Why Did I Get a Running Injury?
A Smarter Way to Think About Running Injury Prevention and Treatment
If you’ve been running long enough, chances are you’ve asked yourself, or a PT, why you got hurt. This article will hopefully give you something to think about, and it also gives you a peek into how I approach running injuries.
Before we go further, it’s worth defining what a running-related injury (RRI) actually is. In 2015, a group of experts formed a consensus definition listed below:
“Running-related (training or competition) musculoskeletal pain in the lower limbs that causes a restriction on or stoppage of running (distance, speed, duration, or training) for at least 7 days or 3 consecutive scheduled training sessions, or that requires the runner to consult a physician or other health professional.”
TL;DR - a running injury is one that prevented you from running or made you seek help.
Researchers have been trying to find the elusive answer to preventing running injuries for decades, knowing how multifactorial they are. And, unfortunately, about 50% of runners still experience an injury each year. If you think about it, it’s challenging for researchers to capture a “uniform” sample of runners. Every runner has a unique training schedule, age, gait pattern, lifestyle, and more. Telling a research group of healthy runners to “maintain their training” over the course of a year looks very different when you consider how a 1:10 half marathoner is training compared to a runner getting ready for a recreational 5K with their family.
A 2022 review concluded that factors such as biomechanics, lower limb alignment, and strength are not clearly supported risk factors for injury - all areas that have been the primary research focus for a long time. Despite this, most clinicians narrowly focus on strength, kinetic chain assessments, gait mechanics, or footwear during assessments - leading to many frustrated runners who don’t get better. It’s time to look at injuries from a wider perspective.
The truth is that injuries happen because of patterns, often subtle ones, that build over time or are ignored. When those patterns go unchecked, it tips the scales in the wrong direction and something eventually gives.
Training errors:
“Training error” is one of the most nebulous terms out there and what I personally spend a lot of time figuring out with patients. Classically, training error means you did “too much, too soon.” Think: 3 speed workouts in a week or jumping mileage from 15 to 30 in one week. But there are much more subtle training errors we don’t think about.
I think of injury risk as two sides of a scale. On one side is everything you’re throwing at your body (weekly mileage, speed, hills, cross training, weights, etc.). On the other side is your capacity to handle that training - (tissue tolerance, recovery, stress, sleep, fatigue, nutrition, active pain, etc.). When you’re handling a high training volume and everything feels great, it’s because your ability to handle it is optimized. If you stop paying attention to one side of the scale, injury risk starts to climb. Eventually, injury risk climbs high enough that something starts hurting - like your Achilles after a faster run.
To give a real-life example, I recently treated a new mom dealing with shin pain. As I listened to her talk, she was only running a couple of days per week at a mileage she was very used to in the past. Any time she ran, her shins would hurt for a day or two. She’d wait until her shins stopped hurting and try again. This went on for at least a month before I evaluated her. As I dug more into her story, I learned she was breastfeeding (affects her energy availability), getting inconsistent sleep from feeding her baby, (affects fatigue/stress/recovery) and had about 6 weeks off from running during the end of her pregnancy (affects tolerance). Strength testing on her exam was fine! The problem for her wasn’t that she was running too much, her shin muscles were too weak or that she was running inefficiently - her entire ecosystem was too imbalanced when she started running again. The best part of her story? Her rehab wasn’t a bunch of strengthening/mobility exercises. We did a simple rework of her training plan and talked about optimizing when she was running. Within a couple weeks, her pain had reduced, and she was back to doing her normal distance.
You’ve been injured before:
A 1-year prospective study done in 2021, confirming other studies, showed that having a prior injury makes you about twice as likely to get a running-related injury. That could be a prior ankle sprain, history of surgery, or having runner’s knee that stopped you for a couple weeks. It’s a tough pill to swallow knowing you can’t just undo having a past injury. Risk isn’t a guarantee you’ll get hurt, but the longer you run, the more likely you are to experience a problem. Knowing that biomechanics and strength aren’t everything, I focus heavily on helping runners figure out when in their training they need to be more careful based on their past and what to do early if something doesn’t feel right.
What about strength and running biomechanics?
I won’t neglect that rehab exercises and strength training for runners is critical in your routine as part of staying healthy, running more efficiently, and potentially mitigating some injury risk; HOWEVER, if you look at injury prevention and treatment of running injuries from such a narrow lens, you will be disappointed when an injury still happens. Strong runners can still get hurt.
Running biomechanics is a whole different beast, and I’ll tackle the topic more in-depth in a separate article. All I’ll say here is that making small gait adjustments during rehab can help in recovery but changing your foot-strike or cadence is not a guarantee to prevent injury. And general advice to do so can actually result in injury.
Preventing running injuries and understanding your risk profile
The best way to reduce your injury risk is by understanding your unique risk profile for injury and learning how to constantly optimize your scale. It is an art to recognize that your scale is imbalanced and knowing how to rebalance it before or when a real injury happens.
You can start thinking about your own risk profile by reflecting on some simple questions:
Have I had any recurring injuries to the same spot? How do I modify training to respect that?
What am I doing to optimize my ability to train?
How do I structure training cycles around my own risks for injury?
How do I prioritize different kinds of training to reach my goals?
If you’re struggling with a problem and don’t have answers to those questions, reach out to me! I’d love to help you figure it out and get you feeling good.
Yamato TP, Saragiotto BT, Lopes AD. A consensus definition of running-related injury in recreational runners: a modified Delphi approach. J Orthop Sports Phys Ther. 2015 May;45(5):375-80. doi: 10.2519/jospt.2015.5741. Epub 2015 Mar 26. PMID: 25808527.
Peterson B, Hawke F, Spink M, Sadler S, Hawes M, Callister R, Chuter V. Biomechanical and Musculoskeletal Measurements as Risk Factors for Running-Related Injury in Non-elite Runners: A Systematic Review and Meta-analysis of Prospective Studies. Sports Med Open. 2022 Mar 7;8(1):38. doi: 10.1186/s40798-022-00416-z. PMID: 35254562; PMCID: PMC8901814.
Desai P, Jungmalm J, Börjesson M, Karlsson J, Grau S. Recreational Runners With a History of Injury Are Twice as Likely to Sustain a Running-Related Injury as Runners With No History of Injury: A 1-Year Prospective Cohort Study. J Orthop Sports Phys Ther. 2021 Mar;51(3):144-150. doi: 10.2519/jospt.2021.9673. Epub 2020 Dec 25. PMID: 33356768.
Disclaimer:
This blog is for informational and educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Every runner is different, and what works for one person may not be appropriate for another. Always consult with a qualified healthcare provider before starting or changing your training or rehab program. If you're dealing with pain or injury, reach out to a licensed physical therapist or medical professional.
