How to prevent running injuries – part 2

In a previous post (How to prevent running injuries-part 1), we discussed the factors that contribute to running injuries, and divided these into 2 main categories:

1. Extrinsic factors

2. Intrinsic factors

In part 1 we looked at extrinsic factors, so now we will focus on intrinsic factors that contribute to running injuries.

Intrinsic Factors

These are factors that relate to the individual runner, and are generally within the runner’s control. That is, if you get all these factors right, you have an excellent chance of running injury free and really enjoying you’re running… and possibly setting some personal bests!

1. Running technique/posture.

Because of the loads experienced by the body in running, it is clear that any posture or technique that is not efficient, or places further strain on the body, is likely to lead to injury. For example, if you run with your feet always landing in front of your pelvis, or you have poor control of your pelvis when you land, or you run in a slouched posture, you will most likely suffer some strain to your body which can accumulate over time. The problem is most people don’t know how they run, so don’t know if they are running correctly(see hint below). There is also some debate in the literature as to what is good running form, eg the jury is still out on whether heel striking increases injury risk(many studies conclude there is no increased risk, but the question is how well can these findings be generalised to all runners). There also have been other techniques that have gained popularity over the last few years, such as Pose and Chi running. However, currently the general consensus on good running technique includes:

1. Erect posture with a slight forward lean from the ankles rather than the
2. Relaxed shoulders with elbows bent at 60-90 degrees and elbows in.
3. Ground contact with a slightly bent knee, lower leg perpendicular to
ground and footstrike with midfoot rather than heel.
4. Legs should drive up and down in forward plane like pistons, and arms not
cross centre of body but move forward and back.
5. Footstrike should generally occur as close to centre of mass as possible ie,
under the moving pelvis rather than too far in front of it which facilitates
forward momentum and reduces braking effect of heel strike.

I have also posted a video on the key elements of running posture based on my clinical experience and knowledge as a Physiotherapist and a runner.

Tip: Get someone to video you running and look to see if you are incorporating the general principles above. If not, try to add in one element at a time, practising your running slowly and mindfully. Also consider  what feels comfortable to do, as we are all built slightly differently. If in doubt, consult a trained professional who is a runner, such as a coach or Physiotherapist.

Skelett Skeleton Muskel Muscle Frau Woman laufen

2. History of previous injury

This may seem obvious to some, but needs to be clarified. If you have suffered an injury in the past, especially to a lower limb muscle, joint, ligament or tendon(tendons are the end point of a muscle that attaches it to bone- ligaments are the non contractile structures that reinforce a joint), this can increase the risk of running injuries, as documented in the research. This is particularly relevant if you have not had the injury treated or followed through with the appropriate rehabilitation. There may be residual   muscle weakness, muscle tension or shortening, joint stiffness, neural tension, proprioceptive loss(loss of joint position sense), scarring or motor control deficits, that will only come into play when the body is placed under more load with running. Most of these dysfunctions may not be detected by the individual, as they are sub clinical(not causing any symptoms). They will affect the way the body moves, and also affect recovery.
Even upper body injuries can affect running, as the arms and shoulders move, and the torso rotates as  you run. In the clinical setting, we have seen hip pain that is being triggered by shoulder dysfunctions, and foot pain that can be traced back to dysfunctions in the thoracic spine(you can find many more examples of this here). This is because the body is largely interconnected, and one region will affect another at some level. This concept is called Regional Interdependence, and there is a growing body of research to support it.

Tip: Make sure you get all injuries checked out by a qualified health professional, and follow through with your rehabilitation as prescribed by the practitioner. If you are just starting out, or wanting to increase your volume or intensity, it may be worthwhile having a thorough musculoskeletal assessment by a trained health professional, to detect any imbalances/dysfunctions before they become a problem…an ounce of prevention is worth a pound of cure!
You may also find my ebook helpful… it has lots of tests you can perform to detect for muscle weaknesses, and exercises to fix them and strengthen your body to cope with the demands of running.

3. Musculoskeletal Dysfunction/imbalance

This follows on well from history of past injury, and is definitely a significant contributing factor that we see clinically for running injuries. Basically, you do not need to have had a past injury to have a musculoskeletal dysfunction. All of us have these in some shape or form, and they essentially take the form of muscle tension/knots/guarding, joint stiffness, neural tension(nerves not sliding properly…more on this in another post), loss of flexibility or strength in a muscle or region of the body, or loss of optimal muscle activation/control for a particular part. These usually result from poor postural habits, sustained positions like sitting/driving which increases strain on the spine and neck, and repetitive tasks such as bending and lifting. Caring for young children, lifting grocery bags, gardening, vacuuming and mopping are other routine activities that place some strain on the body and can lead to dysfunctions developing.
These dysfunctions can build up over time and will affect how well your body moves and recovers from exercise. For example, a shoulder dysfunction will affect the rotation of the torso and shoulder movement during running, impeding free rotation, which can cause compensatory changes in the way the opposite hip and leg move. A problem may manifest as pain in the hip or knee, but the real source is the shoulder, and local treatment at the site of pain is unlikely to fix the problem.
In my opinion and clinical experience, these are the primary causes of most non-traumatic running injuries (those conditions that develop slowly over time). Increases in volume, intensity or other extrinsic factors can trigger these issues, but these exist well before hand, lying dormant until the strain threshold in the body is exceeded.

Tip: see tip above!
If you would like more information about musculoskeletal dysfunction and pain you can find more here.
Strengthening your body will help address some of the dysfunctions, as some of them will relate to muscle weakness. See the link above for my ebook.
A good stretching routine is also important, particularly if you are an older runner,. This is best performed on non-running days or as part of recovery after a run (more on this in another blog).

4. Number of years running.

The more experienced you are as a runner, the less likely are you to get injured. There are 2 reasons for this:
1. Adaptation by the body to the forces experienced in running. The human body has an amazing ability to adapt to virtually any condition and load placed on it, as long as it has time to adapt. Muscles and tendons become stronger with years of running, and joints also adapt to loads placed on them. Efficiency also improves as you practice a skill, so the central nervous system(brain) finds more efficient muscle recruitment pathways to perform the same task. This applies to any sport or motor skill, like riding a bike or playing a musical instrument. Eventually, less muscle effort and energy is required to perform the same task.
2. Increased body awareness. The more experience you have as a runner, the better able you are to read your body and watch for signs that it needs a rest. You become more attuned to those little niggles, and you have either learned ways to manage them, or are aware when your body needs a rest to recover. You are probably also more aware of the benefits of strengthening exercises to prevent injuries, good diet and stretching to aid in recovery, and have developed a stable routine for running.

mature woman running outdoors in the park

Tip: Give your body time to adapt to running and your enjoyment of it will increase. If you are just starting out, 1-2 runs/week is good. You can progress to 3-4 runs/week after about 6 months, and after 1 year you can look at increasing volume and intensity of each session more. Educate yourself about appropriate strengthening and stretching exercises, and what foods that will help your running.


Enjoy your running!