running injuries

When this appeared in my news feed, I was intrigued. Tiger Woods on career regret: Running ‘destroyed my body and my knees.’

“Tiger Woods was asked by a fan what he would tell his younger self  The five-time Masters winner responded, ‘Not to run so much.’  Woods would run 30 miles a week for the first six years of his Tour. He believes that it ultimately caused him injuries resulting in four back and five knee surgeries “

Of course, other factors played a role in Tiger’s injuries, including the biomechanics of the golf swing.  The modern golf swing encourages maximum rotation of the spine relative to the hips. This increased twisting of the lumbar spine, combined with a more powerful downswing, puts increased force on spinal discs and facet joints and tremendous pressure on the trailing side of the spine. It’s why 72 % of pro golfers receive regular chiropractic care provided by PGA chiropractic staff.¹

However, from what I have seen in my practice, I would agree with Tiger.  Running is extremely hard on your body.  If you choose to run to stay fit, your top priority should be to prevent running injuries.

In my practice I see a fair number of runners and their injuries related to running, especially new runners. Most of my new to running patients have started running to get in shape and/or lose weight or to condition for another sport such as golf. These injuries vary in severity but are most often straightforward to treat. I will send the patient off with strong recommendations for cross training. I also make a referral to a specialty running shoe store to be fitted for appropriate shoes. Sadly, patients do not always follow my advice.  When they don’t, they end up back in my office with the same or new injury due to their new workout routine. This can be very frustrating for the patient. They want to get in shape or improve their golf game, but injuries set them back and leave them feeling discouraged.

This brings me back to the Tiger Woods article. Are golfers and other athletes setting themselves up for failure by running? In my opinion many are. It may be an unpopular opinion but as a practicing chiropractor, I believe now more than ever, “Not everyone should be a runner.”  There I said it, out loud.  Here’s why.

Running is a high impact, repetitive activity that puts a lot of stress on your body. This can lead to both acute and chronic injuries, especially if proper protocol is not followed. I have seen countless injuries from running that could have been avoided if an alternative exercise had been chosen. There are several exercises that can be just as effective in weight loss and conditioning without the risk of injury or high impact running. These activities include bike riding, walking, and swimming. When I see a patient who is running and is plagued by injuries,  it’s time for a serious discussion about alternative forms of exercise.  I want to help them achieve their fitness goals without the pain and injuries.

I say this not to dismantle the running community. However, I want to say that running isn’t for everyone and that is okay. There are alternative forms of exercise that are effective and may be better suited for your body type. Do not be ashamed if running is not for you.

Preventing Running Injuries

If running is your passion, then you need to do so safely and effectively.  In order to prevent injuries, you need to do more than just throwing on a pair of well-worn tennis shoes and head out the door.

Sixty percent of runners experience an injury severe enough to sideline them from activity.

There are many injuries that can occur while running including:

•  broken bones
• lacerations and sprains
• overuse or chronic injuries

Acute injuries such as broken bones, lacerations and sprains require immediate medical attention. However, running involves a low-grade, abnormal force being applied repeatedly over a prolonged period of time.  These are classified as overuse injuries.

Overuse injuries from running include:

• stress fractures,
• shin splints,
• iliotibial band (ITB) syndrome,
• runners’ knee,
• achilles tendonitis,
• plantar fasciitis

The thing about overuse injuries is that they happen slowly over time.  So, if your hip starts hurting for no apparent reason, you should suspect that the pain is from an overuse injury.

If you’re going to run for exercise, you must address four key factors:

These factors are proper shoes, flexibility, strengthening and training schedules.

#1 Proper shoes: I can’t overstate the importance of proper footwear if you’re going to run.  Shoes are the only equipment you need to run.  The wrong shoe or an ill fitted shoe can wreak havoc on your body if not appropriate for your foot and running style.

The best way to avoid injury is to prevent it.  Since running shoes are the only protective equipment runners have to safeguard themselves from injury, choosing the correct running shoe is important.  I refer my patients to a specialty running store close to my office to ensure they have the right shoes for them.

#2 Flexibility: Lack of flexibility can make one prone to overuse injuries such as iliotibial band (ITB) syndrome, shin splints, runners’ knee, and achilles tendonitis. This is where cross-training is important. Yoga and Pilates can directly improve your flexibility.

#3 Strengthening: Appropriate strength of the core and other major muscle groups are crucial for high impact exercise. This is another time where cross-training is important. Such cross-training options include Yoga, Pilates, and Strength training with weights. These can offer reduced risk of injury, activation of other muscle groups and aid in injury recovery without sacrificing fitness level.

#4 Training Schedules: Many researchers acknowledge that “training error” is the main source of injury. These training errors include rapidly changing the volume ran and/or rapidly changing the running pace. Both changes can lead to their own set of injuries.

A study published in the International Journal of Sports Physical Therapy ¹ showed that rapid change in running volume may lead to the development of patellofemoral pain syndrome, iliotibial band syndrome, and patellar tendinopathy, while change in running pace may be associated with the development of Achilles tendinopathy, gastrocnemius injuries, and plantar fasciitis.

In plain English, runners need to stick to a training schedule and plan the distance and pace according to your fitness levels. There are many couch-to-5k programs for the novice runner as well as apps that you can download that will help to customize a plan for your fitness levels and goals.

Regardless of your training schedule, you must warm-up before running and stretch after running. This will help to avoid injury and keep you on track. If you do not have time to warm-up and stretch afterward you do not have time to run.

Even with the best preparation and a strict adherence to your training schedule, running injuries can still happen.

If an injury occurs it is important to react appropriately. A 2017 survey ² asked athletes and coaches, “Which factors do you believe influence the risk of running injuries?” An overwhelming majority of the athletes and coaches reported “Ignoring pain” as a risk factor for running injury.

If you have an acute pain, you should seek medical attention ASAP.

For an overuse injury the following first aid is recommended:

• Reduce training, using pain as a guide
• Apply ice to injured area 15 to 20 minutes, three to four times per day
• Use compression to decrease swelling
• Elevate injured area if possible
• Take aspirin or ibuprofen as directed on package instructions.  If you need to take OTC pain relievers for more than seven days, seek treatment with knowledgeable medical professional such as a chiropractor or physical therapist.

To prevent further injury, determining the cause of an injury (e.g., tight muscle or weak hip muscles) is key.  This is where you need to find a knowledgeable chiropractor or physical therapist.

You should see a knowledgeable chiropractor or physical therapist if:

• Pain continues despite decreased training
• Pain persists beyond 10-14 days
• Pain medications are needed to train
• Pain resolves with rest, but recurs once you resume training

Did running play a part in Tiger Woods’ myriad of injuries? Most likely, especially combined with the physically demanding sport of golf. What if he had been instructed to cross-train instead of running 30 plus miles a week?  Would he have been able to avoid his injuries and surgeries? Perhaps, but hindsight is 20/20.  Which is why I’m sharing this information with you now.

The best advice is listen to your body.  Pain is a signal that something is wrong.  Don’t ignore it.   When in doubt, seek a professional’s help.