How common are running-related injuries and who is affected the most?
One of the most common sports or recreational activities is running. With advancements in technology, tracking our running has become a lot easier. Thanks to smart watches like Garmin, we can track many different metrics of our running, with the most important measurement being our total workload. Why is our workload so important to track? It is crucial to track and be aware of as almost all running-related injuries can be attributed to a training load error!
Hopefully gone are the days of thinking biomechanics and our anatomical structure are the primary reason we sustain a running injury. The evidence and research does not support this idea and it has not for some time. Biomechanics (our running technique and form) play a very minor role in why we sustain an injury. There are a lot of things that play a role, with the evidence showing that our tissue load capacity is the most important aspect. What role does biomechanics play then? Our biomechanics dictate what location we will likely get the injury in as a result of a training load error. In other words, if you have built up a progressive and gradual capacity to running, you will likely not suffer an injury. Therefore, your biomechanics really don’t matter a whole lot. Furthermore, your biomechanics are difficult to change long term. Our anatomical structure, such as those individuals with flat feet really should not be of any concern! Don’t listen to anyone creating fear in you because you are built different. If flat feet were the reason injuries occur, then wouldn’t everyone with flat feet get injured? Furthermore, you cannot change your anatomical structure so just focus on building up a load capacity to running.
Despite having so much technology available that can help track our workloads, running injuries have a very high incidence of occurrence. The research suggests a large range of incidence between 18.2% and 92.4%. Another way to look at this is that there are 6.8-59 injuries per 1000 hours of running (Lopes et al., 2012). This is obviously a very large range, which can be explained by differences in patient characteristics from these studies and the definitions of each running injury from these studies. Nevertheless, running-related injuries are a very common occurrence and they need the appropriate care early to reduce the sustained load intolerances to the working tissues.
The number one risk factor for sustaining a running injury is of course having a previous history of a running injury (Van der Worp et al., 2015). This fact right here is why you should not push through your pain and hope it goes away without addressing the reason you sustained the injury in the first place. Speaking to your health professional who has an expertise in running and the injuries associated is crucial. Your health expert will be able to educate you on your training loads and other factors which play a role in your injury onset. By just resting until the pain goes away is known as stress shielding, which is detrimental long term to the runner. By doing this you may further reduce your tissues load capacity, which ultimately leads to a lower threshold needed for re-injury. It is very important to get advice, a plan, rehab and a structured individualised return to running program. Thankfully at The Reform Lab Osteopathy, this is an area in which we are highly experienced in and have an advanced education on the subject.
It is crucial to always start slowly and gradually. An interesting finding in the research by Nielsen et al., 2014 found that if you are classified as obese >30BMI and are a novice runner, you are at a high risk of sustaining an injury if more than 3 kilometres is exceeded cumulatively throughout the week! This is not much volume at all, so these individuals need to be appropriately loaded and their running structured from an expert. Often in these modern times, many are using apps like Runna. These apps are great, however they should be used with caution as they are not individualised and are not structured appropriately for most individuals.
Where do runners get injured?
The lower limbs are obviously the primary area where runners get their injuries. For the most part, especially running injuries that involve more overload from endurance based running, the runner will get their injuries when their leg contacts and is on the ground. This is due to the ground reaction forces the lower limb is being exposed to during this phase of the gait cycle. This is another reason why the total cumulative loading cycles (steps) is an important factor to consider when we are looking at your injury risk profile. If we compound this with the total time spent on the ground per loading cycle, this gives us a good insight into how long and how frequent the runner is being exposed to ground reaction forces. I discussed at length, that biomechanics will determine where the injury occurs in the lower limb. The anatomy of the male and female sexes are quite different, especially the pelvis. Again, we cannot change our built in structure, however the structure will influence the biomechanics and therefore where each sex is most likely to suffer their injury.
There are common injuries that present in the endurance runner. Patellofemoral pain which is colloquially known as ‘runners knee’ is estimated to be 48.8% of all knee injuries. Females are more commonly affected by this painful injury, with a ratio of 2:1. Females are also more commonly affected with tibial stress fractures/shin splints. Shin splints are quite common and are very disabling. Studies have estimated its prevalence to be 9.1% (Kakouris et al., 2021). Males more frequently get an achilles tendinopathy and iliotibial band (ITB) pain. The achilles tendinopathy is estimated to represent between 9.1-10.9% of all running-related injuries, however in elite runners it has a lifetime injury risk of a whopping 52% (Kujala et al., 2005). If you have knee pain on the outside of your knee, you more than likely have ITB compression pain. It is the most common cause of lateral knee pain in runners. It represents between 5-14% of all running related injuries. Males are affected greatly more with this injury, with studies estimating a range from 50-81% of all runners with ITB pain (van der Worp et al., 2012). Plantar heel pain (plantar fasciitis) is estimated to represent 8% of all running-related injuries (Taunton et al., 2002). Plantar fasciitis is actually more common in sedentary people, however is arguably the most frustrating running injury to manage due to its poor prognosis if long term.
Where are the injuries located as we age?
An older runner is what we consider a “masters runner”. I have no idea why we consider these individuals to be a masters runner, however that is what you are called if you are old enough. A masters runner are those individuals over the age of 40. This is certainly not an old age, however certain running injuries are more prevalent over the age of 40. The injury rate in the masters runner is 49% compared to younger runners which is 45%. Furthermore, the masters runner in 30% of running injury cases is likely to experience more than one injury. Comparing this to the younger runner where they are likely to suffer multiple running injuries 24% of the time. The younger runner is also more commonly going to sustain a running injury to the knee and the shins. Whilst the masters runner experiences more calf, achilles and plantar fasciopathy injuries. There are a few plausible reasons why the masters runner has more injuries and a higher injury rate. The main reason is they have been running for longer, therefore have been exposed to more volume and cumulative running loads. They also have had a longer history to experience a running injury. Remember what I mentioned earlier, the biggest risk for a running injury is having a previous running injury. There is also a plausible reason why the masters runner experiences more achilles, calf and plantar fascia injuries. As we age our musculoskeletal system is not as robust as it once was if we don’t put in the work needed. The work needed is strength, power and plyometric training. This is a huge reason why all runners, especially as we age should be completing a structured and appropriate strength program.
Take home message
Running injuries are common and the most important strategy to reduce injury is to monitor training load. The running apps are great, however getting a running program from a trained health professional is recommended so they can individualise your program gradually. If you suffer an injury with running, it is crucial to receive education and treatment from your qualified experienced health professional. The longer an injury goes on, the more likely it is to progress and less likely it is to resolve in a timely manner. As ageing is inevitable, it is crucial to complete a structured strength and conditioning program. The consequences of ageing certainly can be controlled and be significantly minimised if we complete structured strength and conditioning.
At The Reform Lab Osteopathy you can be coached, treated, and taken through an appropriate injury prevention program in the elite facilities of Project Reform. I even bring a community of runners together every Sunday morning for a casual run and social coffee. If you are keen to start your Sunday morning the best way, come along to The Reformed Runner, a run club led by a qualified health professional.
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