Runners Shouldn't Just Run!

Amy, based at Anna Barnsley Physiotherapy Richmond and Chelsea, explains how to get the max out of your training...

It's that time of year again... you may have noticed an increased percentage of the population pounding the pavements in order to cram in the miles before a long distance event such as the Virgin London Marathon. But did you know that during a 10 mile run, the feet make approximately 15,000 strikes at a force of 3-4 times the body's weight? There can be consequences of this repetitive force through the lower limb and therefore I wanted to talk about what to look out for in terms of overuse injuries and why runners shouldn't just run!

Nobody likes to hear terms like overuse or overtraining- infact, most athletes won’t entertain the word ‘overtraining’ as part of their vocabulary, since they have to train to the max to reach their goals. We recognise overtraining as doing too much of one thing, rather than approaching your training with a balanced method. Overtraining results in overload and overload causes injury. With a sensible schedule, you can become a running machine and avoid these pitfalls.

Unlike traumatic injuries, which occur from a fall, twist or impact, overload injuries come about due to the body being put under a repetitive force that it is either unable to cope with, or doesn't have enough time to recover from. This inability to cope is usually due to a biomechanical issue such as weakness or tightness in a particular area which means that another structure (commonly a tendon or bone) is put under excessive force and therefore becomes painful. Examples of these injuries include Plantar Fasciitis, Shin Splints, ITB Syndrome/Runner's Knee and Achilles Tendinopathy. For example a chain reaction can cause an overuse injury such as ITB (Ilio-Tibial Band) Syndrome; pain on the outer side of the knee where this connective band of tissue inserts. If you have poor activation/control of the stabilising muscles around the hip such as Gluteus Medius, overactivity can occur in TFL (tensor fascia lata) to compensate. Since this muscle feeds into the ITB, the ITB then becomes tight and problematic.

But don't fear, these injuries don't usually just suddenly happen, they come with warning signs in the form of niggles which are your body's way of telling you that there's something wrong and are an indication that there is a problem. These signs will differ from DOMS (delayed onset of muscle soreness) which is the diffuse muscle ache and stiffness which develops after an intense training session. Typically, these niggles develop gradually, in a fairly localised area, for example under the heel, after starting a new activity, or following an increase in the intensity of a current activity (such as increasing mileage).  Pain and stiffness is common first thing in the morning or following a period of rest and improves as you warm up. Be aware that there might not always be obvious evidence of inflammation. These injuries are far easier to treat in the earlier stages and unfortunately don' t 'just settle down' so continuing to run through pain will only exacerbate the problem. So that brings me on to my second point, why runners shouldn't just run...

Allowing time in between runs is vital to allow loaded structures to recover and repair so long, hard or hilly runs on several consecutive days is not advisable. Don't be afraid of having rest days, these are as important as running in an intense schedule! Remember there are other forms of cardiovascular exercise which can be used to improve or maintain fitness which can also give your body a rest from all that impact. Swimming or aqua jogging, cycling and rowing are all great ways of getting fit and allow structures that may be put under stress from running to be rested.

Taking time to stretch out, attend a yoga class and use the foam roller are also essential for a runner to prevent muscles and structures like the ITB from becoming tight and problematic. Having a regular sports massage is another great way of loosening up and targeting specific tight areas. Alongside stretching, ensuring that your stabilising muscles are strong enough is also really important. These muscles, e.g. Transversus Abdominus in the lower abdomen, Multifidus which supports each vertebral segment and the Gluteals, powerful buttock and hip muscles, support and sustain forces on a joint or area of your body to ensure correct alignment and control during a movement, while other more major muscles make the movement happen. No thanks to desk based jobs, a surprising percentage of the population have weak Gluteals and core muscles which are essential in maintaining correct lower limb alignment and therefore absorbing the impact of running. Specific strengthening exercises and classes like Pilates are an excellent companion to your running training programme to make sure your body is in tune and protected.

Other things you can do to prevent overload injuries include ensuring a good warm up and cool down which should include dynamic exercises specific to the activity and a good stretching routine. (See our previous blog on what happens when we stretch! http://www.annabarnsleyphysio.co.uk/blog/what-happens-when-we-stretch) appropriate footwear for your foot type and the terrain you are training on, and by increasing training no more than 10% a week (speed, distance etc).

Finally, consider having a body MOT to make sure that everything is in balance, alignment and firing correctly. A thorough assessment where your body’s mechanics and running style are analysed to give you an idea about what areas you need to focus on (in terms of strengthening, stretching and fitness) is a great way of identifying areas which could become a problem, giving you the opportunity to correct them before they stop you. I can provide this for you at either our Richmond or Chelsea clinic but if we're not conveniently located then we would be happy to help you find someone that is! 

Remember, there is so much more to running than just running to make sure that you cross that finish line with a smile on your face!