In this series of blogs I will discuss running injuries, how they happen, if can we prevent them and if so how. I will talk about ways to minimise injury risk, what has been proven to work and what has not, including strength training, stretching and flexibility, how to warm up, form and technique, as well as training errors and how when we think we are doing everything right we can still get it wrong. All this backed up with scientific research rather than just my opinion.
Part 1: How do injuries happen?
In order to understand how to prevent an injury we need to first understand how they happen. How sports injuries occur is largely dependent on the nature of the sport. Team sports will comprise different injury risks to individual sports as they involve contact with either another player or equipment. Individual sports such as endurance running are more likely to result in overuse injuries. Increasing load or intensity too quickly during a training phase, too much, too soon, too fast being an example of where an athlete will increase mileage at a greater rate than their tissues can cope with. Overuse injuries accounted for 44% of all injuries incurred at the 2007 World Athletics Championships (Alonso et al., 2009). Alonso et al. (2014) surveyed the athletes at the 2011 IAAF World Athletic Championships finding the athletes in the endurance and combined events were the most at risk group for sustaining injuries. The nature of these events suggests overuse to be a factor.
Acute injuries occur instantaneously, this can be through impact (with another player or object) or muscle, tendon or ligament tears and strains. Overuse or chronic injuries occur over time and can result in stress fractures, tendinitis or bursitis.
Muscle injuries are reported as the most commonly occurring sports injury, 31% of all professional football injuries (Ekstrand, Hagglund & Walden, 2011) and 48% of all injuries in track and field competition (Alonso et al., 2014). Load tolerances determine injuries, these are affected by both intrinsic and extrinsic factors such as age and gender, injury history, anthropometrics and anatomy alignment, biomechanics, aerobic fitness, muscle strength and imbalances, muscle and joint flexibility and range of motion, central motor control, psychological and psychosocial factors (Taimela, Kujara & Osterman, 1990)
Ekstrand et al. (2011) reported that footballers with a history of previous injury were more likely to incur further injuries, with 87% of players reinjuring in successive seasons. Other causes of sports injury include:
Trauma – resulting from impact or a fall
Fatigue – overtraining, lack of recovery during training and competition.
Lack of warm up – not suitably preparing for play.
Flexibility – often cited as a lack of flexibility resulting in a decreased range of motion.
Equipment – poorly maintained and incorrectly used.
Technique – leads to overloading muscle tissue or loading muscle tissue in a manner it is not able to take repeatedly.
The British Medical Association (BMA, 2019) adds further causes such as:
Muscle weakness or imbalance – one side is stronger than the other
Joint laxity – makes it difficult to control or stabilise joints.
When we understand the factors involved in causing injuries, we can then start to address them, work on them and hopefully reduce the likelihood of them happening at all. So many runners get injured, and for the most part we are good at doing the rehab and getting back to running. But how many of us then stop doing all the good things that got us back running thinking that the rehab is done. Prehab is the answer,
Part 2: The warm Up
Lack of a warm up or an inappropriate warm up has been cited as one reason for why we get injured. Many of us simply put our running shoes on, step outside, start our watch, often even standing there for 5 minutes waiting for the GPS to start working, then we just run. We turn up to races and other events and watch the faster runners doing a warm up, we even wonder why we aren’t that fast, then step up to the start line and start running with no warm up. So, lets’ look at what a warm is for, when we should do one and what it should entail.
Every sports science course, every coaching course in any sport, will include how to do a warm up, how to programme a warm up and how to deliver a warm up. If warm ups were not important or relevant then they would be included in coaching courses. So they are important, but don’t just take my word for it.
Highly respected international athletics coach Frank Dick (2014) lists a number of good reasons for a warm up:
Increasing blood flow, which in turn increases the supply of oxygen to the muscles and carries waste products away from the muscles
Increased speed of nerve impulses
Increased speed of contraction and relaxation of muscles
Increased viscous resistance in the muscle
You can then add:
Prepare the mid for what is about the happen
Mobilise the joints, warm the synovial fluid that lubricates the joints
Activate the muscles
Improve rate of force development & reaction time (Jeffreys, 2007)
Paduan et al. (2012) studied the effects of different warm up strategies on jump performance showed that a general warm up with dynamic stretching improved jump height performance by 16% compared to no warm up at all. Soligard et al. (2010) found that youth footballers were 35% less likely to incur an injury following a comprehensive warm up. If it helps that much with youth athletes imagine how that looks for older athletes? Hopefully you can now see evidence that it does many good things for us, from improved performance to reducing injury risk.
How to Warm Up
We will discuss stretching in part 3, but for now lets just say that static stretching should NOT be part of a warm up. The contemporary model for a warm follows the RAMP principle
1.aise – raise the heart rate and body temperature
2.ctivate & obilise – muscles and joints, get them loose and moving freely.
3.otentiate – the key phase as this is designed to maximise performance in the upcoming session.
All of these parts are not necessarily performed separately, they combine and act together. Indeed, the raise element occurs after activating and mobilising the muscles and joints.
We should warm up to run, so a jog around the field isn’t really a warm up as we are running before warming up to run. The warm up should be dynamic, but focusing of increasing range of motion around the joints, especially the hip, knee and ankle for runners. Activating all those connected muscles and tendons, glutes, hamstrings, quads, calves and other smaller muscles that make up the hip flexors and extensors. Build from smaller to larger and more dynamic movements, towards finally running at increasing speeds. It’s also a time to work on correct movement patterns, such as foot strike, knee lift, triple extension (hip, knee and ankle), posture, and not forgetting the arm drive. As a general consideration and rule of thumb, the more intense the running or session, the longer the warm up needs to be. A 100m runner will need a longer warm up than a marathon runner due to greater intensity and power that is involved in their running, just because you’re only running for 10-15 seconds (OK maybe 20 seconds for me) doesn’t mean a shorter warm up is required.
Example Warm Up
The warm up can be split in to 2 parts, the activation and mobilisation pages, the dynamic stretching. The second part is where we do some running drills, these work to promote good form and technique and start to raise the heart rate to where we want it to be for our run or session.
Warm-Up (focus of full range of movement)
1. Heel-toe Walk: Exaggerating the transition between stepping pushing off your toe.
2. Walking High Knee Pull: Focus on knee drive - pulling the knee towards the chin.
3. Lunge matrix: Walking lunge, reverse lunge, side lunge and reverse diagonal lunge. Adding lunge with a rotation when you have a good lunge pattern is a good progression.
4. Leg Swings (lateral & linear) - 10 reps x ea. leg
Lateral: Standing with one foot on the ground on the ball of your foot - holding onto a post, tree, fence, etc. leaning slightly forward and swing your leg (not the one your standing on) across your body in a lateral movement. This opens up your hips and groin while adding in a dynamic stretch.
Linear: Standing with one foot on the ground on the ball of your foot - standing parallel to a post, tree, fence, etc. standing tall. Your inner leg is standing on the ground with your outer leg performing the swing from front to back. This is a dynamic stretch for your hamstring and hip flexor.
Drills (focus on opposite arm opposite leg, foot placement under centre of mass)
5. ‘A’ Walk: Walking with exaggerated knee lift, with arms, opposite arm opposite leg
6. ‘A’ Skip: More dynamic, add a skip as you do this a little quicker. Improves ankle flexibility & function
7. ‘B‘ Walk: As the ‘A’ walk but extend the knee to a straight leg then pull back and under keeping leg straight and landing under you centre of mass.
8. ‘B‘ Skip: with a skip, explosive movement
9. High Knees: Exaggerated running with knee up to hip height.
10. Heel Flicks: Drive the heel straight to your butt, driving the leg straight up & down
11. Side Stepping: Up and back facing the same direction. Improving hip flexibility.
12. Grapevine (Carioca or over-unders): Like side stepping but crossing your legs over, moving the trail leg over and under the lead leg, swinging your hips/arms. (Add in an optional high knee step over)
13. Straight Leg Run: Exaggerating stride reinforcing landing on the ball of your foot - foot dorsiflexed under your centre of mass
14. Backwards Run: Exaggerating your run stride
15. Strides: Increasing pace repetitions to add leg speed and increase heart to near the intensity of the session or run.
Performing the first four exercises slowly also works balance and stability. Even the ‘A’ & ‘B’ walks performed slowly will test and improve balance, stability and coordination, all important aspects of running. All of this can be done in 10-15 minutes, therefore, not much time in a training session.
Alonso, J., Edouard, P., Fischetto, G., Adams, B., Depiesse, F. & Mountjoy, M. (2014). Determination of future prevention strategies in elite track and field: analysis of Daegu 2011 IAAF Championships injuries and illnesses surveillance. British Journal of Sports Medicine 46(7): 505-514
Alonso, J., Junge, A., Renstrom, P, Engebretsen, L, Mountjoy, M. & Dvorak, J. (2009). Sports Injuries Surveillance During the 2007 IAAF World Athletics Championships. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 19(1): 26-32
British Medical Association, (2019). Guide to Sports Injuries (2nd ed). London: Penguin Random House.
Dick, F. (2014). Sports Training Principles 6th Edition. London: Bloomsbury
Ekstrand, J., Hagglund, M. & Walden, M. (2011) Epidemiology of Muscle Injuries in Professional Football (Soccer). American Journal Sports Medicine 39(6): 1226–32.
Jeffreys, I. (2007). Warm Up Revisited – The Ramp Method of Optimising Performance Preparation. Professional Strength and Conditioning (6): 12-18
Paduan, J., Pojskic, H., Uzicanin, E. & Babajic, F. (2012). Effect of Various Warm-Ip Protocols on Jump Performance in College Football Players. Journal of Human Kinetics 35(1): 127-132
Taimela, S., Kujala, U. & Osterman, K. (1990). Intrinsic Risk Factors and Athletic Injuries. Sports Medicine 9(4): 205-215.