Introduction

More than half of all the amateur runners deal with at least one injury per year. There's really no good reason for this phenomenon. But it's constant, mostly because amateur runners don't train in the most scientific manner or rather they are following the ‘one size fits all’ theory. Injuries happen because the physical stress from running is too much for your body to handle at that time. The human body is great at adapting to stress, but only when you apply that stress in small doses. When you apply the stress too quickly for your body to adapt, something breaks down.

Every time your foot lands on the ground, your leg absorbs two to three times your body weight. Multiply that by the number of steps you take to run on a given training day and multiply that by how many times you run each week, and you can see how much stress your legs have to deal with to be a runner. 

This article will give you an insight to what best you can do to minimise injuries. I purposely use the word ‘minimise’ and not ‘Prevent’ injuries because, how much ever you try to prevent injuries you will face it one day, to be honest I haven’t met an athlete in my career as a sports physiotherapist of more than a decade who has claimed to say that I have never been injured.

Being mindful - understanding your body

“Mindfulness means being awake. It means knowing what you are doing.” – Jon Kabat-Zinn

I often keep telling my athletes  and patients that you have to be mindful in anything that you do whether it is sitting at your work station, climbing a flight of stairs or getting involved in complex activities like running. Anything that you do your body is constantly giving you signals as to how it feels during that activity and you should be attentive to those signals. Most of the running injuries that I attend in my clinic are repetitive stress injuries  which means a low intensity stress that accumulates over a period of time and ultimately results in an injury. Every activity that a human body does, there is some micro trauma constantly happening but we don’t feel pain because there is a super active healing mechanism that is in place (just like a wolverine in the X-men) and during usual circumstances the rate at which healing happens is much faster than the rate at which trauma happens. Only when the stress and trauma reaches a point when the bodies healing mechanism can no more handle the stress levels, you experience the pain. That’s the reason why you need to be mindful and pick up the signals early and take necessary action and prevent those small niggles turning into a major injuries.

Adequate Warmups and cool downs

You’d be surprised how many people decide they don’t need to warm up before their workout or its fine to skip their cool down after running. In most cases, it’s not because people hate doing warm up or cool down, but they want to save time. After all, it is just the main part of the workout that counts, right ?

One of the studies in US found out that 30% of injuries can be prevented by proper warm up and stretching. A good warm-up before a workout dilates your blood vessels, ensuring that your muscles are well supplied with oxygen. It also raises your muscles’ temperature for optimal flexibility and efficiency. By slowly raising your heart rate, the warm-up also helps minimise stress on your heart.

Professional athletes may spend anything between 30-45 mins in warms and almost equal time in cooling down. Cooling down after a workout is as important as warming up. After physical activity, your heart is still beating faster than normal, your body temperature is higher and your blood vessels are dilated. This means if you stop too fast, you could pass out or feel sick. A cool-down after physical activity allows a gradual decrease at the end of the episode.

It’s ideal to go through the routine of mobility and dynamic stretching along with low intensity muscle activation as part of your warmup  and perform more static stretches and foam rolling during the cool down phase.

Strength training 

In the battle against injury, a runner's best armour is a strong body. Strong muscles, ligaments, and tendons guard against impact, improve form, and lead to a consistent gait. "If muscles are weak, one footfall will not be like the rest, how your knee turns in, your hip drops, your foot pronates changes with each step. But with strength, these movements are the same each time, so your mind and body know what to expect. When a strong body runs, the brain tells the muscles to brace for impact before the foot hits the ground. The muscles of the hips and core contract to steady the pelvis and leg. The foot and ankle muscles are activated, providing a solid foundation to land upon. But if one stabiliser isn't strong enough or isn't recruited, other muscles get overworked, and the entire chain of movement is disrupted.

In my practice the most common reason for runners facing knee injuries are their inhibited glutes muscles. Your glutes are the most important muscle if you are a runner as the biomechanics of pelvis, knee and foot is highly dependent on how effectively your glutes can stabilise these joints.  So it becomes essential to strengthen these muscles. One common myth among the running community is that your lower body muscles get stronger as you keep running and therefore there is no need to do strengthening but the fact is that you need to strengthen your muscles to be able to run efficiently.

A strength training program  performed 2-3 times per week which is customised for the individuals need and specific for running enables you to run with greater control and stability and minimising the risk of injuries.

Biomechanics

Just as there is a correct way to swim or swing a tennis racket, there is a right technique for running. Though it would be impossible to come to a conclusion as to what would be an ideal running biomechanics there are certain components of form such as having an upright posture, efficient arm swing, mid-foot to fore-foot landing pattern, proper stride (avoiding over striding) which should be taken care when we talk about running biomechanics. 

Overpronation and knee valgus are the two most common terms you may have heard from your fellow runners, coaches or your physiotherapist must have made a mention while evaluating your gait. Overpronation means that your foot pronates a bit too much, causing your ankle and arches to roll too far inward with each step, this is most commonly seen in people with flat feet, whereas knee valgus is a term used when the knee collapses inwards when you land. Both these are biomechanical abnormalities due to poor muscle control and may end up in serious injuries. Finding a sports physiotherapist who can evaluate the biomechanics and implement proper strategies can help minimise risk of injuries.

Recovery  

Runners typically have a “training” plan, but rarely a “recovery” plan. Recovery can be defined as the act or process of returning towards normal physiological conditions. Recovery is the restoration of energy-producing enzymes inside the muscles, functional proteins, fat and carbohydrate stores, and the regeneration of the endocrine and immune systems. Recovery comes down to repairing, resting and refuelling--while still allowing the body to adapt to the training workload and reap fitness gains.

A quality sleep of 6-8 hours, optimal hydration, paying attention to your nutrition, stretching, foam rolling are all strategies towards effective recovery. Sometimes taking a complete off from physical activity whereas sometimes performing low intensity bike, swim or easy pool exercise are all strategies towards effective recovery. 

I personally feel that sports massage may be the single most effective ways to recover from an intense week of training. Sports massages are not your usual spa sessions, these are the sessions where the muscles and other soft tissues are manipulated in a very technical manner to release the deep knots (trigger points) and release the tension making them more flexible and supple. The frequency of these sessions may depend on how much you are physically pushing your body. For example a professional marathon runner who puts in a weekly mileage of 250 kms will undergo at least 3 sessions of massage per week, whereas an amateur runner who is training for a full marathon and putting a mileage of approximately 80 Kms may need a massage once every week.

Conclusion 

Whatever said and done one can never avoid injuries completely and that’s why I always use the word ‘minimise’ rather than ‘prevent’ when it comes to injuries as there is no foolproof strategy which will guarantee you an injury free athletic career. I believe that every runner at whatever stage of his running career should consult a sports physiotherapist and get a thorough assessment of their body to find out any faults that pre-exists in their body which could put their bodies at a risk of an injury. Remember that the main reason you started to run was to be healthy and not to get likes on Instagram and Facebook (pun intended)