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Running Related Injuries

The fitness world seems to me to be in an odd place at the moment, with lots of heath “experts” – both local to me and internationally – feeling that you are either ‘Team Cardio’ or ‘Team Lifting/Team Weights’. I just don’t get that attitude. Each have their benefits, each have their risks.  Why should we discourage anyone from being active, particularly if that person has a love for something? Why do we feel the need for these “weights make you bulky” or “(running) damages your joints” attitudes? As I say, both cardio and resistance weights carry risks; what in life doesn’t? Certainly anything with something to gain from will incur a level of risk taking, but how risky is it really? In this blog I will focus on Running, which has got a fairly bad rap recently (from some rather dubious sources, I would add –

Running is in our genes. Around 2 million years ago, as the climate changed and forests receded revealing open savannahs, we human beings moved from a chimp-like movement to our present bipedal movement pattern, with an upright posture. We also at this time started eating more meat. This protein rich diet led to more developed brains, less hair and more sweat glands – the latter being the key here. Humans began to hunt animals using a method called persistence hunting; essentially, utilising the bodies ability to sweat, and maintain body temperature, we outran mammals as they lacked this ability (for example, in hot weather a dog pants to try to control its temperature, which is less effective than sweating). This could take hours and hours of – what we would nowadays call – endurance running. Fast forward to present day, and millions of people run not for survival, but for enjoyment. It is undeniably a healthy activity with positive effects on cardiovascular risk factors, alongside social and mental benefits. But there are risks. Running Related Injuries (RRIs) have a high occurrence rate. Figures vary, but it is thought that between 20-85% (reference 1) of runners will have an injury at some point.

When I see runners with injuries, niggles, aches/pains etc. I try and subdivide the risk factors of running into 3 categories;

Training; is this person training too frequent (overtraining)? too intense, too long? are they cross-training? are they training in the ‘right’ gear, on the ‘right’ surface, with the ‘correct’ technique? are they warming up/cooling down?

Anatomical; what foot type do they have? what range of motion do they have through their joints? how is the pelvis positioned?  do they have a leg length discrepancy (and is that important?)? gender, body type, age, Q Angle (angle between hip and knee)

Biomechanical; essentially how does all the above anatomical detail come together?

So can we predict – and more importantly can we really prevent – running injuries? First, we would have to unequivocally correlate the running and the injuries sustained. People (non runners, mostly) will often be heard saying that running is “bad for the knees/hips/ankles”, but as these studies show, the correlation between osteoarthritis and long distance runners is far, far, far from conclusive and in some cases running has been shown to decrease the risk of arthritis –

Long Distance Running and Knee Osteoarthritis A Prospective Study; (“In this analysis, long-distance running was not associated with accelerated incidence or severity of radiographic osteoarthritis”), 

Effects of Running and Walking on Osteoarthritic and Hip Replacement Risk; (… no evidence that running increases the risk of OA, including participation in marathon races, and, in fact, subjects that ran ≥1.8 METhr/d (≥12.4 km/wk) were at significantly lower risk for both OA and hip replacement”)

But to answer that question, I don’t think we can ever fully predict injuries, but I do think we can prevent (some) injuries. To do this we need to know what structures (muscles, joints etc.) are working efficiently, and which are not; those which can lead to imbalances, fatigue and, ultimately, injury. The path leads us to what we do on days when we are not running. Do you cross train? Do you stretch? Is stretching relevant to your needs? And – to bring this full circle – what strength and conditioning do you do?

The most common running injuries are essentially an imbalance between load and adaptation (see diagram)


Does this make running bad for us? Absolutely not. There are a multitude of ways to keep us running safely and pain free, we just need to look in the right places, do the right things, and most importantly, do them at the ‘right’ time.

Now, where are my trainers….


Reference 1. Incidence and determinants of lower extremity running injuries in long distance runners. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SMA, Koes BW.

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

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