RUNNING INJURIES: repetition, repetition, repetition
There are 640 skeletal muscles, 206 bones, 360 joints, and 900 ligaments in the human body (give or take depending on the source). The number of things that can go wrong with any one of those structures at any given time is frightening. All of those structures are aimed to provide smooth and efficient mobility, stability, and strength to our body. Bones come together to form joints, bones are held together at their joints by ligaments, the bones are moved about their joints by muscles. It is a great system that can function amazingly, but just one problem with one of the hundreds of structures can lead to problems. Most of the time our body is not functioning in a perfect, balanced, totally symbiotic fashion and we are none the wiser. That is because our body has an amazing ability to compensate; missing a little motion here, lets get a little more somewhere else…a little weak in this muscle, lets make this other muscle work a little harder. Compensation is a great way to accomplish a task that we are asking of our body but over time this can lead to major problems because we are asking too much from one structure and not enough from another. This can reveal itself when the compensation goes on for too long. We will get back to this in a bit.
For now lets look at distance running: in running we are asking these many structures of the body to perform the same task over and over again. If you think about it running is taking a very basic movement, putting one foot in front of the other in order to move our body forward and hopefully fast. Then we are asking our body to repeat that thousands of times during a run. Some sources say the average runner will take anywhere from 1,000 – 2,000 steps per mile. The enormous repetion of running makes it a prime cause of repetitive stress injuries (RSI) also know as cumulative trauma disorder and overuse injuries.
RSI occurs when we ask the body to work a little harder, stretch a little longer, or endure a little more pounding repeatedly over and over and over again. The trauma incurred in isolation and in the short term is minimal, but its impact comes in numbers. It could take days or it could take years it all depends on the severity of the trauma, the frequency of the trauma, and the ability of our body to heal from the trauma.
There is no better example of RSI than that of the running injury. Over time after milions of steps, thousands of miles, hundreds of pairs of sneakers, and dozens of warning signs from the body (usually ignored by the runner) it finally hits us: the pain that we just can’t run through or ignore anymore. How did it happen? Where did it come from? What did I do wrong? Its got to be my sneakers! This is what goes through our heads when it happens. It’s the unknown that make running injuries frustrating to deal with and difficult to fix when compared to a traumatic type of sports injury. for example,iIf you get hit in the knee by a 250 pound linebacker and tear your ACL there is no guessing or wondering how it happened, it is pretty obvious. A force (linebacker) was introduced to the body, the body could not provide an equal or greater force in the opposite direction, the linebacker wins and something in the body breaks (ACL). Your site of pain is usually at the source of the pain (torn ACL= pain in the knee).
Now a running injury is usually an RSI, and remember earlier I talked about our body’s amazing ability to compensate. Well compensation repeatedly will not only lead to an injury, but the site of pain associated with the injury may not be in the same location as the source of the pain. In other words, the cause of the pain may not be in the same area as the effect. In fact, the site of the pain could be the culmination of repeated stress to several structures in which the body just can not compensate and the pain presents in some unfortunate body part.
Lets look at this example: “I don’t know why my shin hurts, I have been running everyday for the past ten years, 40-60miles per week and PRs in the marathon every year, I am getting in great shape so why did it happen?” The person in this example should consider himself lucky that it took as long as 10 years before the pain stopped him. This person ran everyday adding more speed, more miles, more races, more workouts all along the way. The lack of adequate rest and the increase in demand to the body finally led to an injury. The muscles on the inside of his shin were not strong enough to handle the repeated and cumulative stress of his running. Lack of strength combined with lack of adequate rest led to his pain. It is in our rest that we not only recover, but truley reap the benefits of our workouts. How to recover and rest is a complicated topic and I won’t be able to cover it in full with this article.
This scenario is all too common to runners and endurance athletes. It is the nature of the activity and part of the sport. It is very rare to totally avoid a RSI in running, the key is how you handle it. As I mentioned injuries are part of the sport and should not discourage someone from continuing to run, in fact it is my opinion that the health benefits physically, mentally, and emotionally far outweigh the injuries if handled properly. “Handled properly”…this could mean lots of things to lots of people. We need to listen to our body when we feel something is wrong or if we feel pain. The pain is like the engine light in your car it is warning you to take some action or something is going to break down. The delema is that the runner is usually in great PR shape when the injury comes on so they feel fit and don’t want to lose it. If addressed early these injuries can be treated, pain can be lessened, and sources can be found much quicker then if it goes on too long. Also if handled by a knowledable clinician you can be treated and still be able to run to some extent. If you “run through the pain” and start compensating you can end up with more problems and then the source of the pain becomes harder to find. I call this “running the injury cycle”. See the diagram to understand a typical cycle, it may look all too familiar.
So why is this such a common cycle and why are we running around in pain all the time? I think there are several factors:1. Runners tend to be motivated, driven, dedicated, goal oriented (some may call this stubborn). These positive traits make them successful at what they do, but when it comes to handleing an injury it can be a negative. 2. Our medical system is great at handling traumatic types of sports injuries, but not these elusive running injuries. The system will want to medicate, inject, or operate at the site of the pain, but remember the site may not be the source so this will not be successful. 3. Runners are not taking care of their bodies properly. It takes length, strength, stability and endurance to run successfully, but you can’t get all that from running alone.
We can not ignore the fact that people do have a lie and responsibilities outside of running. Lets look at another scenario. A typical “computer or administrative” type job requires hours of sitting. Sit to eat breakfast, drive 45 minutes to work, work 8-10 hours, sit to eat lunch, drive 45 minutes back home, sit to eat dinner, sit and relax with some reality TV at night. If you add this up this person could be sitting almost 12 hours per day and hopefully snuck in a 45 minute run. Ironically prolonged sitting and distance running can lead to the same imbalances in the back and legs. So the running, the work, and the leisure can all lead to the same imbalances which will eventually lead to an RSI.
The good news is that there is something that you can do to help all this. It may require a paradigm shift in how you look at your workouts and free time, but it can not only help your running it can rid you of pain that you don’t even know you have yet. Taking care of your body is such a unique thing, not everyone needs the same plan. being evaluated by a trained sports medicine professional with experience in running injuries would be the best answer. Learning stretches, strengthening exercises, self massage, proper warm-up techniques can make a world of difference. Contrary to popular belief it will not take up so much time that you will need to quit your job or concede to running only 5k events. Runners can make important changes to the function and structure of their bodies with minutes of work per day not hours.
You probably spend more time maintaining the health of your car and computer then you do on your own body. You only get one body, but you can buy a new car and computer. Be smart, educated, and proactive about your body. The joy, satisfaction, and benefits of running are wonderful don’t let lack of effort to maintain your body not allow you to reap the rewards.
Michael Silva, MS, PT, CSCS