RUNNING and INJURY

Humans are designed to move, there is no question about it and moving by putting one foot ahead of the other is a rewarding exercise that can be done anywhere at any time. Walking in itself, is an essential part of day-to-day life as it allows us to just function and get around. Running, allows us to cover more ground quickly and it is here that we progress to exploring, racing and seeking to improve.

Improving in anything requires training, you need to train to be a doctor, you need to train to be an artist and in sport, no matter what sport, training is required to improve and progress. By definition, *’Training allows the body to gradually build up strength and endurance, improve skill levels and build motivation, ambition and confidence. Training also allows athletes to gain more knowledge of their sport as well as enabling them to learn about the importance of having a healthy mind and body.’

In running, it has often been said, there are three types of runner:

  • The runner recovering from injury.
  • The runner that is injured.
  • The runner that is about to be injured.

The above is a pessimistic look at a runner, but there is some truth. You see, runners get injured because our bodies are only capable of so many miles or hours. Push too much, too hard, too often and the body breaks.

Sports injuries are commonly caused by overuse, direct impact, or the application of force that is greater than the body part can structurally withstand. Common injuries include bruises, sprains, strains and joint injuries. ******

Training in itself is designed to stress the body so that it adapts. The body breaks down on a cellular level (bone cells and networks of cells deform) with long-running, fast-running, climbing, descending, whatever it may be specific to your chosen discipline. The magic happens when we rest. So, the first lesson is to embrace rest. Rest is not a dirty word; rest is essential to make the training stimulus work.

’Experts recommend training is varied and tailored to specific individual needs; this helps keep motivation and establish individual goals. Athletes should take care to rest fully between training sessions; this will help to prevent overtraining, which can have negative effects on performance and contribute to injuries… Sessions should not be too easy or too demanding; they should be pitched at the appropriate level to facilitate improvement but prevent injury and a lack of self-confidence.’ **

Finding the balance is hard. The stress-v-rest equation is a tough one and difficult to get right. You see, running, and most sports in all honesty are addictive.

‘Sports addiction sounds paradoxical, because we usually reserve the word ‘addiction’ for things that are recognizably bad for us, such as illicit-drug use or alcoholism, but there really is a sense in which you can become addicted to exercise. Even modest athletes can relate to the famous ‘high’ after exercising, triggered by the release of ‘happiness hormones’ such as dopamine and endorphins, which have mood-altering effects.’ ***

It makes sense, just as a drug addict needs a fix of ‘x,’ we as runners need a run to get that kick of endorphins. When we don’t run, we get low, our mood changes and well, we can be a little difficult to be around. But, let’s be clear, the positive and psychological effects of an active lifestyle are proven. Improved fitness, stronger heart, better weight management, increased life expectancy, clearer mind, stronger bones and the list goes on. But like in all things, we need balance.

Irrespective of ability, runners need balance. If you are new to running the balance will be different to the experienced runner who is maybe looking to run a personal best. One thing is common though, all training places stress on the body.

Let’s say you are new to running and looking to go from the Couch to 5km. A week may look like this:

  • Monday – 30 min walk
  • Tuesday – Rest
  • Wednesday – 30 min alternating between 5min walk/ 5 min jog
  • Thursday – Rest
  • Friday – Gym working on strength and core
  • Saturday – 30min walk
  • Sunday – 45 min broken down as 5min walk/ 10 min run and repeat

By contrast, an experienced runner looking to break 3-hours in a marathon, may have a week that looks like the following:

  • Monday – 40 min easy run at 90 secs per mile slower than MP
  • Tuesday – 50 min run as 10 min easy, 30min at Marathon Pace, 10 min cool down
  • Wednesday – 90 min endurance run, 1min slower per mile than MP
  • Thursday – 15min war up, hill reps 10 x 2min efforts (85%) on 90 sec recovery, 15 min cool down
  • Friday – Rest
  • Saturday – Park Run
  • Sunday – 2hr 15min run as 90min 1min per mile slower than MP, then 30min at MP followed by 15 min easy to cool down

There is a huge difference between the training plans above. Each applies stress in its own way, and both require rest or easier days to allow the body the strength to train hard when required.

Read about OVERREACHING HERE

So, planning is key in a training plan. Runners require a rest day and easier days in a training week, and importantly, they need easier weeks in let’s say, monthly training blocks. A good strategy is building for 3-weeks and dropping down on week 4, so, 8-weeks training in hours (just for illustration) could  look like:

  • Week 1 : 6 hours
  • Week 2 : 8 hours
  • Week 3 : 10 hours
  • Week 4 : 6 hours

 

  • Week 5 : 8 hours
  • Week 6 : 10 hours
  • Week 7 : 12 hours
  • Week 8 : 6 hours

If a runner never gets injured, one could arguably say that they fall in one of two categories:

  1. They have a superb training plan that balances stress, stimulus and rest.
  2. They are not training hard enough and not adding any stress.

Some coaches actually say, that injury is just part of the process and we need to be prepared for it. In a way, I agree, but that does not mean we must not try to avoid injury… On the contrary.

NSMI provide the following information to avoid injury:

  • Warm Up
  • Use the correct equipment (in our scenario, appropriate footwear)
  • Use the correct technique (run style and technique for gym/ weight training)
  • Do not over-reach (Listen to your body, know your limits)
  • Remain hydrated
  • Cool down

The above is a simple bullet list of points that provides a great starting point. But running is a harsh sport that creates great impact and stress, so, maybe we can be a little more creative.

Diet – Food is fuel and it provides us with energy to undertake training and importantly it allows us to recover. So, think about the food you eat and consume good quality calories from a variety of sources.

Cross-Train – Just because you are a runner, you don’t need to run every day. In all honesty, a good cross -training regimen is essential in my opinion to keep the body healthy and the mind healthy. One or two sessions per week in a gym on a stepper, elliptical or rower all increases fitness and gives the ‘running’ body a break. Weight training, core training and yoga are all positives to running.

Treatments – Having a massage every week or every month is a great way to have an overhaul of the body. It’s like taking your car to the garage to make sure that everything is working okay… A good sports therapist seen on a regular basis is a great way of nipping potential niggles before they become injuries.

Get a coach – A good coach will take into consideration your targets, available time, family and life stresses and provide you with a plan that balances stress and rest. In addition, they are a sounding board for your concerns, and they will keep you honest. They will push you when you need it and they will tell you to rest.

Variety – Don’t always run on the same routes. Mix up terrain so that it provides not only physical stimulus but mental stimulus. However, don’t lose sight of the reason why you are running. For example, if your target is a road marathon, you need specific road training. Equally, if you are running a trail 100-miler with loads of vertical, don’t do too much running on the road.

WHAT IF YOU GET INJURED?

The secret is noticing injury early and doing something about it. Runners are historically bad at this and I get it. We all have runs with some level of pain or discomfort and the secret is, in time, understanding what is just training discomfort (stress) or an injury waiting to happen. Simply. When in doubt, do not run.

RICE has often been used as an option in the 24/48-hour window:

  • Rest – At least 48 hours of rest for the injured area
  • Ice – Apply ice packs to the affected area for period of between 10 and 30 minutes. Be sure to place a towel over the injured area before applying the ice pack as direct contact with the skin can cause an ice burn.
  • Compression – In order to reduce swelling and also to restrict movement, compression bandages can be used.
  • Elevation – By raising the injured limb to a comfortable and elevated position, swelling can be reduced, and the limb will be at full rest.

As mentioned above, having a coach or getting regular treatment will help here, as you have at least two avenues to explore and discuss your problem with.

But shit happens and that ‘one extra run’ or not listening to your body is when the scales tip over and injury occurs.

See a professional. Don’t guess, do not go on social media and ask your peers what is wrong. Pick up the phone, get an appointment and start on the right path to a healthy body from the beginning.

There is no one type of injury and of course some injuries can be resolved in a week with some RnR and treatment, whilst others may see you sidelined for weeks, or months.

This is where cross-training in a training plan may well have been a god send. Remember we said early on, runners (all sports people) are addicted to an endorphin kick; we are addicts. So, while you may not be able to do the thing that you really, really want to do. Doing something is always better than nothing! Cross training is almost always given by a sports professional to help you on the road to recovery, so, embrace it.

Rest. Yes, if you have not already realized it. Rest is one of the key disciplines of any training plan. Embrace the rest days.

As an injury progresses and heals, be sensible. The urge to rush out the door and pick up where you left off is not a good idea. Ease the body back in, start slow, be progressive. Add stress, rest a great deal and slowly but surely increase time on feet and avoid any hard sessions. Once the body starts to feel good again, you can start to introduce other training stimulus such as speed and hill work.

Naturally, prevention is better than cure and there are many things that should be advised to professional and amateur athletes alike in order to avoid chronic muscle pain and injuries. Proper alimentation and stretching are key. A diet rich in proteins, vitamin C and A, and zinc, will help rejuvenate muscle tissues and prevent any damage and long-term injury. Making sure enough calories are consumed on a daily basis is also crucial to help maintain the body’s ability to repair itself. Perhaps also counterintuitively, the athlete also has to consume enough fat: an optimal level of fat has been proven to help reduce the inflammation process. Finally, it is recommended to eat within two hours after a workout, as it has been demonstrated that muscle tissue heals faster during these 2 hours-window frames. Stretching exercises are equally recommended by sports specialists in order to help increase flexibility and avoid muscle sprains. Warm-up stretches in particular serve to increase body temperature and prep the body to perform each activity. *****

Finally, learn from the process. Sit down and look at the training that lead to the injury. Try to see markers or key points that you can pinpoint and then moving forward, plan accordingly.

References:

* Here – ** Here – *** Here – **** Here – ***** NSMI – ****** Better Health

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Damage Limitation by Marc Laithwaite

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The term D.O.M.S. is used frequently within the world of endurance, it represents the ‘Delayed Onset of Muscle Soreness’. The name refers to the fact that sometimes you don’t actually feel the effects of a training session or race until the following day when you step out of bed. Those who have ran a marathon will understand the sensation. You cross the line and undoubtedly you’re tired but there isn’t a great deal of physical pain. However, the next morning, or perhaps even the morning after that, your attempts to walk downstairs backwards provide the family with the highest level of entertainment they have ever experienced.

The same may be said of the inexperienced cyclist who decides to enter a 100 miles hilly cycle sportive, despite a poor training background. Aside from the embarrassment of being unable to sit down for a week, the morning after generally requires a family member to assist their descent to breakfast. So what’s happened? Has someone been repeatedly battering your tired legs throughout the night whilst you failed to wake from your exercise induced, coma like sleep? The answer lies with D.O.M.S. and the inflammation process.

The inflammation process

During a marathon running event the muscle tissue is damaged due to repeated stress and this triggers the inflammation process. The damage occurs ‘during’ the marathon but the inflammation process takes 24-48 hours to reach its peak, so the pain you feel the following morning was actually happening ‘real time’ during the second half of the race.

An important note to make here is that when people slow down in the final 6 miles of the marathon, we generally assume it is caused by low carbohydrate stores, often termed ‘hitting the wall’. However, there is likely to be a significant amount of muscle tissue damage by this stage in the race which will undoubtedly have an impact upon performance. Due to the D.O.M.S. effect, we rarely discuss the significance of tissue damage during the event. It’s important to recognise that the pain you experience 24-48 hours after the race is caused by damage which happened ‘real time’ in the second half of the marathon. That’s why you were getting slower!!

*Part of the inflammatory process involves fluid build up in the damaged area, due to this fluid build up you may weigh more 24-48 hours after the marathon that you did before, perhaps even 1-2kg extra in weight! Don’t worry.. it’s just water and it will pass.

How do I know if I’ve got tissue damage as opposed to simply having tight muscles?

  1. It’ll be very ‘tender, warm and swollen’ and if someone squeezes your leg you’ll instinctively want to punch them (NB: they never see the funny side of your response).
  2. When you stretch, it makes no difference to the tenderness, the pain still exists (it’s not tight, its damaged) and its probably better if you actually don’t stretch!

*Myth explosion – the pain and tenderness the day after the event has absolutely nothing to do with lactic acid in the muscles. It’s an old wife’s tail and I’m not even open to discussion on the matter.

How does damage affect performance?

You don’t have to be a rocket scientist to understand that a damaged muscle will not work as effectively as a healthy muscle. However, aside from the actual physical damage directly affecting performance, it’s possible that the inflammation process is acting on a much higher plane and going straight to the governor.

The central governor

There are various theories regarding ‘why we slow down’ and one of the most prominent in recent years has been the ‘central governor’. This theory suggests that fatigue is controlled by the brain (which can effectively switch off nerve signals to muscles) rather than fatigue being controlled by ‘peripheral factors’ such as the ‘actual muscle damage’.

Okay, here is a simple example:

  1. The muscles is damaged and therefore doesn’t work well, as a result you slow down. That is ‘peripheral control’, the muscle is damaged and the muscle doesn’t work, at no point is the brain involved.
  2. The muscle is damaged and somehow the brain’s monitoring system detects this. As a result the brain blocks nerve signals to the muscle so it can’t function fully and you are forced to slow down, that’s central governor control.

Why are we talking about central governor and gone off track from inflammation?

Yep, I was hoping you’d ask that. When we damage a muscle we kick start the ‘inflammatory process’ which is a chain of events involving a series of chemicals, each having a different purpose and action. One of the most widely researched in a chemical known as Interleukin-6 (IL-6) which is released into the blood stream during early stages of muscle damage and inflammation. Research suggests that IL-6 is detected by the brain and as a consequence, the brain then acts to slow you down in some way. In an old study (completed by Tim Noakes 2004) runners completed 2 separate 10k runs a week apart. They were healthy during both but prior to the second run they were injected with IL-6 and ran almost a minute slower.

Just stop and think about this for one second

Look at the 2 examples given at the top of this page for ‘peripheral control’ and ‘central control’. These 10k runners did not have muscle damage prior to either 10k, they were healthy, fuelled and ready to go until injected with IL-6. Their slower time cannot be explained by muscle damage, low fuel or any other form of peripheral control. The only possible explanation is the circulating chemicals. The chemical IL-6 has even been suggested as a possible cause for the lethargy associated with ‘chronic fatigue’ or ‘chronic overtraining’. We know that all general illnesses and all forms of stress kick start the inflammation process and that in turn creates IL-6.

How does energy and nutrition relate to tissue damage?

VERY IMPORTANT: In previous blogs we have talked a great deal about carbohydrate and fat use during exercise and how to refuel. There is a presumption that if you refuel correctly and use fat as a fuel source, you will be successful in endurance events. As a consequence, when people fail to hit their target times, the first thing they turn to as an excuse is ‘failing to get the nutrition correct’. We treat nutrition as some kind of magic wand and if it’s done correctly, you can cycle and run forever, but the reality is very different. It doesn’t matter how much fuel you pour into a broken car, it isn’t going to drive anywhere fast. Without the conditioning which comes from running long miles on hard surfaces, even the most fuel efficient athletes will break down due to tissue damage. CONSIDER THIS: The energy used when cycling and running at a steady pace are not significantly different (slightly higher for running). However, many people who can cycle for 6 hours with little issue, will find themselves in pretty bad shape after as little as 2 hours of running. So ask yourself this question, is it fuel intake or is it damage causing the issue?

What causes the damage?

  1. Damage will be far greater if you’re not conditioned to the distance and terrain. In simple terms you need to spend time on your feet and do the longer sessions.
  2. Harder surfaces are more likely to cause damage, although this isn’t always strictly true as runners do become accustomed to the surface they train on.
  3. Running down hill is the real killer as the muscles contract eccentrically, braking your speed, thereby causing much greater damage.
  4. This isn’t limited just to running. Cycling for several hours and repeatedly performing the same pedal action will lead to muscle tissue stress and damage.

How can you avoid the damage?

  1. As above, you need to complete longer sessions, including downhill running if relevant.
  2. It’s possible that damage may be reduced, by using compression clothing. Research is very poor but ‘subjective’ feedback suggests that it certainly helps.
  3. Your weight will have an impact upon damage, if you have a few KGs to lose, it will help!
  4. Whilst this is a subjective / commercial / controversial addition to the list, specific shoes such as HOKA which are specifically designed to reduce impact can reduce damage and associated DOMS.

What should I do if I have tissue damage?

  1. Rest and let your legs recover for a few days.
  2. Avoid very deep post event massage or stretching, sticking fingers into or stretching damaged tissue is never a good idea, wait a few days at least.
  3. After a few days do some light exercise such as cycling to encourage blood flow to the area and assist the repair process.

If you found this article useful, it would help us a great deal if you share on Facebook, Twitter and social media.

Until then, limit the damage…

About Marc:

Sports Science lecturer for 10 years at St Helens HE College.

2004 established The Endurance Coach LTD sports science and coaching business. Worked with British Cycling as physiology support 2008-2008. Previous Triathlon England Regional Academy Head Coach, North West.

In 2006 established Epic Events Management LTD. Now one of the largest event companies in the NW, organising a range of triathlon, swimming and cycling events. EPIC EVENTS also encompasses Montane Trail 26 and Petzl Night Runner events.

In 2010 established Montane Lakeland 50 & 100 LTD. This has now become the UKs leading ultra distance trail running event.

In 2010 established The Endurance Store triathlon, trail running and open water swimming store. Based in Appley Bridge, Wigan, we are the North West’s community store, organising and supporting local athletes and local events.

Check out the endurance store HERE

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