Simple Strategies for Distance Running Injury Prevention

Written by Isaac Enbom.

It’s that time of year again when a lot of our patients pound the pavement in an attempt to return to normality or to achieve a new year’s goal. Often the increase or change in running habits results in injury. This article attempts to provide manual therapists with some simple strategies to keep your patients running injury free.

Most running related injuries are a result of musculoskeletal overload which is commonly caused by poor training habits. It’s important that runners understand appropriate training volumes and good recovery strategies. However, this is difficult to achieve without a running coach or a professionally tailored running program. Most distance runners will measure their training progress by distance (kilometres), duration (minutes) and / or speed (minutes per kilometre). All of these are now very easy to measure with the use of technology such as smart watches or apps for example. These metrics can become an obsession with runners which can lead to over-training, cumulative stress and ultimately, a running related injury.

So, what is an appropriate amount of training volume and what sort of training principles should runners take into consideration?

Historically, runners have considered distance, duration, or speed to be the measure of success. Relying on these metrics alone can significantly underestimate the total training stress that is applied, especially if it is applied repetitively over time. Focussing solely on these ‘External Training Loads’ fails to take into consideration how runners ‘feel’ during a given training session, which is not only influenced by distance or duration but also by the runner’s state of recovery and daily stress (e.g. sleep, illness, relationships etc.)1

Clinical commentary by Paquette et al. (2020)1 describes training loads in two categories:

• External Training Load – the mechanical load such as distance or duration, and

• Internal Training Load – the physiological and psychological responses to the external load such as rate of perceived exertion, heart rate and blood lactate levels.

External Training Load is easy to quantify but Internal training load is more difficult without the use of sophisticated equipment. The easiest way to measure Internal Training Load is to use a session Rating of Perceived Exertion (sRPE) on a numerical scale of 1-10, similar to that of the Visual Analogue Scale (VAS) commonly used to assess pain. The sRPE has been found to correlate well with blood lactate threshold which further validates its use2

Manual therapists should encourage runners to be mindful of their total training loads. A study by Napier et al. (2020)3 examined a combination of External and Internal Training Loads to determine individual training responses. The study found this method provided a more accurate representation of total training load as well as a more individualised estimate of week-to-week changes in training stress. This can have significant implications for monitoring training adaptations, resulting performance and possibly injury prevention.

The method combined session running duration (minutes) multiplied by the sRPE (1-10) which resulted in the session training load. This value is then monitored and compared to previous session loads over time. For example, during a typical training week, a runner might document the following:

Run 1: Duration: 60 mins sRPE: 3/10 (relatively easy)

Training load = 60 x 3 = 180

Run 2: Duration: 70 mins sRPE: 5/10 (moderate exertion)

Training load = 70 x 5 = 350

Run 3 Duration: 45 mins sRPE: 7/10 (difficult)

Training load = 45 x 7 = 315

Total weekly training load = 180 + 350 + 315 = 845

This weekly load value can then be monitored over time with attention to any major or progressive increases beyond a couple of weeks. This simple method of monitoring the training load could be a useful predictor of injury. However, running related injuries are multi-factorial. Other training factors such as frequency, surface, type (i.e., track, hills etc.) and recovery strategies should be considered in how they can contribute to injury.

As manual therapists, we have a responsibility to investigate and implement injury prevention strategies with our clients where possible. The simple act of runners paying attention to their Internal Training Loads and monitoring their total weekly training load over time using these methods could be a useful predictor of injury. In addition, it can be an easy method to help runners self-quantify and adjust their optimal weekly training volume. The methods should be practiced over time taking into consideration the individual goals and training tolerances. The crucial step is for runners to think outside distance or duration and to be more mindful of how their body is feeling and adapting to training. Thinking about the total training strategy can lead to more efficient training, less cumulative stress and reduce the risk of injury.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles.

Utilising an evidence informed and interactive learning approach with pre-course online modules, combined with face-to-face practical training, and post-course supportive materials, all designed to help you become the best practitioner you can be.

Dry Needling course

Refresher Dry Needling course

Advanced Dry Needling course

Hip and Pelvis Dry Needling course

Podiatry

Hand

Dental