This time last year our country had started adjusting to an modified level four lockdown that shifted citizens from the isolated home exercises and running laps in the garden to a more lenient but still time allocated exercise window. This saw a massive push within the recreational running community with a lot of newbies out on the road between 6 and 9am.
We all felt a sense of togetherness and proudly South African spirit during this time, people pushing themselves in their day-to-day life inspires others as well as us physiotherapists who advocate for regular exercise on a daily basis. At the same time, with this increased shift and load, comes an increased rate of running injuries that could have been easily prevented.
Amongst all the world’s swimmers, cyclists and runners- some of these are elite competitors or endurance athletes, but the vast majority of these are exercising to maintain a certain level of fitness or general well-being. Unfortunately, anywhere between 45-75% (depending on what type of articles/studies you are looking at) will suffer some form of injury over the course of a year of consistent exercise.
Prevention or early intervention is the ideal standard, the tricky part comes in that running injuries are often subtle and difficult to diagnose. As clinicians, we attempt to dive deeper into certain risk factors and training errors that can set off a light bulb in our minds. The term “training error” can be an ambiguous one as it encompasses many factors such as continuous high mileage, rapid changes in training, sudden inclusion of multiple hard interval or hill days, etc. These can all be a cause for many overuse injuries. Less common training errors include wearing inadequate or worn-out shoes, running on uneven surfaces (we’ve all had to avoid that dodgy pavement at some point), and returning to previous mileage after a period of rest or return after an injury.
Injury is commonly blamed on biomechanical abnormalities or malalignments. It is worthwhile dividing these into structural and functional abnormalities. Structural entails our body structure make up i.e. leg length discrepancy, hip asymmetry, flat feet, etc. However, some individuals could present with these structural abnormalities and be injury free because their muscles have functionally adapted well over the course of their training life.
The more important risk factors come in with the functional abnormalities. These include muscle imbalances around a joint (especially in our legs due to their weight bearing function), inadequate strength and inadequate range of motion of a joint are much more important risk factors. It is quite a phenomenon within the running community how some individuals may go seasons and seasons without an injury, while others are extremely injury prone. Another important risk factor to note would be the risk of re injury of a pulled or torn muscle for example due to inadequate medical intervention and rehabilitation.
Three common types of injuries in runners are tendinitis/tendinopathy, muscle strains and stress fractures. Tendinitis is inflammation of a muscle tendon caused by small tears of the tendon and is more common in muscles that help to decelerate us while running than in those that accelerate us. If a tendinitis is ignored, it could progress from an acute inflammatory phase to a chronic fibroblastic issue and will become a tendinopathy- Prevention is vital in this case!
Muscle strains are more common in athletes that change direction at a high velocity, such as sprinters or short burst athletes and are therefore less common in the endurance running population but can still be problematic at any time, especially with regard to the hamstrings and quadricep muscle groups.
Stress fractures are related to either a single training session or a series of high intensity trainings over a short period of time, a stress fracture should be suspected by us clinicians as a differential diagnosis anytime there is persistent, activity-related pain.
During times of an injury, it is important not to lay off exercise completely. Some injuries may be severe enough that the affected joint might require surgical intervention and complete immobilization, but there are ways of modifying a weekly exercise routine to maintain the integrity of our cardiovascular system. Exercise modification through strategies of cross-training is extremely beneficial during a period of injury where a break from running is needed.
Cross-training is commonly referred to as an alternative activity or concurrent training in more than one activity. The specific type of cross-training is completely dependent on the individual’s personal interests. In most cases, swimming is a fitting way of maintaining the bodies cardiovascular fitness while reducing the weight bearing of our joints, however it is not very similar to running, so a modification may be pool running if indicated. Cycling, walking, using a rowing machine are all examples of other cross-training modalities of keeping active while injured and away from running. However, it is important to note the type of injury to understand what type of cross training will be beneficial in any specific case.
A take home message regarding recreational running would be to address those niggles as soon as they start to concern you. The biomechanics of running can be quite difficult to comprehend in layman’s terms and often overwhelming, causing the general recreational runner to overthink one’s running style which can bring about a snowball effect of a problem that could very well be quite straight forward to correct with the right assessment, advice and intervention.