Why Do Runners Get Injured?
Why do some runners get knee pain, and others calf, hip, or ankle pain? Some people get multiple areas of injuries, others none at all. Whats the deal? What determines what kind of injuries you get from running?
Running injuries are best explained by the concept of the 'Running Threshold'. There are specific risk factors that will make you more or less prone to certain injuries:
- Flexibility/ Range of Movement
- Kinematics/ Biomechanics
- Past Medical History
Flexibility - another modifiable factor. Some people naturally have more flexibility than others. What you do in your day to day life as well as in training will also impact your range of motion. If you stretch, roll, or perhaps are a yoga teacher - you likely will have more flexibility than someone who doesn't do all of those things.
Kinematics/Biomechanics - refers to how you move. When you are running, do you have appropriate amounts of movement at each joint in all three planes of movement - sagittal, frontal, transverse. Too much or too little movement at these joints when running over long distances can create problems of compensation and overload.
Structure is largely unchangeable (except for reconstructive surgery and other special exceptions). This is based on how your bones are put together .Feel free to blame your genetics for this one!
Training is an external factor and modifiable. How far you run, how often, on what surfaces, in what shoes, intensity, frequency - all of these factors fall under your training.
Past medical history can be anything from previous injuries that you've had - to a genetic disorder that changes your ability to move or build muscle ( for example). An injury is often referred to the umbrella term of a 'pathology' - it sounds scary, but really its just means something is abnormal. For example, if you have an achillies tendinopathy your body heals from these injuries by replacing damaged tissues with weaker collagen fibers than the original. Although you will have still healed from the original injury, that is going to be an area of weakness and risk if overloaded. Injuries often lead to a pathway of compensations that are hard to unravel if you don't know exactly what is going on.
Consider these 3 case scenarios to better understand an injury threshold.
Example of the Running Injury Threshold
Consider our fictitious runner - lets call her Sarah. Sarah has pretty good structure, which she thanks her parents for, her flexibility generally is OK (perhaps a bit of a tight calf now and again), she isn't very strong, had knee pain when she was in school and sprained an ankle once.
Scenario 1 - Sarah runs park run every Saturday morning with her friends, and she has 2 other runs she does during the week. Mileage is about 15 miles per week if she gets enough time, and she occasionally will do a few stretches after a run. Because Sarah isn't running very much, she has generally quite good structure and biomechanics, she doesn't ever surpass her injury threshold.
Scenarios 2 - Sarah has FINALLY been given a place at the London Marathon through the ballot draw (who, like most of us, enters every year). Naturally, she increases her training to running 30-40 miles a week, but doesn't change anything else. Surprise surprise, Sarah gets an injury. As you can see, her structure and injury history have stayed the same - that doesn't change. She also hasn't done anything to change her strength or flexibility, so they have stayed the same. But her training and kinematic risk factors have increased. Because Sarah has added more load and more forces to her body, she is having to work a lot harder and therefore inefficiently to maintain her running. As a result, her movement patterns have compensated. These two factors have sent her over her injury threshold and she has developed an injury.
Scenario 3 - Sarah is still training for the London Marathon, but she is now doing regular strengthening for her weaknesses, a bit more flexibility work, and she has tailored her training program to suit her recovery times. As you can see her weaknesses have improved and her kinematics have also improved. Sarah can now train how she wants to without going over the injury threshold.
So why do I keep getting the same injury?
Research tells us that there are certain things about your risk factors which will determine where excessive load goes. Keep in mind there IS NOT ONE single recipe for an injury (which would have made life so much easier) and there are an enormous number of injury combinations, we simply don't have enough space to tell you about them all here. But here are a few examples to give you an idea.
Knee pain ( Patello Femoral Pain Syndrome - or PFPS)
Risk factors (may) include:
Kinematics - Heel striking, over-striding, excessive hip or ankle collapse, cross over gait patterns, excessive anterior pelvic tilts.
Strength - weak hip abductors, reduced glute activation
Flexibility - tight quadriceps, hip flexors, calves
Training - excessive mileage, running on pavement
Structure - greater Quadricep Angle, anteverted or retroverted femurs
History - previous knee pain, ACL surgery, growth problems when younger, osteoarthritis
Ankle Pain - ex. Achillies Tendiopathy
Kinematics - forefoot striker, over striding, excessive inversion on foot strike, reduced dorsiflexion at midstance, reduced hip extension at toe off, increased ankle velocity etc.
Strength - weak ankle invertors, evertors,
Flexibility - reduced 1st MTP mobility, reduced calf mobility, tight hamstrings
Training - Changing how you run onto forefoot striking too quickly, lower drop in a shoe, unaccustomed to high intensity training, running on a track
Structure - Bunions, wide forefoot, leg length discrepancy
History - previous achillies tendinopathy, chronic ankle weakness, ankle sprain, sever's disease when younger.
What can you do about it?
First of all - recognise your risk factors. We aren't all going to be the same. Some of us are luckier than others and can get away with a lot more. Others have several risk factors and need to take better control of them to make sure they don't surpass their injury threshold. The sooner and more accurately you can determine this crucial information - the more optimised you can tailor to your needs. 3D gait analysis is one of the most accurate ways to find out your kinematics and your biomechanics. It's the missing piece to the puzzle that will help you to be a better, and faster runner.
Once you know where your weakness's are - improve them. Strengthen, foam roll, get enough recovery between training, modify everything within your power to improve upon. Then the world is your oyster.
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