In the mid-1970s, Runner's World Medical Editor George Sheehan, M.D., confirmed that he was hardly the only runner beset by injuries: a poll of the magazine's readers revealed that 60 per cent reported chronic problems. To describe himself and the rest of us, he quotes author Ralph Waldo Emerson: "There is a crack in everything God has made."
With all the amazing advancements in sports medicine, you'd think that our rates of injury would have dropped since then. But 30 years after running's first Big Boom, we continue to get hurt. A poll reveals that 66 per cent of runners suffered an injury in 2009.
Still, I figured medical science must have uncovered lots of little-known prevention secrets since then. After reviewing hundreds of published papers, I found few answers. The studies had conflicting results, making it difficult to draw conclusions. I learned, for example, that injuries can be caused by being female, being male, being old, being young, pronating too much, pronating too little, training too much and training too little.
So I went to Plan B: I interviewed the best running-injury experts in the world. Like the medical studies, the experts didn't always agree. But certain principles emerged. From these, I developed 10 laws of injury prevention. Abide by these, and you'll be more likely to enjoy a long and healthy running life.
1. Know Your Limits
It's easy to get injured; anyone can do it. Just run too much. "I firmly believe that every runner has an injury threshold," says physical therapist and biomechanist Irene Davis from the University of Delaware's Running Injury Clinic. "Your threshold could be at 10 miles a week, or 100, but once you exceed it, you get injured." Various studies have identified injury thresholds at 11, 25, and 40 miles per week. Your threshold is waiting for you to discover it.
Of course, your goal is to avoid injury. Stephen Pribut, sports podiatrist and author of Everything Running (£9.99, Adams Media), warns runners to beware the 'terrible toos' - doing too much, too soon, too fast. Every research paper and every expert agrees that this is the number one cause of self-inflicted running injuries. The body needs time to adapt from training changes and jumps in mileage or intensity. Muscles and joints need recovery time in order to handle more training demands. If you rush that process, you could break down rather than build up.
Running experts have recognised this problem, and long ago devised an easy-to-use 10 per cent rule: build your weekly training mileage by no more than 10 per cent per week. If you run 10 miles the first week, do just 11 miles the second week, 12 miles the third week, and so on.
Yet, there may be times when even a modest 10 per cent increase proves too much. Biomechanist Reed Ferber, an assistant professor in the faculty of kinesiology and head of the Running Injury Clinic at the University of Calgary, says that he sees a lot of newly injured runners during that third month of marathon training, when a 16-week programme pushes the mileage hard. Meanwhile, his clinic's nine-month marathon programme for first-timers increases mileage by just three per cent per week. "We have a 97 per cent success rate in getting people through the entire programme and to the marathon finish line," says Ferber.
Action Plan Be the tortoise, not the hare. Increase your weekly and monthly running totals gradually. Use the 10 per cent rule as a general guideline, but realise that it might be too aggressive for you - especially if you are injury prone. A five per cent or three per cent increase might be more appropriate.
In addition to following a hard day/easy day approach, or more likely a hard/easy/easy pattern, many top runners use a system where they scale back their weekly mileage by 20 to 40 per cent on a regular basis, maybe once a month. And remember that mileage isn't the only issue. Experts point out that an overly aggressive approach to hill running, intervals, trail running - indeed, any change in your training habits - can produce problems.
Keeping a detailed training log can help you gauge your personal training threshold. Record your weekly mileage and how you feel after your runs. Look for patterns. For instance, you may notice that your knees ache only when you're logging more than 40 miles a week.
Another major concern: you used to run 30 miles a week, you got injured, now you want to get back to your old routine as quickly as possible. Don't. Take your time. The same applies to that upcoming race - if you missed some training time, don't accelerate the pace and distance of your remaining workouts in an effort to 'catch up'. Instead, adjust your goals as needed.
2. Listen to Your Body
This is perhaps the oldest and most widely repeated advice for avoiding injuries, and still the best: if you don't run through pain, you can nip injuries in the bud. Most running injuries don't erupt from nowhere and blindside you. They produce signals - aches, soreness, persistent pain - but it's up to you to not dismiss them. "Runners can be crazy the way they'll run through pain," says Ferber. "They need to pay more attention to pain and get to the root of what's causing it."
Action Plan At the first sign of atypical pain (discomfort that worsens during a run or causes you to alter your gait), take three days off. Substitute light walking, pool running or cycling if you want.
On the fourth day, run half your normal easy-day amount at a much slower pace than usual. If you typically run four miles at nine minutes per mile, do just two miles at 11-minute pace. Success? Excellent. Reward yourself with another day off, and then run three miles at 10-minute pace.
If you're pain-free, continue easing back into your normal routine. If not, take another three days off, then repeat the process to see if it works the second time around. If not, you've got two obvious options: take more time off, and/or schedule an appointment with a sports medicine specialist.
3. Consider Shortening Your Stride
This comes as a bit of a surprise because it's not discussed much in running circles. Nonetheless, more than half the experts I interviewed mentioned it. And a December 2009 study reports that runners who shorten their stride by 10 per cent could reduce risk of tibial stress fracture by three to six per cent.
The basic idea: overstriding is a common mistake that can lead to decreased efficiency and increased injury risk. If you shorten your stride, you'll land 'softer' with each footfall, incurring lower impact forces. "A shorter stride will usually lower the impact force, which should reduce injuries," says biomechanist Alan Hreljac, a retired researcher from California State University Sacramento.
For the last decade, Davis has been researching runners' abilities to change their stride. Previously, experts believed that your stride was as immutable as your fingerprint, but Davis has used biofeedback equipment to disprove the old view. "We have shown that running and walking gait can be altered in such a way as to reduce pain, improve function, and reduce injury risk," she says.
Action Plan If you've had frequent running injuries, you might want to experiment running with your normal stride, just slightly shorter - about 10 per cent. "This will help reduce your stride so you have more turnover," says Davis. "The number of footstrikes or repetitions trumps having a longer stride because it reduces your impact load." Start with a short distance, like a quarter of a mile, when making this change. If you have an injury that's related to your gait, see a physical therapist.
4. Use Strength Training To Balance Your Body
You need something to keep your body properly aligned while you're running down the road at 200kg of crunching, twisting-in, and torquing-out force per stride - and what better than muscle? According to Ferber, it's particularly important to strengthen the hip muscles. He claims his clinic has cured 92 per cent of knee injuries with a hip regimen.
"Strengthening the hips is optimal for effective rehabilitation, as opposed to treating the area where the pain is located (e.g. your knee)," he says. "When you strengthen the hips - the abductors, adductors and gluteus maximus - you increase your leg stability all the way down to the ankle."
Action Plan You don't want to train for bulging muscles. You need just enough core, hip and lower-leg strength training to keep your pelvis and lower-extremity joints properly positioned.
"Healthy running should be as symmetrical and fluid as possible," says Michael Fredericson, associate professor of sports medicine at Stanford University School of Medicine. "If you don't have muscle balance, then you lose the symmetry, and that's when you start having problems."