Why prevention starts with personalization.
Most runners will experience a running injury each year, with research showing upwards of 80% of runners getting injured annually. The best way to treat running injuries is to prevent them! The problem is that there is not a one-size fits all solution.
Two runners with the exact same injury will have very different causes of the injury. Take 2 hypothetical runners both with shin splints. Runner A is a 28 year old male who has great mobility and strength but tends to run way too fast on his easy runs. Runner B is a 29 year old female who follows all of the recommended guidelines for training but has chronically tight ankles from recurring ankle sprains.
Both of these runners may have identical running injuries, but Runner A’s injury is from a training load error and Runner B’s injury is from a mobility limitation. If you find yourself asking what can you do to prevent running injuries, the answer is to start with personalization. Whether you are looking to treat or prevent running injuries, finding the underlying cause of the injury is the key to success.
Catz Run+ has created a systematic approach to assessing runners that has proven results amongst all levels of runners. In this article we are going to introduce the way and the knowledge, gait analysis tools, and tech that can be used to prevent running injuries and stay out of the Infinite Injury Loop many runners fall into.
The knee bone is connected to the…
Unfortunately, some of the best anatomy people are taught in school is the kindergarten song about the knee bone connecting to the hip bone. The truth behind that song is that the body part that commonly hurts can often be the one making up for another body part not doing its job. In other words, we cannot look at anything in isolation.
Let’s take that a step further. Most people can understand that a weak hip can contribute to knee pain. But why is the hip weak…or is it really even weakness? What if the hip flexors are tight and that is limiting the Gluteal muscles? What if the hip is overworked because of an insufficient core?
Yes, we have to look throughout the entire body to see how seemingly unrelated body parts can affect each other. We also have to consider the reason for the limitation. When you identify the true cause of running injuries, the results come quicker and last longer. We need to look at things like mobility, strength, and running form for each runner.
Running injury profile
Research shows that runners posses a series of risk factors and then participate in running to a certain extent that an injury threshold is met. Each runner has a unique profile that contributes to their risk for running injuries.
Where to start
The trick for injury prevention is finding the element of the running injury profile that will have the most benefit. The multifactorial nature of running injuries can be daunting when trying to figure out injury prevention, but if you know how to prioritize it becomes a lot simpler.
We are going to discuss each modifiable element of the running injury profile and how to quickly and efficiently figure out if this area will have the most positive impact on a runner’s injury risk. Runner A and Runner B from the example above have the exact same injury, but will need very different programs. Read on to learn how to design those personalized programs.
Movement capabilities
Runners should be athletes that run! This means that runners are not exempt from needing foundational strength, flexibility/mobility, and coordination required for any sport. Many runners think that because they are often running in one direction that they don’t need the same abilities as an athlete that will be jumping, cutting, and pivoting in all directions. While there is truth in the repetitive nature of running (which can contribute to the risk of overuse injuries), that doesn’t mean that their body is not resisting forces pulling it in every direction. Runners need strength and mobility in all planes of movement to perform their best and limit overuse injuries.
The question becomes, how do you determine what mobility, strength, and motor control a runner has or needs to focus on? RunDNA uses a movement screen called the Runner Readiness Assessment (RRA) [LInk to RRA Update Blog]that quickly identifies limitations in movement capabilities during the 6-8 min screen. The RRA looks at fundamental movements, strength/stability, and foot function to identify limitations related to the most common running injuries. If done in the RunDNA app, an algorithm will identify the most important limitation and assign a program[Link to app]. Runners can do a self-administered version [Link to Plan Builder] to help them add personalized strength training, a run training program, or a flexibility program customized to how they move.
Test yourself below to see how you do on the squat assessment (make sure you are healthy to do so!) that is one of 13 different movements that make up the RRA. You will see that the devil is in the details!
Runner readiness assessment: Test Your Movement Capability!
In general, we prioritize limitations in flexibility/mobility first. Having limitations in mobility is like driving with a parking brake on, you can get there but it will take a lot more energy and put a lot more stress on the body.
Strength training is key for injury prevention and performance, and has been shown to significantly improve running economy. Targeting specific running muscles from the RRA will help to maximize time in the weight room and focus on reducing running injuries. Using specific mobility and strength exercises for common running injuries like runner’s knee, plantar fasciitis, achilles tendinitis, and shin splints will help to significantly reduce pain and keep you on the road instead of in physical therapy.
Running form
While there is no perfect running form, there are lots of way NOT to run! Improper running form can place increased stress on the body. Unfortunately, much of the running research has failed to look at a personalized approach to running form and has focused on “one size fits all” solutions. Not every runner needs to have a cadence of 180 steps per minute or run on their forefoot.
Research showing deviations in running form that can contribute to running injuries. There are 5 categories of running form. Each of the categories has specific drills and gait retraining cues to help improve form and reduce stress on the body.
In a more detailed analysis of running categories, we’ve identified 12 categories that were developed as part of a military grant. The goal in analyzing a runner’s form is to give them 1 or 2 simple ways to improve their form. Research has shown that reducing the stress of each step by 10% while running can allow a runner to go twice as far before their body breaks down for common injuries like stress fractures. Running form goes a long way in injury prevention!
Check out the categories in the picture above. Which characteristic(s) do you see most commonly? Hint – there may be more than one but it is still important to focus on the category that will have the biggest impact.
The gold standard for analyzing running form is to use 3D technology to get a complete picture of the most accurate data. If you are using 2D techniques, you may be able to identify some characteristics like overstriding, but are limited in quantifying running form errors. Luckily, 3D is much more affordable for runners wanting to improve their technique, performance, and reduce the risk of injuries.
Training load
60% of running injuries are due to training load errors, which often means that a runner is running too far, too frequently, or too fast. If we are really looking to prevent running injuries, training load must be part of the conversation. Training load goes beyond weekly mileage and looks at all stresses on your body (from running or from anything else).
Training load should also look at what your body is chronically prepared for, not just what you did last week. (Sorry, the 10% rule is kinda crap!)We describe in detail a method that we use called Acute to Chronic Workload Ratio that has been shown across various sports to be useful in injury prevention.
This method uses a combination of session based rate of perceived exertion (sRPE) and duration to calculate what a runner has done in the short term versus long term.
No matter how you decide to track your training, the most important thing is that you are consistent so that you can monitor trends that exist around running injuries. Learn what things contribute or prevent injuries so that you can modify your training for the future.
A general rule to avoid overtraining is to gradually increase your duration of activities per week while considering how much training you have done in the past month. Roughly 80% of your runs should be at 4/10 or less of intensity, which means you should be able to say the pledge of allegiance without gasping for air. This is a very simplified version of training advice, but something still that few runners do!
Equipment and environment
Equipment
Running shoes are often what runners look to when it comes to injury prevention, but unfortunately there has been limited evidence to show that running shoes can prevent injuries. What we have found is that runners have very unique responses to different shoes and they should definitely get their form analyzed in different shoes to see which pair suits them best. It may not be the case that shoes can’t help with injury prevention, it may just be that runners are not getting the right shoes for their unique needs!
Our general rules when it comes to running shoes are:
- They should be comfortable
- They should be light weight
- They should not force a certain running form
Many running specialists would agree with the first 2 rules. Unfortunately, few people are considering the 3rd rule, which we feel may be the most important. Improper shoes have shown dramatic differences in running form using Helix 3D . Over time, this can have a big impact on injury prevention.
Environment
This may be a slightly counterintuitive point for running injury prevention, but softer surfaces may actually contribute to MORE injuries. I will preface this by saying that there are supported hypothesis of why this MAY be, but limited evidence to directly support it. (a challenging study to design).
The reason for this lies in a concept called stiffness. Think of stiffness as it relates to a spring. A spring with high stiffness does not move very far. A spring with low stiffness will go through more motion. When it comes to running and the human body, higher stiffness often means reduced ability to absorb the forces of running.
If someone runs on a soft surface (think track or grass), the body is able to immediately adjust their stiffness. This can lead to more stress on the joints instead of the muscles dynamically absorbing the forces.
The takeaway, softer surfaces may not always be best and we should acknowledge that changing surfaces will work the body in a different way that may contribute to injuries.
Well being
This is a pretty broad category that includes things like sleep, nutrition, mental health, etc. I could write long articles about each of these elements, but what I will say is that SLEEP is the number one performance enhancing activity any athlete can do and all of these elements of well being should be considered. A common message to my runners is that most people plan to increase their training but neglect to increase their recovery. The goal of any workout is for the body to adapt to the stress of the workout in a favorable way. Don’t skip out on the recovery, and realize that sometimes doing less may be more!
Time to start running
A lot goes into injury prevention, but few people can (or need to) address everything that goes into an injury profile. Small changes make a big difference IF those small changes are focused on the biggest priorities.
Proving that injury prevention works is extremely challenging, but we’ve have seen countless runners in my career from first timers to first place finishers reporting less injuries and way more enjoyments with running when they take the time to do the little things that matter most. It is worth the time invested. The best time to start is before the onset of even a slight pain…so get moving!
