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Why Do Runners Get Hurt?

As a general rule, I try to not reduce things down to generalizations, but I have a good idea why most runners end up coming to physical therapy.  Many of the injuries runners suffer are from increasing loads too fast.  There is no way of predicting an acute injury like a sprained ankle, broken bone, or torn tendon.  However, IT band pain, achilles tendinopathy, plantar fasciitis, and hip bursitis all have a common theme:  too much, or too fast.  The current buzz word in physical therapyworld is load.  Load comes in the form of distance, intensity (speed or difficulty of terrain), or frequency (times per week).  Subtle changes in any of these can derail the best laid running plans. I will outline some general training tips to help you be cognizant of small changes in your workouts to continue your progression.

                 Distance is the easiest variable to control due to it’s specific measurement.  The general rule is to only increase overall distance each week by 10%.  This is not a hard-fast rule, and has not been researched significantly, but it holds some water depending on your running experience.  If a novice runner starts 4 miles a week, they can likely increase by about 30% for the week; an experienced runner putting in 50 miles a week should only increase by 10%.  

                 Intensity is a fairly tricky.  Some days you feel good and want to run faster, other days it’s a struggle to run a mile in 15 minutes.  Research shows that exercising at lower intensities for 80% of your weekly mileage limits the chances of injury, improves running economy and capacity, and can improve your performance ( slower to run faster).  That means 20% of your mileage should be at higher speed (intervals), or on hills.  A common cause of injury in this area is a runner who has been putting in miles and miles on the road, decides to run the same distance on trails, and ends up with a tendinitis because they are on a new surface, as well as having to run up and down a lot of hills.                    

                  Current evidence would say that you should be training at 90% effort, or 90% of your heart rate max, or 9/10 on the rate of perceived exertion scale on a high intensity interval day; while keeping your easy mileage days, well, easy.  Try to stay below 70% of your max effort(7/10 effort, feeling relaxed effort). The best thing I did for my own training was to talk to a trainer and get specific programming to provide gradual increases in difficulty.

                 Frequency may be of lower importance to the other loads, but it is good to be aware.  This can be easily controlled; don’t jump from running 2 days a week, to running 6 days a week without building up a tolerance. In my own training, I know I only have a certain amount of time to run due to job and family responsibilities (babies take a lot of time).  I make the most of the days that I can run longer, and plan carefully to allow for enough rest after long runs or high intensity runs.  

                 A common misconception from injured runners I have treated is that there is something wrong with their form.  More and more studies are showing no significant benefit or detriment with heel strike versus forefoot strike and the rate of injury.  There is not a one perfect style or form that has been proven to be superior in preventing injury, or significantly improving performance.  Plus, many studies have shown that changing form takes hours, weeks, months, or years of focused practice to have a significant change in form. I try to have injured runners focus on what they can change: increasing cadence (steps per minute) will decrease muscle and joint load, run manageable distances (within tolerable pain), and gradually increase.

                 Again,I am not one for generalizing.  Every runner is different, and requires a different program, or shoe, or footstrike.  If you find yourself continually getting injured with training, it may be helpful for you to work with a trainer to write a specific program and monitor your progress.  I know I have improved leaps and bounds by working with my friend, trainer, and running guru Dewey Peacock (he’s going to hate that I said that about him) and have not had a running injury in four years.  There is a lot of nuance and adjustments that go into a running program. Working with a good coach or trainer can make all the difference in preparing for your next race.  I hope there is a nugget of information you can apply to your training in this paper, and maybe it will make a big difference for you.  If you end up suffering an injury while training, I hope you will consider visiting one of the very talented runners, trainers, and physical therapists at Bridger Orthopedic.


Levi Taylor, DPT



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Levi Taylor