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WHY RUNNERS GET HURT
I'm often asked, "What separates world-class runners from the rest of the pack?" My first answer is "freedom from injury."
Very few runners can tolerate high levels of training for many years. Many runners have the talent to rank among the best, but injuries slow them down or force them into an early retirement.
Injuries are, unfortunately, a fact of the runner's life. While running is an excellent way to improve the cardiovascular system, it puts tremendous strains' on the musculoskeletal system. Runners' feet and legs take more pounding than they are made to handle, making runners the most frequent visitors to sports-medicine specialists with problems ranging from minor aches and strains to torn Achilles tendons and damaged knees.
Runner's World surveys conducted since the 1970s have shown that in any given year about half the magazine's readers have their running program interrupted by injury. According to a survey of 10,754 runners I helped conduct, 75 percent of male runners and 80 percent of female runners have suffered at least one injury serious enough to halt their running at least temporarily. More than half of them sought professional treatment.
The Perils of Overuse
The number-one reason for injuries is overuserunning too much, too fast, too soon or too often. We term all of theseoveruse problems "training errors." This is a polite way of saying that your body cannot handle the stresses that you have placed on it.
Nevertheless, runners are frequently tempted to overdo. Bob Babbitt of The Competitor magazine once asked finishers of the Long Beach Marathon, "What would you do differently in preparing for your next endurance event?" The unanimous answer: Train more.
Runners forget that there is a limit to how much training the body can absorb and that rest and recovery are as vital to improvement as hard work. Training too much and not listening to the signals that your body gives when it needs rest are the main reasons that injury rates are so high among runners.
That's the bad news about running injuries. But there's good news, too:
Most of these injuries result from training mistakes that can be prevented or corrected without elaborate or expensive medical care.
Other problems, such as misalignment, can be accommodated with proper shoes and special shoe inserts.
Few running injuries are serious enough to disrupt your everyday life or end your running career.
No doubt about it: Runners who ward off injuries by listening to their bodiesand adjusting their training programs in responsestand the best chance of reaching their potential.
If you heed your body's signs of fatigue and overuse and react accordingly, you will outrun and outlast the runners who try to go all-out all the time.
Who You Are and How You Run
There's one sure way to beat running injuries: Don't get them in the first place. That may sound ridiculously obvious, but it's easier said than done. Most runners don't realize they're headed for a problem until the injury actually occurs.
That's where the Injury Predictor Quiz at the end of this chapter comes in. This quiz helps you take a detailed, discerning look at your potential for different running injuries. It asks about your physical makeup and your running habits and tells you what you can do to help avoid injury.
To take this quiz, all you need is a tractograph, which you can purchase for less than $10 at a stationery store, and, in some cases, a friend to help. The only test you can't administer yourself is the body-fat test; you can get this done at a medical clinic, at a health fair or by your physician. Here's how to administer the simple self-tests required for this quiz.
1. Are You Male or Female?
Unfortunately, gender does make a difference when it comes to runningand women come up short. Women's hips are, on average, wider than men's. Therefore, a woman's foot strikes the ground at a greater angle than a man's. This promotes overpronation, an excessive inward rolling of the foot, which can lead to a variety of injuries.
What's more, women's tissues are more elastic than men's. This makes women more liable to ligament and joint damage.
Injury statistics also indicate that women are more susceptible to stress fractures than men. Women's bones tend to be smaller and, consequently, less able to absorb the shocks of running.
To counteract these gender-based tendencies, women may need to do specific exercises designed to strengthen leg muscles and promote flexibility. (See chapter 23 for specific exercises.) It's also especially important that women find shoes that meet their biomechanical needs. (See chapters 4 and 5.)
2. What Is Your Body-Fat Percentage?
The more you weigh, the greater the shock and stress your body sustains with each step you run. The more pounds you're carrying over your appropriate body weight, the more likely it is that those shocks and stresses will translate into running injuries.
If you're overweight, you may tend to develop a wider running stance, hitting the ground with your feet farther apart than they'd be if you weighed less. That wider stance puts stress on your medial tendons-the ones along the insides of your legsand may cause you to overpronate (roll inward excessively). Overweight runners are at high risk for injuries related to the shock of running impact, as well as those caused by lack of foot stability, such as muscle strains and tendinitis.
The best measure of ideal weight is not the scales or a chart that lists how many pounds you should weigh. A much more reliable figure is percentage of body fat. There are several ways to check your body-fat percentage. Underwater weighing is probably the most accurate, but it's also the most involved and expensive.
Having skinfold measurements taken with calipers is a reliable alternative. Bioelectrical impedance analysis (BIA) is another economical possibility, although some experts think BIA tends to overestimate the body fat of lean peopleincluding most runners. Both tests can be performed for around $50 by an exercise physiologist, cardiologist, internist or other professional trained in the technique.
Average body-fat percentages for runners are about 12 percent for men and 18 percent for women; more than 15 percent for men or 20 percent for women will result in negative points on the Injury Predictor Quiz.
To reduce your chances of weight-related injuries, take a slow, easy approach to your running program. Alternating running with walking while you cut back on fatty and sugary foods will help take off a few unwanted, unneeded pounds.
3. Do You Have One Leg Shorter Than the Other?
Although no one's body is exactly symmetrical, pronounced differences in leg length can cause problems for runners. There are two kinds of discrepancies: structural and functional.
In structural discrepancies there is a real, measurable difference in length of the bones. In functional discrepancies the bones may be the same length, but because of biomechanical problems the legs look and work as if one is shorter than the other. This could happen in a person if the pelvis is tilted, for example.
A difference greater than a quarter-inch between the right and left legs usually causes lateral-hip pelvic pain (on the outside of the longer leg) or low-back strains. Such injuries occur when the upper body tries to compensate for the lower body's imbalance by twisting or bending.
How do you know if you have a leg length difference? Take a look at your running shoes: The shoe on a longer leg will wear down more quickly than the other. Or stand in front of a mirror with your hands resting on top of your hips: If one hand appears higher, that leg is probably longer than the other.
A lift in the shoe of the shorter leg should solve the problem. Start with a 1/8-inch lift. If that's not enough, try a higher one.
4. How High Are Your Arches?
In general, the arch of your foot determines how your feet and legs will function when you run. Flat feet, with little or no arch, can cause problems, as can feet with very high arches.
To check your arches, take what's called the "wet test." When you step out of the shower, step on a brown paper grocery bag. Put your full body weight on the foot that you are checking.
Now step away and check your footprint. If you can see the full outline (or almost a full outline) of your foot, you have a flat foot. An ant would not have a chance to escape underneath this foot type.
The high-arched foot type produces a completely different tracing. The heel and the ball of the foot yield the greatest impressions, while you will usually see only a very faint line along the outside portion of the foot.
Sometimes that line disappears. This indicates the pressure points are strictly at the heel and the ball of the foot and the entire arch is well above the supporting surface. A rigid, high arch is very stiff and doesn't give much when you run.
A runner with a normal arch will see an imprint of the heel, about half of the arch and the ball of the foot. The arch will actually collapse a little bit as you run and walk, allowing a normal amount of pronation or rolling in.
Both flat feet and high-arched feet tend to be prone to injury, but you can compensate somewhat with the right shoes and orthotics, which I discuss in chapters 4 and 5.
5. Do You Overpronate?
Pronation is naturalit's the rolling-in motion that occurs after the outside heel of your shoe strikes the ground. A little bit of pronation (four to six degrees) is good, but either too much or too little can make you highly susceptible to a host of running injuries.
Finding out whether you have flat arches via the wet test is one of the best ways to diagnose pronation problems. The flatter your arch, the more support is needed in the shoe. But the condition of your running shoes' heel countersthe firm cups that hold your heels in placecan also be a tipoff.
Have a friend watch you standing or running. If the heels tilt inward, you probably suffer from at least mild overpronation. If your shoes appear distorted after you take them off, with the heels tilted inward, you're a moderate overpronator. Heel counters broken down toward the inside are a sign of severe overpronation.
The heel counters of underpronators generally tip outward. The more excess wear in that direction, the bigger your underpronation problem. This problem can be dealt with by buying the right kind of shoe.
6. What's Your Q-Angle?
The Q-angle is the angle of intersection of your tibia (shinbone) and your quadriceps muscle. To measure your Q-angle, you'll need a tractograph.
Use the tractograph as shown below to measure the angle of intersection of two imaginary lines: one that bisects your thigh and kneecap, and one that passes from the kneecap through the tibial tubercle, the bony protuberance directly below your knee near the top of your shinbone. A normal angle is 8 to 10 degrees for men and 15 degrees for women.
Overpronation can make an excessive Q-angle worse. Shoes with good motion control can help check overpronation, reduce the Q-angle and cut down your chances of knee injuries.
If your Q-angle is particularly high, you may need orthotics. Strengthening your quadriceps, which is detailed in chapter 17, can help minimize the symptoms of knee pain that may come with a high Q-angle.
7. Are You Bowlegged?
Bowleggedness can mean trouble for both overpronators and underpronators. For overpronators, and most bowlegged runners fall into this category, it may contribute to excessive foot motion. For underpronators, it may create ankle instability.
Most people's legs bow slightly. To check yours, stand with your feet together and note the distance between your knees. If they almost touch, you're only mildly bowlegged. But if you look more like you just dismounted a horse, your problem is more severe.
There's not much you can do about being bowlegged, so you must take great care in selecting your running shoes. Again, most bowlegged runners are prone to overpronation and should consider buying very stable shoes. (See chapter 5.)
8. Are Your Calves Flexible?
Flexibility is one of the most important indicators in the prediction and prevention of running injuries. Good flexibility lets your joints and muscles move as they are supposed to when you run.
In contrast, if your muscles are tight and your joints stiff, your body will be less able to resist abnormal biomechanical forces such as excessive pronation. Running, unfortunately, creates muscle imbalances and increases inflexibility in the muscles running down the back of your legs.
The calf muscles (gastrocnemius and soleus) are attached to the Achilles tendon, and work to lift up the heel and flex the foot downward when you run. When calf muscles are too tight, the heel of the foot that's supporting your body's weight will get pulled off the ground prematurely. This in turn yanks hard on the Achilles tendon and may cause it to become inflamed. This injury is almost always the direct result of too-tight calf muscles.
Inflexible calf muscles can also lead to what people refer to as shin splints, pain caused by a variety of different afflictions of the lower leg. Plantar fascia pain (under the arch or heel) can also be caused by tight calf muscles. (When a muscle is tight, it also pulls hard at its attachments.)
To test your calf-muscle flexibility, lock your knee and bend your foot up as far toward your knee as you can. Have a friend use a tractograph to measure the angle formed by your foot and leg as shown above. Your foot should be able to flex up at least 15 degrees from its perpendicular position. That amount of flexibility will give you a normal range of motion.
If you come up short on this test, you should immediately begin a stretching program designed to lengthen your calf muscles. (See chapter 23 for flexibility exercises.)
9. Do Your Hamstrings Flex?
The hamstrings are the muscles and tendons behind your knees and thighs. Your hamstrings need to be long enough to allow your knees and hips to move freely through their proper range of motion. Hip pains and injuries to the knee and thigh occur when the hamstrings are too inflexible.
To test your hamstring flexibility, lie on your back and lift your leg as far as you can while keeping your knee locked. You should be able to form at least a 90-degree angle with your other leg. If you can't, you'll have to start stretching. Chances are that if your calf muscles are too tight, your hamstring muscles will be as well. (You'll find a stretching program in chapter 23.)
10. Check Your Iliotibial Band
One of the most common knee injuries is an inflammation of the iliotibial band (ITB) where it joins the tibia just below the kneecap. This problem usually has a double cause: excessive pronation and a tight ITB.
When the band is too tight, it tends to rub against the lateral femoral condyle (a bony structure on the outside of your knee) and become inflamed. To check whether your ITB is too tight, give yourself the ITB or Ober test, as shown on page 11.
If your ITB is tight, the solution is simple: Stretch the ITB. (See chapter 18.) In addition, you might need to take steps to minimize your overpronation with shoes, orthotics or both, which are covered in chapters 4 and 5.
11. How Long Have You Been Running?
Many studies cite training errors as the most common cause of running injuries. Remember the curse of the injured runner: Too much, too fast, too soon or too often.
Beginning runners are more likely to get injured than those who have been at it a while. The muscles, joints, tendons, ligaments and bones of a beginner aren't used to the rigors of running's repetitive stresses. The first four months of running are the most critical. For beginners, shin splints are a common problem and stress fractures can occur because leg muscles develop quickly and may actually overpower the bones.
If you're just starting to run, begin slowly and gradually with a combination of slow jogging and walking. A related warning to runners who cut way back on their training during the winter: A high number of injuries occur in March and April, foiling runners who rush back into full-scale training too quickly. (A good general rule of thumb is to increase your mileage no more than 10 percent each week.)
12. How Many Miles a Week Do You Run?
Assuming that you've been consistently running a certain number of miles for at least three months, you can use your weekly total to predict the likelihood of an injury. The rule is simple: The more miles you cover, the more likely you are to get injured.
Kenneth Cooper, M.D., president and founder of the Cooper Aerobics Center in Dallas and author of best-selling books on aerobic exercise, concluded after extensive research that 12 to 15 miles per week is the optimum amount. Dr. Cooper says running two to three miles a day, three to five days a week, is enough to be aerobically fit while minimizing the chances of getting hurt.
But many fitness devotees assume that more is better. They think that if 12 to 15 miles per week is good for their health, twice as much must be twice as beneficial. In fact, Dr. Cooper has found that after 15 miles fitness returns diminish and injury rates climb.
Many runners exceed that figure, of course, and do so without getting hurt. But if you're injury-prone or discover from this quiz that you're at high risk for injury, cutting back your mileage may be one easy way to beat the odds.
13. Do You Progress Too Quickly?
You shouldn't increase your mileage by more than 10 percent per week, as mentioned previously. So if you ran 25 miles last week, don't add more than 2 1/2 miles to your total this week.
That 10 percent is the amount your body can tolerate without increasing your chances of injury. Anything more puts you at significant risk.
14. Do You Take Time to Fully Recover?
If an injury has caused you to miss more than two weeks of running, you must return slowly and easily. Most runners are champing at the bit after that kind of layoff, but the first few weeks back are crucial in preventing future injury.
Unfortunately, an injury doesn't make you stronger; it makes you susceptible to a recurrence. To keep that from happening, make yours a careful comeback. If your injury is three months old or less, a good rule is to start back at 50 percent or less than what you were previously doing. (See chapter 22 for more details.)
15. When Do You Run?
Statistics show that if you run in the afternoon or evening, you'll have fewer injuries than if you run the first thing in the morning. The soft tissues (muscles, tendons and ligaments) are tighter and less forgiving in the morning, before your normal daily activity has warmed them up. Muscle strains and various tendinitis complaints are also more likely to crop up during morning runs.
Morning runners do have one advantage, however. Statistics show that they're more likely than afternoon or evening runners to stick with a running program.
16. What about Speedwork?
Doing speed training on the track, or time trials on the road, is a great way to improve your racing performances. It's also a great way to get hurt. The risks of speedwork are highest when you're taking your first fast steps and when you really pick up the pace.
Once you're used to a reasonable amount of fast running, your body ought to be able to handle the stress. But always be sure to warm up before a speed session and to cool down afterward. Follow a sane speedwork program that tailors your training pace to your race pace.
17. Do You Race?
Runners who race have a 10 percent greater likelihood of injury than runners who don't. And the more often you compete, the bigger the risk.
To improve your chances of staying healthy, race only when you're certain your training is adequate for both the distance of the race and the pace you're planning to maintain. And accept the fact that there are some days when you're just not up to par or when the weather conditions are bound to slow you down. Know your limitations, and adjust your pace accordingly.
Excerpted from RUNNING INJURY-FREE by Joe Ellis, D.P.M., Adviser, with Joe Henderson Columnist. Copyright © 1994 by Joe Ellis and Joe Henderson. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.