Preventing Over Training and Injuries in Distance Runners

Received the following comments and questions from a blog reader and I thought my answers and follow up comments would make for a good post.

PJ:


I regularly read your blog and really enjoy it...keep up the great work. I'm a fitness enthusiast and I also compete in 5k's, 10k's and half marathons. I read an article in the Wall St. Journal and I wanted to get your thoughts on it. I can relate to a lot of what the article had to say as I've battled injuries and over training due to running in the past. Can you offer me any other tips for preventing over training and injuries due to running? Thanks!


John from Sarasota

While I do not enjoy distance running and do not receive or chase the "runner's high" so many people seem to need and seek, I will concede many people, for whatever reason (maybe it was those scenes in the Rocky movies), enjoy running, and, despite my objections, are going to engage in the activity no matter what. Furthermore, I deal with both recreational and competitive runners on a regular basis at my training facility whom I'm trying to keep injury free (or at least minimize the wear and tear), so I have some experience in dealing with this population.

With the above being said, I read through the WSJ article, and I agree with most everything in the article. I've told my "runner clients" for years that if they absolutely feel they have to run-and enjoy it-the best way to avoid or minimize the risk of injury is to do all of the following:

1. STAY AT OR BELOW DOUBLE DIGIT MILEAGE WEEKLY

If someone wants to do two 4 miles runs, four 2 mile runs, three 3 mile runs, etc., on non-consecutive days, I suppose that's fine. I don't have any real scientific evidence (although the general theme is backed up in the WSJ article) to support this recommendation, but, over the years, on a purely anecdotal level, I've noticed those who exceed double digit mileage on a weekly basis seem to have the most problems with injuries (for obvious reasons).

Those who exceed double digit mileage are likely running more often and for longer periods of time. If you combine this with the assumption (and it's a good one), that most non-elite runners have terrible running mechanics, the likelihood of becoming injured goes up. For most non-elite runners, repetitive low amplitude (not a lot of hip flexion) movement in the sagittal plane, combined with the impact of the activity (and the horrendous footwear most people run in), is a recipe for disaster.

Finally, those who are running more often and logging more miles are not going to be able to devote adequate time to "cross training" (and, sorry, I don't think yoga and pilates are effective forms of cross training for runners as noted in the WSJ article). More on this below.

2. STRENGTH TRAIN AT LEAST 2 DAYS PER WEEK

As noted above, runners who are logging dozens and dozens of miles each week don't have enough time to devote to other forms of training-namely strength training-because these other forms of training become competing demands. Furthermore, runners, and other endurance athletes, have preconceived (and incorrect) assumptions about strength training. They feel strength work will "bulk" and stiffen them up. This could not be further from the truth, and, on the contrary, the ridiculous number of low amplitude miles they are running week in and week out will stiffen up their hips and low backs faster than a 4 minute mile.

Runners, and other endurance athletes, absolutely need to strength train 2 days per week in order to prevent injury, improve running efficiency, and improve force production. As long as runners are performing full range of motion strength exercises (not on machines), they absolutely will not lose flexibility or mobility and will actually improve both. For more on the benefits of strength training for runners, check out this article by Eric Cressey...he does a much more thorough job of explaining this than I can.

3. GET OUT OF THE SAGITTAL PLANE

I'm all for specificity of training, and, if you are going to compete or just want to finish a 5K, 10K, etc., what's more "sports specific" than running itself, right? Well, yes...and no.

In my opinion, true sports specific training, from an injury prevention standpoint (and that's the focus of this blog), should basically have the athlete do the exact opposite of what they are doing in their activity specific training, which, in this case, is running.

Running is performed in the sagittal plane. Runners are doing plenty of sagittal plane work. Doing more sagittal plane work is not necessary and is going to contribute to over use injuries, muscle imbalances, and muscular dysfunction. Runners need to do more FRONTAL and TRANSVERSE PLANE work: core rotation and anti-rotation, lateral lunges, rotational lunges, cross over step-ups, slide board work, etc. All of these exercises and activities recruit the "lateral sub-system": think glutes, hip internal and external rotators, piriformis, glute med, etc. These muscles are woefully underdeveloped in most runners (and most any athlete for that matter). Shoring up these weak links is a great way to prevent imbalances and overuse injuries.

4. DEVOTE PLENTY OF TIME TO SOFT TISSUE WORK AND DYNAMIC WARM-UPS

I have a lot of clients who get up first thing in the morning at 5:30 a.m., put on their shoes, walk out the door, do a few toe touches, "air hanky" (blow snot out of each nostril), and then go run. Bad idea.

If you are going to run (and I'm not going to get into the myriad of reasons why you shouldn't...I'm not going to "hate"), at least take the time to foam roll (or some other form of soft tissue work) the glutes, quads, adductors, calves, anterior tibs and peroneals, etc. If you don't know how to do this, get on over to Mike Roberston's site and sign up to his newsletter...subscribers receive a very comprehensive soft tissue work guide.

Foam rolling should be followed up with a dynamic warm-up which mobilizes and activates the joints and muscular structures most involved in running. Runners should mobilize their ankles, hips and thoracic spines and also do some glute activation work as part of their dynamic warm-ups. This need not take more than 5-8 minutes.

After the dynamic warm-up, I'd recommend static stretching the Achilles tendons, calves, the hamstrings and hip flexors for about 20-30 sec. each.

This entire warm-up-foam roll, dynamic drills and stretching-should take about 12-15 minutes. Yeah, I know, that's taking time away from your "running workout", but you'll thank me when you don't get hurt and can actually make it to the starting line on race day.

Ok, I can't help myself...I need to end this post with a little rant about running for fat loss and general fitness. Like I said earlier, I understand some individuals desire to run, especially if you enjoy competing in road races...you have to do it in order to prepare optimally.

However, those who feel they "have to" run for general fitness and fat loss purposes, as a superior alternative to other forms of activity, are completely missing the boat. Despite what many believe (and I have to diffuse and refute these beliefs almost daily), there is nothing special about running for general fitness. Yes, it is an activity. Yes, it burns calories at an accelerated rate. Yes, for most, even light running will increase one's heart rate substantially. HOWEVER, there are a whole host of activities which do the exact same things, WITH A MUCH LOWER RISK OF INJURY.

It has been said one needs to be fit to run but should not run to get fit. I agree. For most out of shape beginners who decide to "take up" running, the metabolic demand of even light running (5-6 miles per hour) is going to be entirely too much to sustain. This population is going to be miserable because they just can't handle the demand. If we also acknowledge that the typical out of shape beginner is weak, has serious muscular dysfunction, poor movement quality, sits at a desk 9 hours a day, has awful running mechanics and wears concrete blocks (most modern footwear), the entire situation becomes exponentially worse.

Bottom line: if you "must run", or if you want to complete or compete in road races, then fine...RUN! Just make sure you follow the tips and advice in this article. You'll likely experience fewer injuries due to running (although I can't guarantee you'll stay completely injury free due to the nature of the activity itself). For those of you who are running simply for general fitness and/or fat loss, you might strongly consider other, safer activities, like lifting heavy stuff (but I'm biased).

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Running for Fitness and Weight Loss

I get a lot of questions about running for fitness and weight loss. Here is a recent email I received from a blog reader:

"I started a walking program many months ago (and changed my diet) to lose some weight and get in shape. I'm up to 5 miles about 4-5 days/week. I really enjoy it, and I was thinking about trying to start jogging/running a bit. I was thinking of maybe jogging for a minute, and then walking for 4 minutes and going back and forth like that for my 5 mile route. Eventually, I'd like to be able to jog the entire 5 miles, although this is way down the road. What are thoughts on my plan of attack and running for fitness and weight loss improvement in general? Thanks."

-Angie from Salt Lake, UT

Running/jogging is no doubt a popular activity. On the positive side, running or jogging burns a significant number of calories per minute relative to one's body weight, especially at higher speeds. Activities which burn a significant number of calories obviously can play a role in weight control. Running also provides a significant cardiovascular demand (as many other things do as well) which can help to increase cardiovascular fitness (as many other things can do as well).

On the negative side, running/jogging, especially outside, is a high impact activity, placing a lot of stress on a number of joints. Also, the vast majority of people have a significant amount of muscular dysfunction and/or muscular imbalance and/or soft tissue restrictions and/or mobility issues in the ankles, knees, hips and lower back. If you take a person who is "jacked up", and then have them perform a repetitive high impact activity, over time, they are going to become even "more jacked up".

It has often been said that one must be fit to run, and one should not run to become fit. I couldn't agree more with this statement. I typically steer my clients away from distance running, especially if they are rank beginners with a low level of muscular and cardiovascular fitness. If they absolutely insist on doing it, and derive a great deal of enjoyment from it (and many do...I get that), I at least advice them to spend 2 months bringing up their base cardiovascular fitness via lower impact modalities and activities. Furthermore, I INSIST they also spend 2 months participating in a vigorous strength training and corrective exercise program so that we can at least prepare their musculoskeletal system for the demands of the activity and minimize the ill effects.

Once a client does get to a point where they are somewhat "safe guarded", they must continue their strength training and corrective exercise regimen. They must also implement a proper dynamic warm-up prior to their runs so they minimize the risk of injury. A few other tips for recreational joggers/runners:

1. I suggest keeping the total mileage under double figures weekly. Think 3 3 mile runs, or 4 2 mile runs, etc. While I have no scientific data to back up this recommendation, common sense dictates that a high volume of high impact activity, as you would see in someone preparing for a marathon, probably isn't the best idea.

2. The "walk run" method, which Angie discussed in the question above, is a good idea (run one minute out of every five). Again, this minimizes the high impact forces on the joints. Throwing in 5 or 6 one minute runs over the course of 3 miles may be just enough to satisfy one's running craving and make them feel athletic, without trashing their joints.

Bottom Line: if you insist on jogging/running, make sure you are fit enough, both muscularly and cardiovascularly, to participate in the activity in the first place. Then, make sure you keep up with a balanced strength training regimen. Finally, stay under double digit mileage and possibly incorporate the "walk run" method. Implementing this plan of attack should allow you to benefit from the activity while staying somewhat healthy. Just realize their is a cost benefit or risk reward situation with running for fitness and weight loss.