This is your safety guide to putting one foot in front of the other whether you’re a weekend warrior, training for a marathon or just jogging for lunchtime fitness.
Did you know? 65% of runners experience an annual injury (1). It reaches 90% for those that are training for a marathon (2). But, what do we Injure? Most commonly, it’s the knee at 42.1%. The most common injuries include patellofemoral pain syndrome, iliotibial band friction syndrome, plantar fasciitis, tibial stress fracture, and a knee meniscus injury (3).
So, why are injuries so common during a movement that is so mundane as putting one foot in front of the other. Seriously? 2 mechanisms explained by research describe that it’s the excessive and repetitive impact between foot and ground (4). This means there’s too much energy going into our feet for our bodies to safely absorb. The second mechanism is poor foot mechanics (4). Some research states poor lower limb mechanics e.g. excessive pronation (flat foot) which decreases the amount of shock absorption going through the foot when we run.
Four factors that contribute to injury, these include strength, flexibility, alignment and behaviour;
As a chiropractor, alignment comes first. After making yourself aware of these misalignments you’ll be noticing dysfunctions everywhere. Maybe not on yourself but the person running in front of you, have a look but not in a creepy way. You’ll start seeing patterns everywhere. Unsee it, I dare you.
Starting at the pelvis, instead of having a level pelvis from left to right and front to back you may notice a sudden drop to one side or a rotational component to help swing the leg in front of the body for the next stride (4,5). This pelvic dysfunction will have an impact on our hips which will impact our knees and in turn our ankles and feet. At the knee joint its common to see (watch out for it) slight inwards angle (valgus) of our knee making the foot kick out towards the side. This small dysfunction will increase the stressful load going through the knee. Connected to the knee is the shin bone (tibia), this tends to rotate as well giving the foot decreased capacity to be aligned and function optimally. Manual therapy is recommended to work specifically through the sacroiliac joints (pelvis), hip capsule, knee and talar joint (ankle) (4,5).
Strength training for a diagnosed injury needs to be injury specific!! I do not recommend self-diagnosis and treatment. Always seek advice from your therapist first. However, there are several awesome exercises for prevention training. These include squats (single leg), forward lunges, side-lying hip abduction (clams), thera band hip external and internal rotations. Forefoot lifts and strength training that also includes coordination e.g. step-ups. These exercises hit the main muscle groups to facilitate the ultimate running technique.
To balance strength, we need flexibility. To prevent compensatory patterns in our lower limb we need the flexibility to allow for optimal joint movement. Flexibility allows an even distribution of load through our joints, decreases tissue tension and reduces baseline muscle activity (efficiency) (6). Key muscle groups include hip flexors (including quads), calves and a deep butt muscle called the piriformis.
Lastly, the shoes we wear also contribute to injury. I get asked quite often about the type of shoe to be worn and honestly, it’s a tricky one. There’s no exact algorithm, although foot scans can give us a really good idea. When looking at arch height and plantar shape through the foot we can get a rough idea of what shoe you should wear. People with a high to normal arch should look for a neutral shoe. A foot that has a moderate arch drop should look for a shoe with more stability and feet with severe arch drop should look for a motion control shoe (broad, stable sole) (7).
With this, specific technique habits should be avoided. We should avoid overstride (increased step rate), avoid bouncing (airtime) as this increases lower limb stiffness when we hit the ground (8). Lastly avoid excessive compliance e.g. pelvic tilts, knee separation as well as incorrect foot placement according to our centre of mass.
In summary, there are so many variables as to why there is a high incidence of injury in runners but if we incorporate strength, flexibility, alignment and healthy behaviour into our lives this will decrease the chance of annual injury. If injury does occur, please seek professional advice to get you back from a walk to run and then maybe even to sprint in no time.
1. Lysholm and Wiklander (1987) Am J Sports Med
2. Satterthwaite et al. (1993) Br J Sports Med
3. Taunton et al. (2002) Br J Sports Med
4. Twellaar et al. (1997) Int J Sports Med
5. Wen et al. (1997) Med Sci Sports Exercise
6. Brushoj et al (2008) Am J Sports Med 36:663
7. Ryan et al. (2011) Br J Sport Med
Heiderscheit et al. (2011)