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| ’Tis the Season for Running Injuries. Here’s How to Avoid Them. | ’Tis the Season for Running Injuries. Here’s How to Avoid Them. |
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| Fall is marathon season. And after two years of reduced participation at major marathons like Chicago, Berlin, London and New York, race numbers are finally back up. | Fall is marathon season. And after two years of reduced participation at major marathons like Chicago, Berlin, London and New York, race numbers are finally back up. |
| That, coupled with a pandemic running boom, means there are more people showing up in sports medicine clinics like mine with injuries such as shin splints, Achilles tendinitis and runner’s knee. On a recent day, I saw eight patients in a row with marathon-training injuries. Other times of the year I might see eight in a month. | That, coupled with a pandemic running boom, means there are more people showing up in sports medicine clinics like mine with injuries such as shin splints, Achilles tendinitis and runner’s knee. On a recent day, I saw eight patients in a row with marathon-training injuries. Other times of the year I might see eight in a month. |
| An estimated 30 percent of runners training for a marathon suffer some kind of injury, and roughly 15 percent will never make it to the starting line because of it. This also holds true for shorter-distance events, such as half marathons, where the injury rate is comparable. | An estimated 30 percent of runners training for a marathon suffer some kind of injury, and roughly 15 percent will never make it to the starting line because of it. This also holds true for shorter-distance events, such as half marathons, where the injury rate is comparable. |
| Whether you’re training for a marathon or walking in your neighborhood, preventing injuries is far easier than treating them after they’ve occurred. Rather than waiting for an injury to find you, here are several useful considerations to keep you on the road. | Whether you’re training for a marathon or walking in your neighborhood, preventing injuries is far easier than treating them after they’ve occurred. Rather than waiting for an injury to find you, here are several useful considerations to keep you on the road. |
| Once upon a time, the default view among athletes was best summarized by an old quote from the war hero General Lewis Puller: “Pain is weakness leaving the body.” This meant pushing training volume — be it miles, weight or intensity — to achieve athletic success. | Once upon a time, the default view among athletes was best summarized by an old quote from the war hero General Lewis Puller: “Pain is weakness leaving the body.” This meant pushing training volume — be it miles, weight or intensity — to achieve athletic success. |
| Today, sports medicine experts recognize this philosophy can cause injury in any sport. The number of innings thrown per season in baseball affects a pitcher’s risk for shoulder and elbow injury. In basketball, the number of minutes played affects the risk of ankle and knee injury. To reduce these, teams use something called “load monitoring” — playing fewer back-to-back games or pitching fewer innings — to lower the stress on specific muscles or joints. | Today, sports medicine experts recognize this philosophy can cause injury in any sport. The number of innings thrown per season in baseball affects a pitcher’s risk for shoulder and elbow injury. In basketball, the number of minutes played affects the risk of ankle and knee injury. To reduce these, teams use something called “load monitoring” — playing fewer back-to-back games or pitching fewer innings — to lower the stress on specific muscles or joints. |
| The same is true in running. In a recent study published in The British Journal of Sports Medicine, my colleagues and I evaluated the risk factors for injury in 735 runners training for the New York City Marathon. We found that, of all the modifiable factors, like body weight or number of marathons completed, the strongest predictor of injury was rapidly increasing training miles. This was true for all levels, from novices to experienced runners. | The same is true in running. In a recent study published in The British Journal of Sports Medicine, my colleagues and I evaluated the risk factors for injury in 735 runners training for the New York City Marathon. We found that, of all the modifiable factors, like body weight or number of marathons completed, the strongest predictor of injury was rapidly increasing training miles. This was true for all levels, from novices to experienced runners. |
| In short, don’t do too much, too fast, whether marathon training, preparing for a walking event or just trying to meet a particular running goal. Even the age-old 10 percent increase per week rule of marathon training may be too much for many people. Instead, runners of all ability levels need to create an individual training program that focuses on slow, steady progression. | In short, don’t do too much, too fast, whether marathon training, preparing for a walking event or just trying to meet a particular running goal. Even the age-old 10 percent increase per week rule of marathon training may be too much for many people. Instead, runners of all ability levels need to create an individual training program that focuses on slow, steady progression. |
| While some runners can handle a more rapid mileage buildup, a 5 percent mileage increase per week is safer for most. Ideally, marathon runners complete a 20-mile run in their training cycle three weeks before their race, but it should take four to five months to work up to that. Make sure to give enough runway to reach the goal. | While some runners can handle a more rapid mileage buildup, a 5 percent mileage increase per week is safer for most. Ideally, marathon runners complete a 20-mile run in their training cycle three weeks before their race, but it should take four to five months to work up to that. Make sure to give enough runway to reach the goal. |
| Even under the best circumstances, running is uncomfortable, but not all aches and pains are equally serious. How do you know when to seek medical help? I have a simple rule for athletes of all ages: If pain alters the mechanics of your movement, get it checked out. For example, if you’re a tennis player and the elbow pain during your forehand changes how you swing the racket, your easily treatable tennis elbow could be turning into a tear in the extensor tendon, a more serious injury. | |
| The same is true with running. When shin splints are so painful that your running mechanics are altered and you’re hobbling, every foot strike could be turning the inflammation on the surface of the tibia into a far more serious tibial stress fracture. | The same is true with running. When shin splints are so painful that your running mechanics are altered and you’re hobbling, every foot strike could be turning the inflammation on the surface of the tibia into a far more serious tibial stress fracture. |
| Recognizing an injury is step one. Treating the injury is step two. Preventing it the next time is step three. | Recognizing an injury is step one. Treating the injury is step two. Preventing it the next time is step three. |
| Left undiagnosed, repetitive use injuries become more severe, and recovery takes longer. Once your running injury is diagnosed, work with a sports medicine doctor or physical therapist to find the cause. It could be the type of shoes, running form, arthritis in a knee or hip or just the number of miles and pace. Although injuries among runners can be similar, the causes are often different, and effective prevention depends on fixing the cause. | Left undiagnosed, repetitive use injuries become more severe, and recovery takes longer. Once your running injury is diagnosed, work with a sports medicine doctor or physical therapist to find the cause. It could be the type of shoes, running form, arthritis in a knee or hip or just the number of miles and pace. Although injuries among runners can be similar, the causes are often different, and effective prevention depends on fixing the cause. |
| As runners train for longer distances, whether two miles or 26.2, their backs, hips and knees become achier. I tell my patients that running is a constant battle between gravity and your body. | As runners train for longer distances, whether two miles or 26.2, their backs, hips and knees become achier. I tell my patients that running is a constant battle between gravity and your body. |
| To win this battle, build strength. The stronger your muscles, the better able you are to withstand the forces from the ground that make everything hurt. High repetition, light weight strength training has been shown to reduce joint loading forces. Stronger muscles including hip flexors, glutes, quads and hamstrings are better able to withstand the pounding on the road and allow runners to better tolerate the miles, although scientists still haven’t found the perfect training method. | To win this battle, build strength. The stronger your muscles, the better able you are to withstand the forces from the ground that make everything hurt. High repetition, light weight strength training has been shown to reduce joint loading forces. Stronger muscles including hip flexors, glutes, quads and hamstrings are better able to withstand the pounding on the road and allow runners to better tolerate the miles, although scientists still haven’t found the perfect training method. |
| If you are a runner or walker, consider a full body strength program, such as The Times’s 9 Minute Workout, that incorporates functional movements like squats, lunges and burpees. Try and complete the regimen twice per week to build total body strength. | |
| One of the most important choices a runner makes is what shoes to buy. | One of the most important choices a runner makes is what shoes to buy. |
| Studies show that most runners choose their running shoes based on comfort, price and recommendations from peers, which aren’t bad places to start. Although some companies claim their shoes reduce injury-risk, studies have shown there’s no evidence that a specific type of running shoe dramatically reduces injuries. | Studies show that most runners choose their running shoes based on comfort, price and recommendations from peers, which aren’t bad places to start. Although some companies claim their shoes reduce injury-risk, studies have shown there’s no evidence that a specific type of running shoe dramatically reduces injuries. |
| When choosing your shoes, go to a running specialty store and try on several pairs. Put them on and walk around the store and place the most importance on what feels best on your feet. Getting the right pair might require trial-and-error, but once you find something that works, it should help make running and walking more comfortable. | When choosing your shoes, go to a running specialty store and try on several pairs. Put them on and walk around the store and place the most importance on what feels best on your feet. Getting the right pair might require trial-and-error, but once you find something that works, it should help make running and walking more comfortable. |
| Exercise is one of nature’s most effective medicines. It works for every patient in every country who can do it safely, no matter their age. And running and walking are among the most accessible forms, given that you don’t need much equipment. Studies suggest that regular walking and running prevent depression, diabetes, lowers blood pressure and reduces the risk of heart attack and stroke. Furthermore, running increases life span (lived years) and health span (health during lived years). | Exercise is one of nature’s most effective medicines. It works for every patient in every country who can do it safely, no matter their age. And running and walking are among the most accessible forms, given that you don’t need much equipment. Studies suggest that regular walking and running prevent depression, diabetes, lowers blood pressure and reduces the risk of heart attack and stroke. Furthermore, running increases life span (lived years) and health span (health during lived years). |
| As we head into peak running season, the true victory is getting out and moving every day. If you are just walking around the block, savor the fresh air and joy of movement. If you’re training for a marathon, I look forward to seeing you on the starting line. | As we head into peak running season, the true victory is getting out and moving every day. If you are just walking around the block, savor the fresh air and joy of movement. If you’re training for a marathon, I look forward to seeing you on the starting line. |
| Dr. Jordan Metzl is a physician at Hospital for Special Surgery and the author of “Running Strong.” | Dr. Jordan Metzl is a physician at Hospital for Special Surgery and the author of “Running Strong.” |