The running injury equation

Whether you run for fitness, pure enjoyment or to satiate your competitive urges, the one thing you have in common with your fellow runners is the need to avoid getting injured. If you listen to running skeptics then injury is an inevitable consequence of running, not something that can be avoided. I believe things are not as grim as this. In this article I outline the usual suspected causes of running injuries and their relationship to running technique. Improving your running technique can help you avoid injury, especially in the longer term by reducing the risk of developing overuse running injuries.

As with most elements of running, the causes of injury are complex, can be varied and are often interrelated.  There is rarely an easy diagnosis or answer to what eventually stopped you running.  To give you a taste, the diagram below illustrates some commonly held reasons for getting injured.  What’s important to note is that the factors that you thought led to your injury may have only contributed to not caused the problem.  This is where the injury multiplier comes into play.

Running Injury Multiplier - Running Technique

All of these are reasonable contributory factors that might lead to the development of a running injury.  But there’s rarely a case where you could point at only one of these factors and say with confidence that this is what caused my injury.  Problems with running technique + change in training volume and intensity = overuse injury. This is probably the most common scenario that leads to injury.  At low volumes the body can survive and compensate for technical weaknesses in your running, but ramp up the training and you have a ticking bomb on your hands.  Overuse injuries of many types curtail the aspirations of thousands of would be runners.

However, the term overuse actually deserves closer examination – unless you’re approaching elite training volumes then your regular jogger or runner really shouldn’t start breaking down running 20-40 kilometers per week.  But the reality is many do with these nasty, hard to cure overuse injuries.  These injuries are likely to be the consequences of poor technique rather than signs of over training.  During the research to write my book Running Technique I found numerous studies containing compelling evidence of clear technical weaknesses in running that can be observed as directly contributing to many common running injuries.  So the injury equation might not be that hard to solve after all.

Running Injury Equation

In this category are injuries such as shin splints, MTSS, soleus syndrome, stress fractures of the shin, compartment syndrome, iliotibial band syndrome, planta fasciitis, knee pain, groin pain, pelvic & back stress fractures and achilles problems.  All seem to have their roots in readily explainable technical flaws in running.  It could more specifically be argued that many of these injuries have their genesis in misalignment and weakness about the hips.  That is, the thigh tracking out of alignment with the hip joint and being forced into unnatural ranges of motion because of lack of gluteal muscle activation and strength.  This puts strain through the hips, back and pelvis in addition to leading to twisting and torsion through the knees, lower legs and feet.

People often talk about core strength as being the key to avoiding injury, I agree core is important, but many runners think of core as only the deep abdominal muscles.  I prefer to focus on specific strength training of the buttocks, hamstrings and lower back.  This type of training also invariably hits the core abdominals and builds the specific strength and coordination needed to run with good technique.  Correct posture, muscle activation patterns and sufficient strength are all needed to run with the thighs and feet in proper alignment under the hips.

If you look at the body as a series of connected structures, bones, muscles and tendons it starts to get relatively easier to isolate what might have caused your running injuries.  If you know that certain muscles are designed to operate in a particular range or motion or that a bone has muscles attached to it that are capable of generating large forces, then these are the things to look to understand what might have gone wrong.

Running injuries caused by poor joint posture and incorrect range of motion

In summary, the regular factors discussed as causing injury do play a role, but it is often coupled with a technical weakness that multiplies the effect on your body.  Don’t ignore the warning signs of injury: constant pain, tightness or stiffness. This is asking for trouble, even if your regular massage keeps you on the road for a time, there’s an inevitable risk of injury.  The most important of the running technique tips I can give is to take the time to check your running mechanics.  Get your gait analyzed before you’re forced off the road and into the swimming pool.

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7 Responses to The running injury equation

  1. Sharla July 1, 2012 at 10:50 am #

    Hi

    I’m just wondering whether you advocate pool running for people who have had injuries and want to run without increasing volume too quickly as they return to training.

    I’ve looked into pool running a little but I’m not sure of whether or not it will help or hinder good running technique development.

    • Brian July 1, 2012 at 12:13 pm #

      Hi Sharla, Great question, there’s two schools of though on this. Some people advocate for pool running and would say yes it’s great, I’m not a huge fan of it myself, but in some circumstances it might be warranted i.e. if you’re trying to maintain/enhance fitness after all ready reaching a good standard. The main reason I don’t like it is that even if you try and mimic good running technique the resistance of the water is going to mean you use a slightly different collection of muscles. I think a swim or two per week is a better way to complement your running training, use it as enhanced recovery rather than primary fitness.

  2. Chris Southby April 12, 2012 at 11:50 am #

    Hi Brian
    I’m recovering from a piriformis injury caused by ignoring a niggle and running through the pain. Have seen a physio and have glute and hamstring strengthing exercises that are the same as the link to ones on this site.
    My question is about when to start running again. The pain is gone but there is still a little “niggle”, can I start doing a small amount of running, say a few laps around an oval or should I not run until the niggle has completely gone?
    Is running a small amount that doesn’t inflame the injury ok?

    cheers,

    Chris

    • Brian April 12, 2012 at 9:51 pm #

      G’day Chris, usually after the acute phase of an injury is over it’s ok to gradually start jogging again if the injury was not too serious: minute on minute off etc, however given you’ve still got pain perhaps you’re not quite ready yet? Did your physio give you some guidance about when to get started again? Be worth taking that advice on board and making sure that you’ve addressed the root cause of the injury with the strength work before doing too much running. Brian

      • Chris Southby April 13, 2012 at 10:16 am #

        Thanks Brian
        That’s what I was expecting, it’s damn hard not to try too running early.

        Chris

  3. Jimmy Holub November 26, 2011 at 8:52 am #

    Brian,
    There is one thing missing: Equipment.

    Sometimes people get the wrong type of SHOES and it screws up everything. Those with ITB issues typically should use Neutral shoes, NOT Stability shoes. Those with medial shin splints typically should use Stability shoes, NOT Neutral shoes. I have performed 1500 fittings for running shoes. I have seen these two particular situations play out over and over and over and over again. Customers come back very relieved and excited for their next pair of shoes.

    • Brian November 26, 2011 at 9:10 am #

      Hi Jimmy, I tend to agree that poor shoes can lead to issues, especially over cushioned and posted models, however, in my experience even fitting into correct shoes is usually not going to solve the injury problems of the runner. A combination of shoes, some strength work and in some cases gait retraining gets the best results. Brian