All things exercise, injuries, treatment & rehab!
Running is a great way to stay active and healthy but with an increase volume or intensity in training, injuries can occur. Here are some of the most common running injuries along with some advice on how to help relieve the symptoms and reduce your likelihood of injury in the first place.
What is it?
Often referred to as Achilles tendonitis or tendonosis, Achilles tendinopathy affects the tendon at the back of the leg. The Achilles tendon connects the muscles of the calf (gastrocnemius and soleus) to the back of your heel and helps with plantarflexion (pointing your foot). Symptoms of Achilles tendinopathy usually develop gradually and include stiffness and pain around the Achilles region which is worse in the morning, but it often eases quite quickly. It may be sore when you start activity but quickly reduce as you continue and is often sore the next day. The tendon may be painful to touch and swelling may be present at the area of the Achilles tendon affected.
Why does it occur?
Whilst running, the foot should move through dorsiflexion during heel strike and plantarflexion during the push off phase of a stride. This repetitive movement means the muscles and the Achilles tendon are working constantly, in a spring-like fashion. Runners have a high chance of developing Achilles tendinopathy due to overuse, which disrupts the structure of the tendon and causes detriment to the spring-like mechanism.
Increases in loading are the biggest contributor to the onset of Achilles tendinopathy, whether this be from training or competition. Also, reduced recovery between training sessions, training on different surfaces and poor or different footwear are all factors that can contribute to the development of symptoms.
Predisposing factors for Achilles tendinopathy include gender – it is more common in males - type 2 diabetes and genetic predisposition. Altered lower limb biomechanics such as reduction in range of motion of the ankle joint and restricted flexibility of the calf muscles also contribute to Achilles tendinopathy arising.
Al & Ben completed the Yorkshire Marathon on Sunday 14th of October in a very damp York. Fortunately the wind of 24 hours earlier had settled down and initially it seemed like perfect conditions for a good time but it never stopped and was a miserable day in the end. Now that the dust has settled from completing their first marathon, Al and Ben reflect on the experience.
Ben - I wouldn't say that I hit the wall. My pace definitely slowed and I felt like I had lost power from about 16 to 21 miles, but mentally I kept strong and like Al, used a number of explicit phrases to ensure that I did not walk. I knew that if I walked, I would not get moving again. There was one point that was mentally quite tough, as I looked up to see a female athlete power walking in front of me and I couldn't catch her! In the end I got a second wind and went past!
Did anything help you through?
We raised over £500 for The Whole Autism Family. Al tells us "It has been brilliant to raise money for The Whole Autism Family. The charity is very close to my heart as it was set-up by my cousin and his wife in light of their experience of the support (or lack of) for families with Autistic children. It certainly helped to keep me going when it got tough."
How has the recovery gone?
Ben - In the grand scheme of things not too bad. The only thing that took a while was the calf where I have had a previous muscle injury. But after about 5 days it was back to normal. One thing that I have noticed is that I have felt drained for the two weeks since, and a couple of gym sessions have resulted in some quite heavy DOMS.
Al - I've been surprised by how quickly I recovered. I expected to be walking like John Wayne for around a week afterwards but within a couple of days the muscle soreness settled down. I think the biggest difficulty has been getting a decent sleep, I felt pretty knackered for the whole week afterwards.
Thank you to everyone who sponsored us and all the support we received in the lead up to the race and on the day, it was a massive help!
Since my last marathon blog post I have been plugging away with training for the Baildon Boundary Way. This isn't your usual half-marathon, as you can see from the photo it is often muddy and always hilly! I have posted previously about the race and my aim to beat last years time of 1:53. I am pleased to say I managed to beat that, completing the course in 1 hour 50 mins. I was a bit gutted to miss out on sub 1:50 by about 10 seconds, which was my aim before the race but happy to pull out my best performance on my fourth attempt.
I did struggle on the hills this time around, an ankle injury I picked up a little while back (I missed a step whilst carrying Billy and managed to damage my syndesmosis a bit) left me with very little power from my left leg from a dorsi-flexed position. It doesn't cause me any problems on flat and slight inclines, but left me with little more than a shock absorber on the steeper hills - and there were a few of those! Some strength, balance and power work to do over the next few months to get that one sorted.
After the race we did notice that a diversion that had been forced on the organisers meant another hill had been added to the course this time, much to our delight! The descent in this case was through a lot of mud and leaves, I managed to fall on my backside 3 times on the way down, hopefully nobody caught it on camera!
The nights are getting lighter, the weather is getting warmer and there are lots of people pounding the pavements and clocking up the miles. Running season is now in full flow and it is this time of year that we often speak to runners about how to improve their training and avoid injuries. I am still amazed that despite clear evidence to support the positive effects of strength training on endurance performance and athletes like Sir Mo Farah extolling the virtues of strength training, many runners still avoid lifting any weights.
In this blog we will discuss some of the popular myths we hear from runners who do not undertake any form of weight/resistance/strength training and the benefits of incorporated it into your training program.
Myth #1 - if I do weights I will get heavier
Simply lifting weights will not result in you turning into Arnold Schwarzenegger. Bulking up and getting heavier is not that simple. The shear volume of internet and magazine articles and social media posts about getting 'ripped', 'stacked' or looking like Tom Hardy or Chris Hemsworth should tell you this.
The volume of weights you need to lift to put on serious muscle mass is way over the amount you would be lifting as part of your running training programme. The amount of time you spend running will far outweigh your time in the gym making it almost impossible to gain weight. If you are, it is more likely to be a nutrition problem than a training issue.
Myth #2 - strength training is an added bonus to running training
For all the reasons I will discuss later in this post, strength training should be a integral part of a running training program to improve performance and reduce risk of injury, not something seen as an added bonus.
Myth #3 - Bodyweight exercises are enough for runners
The forces our body experience during running are much greater than bodyweight exercises alone can train us for. Typically we would expect vertcial ground reaction forces (the force we experience when we land during each step) of at least two times our bodyweight during running - so an average person weighing around 70kg will experience at least 1400N of force (equivalent to ~140kg) during each and every step they take during a training run. Hopefully you can see why doing a bodyweight squat simply will not cut the mustard.
It is recommended for optimal performance that athletes are able to squat at least 2x their own body weight. In fact, during rehabilitation from injury we often require our patients to be able to single leg squat or leg press 1.5x their body weight to ensure they are robust enough to start jumping and running training. In practice therefore, we would expect a 70kg patient to single leg squat with a 35kg external load; or single leg press 105kg.
Myth # 4 - lifting weights will give me DOMS
DOMS (delayed onset muscle soreness) is most often caused by a high volume of unaccustomed training or eccentric loading. Put simply, if you have a good training programme which is personalised to you, then you are unlikely to experience DOMS. If you have never done any strength training before, then you may experience some soreness after the first few sessions, but as you become accustomed to the strength training then DOMS is unlikely.
The benefits of strength training.
This now brings me nicely onto the benefits of strength training. When done correctly and as part of a well structured program, strength training can both improve performance and reduce injury risk. Strength training can build the platform for injury-free running and a more robust system that has the ability to adhere to the regimen of mileage, speed and tempo work you have set. Here are some of the benefits proven by research:
- increased performance (ie. quicker times)
- increased VO2 max
- improved resting metabolic rate
- improved body composition (more muscle, less fat!)
- improved running economy
- decreased injury rates
If you would want to improve your running performance but are not sure where to start why not book in with one of our Team or try a Strength & Conditioning class?
The acute:chronic workload model has gained a lot of attention over the past year or so after a series of research papers were published showing it's ability to predict injury in team sports - a full list of these publications can be found here. The model provides a ratio of recent training load (acute) to training over a prolonged period (chronic), usually the most recent week vs the previous four weeks. This can be calculated using a number of different variables - distance covered, weight lifted or minutes*RPE (rating of perceived exertion).
To work out the ratio, the acute workload value is divided by the chronic workload value. So for example if both acute and chronic workload was 3000m the ratio would be 1, whereas if acute was 3000m and chronic workload was 1500m the ratio would be 0.5. The figures below show how this would look when this is calculated in practice, using high speed running distance as the workload measure. Graph A shows acute workload measures over 4 weeks, with graphs B & C showing the addition of the chronic workload after 4 & 5 week respectively. Graph D shows the acute:chronic workload relationship over the course of a full season.
According to the research papers that have been published thus far, an acute:chronic workload ratio of 0.8-1.3 is regarded as the sweet spot, with injury risk being relatively low in this range. A ratio of 1.3 to 1.5 shows a slight increase in injury risk, whilst a ratio of >1.5 is regarded as the danger zone, where injury risk is significantly elevated. You may also note from the figure below, undertraining increases your risk of injury! So having a complete rest week may not be the most beneficial training method, however a tapering week, where workload is lower than usual would be more advantageous from an injury risk perspective.
In terms of applying this workload model to real-life, there are some spreadsheets available online to help with the calculations. It is important to consider cross-training to help maintain training loads whilst injured or when thinking about returning to play.
this week has seen the start of my marathon journey, I’ve been back out pounding the pavement and clocking up the miles. Running 26 miles is quite a daunting prospect, and thinking about training for this does make me wonder why I am doing it! I have signed up to run the Baildon Boundary Way in April for the fourth time to give me an early goal to aim for. I think that having smaller more achievable goals along the way is going to make a huge difference to keeping me motivated.
I managed to get down to Burnage Parkrun on Saturday morning, despite the cold, wet weather. I was really happy to come in at sub 22 minutes having not run properly for a few months. This was all despite Lake Burnage which was knee high and meant you lost feeling in your feet for a few hundred yards (see image!), and a tumble towards the end!
In order to make sure I don’t overtrain and help avoid injuries I have adopted the acute:chronic workload model for my training - see separate blog post on this subject. There has been a great deal of hype around this model and it’s ability to predict injury in team sport athletes. Basically it compares your most recent week of training against the previous 4 weeks. It can be calculated using a number of variables, I have decided to use ‘distance/time x RPE’ to give me a workload value. Time x RPE is a commonly recommended method but I feel it doesn’t give a full picture of how hard I have worked. If I cover 10km in 45mins then I will surely have worked harder than if I cover 10km in 1 hour, right? But if my RPE is 8 vs 6 respectively (workload equates to 360 in both cases) then I don’t really get the credit for the work, so the addition of distance should help (workload = 1.78 vs 0.83 respectively). Whilst this method may have some flaws (like anything) it is certainly an improvement on the previous 10% rule.
So week 1 down, many more to go. The journey has started well but there are plenty of challenges ahead.