that strengthening alone may not be adequate to have the desired benefit on running biomechanics. There is stronger evidence, however, that supports the use of strengthening in conjunction with neuromuscular control, showing significant improvements to movement efficiency. Neuromuscular control is referred to as the unconscious response of a muscle to a signal during dynamic joint stability. It incorporates many systems including muscle contraction, coordination, stabilisation, posture, and balance. It is your ability to control mechanically efficient movements of your hip, knee and ankle joint whilst performing dynamic tasks such as running. Therefore, good rehabilitation or prevention programs should incorporate neurodynamic training in conjunction with strengthening in order to get maximal improvements in running mechanics.
Running related injuries are most often related to the lower limb, however, we need to assess the entire biomechanical chain in order to help provide targeted prevention strategies. At the end of the chain, we have the first point of contact to the ground – the foot. As a runner, your only form of equipment required are shoes, and it is imperative that you have appropriate shoes for your individual foot mechanics – and has nothing to do with colour! It is recommended that you seek professional advice when looking for appropriate shoes to meet the demands of your running. In addition, some individuals may require orthotics to help provide further support or offload specific structures.
With improvements in your strength, neuromuscular control, and equipment, we can now look at running training and attempt to understand the concept of load, and how this can impact on injury risk.
Load management is an important risk factor for running injuries as the majority of injuries are associated with increasing training load or frequency too quickly, which puts increased demand on the body. If we don’t respect the balance between load and recovery it can lead to abnormal training responses, maladaptation of tissues and, therefore, an increased risk of injury. Your tissue requires time to remodel, recover and adapt following stimulation and load if we have not given sufficient time to between sessions it can create loading beyond the tissue’s capacity. These are referred to as overuse injuries which may include bone stress injuries, tendinopathy, and patellofemoral pain – all of which are commonly associated with running athletes.
Load management can be somewhat confusing as both low and high absolute loads can be associated with an increased risk of injury. Overall, athletes respond signiﬁcantly better to relatively small increases, rather than larger ﬂuctuations in loading. There is evidence for running related sports that if the load is monitored and applied in a progressive manner, relative to what the athlete is prepared for, that the athlete can adapt to withstand relatively higher loads. Converse to that, if an individual had a lay off from running (injury or other), therefore, reduced running load they need to have a graduated return to activity. It is considered that if an athlete’s training and playing load for a given week or session (acute load) significantly rises above what they have been doing on average over the past three to six weeks (chronic load), they are at greater risk of injury. It is important to consider that progressions and fluctuations in running must be prescribed on an individual basis, we will all adapt to different training stimulus in different ways and therefore requires flexibility and regular monitoring in order to maximise performance and minimise the risk of injury.
If we are going to have an impact on preventing running related injuries we need to consider each runner on an individual basis, however, the key concepts we have discussed are important preventative strategies for all runners. It is imperative with any preventative program that we incorporate strengthening in conjunction with neuromuscular control in the form of targeted functional exercises that are specific for the individual’s movement deficiencies. If we can improve the efficiency of movement whilst running and combine this with careful monitoring of fluctuations in running loads and appropriate equipment, we may go a long way to help reduce running related injuries.
Gabbett, T.J. “The training-injury prevention paradox: should athletes be training smarter and harder?” Br J Sports Med 2016; 0:1-9.
To learn more about Brendan Goonan visit http://www.opsmc.com.au/person/brendan-goonan/