June 1, 2017 Inner North Osteopathy

Running injuries… ‘Loads’ better.

By Sudi de Winter

A systematic review of 17 high quality studies showed that, at any time, 19-79% of runners are experiencing injury. If we assume injury incidence is somewhere in the middle of these wide ranges, the numbers are very high. No wonder running gets a bad rap.

Why do I always get injured?

Most running injuries are due to tissue overload. Each tissue; bone, muscle, joint, tendon or ligament, has a certain capacity to withstand force applied to it (load). Usually with running, we load our tissues within in a tolerable limit, rest, recover and run again uninjured.

Sometimes, however, we load a tissue too much or too frequently, without giving it adequate time to adapt. The result is overload and grumpy or injured tissue. A stoic runner can even develop bone stress fractures if they continue to run through symptoms and signs of bone stress reaction.

It is also important to consider overall load history. If someone has taken up running later in life and does not have much experience with sport and physical activity, their tissues and bones will not have developed the same capacity as the lifelong sportsperson. It may seem obvious, but these people will be more vulnerable to injury.

The good news is that the body is incredibly good at adapting, and, if done carefully and slowly, even the most sensitive person with complex injury history, can build up their running to surprisingly high loads and volumes.

The problem is that there is no one size fits all. Many people will find couch to 5km programs overload them. For many runners I advise taking double the recommended time. Rest and recovery are crucial. For someone with a sensitive system and complex pain/injury history (eg. a chronic fatigue individual), they may need to take much more time to adapt and even more care with a supportive, holistic approach. The key is that each running program needs to tailored to the individual and their story.


It’s all about balancing load with capacity.

What can I do to better manage loads, adapt quicker and increase capacity?

Relative to other sports, running is not particularly high impact. This is especially true at low to moderate speeds. However, running is extremely repetitive. Particularly if we always run on the same surface, the same route at the same speed with the same technique again, and again.

If we are injured, or we just want to be smarter about training, it is clever to mix up these training variables to reduce overload. This might mean

  • running on different surfaces
  • introducing variation to your runs eg. interval training, hill training, long/slow runs, tempo runs and really easy recovery runs
  • try different routes, trail runs
  • get some running retraining or gait analysis to learn different running techniques
  • running in different styles of footwear

Aside from load management and load variability, we can influence a body’s capacity to withstand load with strength training. If we train the muscles best adapted for running, we can absorb running loads more efficiently with these muscles, thus taking loads off the passive structures like the joints, tendons and ligaments.

How important is running form?

There is no one ‘right’ way to run…


Priscah Jeptoo won the silver medal in the marathon at the London Olympics with funky running technique.

However, we have enough understanding of the gait cycle and biomechanics to appreciate how different running strategies and techniques will manipulate and shift loads around in the body. This is why running retraining and gait analysis can be very useful for the injured runner.

The answers are often simple.

The merits of running are huge. Countless studies cite its mental and physical health benefits and implications for increasing life expectancy. And no, it is not bad for the knees. A massive study, showed less arthritic development in runner’s knees compared to non-runner’s knees.

I often walk to work along a popular running track. It is a real pleasure to watch the myriad of different shapes, sizes and running techniques these people have. I think about changes I could make to their running and remind myself.. “if it ain’t broke, don’t fix it”! Nearly everyone can run if they wish to and the answers to staying healthy are surprisingly simple. The main message is avoid doing too much too soon. The body can adapt to running loads beautifully if given time.

I love when someone wanting to run tells me they are unable to run or have been advised to avoid running. It is satisfying to get them back on track and running with confidence. Running is not dangerous. We just need to be smart, patient and take a simple load management approach.





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