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10 Tips to Extend Your Running Life
By Amby Burfoot
Runner's World
In the mid-1970s, Runner's World
medical editor George Sheehan, M.D., confirmed that he was
hardly the only runner beset by injuries: A poll of the
magazine's readers revealed that 60 percent reported chronic
problems. "One person in 100 is a motor genius," who doesn't
have injuries, concluded the often-sidelined Sheehan.
To describe himself and the rest of us, he
turned to Ralph Waldo Emerson: "There is a crack in
everything God has made." With all the amazing advancements
in sports medicine, you'd think that our rates of
shinsplints and stress fractures would have dropped since
Sheehan's era. But 30 years after running's first Big Boom,
we continue to get hurt. A recent runnersworld.com poll
revealed that 66 percent of respondents had suffered an
injury in 2009.
Still, I figured medical science must have
uncovered lots of little-known prevention secrets. So I went
searching for them. After reviewing hundreds of published
papers, I was surprised to find few answers. Most of the
studies are retrospective, looking back. A few are
prospective, looking forward. Even then, they're not the
gold standard, which are randomized, controlled, double
blind experiments. And conflicting results make it difficult
to draw meaningful conclusions.
I learned, for example, that running
injuries can be caused by being female, being male, being
old, being young, pronating too much, pronating too little,
training too much, and training too little. Studies also
indicate that the "wet test" doesn't help shoe selection,
old shoes don't offer less cushioning than newer shoes, and
leg-length discrepancies don't cause injuries (but
too-little sleep does). Oh, here's good news: To get rid of
blisters, you should drink less and smoke more.
Clearly, the medical studies wouldn't
offer much help. So I switched to Plan B: I interviewed
nearly a dozen of the best running-injury experts in the
world. They come from the fields of biomechanics, sports
podiatry, and physical therapy. Like the medical studies,
these experts didn't always agree. But the more I talked
with them, the more certain principles began to emerge. From
these, I developed the following 10 laws of injury
prevention. I can't guarantee that these rules will prevent
you from ever getting hurt. But if you incorporate these
guidelines into your training, I'm confident you'll be more
likely to enjoy a long and healthy running life.
I. Know Your Limits
It's easy to get injured; anyone can do it.
Just run too much. "I firmly believe that every runner has
an injury threshold," says physical therapist and
biomechanist Irene Davis, Ph.D., from the University of
Delaware's Running Injury Clinic. "Your threshold could be
at 10 miles a week, or 100, but once you exceed it, you get
injured." Various studies have identified injury-thresholds
at 11, 25, and 40 miles per week. Your threshold is waiting
for you to discover it.
Of course, your goal is to avoid injury. Runner and sports
podiatrist Stephen Pribut, D.P.M., warns runners to beware
the "terrible toos" — doing too much, too soon, too fast.
Every research paper and every expert agrees that this —
"training errors" — is the number one cause of
self-inflicted running injuries. The body needs time to
adapt from training changes and jumps in mileage or
intensity. Muscles and joints need recovery time so they can
recover and handle more training demands. If you rush that
process, you could break down rather than build up.
Running experts have recognized this problem, and long ago
devised an easy-to-use 10-percent rule: Build your weekly
training mileage by no more than 10 percent per week. If you
run 10 miles the first week, do just 11 miles the second
week, 12 miles the third week, and so on.
Yet, there may be times when even a modest 10 percent
increase proves too much. Biomechanist Reed Ferber, Ph.D.,
an assistant professor in the faculty of kinesiology and
head of the Running Injury Clinic at the University of
Calgary says that he sees a lot of newly injured runners
during that third month of marathon training, when a popular
16-week Canadian program pushes the mileage hard. Meanwhile,
his clinic's nine-month marathon program for first-timers
increases mileage by just three percent per week. "We have a
97 percent success rate getting people through the entire
program and to the marathon finish line," Ferber says.
ACTION PLAN
Be the Tortoise, not the Hare. Increase your weekly and
monthly running totals gradually. Use the 10-percent rule as
a general guideline, but realize that it might be too
aggressive for you — especially if you are injury-prone. A
five-percent or three-percent increase might be more
appropriate. In addition to following a hard-day/easy-day
approach, or more likely a hard/easy/easy pattern, many top
runners use a system where they scale back their weekly
mileage by 20 to 40 percent on a regular basis, maybe once a
month. And remember that mileage isn't the only issue.
Experts point out that an overly aggressive approach to hill
running, intervals, trail running — indeed, any change in
your training habits — can produce problems. Keeping a
detailed training log can help you gauge your personal
training threshold. Record your weekly mileage and how you
feel after your runs. Look for patterns. For instance, you
may notice that your knees ache only when you're logging
more than 40 miles a week.
Another major bugaboo: You used to run 30 miles a week, you
got injured, now you want to get back to your old routine as
quickly as possible. Don't. Take your time. The same applies
to that upcoming race — if you missed some training time,
don't accelerate the pace and distance of your remaining
workouts in an effort to "catch up." Instead, adjust your
goals as needed.
II. Listen to Your Body
This is perhaps the oldest and most-widely-repeated advice
for avoiding injuries, and still the best: If you don't run
through pain, you can nip injuries in the bud. Most running
injuries don't erupt from nowhere and blindside you. They
produce signals — aches, soreness, persistent pain — but
it's up to you to not dismiss them and take appropriate (in)action.
"Runners can be crazy the way they'll run through pain,"
Ferber says. "They need to pay more attention to pain and
get to the root of what's causing it."
ACTION PLAN
At the first sign of an atypical pain (discomfort that
worsens during a run or causes you to alter your gait), take
three days off. Substitute light walking, water training, or
bicycling if you want. On the fourth day, run half your
normal easy-day amount at a much slower pace than usual. If
you typically run four miles at nine minutes per mile, do
just two miles at 11-minute pace. Success? Excellent. Reward
yourself with another day off, and then run three miles at
10-minute pace. If you're pain-free, continue easing back
into your normal routine. If not, take another three days
off, then repeat the process to see if it works the second
time around. If not, you've got two obvious options: Take
more time off, and/or schedule an appointment with a
sports-medicine specialist.
III. Consider Shortening Your Stride
This comes as a bit of a surprise because
it's not discussed much in running circles. Nonetheless,
more than half the experts I interviewed mentioned it. And a
December 2009 study reports that runners who shorten their
stride by 10 percent could reduce risk of tibial stress
fracture by three to six percent. The basic idea:
Overstriding is a common mistake that can lead to decreased
efficiency and increased injury risk. If you shorten your
stride, you'll land "softer" with each footfall, incurring
lower impact forces. "A shorter stride will usually lower
the impact force, which should reduce injuries," says
biomechanist Alan Hreljac, Ph.D., a retired researcher from
California State University-Sacramento.
For the last decade, Davis has been researching runners'
abilities to change their stride. Previously, experts
believed that your stride was as immutable as your
fingerprint, but Davis has used biofeedback equipment to
disprove the old view. "We have shown that running and
walking gait can be altered in such a way as to reduce pain,
improve function, and reduce injury risk," she says.
7 Mental tricks that add miles to your run.
ACTION PLAN
If you've had frequent running injuries, you might want to
experiment running with your normal stride, just slightly
shorter — about 10 percent. "This will help reduce your
stride so you have more turnover," Davis says. "The number
of footstrikes or repetitions trumps having a longer stride
because it reduces your impact load." Start with a short
distance, like a quarter mile, when making this change. If
you have an injury that's related to your gait, see a
physical therapist.
IV. Use Strength Training To Balance Your Body
You need something — and what better than
muscle? — to keep your body properly aligned while you're
running down the road at 450 pounds of crunching,
twisting-in, and torquing-out force per stride. According to
Ferber, it's particularly important to strengthen the hip
muscles. He claims his clinic has cured 92 percent of knee
injuries with a hip regimen. "Strengthening the hips is
optimal for effective rehabilitation, as opposed to treating
the area where the pain is located (e.g., your knee)," he
says. "When you strengthen the hips — the abductors,
adductors, and gluteus maximus — you increase your leg
stability all the way down to the ankle."
ACTION PLAN
You don't want to train for bulging muscles. You need just
enough core, hip, and lower-leg strength training to keep
your pelvis and lower-extremity joints properly positioned.
"Healthy running should be as symmetrical and fluid as
possible," says Michael Fredericson, M.D., associate
professor of sports medicine at Stanford University School
of Medicine. "If you don't have muscle balance, then you
lose the symmetry, and that's when you start having
problems." For a strength-training routine, visit
runnersworld.com/injuries.
V. RICE Works
When you've got muscle aches or joint
pains, there's nothing better than rest, ice, compression,
and elevation for immediate treatment. These measures can
relieve pain, reduce swelling, and protect damaged tissues,
all of which speed healing. The only problem with RICE is
that too many runners focus on the "I" while ignoring the "RCE."
Ice reduces inflammation, but to ice-and-run, ice-and-run,
without giving the tissues enough time to heal, is a little
like dieting every day until 6 p.m. and then pigging out.
And so Bruce Wilk, an orthopedic rehabilitation specialist
in Miami, has added another letter to the acronym, spelling
out PRICE. The P stands for "protection," which means don't
run until the injury is better.
ACTION PLAN
RICE is most effective when done immediately following an
injury. If you twist your ankle or strain your hamstring,
plan to take a few days off from running (see Law II). Apply
ice — for 10 to 15 minutes at a time, several times a day. A
homemade ice pack — a baggie filled with ice cubes and water
— is best. A bag of frozen vegetables is also effective. If
you can, elevate the area (easy for foot and ankle injuries,
not so much for hip or hamstring issues) to limit swelling.
Compression can also further reduce inflammation and can
provide pain relief, especially when you first return to
running. An ACE bandage is the simplest way to wrap a
swollen area, but Amol Saxena, a sports podiatrist in Palo
Alto, California, uses a compression dressing with 3M Coban,
a self-adherent over-the-counter product. He then uses
Kinesio Tex Tape or a Darco Body Armor Walker for when the
swelling goes down. "The tape pulls up the skin slightly,
allowing more blood to flow to the injured area," he says.
He teaches runners, including 2008 Olympic bronze medalist
Shalane Flanagan, how to put it on themselves.
VI. Run on a Level Surface
Here's another factor that could have a
significant impact on running injuries, but has been rarely
studied: road camber. No doubt you always run on the left
side of the road facing traffic. That's good for safety
reasons. But it also gives you a functional leg-length
discrepancy, since your left foot hits the road lower on the
slope than your right foot. You're also placing your left
foot on a slant that tends to limit healthy pronation, and
your right foot in a position that encourages overpronation.
And you're doing this — running in an unbalanced way — 160
to 180 strides a minute for mile after mile, day after day,
week after week. Clint Verran, a physical therapist in Lake
Orion, Michigan, sees the results of this cambered running
in his clinic, where he treats a higher incidence of
left-hip injuries in runners than right-hip injuries.
Follow these expert tips and rules for safer road running.
ACTION PLAN
True, it's not easy to escape cambered asphalt. And safety
concerns demand that you run on the left side of the road.
So now you've already got two strikes against you. To avoid
strike three, remember that road camber can cause problems.
If you're increasing your mileage, feel an injury coming on,
or are returning from injury, try to do some of your
training runs on a level surface like a bike path or dirt
trail. The local track also provides a firm, essentially
flat surface that's great for slow-paced running. (When you
do faster interval training on a track, you put unequal
torque on your feet and legs due to the need to keep turning
left, so be careful if you are injury prone.) Also consider
the treadmill. It's hard to imagine a better surface for
balanced running. At the very least, a treadmill provides a
great surface for beginning runners, runners who are
recovering from an injury, and perhaps even marathoners
aiming to increase mileage without increasing their injury
risk.
VII. Don't Race Or Do Speedwork Too Often
Researchers have found a correlation between
injuries and frequent race efforts. This connection might
extend to speedwork since intervals also require a
near-maximal effort. So if you train fast once or twice a
week and then race on the weekend, that's a lot of hard
efforts without sufficient rest, particularly if you follow
this pattern week after week. Some experts are cautious
about recommending regular speed training for certain
runners, especially those who get hurt easily. It's fine for
those chasing podium placements or age-group awards. But for
mid-and back-of-the-packers? "You might get five percent
faster, but your injury risk could climb by 25 percent,"
Verran says. "That's a bad risk-benefit ratio. I think most
runners can hit their goals without going harder than tempo
pace."
ACTION PLAN
Recognize that races take a heavy toll, so give yourself
plenty of recovery time (one day for each mile raced). If
you are trying to quicken your pace for a specific goal, add
a weekly speedwork session to your training plan, but be
judicious about it. Even Olympic gold medalists only do five
to 10 percent of their training at 5-K race pace and faster.
If you're coming back from an injury or have chronic issues
you're fearful of aggravating, consider Verran's advice. Do
your faster workouts at tempo pace (5-K pace plus 25 to 35
seconds per mile).
VIII. Stretch the Back Of Your Legs
Few running practices are as hallowed as
stretching. And none have been debated as much in recent
years. Studies have failed to reliably show that the
addition of stretching to a warmup before activity reduces
overuse injuries. "The jury's been out on stretching for
about a decade," says Michael Ryan, Ph.D., a post-doctoral
fellow at the University of Wisconsin-Madison. "And as far
as I can tell, it hasn't come in yet." Yet few experts in
the field are ready to abandon stretching. The reasoning:
Runners are tight in predictable areas, they get injured in
and around these areas, and therefore they should increase
flexibility in these areas. The muscle groups at the back of
the legs — the hamstrings and calf muscles — stand atop most
lists of "best muscles for runners to stretch." Hamstring
and hip-flexor flexibility seems to improve knee function
(several reports link poor hamstring and hip-flexor
flexibility with "larger knee joint loads"), and calf
flexibility may keep the Achilles tendon and plantar fascia
healthy.
ACTION PLAN
Little evidence indicates that stretching prevents overuse
injuries. That said, knee and Achilles problems are among
runners' most frequent complaints, and so experts recommend
increasing the range of motion of muscles that can strain
these areas if there is underlying tightness. Just don't do
static stretches (holding an elongated muscle in a fixed
position for 30 seconds or longer) before running. However,
dynamic stretching can be done as a safe, effective prerun
warmup.
IX. Cross-Training Provides Active Rest and Recovery
Running is hard on the body, although
claims that it creates impact forces up to seven to eight
times body weight are exaggerated, according to the experts
I consulted. But they acknowledge the forces can reach two
to three times body weight with each stride, and even more
on downhills. It's no surprise that our muscles, joints, and
connective tissues get weary from all this shock-absorbing.
So experts agree that most runners benefit from at least one
nonrunning day a week, and that injury-prone runners should
avoid consecutive days of running. Cross-training offers a
great alternative.
ACTION PLAN
Use cross-training activities to supplement your running,
improve your muscle balance, and keep you injury-free.
Swimming, cycling, elliptical training, and rowing will burn
a lot of calories and improve your aerobic fitness, but be
careful not to aggravate injury-prone areas (see below).
X. Get Shoes That Fit
Running shoes have changed a lot over the
years. They breathe better, are more likely to come in
various widths, and are constructed from superior materials.
Most important, there are far more shoes to choose from
(racing, training, track, cross-country). There are even
minimalist shoes designed to mimic barefoot running
(although there's no scientific evidence that forgoing shoes
decreases injury risk). This gives you more options. Of
course, you still have to figure out which shoe will work
best for you — not an easy task. "There's no single best
shoe for every runner," says J. D. Denton, who has owned a
Fleet Feet running store in Davis, California, for 14 years.
Not only that, but it's impossible to say that shoe ABC will
eliminate injury XYZ. Denton and his staff are careful to
draw a line between giving medical advice and suggesting a
top-notch shoe. "We're careful not to say, 'This shoe will
cure your plantar fasciitis,'" Denton says. "Shoes aren't
designed to cure injuries. Our goal is to make sure you get
the shoe that fits and functions best on your feet."
Others are less cautious than Denton. They point out that
while a given shoe isn't guaranteed to heal a given injury,
the right shoe on the right runner can help. Verran says
that he has been able to help patients overcome injuries by
suggesting a better fit. "It happens all the time," Verran
says. "It's a matter of finding the shoe that's right for a
certain foot type."
Check out the Runner's World 2010 Spring Running
Shoe Guide.
ACTION PLAN
Don't expect shoes to correct an injury resulting from
training error or muscular imbalance. However, when you need
new shoes (replace them every 300 to 500 miles), go to a
specialty store to get expert advice. As a general rule, buy
less shoe rather than more shoe (unless you weigh 220 pounds
or know you need the Monster Mash model). Studies show that
shoes perform best when they fit best. Ask your shoe
salesperson: "Why is this the best shoe for me?" If he or
she can't provide a sound answer, find another store. |
