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Wednesday, June 18, 2008

How to prevent a running injury

The "Training Error:" The root of most injuries

In a recent post on the Comrades Marathon we posted on the shear dearth of training some runners race on. Incredibly there are runners out there who do hardly any training at all, and still run Comrades year in and year out. To be certain, they are not breaking any records, but yet they still finish withing the cut-off time and walk away with another medal to add to their collection.

Earlier this week we received a newsletter from the folks at Total Immersion, a swimming site. It was unremarkable except for the story of a runner who became a swimmer:

At 36, I was a self coached runner; I believed that if I kept running faster and farther on a regular basis I could eventually run a sub 4-hour marathon. I would run fast, recover from injury, run fast and recover from injury, in an increasingly fruitless cycle.
He actually went on to take up swimming before eventually returning to running, but this snippet illustrates the approach many runners take, and they of course experience the same results.

What is a training error?

A training error is what we use to describe any sudden change, mostly an increase, in training load that results in either acute or chronic injury. In more simple terms it is the "zero to hero" concept---a runner takes up running or returns from an injury or hiatus, guns blazing. . .and starts running right away and increasing intensity and volume each a day and week. This is all good and well, and in fact our athlete sees steady improvements for 4-8 weeks. They feel better all the time, and this reinforces to them that they must be doing something correct. Eventually, however, a running injury rears its ugly head. Be it shin splints, a strain, back pain, or something else, it becomes inevitable on this schedule, and soon our runner is again reduced to no running.

A training error can also be related to "out-racing" one's training. For example, we have often spoken to runners who train for a 3:30 marathon, but on the day get swept up and decide to run three-hour pace because they are feeling so good in the beginning. Of course they can do this for 20+ miles, but then fall into a crumpled heap on the side of the road with five km to go, battered and bruised and with a sure prescription to stop running for some weeks while they heal.

These are two examples of training errors, and it is our belief that the vast majority of running injuries are the result of a training error, and not because of biomechanical problems, shoe problems, leg length discrepancies, or any other static variable.

P.S. - Running is hard on your body

Many will agree that running is tough on your body. The impact can really wear you down, but the really amazing thing about our bodies is that we can adapt to these kinds of stresses. However we must allow our bodies sufficient time to make these adaptations, else something has to give and an injury is the result.

Therefore when consulting a novice runner who has just entered the Chicago Marathon, for example, the easy advice is not to race the event. Take it easy, build up your mileage progressively for the next 12-14 weeks, and then simply complete the distance at an easy pace. If you want to run hard(er), then you must give your body the time it needs to make all kinds of chronic adaptations on a number of different levels. This requires a strong commitment to running regularly for the next year, as the the time it takes to make all the necessary adaptations might be 12 or more months.

The problem is that many of us are impatient, and life can be unpredictable. We might have the time now to train for a fast marathon in October, but next year the circumstances might be different. It is a seemingly difficult decision, although if you place a high value on your ability to keep running for most of your life, then it should become much easier task.

Charity runners: classic zeros to heroes

These days running marathons for charity is big business, and of course it makes us feel good to support charitable or non-profit organizations. But these programs are fraught with problems as they often take previously sedentary individuals and "train them up" for a marathon with volunteer coaches who have little to no formal training. In fact at this year's annual meeting of the American College of Sports Medicine there was much discussion about injury rates among charity runners, and whether or not the rates are higher compared to more experienced runners. The saving grace for this population is that hardly any of them are racing, and instead most run just for completion. As a result they run/walk their way safely to five hour marathons.

Avoiding training errors

Perhaps the best way to reduce your risk of a training error is to consult a coach, either as a once off or regularly. Following what we refer to as "progressive overload" is crucial, and this means that you must increase the stress on your body in a very incremental manner so that it can always keep up with the stress(es) by making the necessary physiological and other adaptations. Generally speaking, weekly increases in volume should be 10% or less. This seems to be a rate with which most people can readily cope and avoid problems. Such a progressive approach does not necessarily appeal to our sense of urgency, but it is likely to keep you healthy and injury free!


11 Comments:

Derek said...

I would like to add that the 10% rule is a maximum, not a minimum.

It doesn't mean "I need to increase 10% each week".

For some people 10% is too much. Everyone needs to listen to their body, and learn how much is right for them.

Thanks gusy

The Sports Scientists said...

Hi Derek,

Thanks for the comment here.

Indeed, as we emphasized in the post, the increases in volume should be 10% or less. Of course it can be tricky to determine exactly what is right for each person, but our experience tells us that the 10% rule will apply to most athletes out there.

However when in doubt, one must err on the side of being too conservative, as the only consequence of under-training is that you do not stimulate adaptations. It will not increase your risk of injury. Increasing too quickly, though, can leave you hobbling around and very frustrated.

In the end you said it best: "Listen to your body!"

Thanks again for the comment.

Kind Regards,
Jonathan

vikram said...

Thanks for sharing this. While I cannot speak about every charity related training program, I definitely have experienced one of these programs - and can say that the training in the program I was a part off - was based very little on scientific knowledge. A couple of points which I later learned were not good ideas
1) from the third month of the program itself, we were doing two weekly tempo paced runs, one long run and one track workout. the mileage at T pace was far more than 20 % of the weekly mileage. My current understanding is that it is best that at least 80% of weekly mileage be Endurance paced.

2) For weeks, we used to be doing track workouts (primarily intended at VO2 max pace and anaerobic paces) with the notion that it will help improve our lactic acid tolerance. After reading the following page
http://home.hia.no/~stephens/interval.htm
I learned that anaerobic training need not be done more than 4-6 weeks prior to the event.

I'm glad to have learned more. A book which I would definitely recommend - written to explain the physiological adaptations of running, how to train is Daniels running formula . Excellent book.

That said - I had a question for you folks. Running is intense on the body and is likely to result in injury if one increases mileage dramatically. Is the same true of cycling and swimming. I've just started cycling (after about a 6 month winter break. Got in only about 3 weeks of drills during the winter) and have increased my weekly volume from about 3 hrs a week (for the first four weeks) to about 10-12 hrs a week (about 160-170 weekly miles including drills like 1 leg pedaling and fast pedaling), including a jump in long rides. I've done this for the past 3 weeks and am currently in the recovery week (drop volume to between 5-6 hrs mostly spinning). Is this a bad idea. Will this eventually catch up with me ? I don't intend to go more than 200 miles a week, but is it safe ? (I guess I'll come to know the coming weeks, but would definitely like to know.

What about swimming. I've heard that increasing volume in swimming is the safest bet - least likelihood for injury.

Great series of posts on the Comrades marathon.

Lastly, did I miss the final post on fatigue and pacing series ? Or is it still to be posted. I sort of lost it in the other posts.

Cheers.

vikram said...

Hi Jonathan and Ross, I had another question - not exactly related to running. Is it true that during exercises lasting longer than two hours - whether it be running or cycling or a combination, that the body tends to break down lean muscle ? What is the best approach to fueling yourself during exercises lasting longer than 2 hours. I've been following the information on

Hammer Nutrition
website. I'm not a big fan of supplementation but do know that without appropriate fueling, events longer than three hours become a drag towards the end.


Cheers.

GrĂ¡inne said...

Thank you so much for this. It has encouraged me to continue with my current course of action!
I was the typical novice runner you describe above...went from a bit of walking to running, loved it...and went at it with all my enthusiasm. Ran a half marathon 4 months after my first jog. And raced it. A week later got groin pain on a run. 10 sore weeks later an MRI showed a healing inferior pubic ramus (pelvic) stress fracture. Took 5 months off in total and went back. Thought I was going back slowly but wasn't really I suppose. Ended up with early metatarsal stress fracture a month in!

Soon afterwards was in Washington and met a great podiatrist (www.drpribut.com) who gave me a return to running schedule. It's very slow and gradual...much more so than I would have made for myself. But I'm following it religiously. It makes a difference when somebody gives it to you and instructs you to follow it! And my 18 min jog today felt wonderful after so long injured. I think I may have learnt my lesson. There's no rush to get the race times down or run a marathon fast in 4 months time. There are plenty of them. Better to put in the miles and build gradually to get there eventually than limp around not able to run at all! It's good to get the reminders though :-)

GrĂ¡inne

Ashish M said...

I strongly disagree with your assertion that "training errors" are the root of most injuries. It seems far more likely that injuries are are the direct result of incorrect technique.

Certainly, too much too soon will lead to problems, but if you're an overstriding heel-striker, the slowest mileage ramp up in the world will not prevent eventual shin, knee, ITB and/or back problems. (Trust me - I've been there.)

Gymnastics, tennis, yoga - for each of these physical activities, all agree that technique is key. Why would running be different?

So what is the proper technique for running? Well, let's just say that I run wearing the Puma H Street. Your mileage may vary.

vikram said...

interesting point Ashish. The only way to conclude what is the cause of most injuries is to look at a study of runners, look at their training regimen, technique, and injuries if any. That would probably provide a hint as to whether technique or over training is responsible for most injuries.

That said, what exactly is proper technique ? Is there one single technique which works for every runner ? (I mean I've heard of over pronators who have been running for years and continue to run. If there was "a" technique to run, then should they not keep getting themselves injured ?). So, is there "a" way to run ? Or do we think of technique only when there is an injury ?

Ross Tucker and Jonathan Dugas said...

Hi everyone

Thanks for the feedback and comments. To respond to each one (Derek's already been responded to):

Vikram:

I'd be cautious about playing by "rules" when it comes to training. There are guidelines, yes (the 10% thing is one such guideline), but they should never been seen as rules to live by. Because when you start trying to plan your training by slotting sessions in the "proper" place, it's like paint by numbers and the quality of the programme as a whole often suffers.

So the anaerobic thing, I disagree with, specifically because it depends on the event. A marathon runner can get away with it, a 10km runner almost has to do it. So you have to very specifically define the objectives in order to understand the "ingredients".

as for the question about the training for cycling and swimming, yes, absolutely. Any increase in volume makes a substantial difference to the body's recovery time, regardless of sport. Because of the impact, running tends to amplify that effect, but it certainly exists for cycling and swimming. Tendinosis is the most common problem, especially of the knee for cycling and the shoulders for swimming, because repetitive motion, fatigued muscles, and more motion adds up to a dangerous mix! So similar GUIDELINES must apply.

I have to stress what Jonathan mentioned in his reply to Derek, and what Derek himself said - "Listen to your body". If it says slow down, ease off, then failing to do so will, in 90% of cases, lead to injury, regardless of sport.

Finally, the fatigue series is still in play! I must apologize for the delay, but I've had a particularly busy period at work and that Fatigue series was just incredibly tough to write because of the sheer volume. But there's actually a great deal still to be said, and I will say it, in good time...I hope!

Oh, and then lastly, your suggestion for a post or two on nutrition is duly noted, and we'll tackle that in due course too. So many topics, so little time...!

Thanks again Vikram, always good to have your comments!

Grianne

Thanks for the story, I'm glad to hear you've made a good recovery after your previous injury. I think the key now is to slow your mind down, because it's always so difficult to hold yourself back after injury. Your mind remembers the feeling of pushing it and "racing", but the body has long since "forgotten", and the temptation is to follow your own mental expectation. So just hold yourself back, and make the most of injury-free running.

Also, I'll be doing a post later on how to remain injury free when increasing intensity.

Ashish

Unfortunately, I have to disagree - running technique has been packaged and "sold" to people as though it's the cure all and answer to all your problems, and it's not. Training is. I'd look at training, then training, then training, as the first 3 reasons why people get injured. Fourth would be inflexibility, fifth would be weaknesses in certain muscles, sixth would be training (because you've missed it if you didn't see it before), and seventh is technique.

There is ZERO evidence for technique as a means to prevent injury. None at all - the marketing hype around it has grown the perception that you have to run "the right way" and it's not true.

We did an entire series on technique though, and you can read all our insights there. You can find those posts on the top right of the page, in the tabs just beneath our title banner. I just don't believe that technique matters, unless you're an Olympic athlete trying to find an extra 0.5 seconds.

Ross

cassio598 said...

Ross, I'd like to respond to a couple of things if I may.

Regarding the training of VO2 Max for 10k athletes vs. marathoners, we really ought to be talking about the time duration of the event, shouldn't we? I mean, a 60 min 10k runner is running the same length of time as an elite half-marathoner. Shouldn't they both be focusing on lactate threshold first and VO2 max second, whereas a 30 min 10k runner should be more focused on VO2 max?

As for technique, I think you're probably right about things like Pose and Chi running, but what about someone who's bounding around and overreaching with a stride rate of 70 spm? Isn't that person at risk of hurting themselves? Wouldn't they reduce their risk of injury but shortening their stride and increasing the frequency to 80-90 spm?

Sean said...

Jonathan and Ross- nice work with the blog. Useful info...
I would offer that in my coaching experience, particularly with the recreational runner, one of the issues that lead to the typical soft tissue injuries experienced is that of the lack of 'tone' or balance between the eccentric and concentric muscle action in the major muscle groups required for running. T
his is also where I think the 'learning' curve for runners is much higher than other sports (swimming, cycling,etc) because to develop and maintain the appropriate 'suppleness' (in Lydiard's parlance) one must be consistent with their running (often not present in recreational runners) AND drills, strength exercises and some stretching.

I would enjoy your perspective on this and any research articles related.

robbyp123 said...

Training injuries can be very serious, as people try "too much too fast" and end up hurting themselves. A slow and steady progression over the course of 6-8 weeks is always the best option to take, as it prepares the body for a gradual increase in workload, and hence reducing the possibility of a sports injury.