A study in the Journal of Orthopedic Sports Physical Therapy did just this; they asked almost 100 recreational runners “what do you think is responsible for injuries in runners?”
Here were the responses...
- Not stretching
- Wearing the wrong shoes
- Not warming up
- Excess training
- Lack of strength
- Foot-type changes (too much pronation)
Which one of these would you have said?
It's always interesting to hear the perception of what matters in a sport such as running.
So what really does matter? (hint: it's not stretching or proper shoes)
One study in the Orthopedic Journal of Sports Medicine found the following characteristics to increase the risk of running-related injuries:
1) Body Mass Index > 30
2) Age between 45-60
3) Previous Injury
"Okay. So, from this study, you’re telling me if I have a high BMI, am between 45-65yrs old, and was previously injured, I’m more likely to get hurt? But I can't control my age or previous injuries!? "
You're right. Unfortunately, we can’t control our age or if we were previously injured...but, there is GOOD NEWS!
Despite age or whether or not you've previously been injured, research has also demonstrated ways to REDUCE the likelihood of becoming injured.
Here are the top 3 ways (other than lowering your BMI) to reduce running-related injuries:
#1 - Increase your step rate
By increasing your step rate by 10%, your stride length will ultimately DECREASE. What does this mean? A decreased stride length has been shown to reduce loading of the hip and knee and improve shock absorption at impact. While we can’t entirely change the amount of ground reaction forces when we run, we can definitely manipulate where these forces go! Knee injuries are common in runners, which makes sense if they run with a decreased step frequency and increased stride length (think slow and long strides). By simply increasing your step rate, you will decrease your stride length, and potentially influence the forces that may be causing repetitive stress injuries in your knee or hip.
A study in the journal Sports Health identified increasing step frequency by 10% for best results.
How do you do this? Count the number of steps you take in 60 seconds, then increase that number by 10%! A metronome works well here too.
#2 - Strength Training
If you’re a runner and you’re not strength training, please start.
No, really. Start right now.
PLEASE don’t think of strength training as “bulking up,” but rather think of strength training as a way to increase the resiliency of the tissues in your body (muscles, ligaments, tendons).
This makes sense if we look at the basic mechanism of how an injury occurs…
Injury occurs when a force to a tissue exceeds that tissues capacity to tolerate this force. For example, when you land from a jump, the ground reaction forces from landing are absorbed by the tissues in your legs (muscles, ligaments, etc). If the force is greater than you tissues capacity to absorb it (think jumping from a 3 story house and landing on your feet), then injury occurs. If your tissues are able to absorb that force from landing, no problem, you go on with your day. No injury.
So, what contributes to a tissues capacity to tolerate a force? It’s strength!
How do we increase strength? Strength training!
A stronger a muscle, the more force it can absorb before it’s injured! (Plus, don’t forget all the benefits in performance strength training can have i.e. increased power, endurance, etc.).
Need more reasons why it’s important to strength train? This study in the British Journal of Sports Medicine found that strength training decreased overuse injuries by almost HALF!
No excuses. If you’re a runner, you need to be strength training. Period.
#3 - Monitor Your Training Volume
I’ll keep this one short as I know if you're a runner, you've heard this many times before.
I will never tell a runner not to run, or a Crossfit-er not to Crossfit, if they come see me with an injury, but what I will request is more attention to recovery, rest days, and overall volume of training.
“But Doc, I do have rest and recovery days! I go for a slow run on those days!”
‘Recovery run’ is an oxymoron.
Running is a plyometric activity...meaning, there may be "better" alternatives for recovery.
I’m an advocate for at least one day per week of complete rest, but on those other days, why not do something a bit easier than a plyometric activity? (think yoga, mobility, etc.). Also keep in mind that it’s not ‘total mileage’ being a risk factor, but rather how quickly your total running mileage increases or 'spikes.'
Like most things in research, there are many variable to consider in each study used to "support" recommendations (novice vs. habitual runners, etc.). That being said, most runners will benefit from the above recommendations!
The key to managing running injuries isn’t getting massages or stretching all the time. Nor is it in buying the most expensive shoes on the market. It’s about loading the tissues in your body in a way that allows them to adapt and be more resilient, but also about managing this loading via running mechanics and training volume.