How do I stay injury free? I get asked this question almost daily from my patients. There is no perfect formula you can follow, unfortunately. Injury doesn’t discriminate; it’s an equal opportunist. The best predictor for future injury is your previous history of injury. As runners, the statistics are not in our favor. Between 50-75% of all runners will sustain a running related injury (RRI) every year [1-3]. Every year?! Yes, you read that correctly. There are a variety of reasons why injuries occur and reoccur. I wish there was some way to eliminate your chances of becoming part of this statistic. Well, I could say don’t run, but who am I kidding?! Runners gunna run! So with that being said, here are three important tips you can implement today to significantly decrease your risk of being sidelined:
Strength train 2-3x/week
Most runners just run. I, too, was guilty of this same approach until I developed Achilles tendonitis in PT school. Strength training is typically nonexistent until runners get injured and/or start working with a physical therapist. Strength training 2-3x/week is critical to decrease risk for injury and improve running efficiency [4,5]. Here’s why…Running is a repetitive activity. You’re primarily moving in one plane for an extended time and distance, placing wear-and-tear on the body in the same way over and over again. As your body becomes fatigued running form deteriorates, thus highlighting weak links in your kinetic chain and increasing excess strain on bones, joints and soft tissues. Those structures eventually sustain too much cumulative stress resulting in overuse injuries. Strength training of the deep core and hip complex helps combat these cumulative stresses by improving pelvic stability during single leg loading (note: running is a repetitive single leg loading activity) . This enables your body to accept the loads being placed on its system in a more balanced way, which in turn decreases localized stresses at a single joint by distributing them throughout the entire lower extremity. The larger the surface area that a stressor is being applied to, the better the body can accept and adapt to that stress without succumbing to injury. I advise my runners to start with 30-45min strength training sessions, working their way up to an hour. These sessions should incorporate exercises that strengthen the whole body while also focusing on running specific movements as well. If you’re unsure where to start, refer to my other blog post and consult with your local physical therapist, ideally one that works with runners, for more guidance.
Avoid running on consecutive days
Running is a high impact sport. Balancing running, cross-training, strengthening and rest days is critical for achieving optimal performance and decreasing your risk for injury. This doesn’t mean you can’t workout back-to-back days. However, it is important to avoid consecutive impact days since our bodies need more time to recover from those more strenuous workouts . If the body doesn’t get adequate recovery time, then the system begins to break down. You may not see or feel the effects right away since it is a cumulative process. However, I can promise you that overuse injuries will occur, and reoccur, unless you make adjustments to your training routine. Being sidelined for multiple months with Achilles tendonitis or plantar fasciitis or (fill in your RRI here) will not bode well for your mental and physical wellbeing. When runners can’t run, it’s not pretty, and I’m speaking from personal experience. It’s usually how most of us burn off the crazy! Remember what I said earlier, the best predictor for future injury is your previous history of injury. I encourage my runners to alternate their running days and perform cross-training and strength work (e.g. Pilates, yoga, cycling, swimming) on non-running days. I also highly recommend runners take at least one full rest day off per week for recovery. Yes, rest days are just as important as training days.
Be thoughtful about mileage increases
Ramping up your mileage too quickly is the perfect recipe for disaster. It’s almost always one of the top two reasons why runners become injured. And yes, I’ve been guilty of making this same mistake also. Research shows that increasing mileage too quickly without allowing adequate time for your body to adapt to that change results in overuse injuries (most notably Achilles tendinopathies, knee pain, shin splints, and plantar fasciitis) [8,9]. I typically recommend my runners increase their mileage by no more than 10% each week as long as they didn’t have any adverse effects with their previous week’s training load. That’s a very gradual increase and one that allows my runners to fine tune how many miles per week works well for their bodies. It’s important to note that every body adapts differently. There is no perfect formula for determining this information. It’s an art and a science. I work individually with my runners to determine appropriate mileage increases based on their training needs/goals, injury history, and how their body is feeling and responding during their workouts. The latter is especially important. Listen to your body, it knows best.
As I mentioned earlier, there is no perfect formula you can follow to stay injury free. However, you can significantly decrease your risk of developing a RRI by doing the following: strength train 2-3x/week, avoid running on consecutive days, and be thoughtful about mileage increases. Now you may be thinking, what about other important factors like my running shoes, using orthotics, or having my running mechanics analyzed by a physical therapist? Great questions. Yes, those are important factors to consider as well. Check out my post about running shoe essentials to learn more!
- Van Gent RM, Siem D, van Middlekoop M. van Os AG, Biermanzeinstra AMA, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007; 41:469-4807
- Taunton JE, Ryan MB, Clement DB, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002; 36:95-101
- Van Mechelen W. Running injuries. A review of the epidemiological literature. Sports Med. 1992; 14:320-335
- Støren Ø, Helgerud J, Støa EA, Hoff J. Maximal strength training improves running economy in distance runners.Med Sci Sports Exerc. 2008; 40(6):1087-92
- Barnes KR, McGuigan MR, Kilding AE. Lower Body Determinants of Running Economy in Male and Female Distance Runners. J Strength Cond Res. 2013 Oct 11
- Leetun, Darin T., et al. Core stability measures as risk factors for lower extremity injury in athletes. Medicine & Science in Sports & Exercise 36.6 (2004): 926-934
- Budgett R. Fatigue and underperformance in athletes: the overtraining syndrome. Br J Sports Med. 1998;32:107-110
- Knobloch K, Yoon U, Vogt PM. Acute and overuse injuries correlated with hours of training in master running athletes. Foot Ankle Int. 2008 Jul; 29(7):671-6
- van Gent, Bobbie RN, et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British journal of sports medicine (2007)
- Photo source: https://unsplash.com/photos/EYX2WaQ4OjI