The popularity of running as leisure sport has been growing, mostly among women. Most amateur runners are long-distance runners, meaning that they run on average over 3 km and below 42 km. However, there are more and more ultra-distance runners, that train and run above the 42 km of traditional marathon. Running is the cheapest and most popular sport that can be done as leisure, because it is good for health, to clear the mind… But it should be done with due caution to avoid injuries. In runners, the most common injuries happen mostly among the less experienced ones: people who haven’t exercised for years and then, from one day to the next, decide to start running, abruptly and without preparation. People who, usually, for lack of running practice and lack of body preparation, do not have the necessary knowledge to do it properly. The most common injuries The most common injuries of runners are located in: Thee knee, the most frequent in women; The ankle; The foot; The hip. The most common lesions are: Patellofemoral pain: a pain in the knee, typical in runners, often known as “runner’s knee”; Different types of tendonitis or tendinopathy (in the Achilles tendon, in the patellar tendon, etc.); Blisters in the feet. Risk factors for injury in runners The major risk factor is overload. Most injuries in runners are due to overload or overuse and translate an imbalance between the load imposed by the runner on his body – joints, tendons – and the load this is adapted to. The load can be generically understood as the result of: the frequency of running (number of times per week); the speed / rhythm of running (intensity indicators); the duration or distance of running. Moreover, one must also consider the individual’s capacity to tolerate the load. And this capacity varies, depending on the quality of sleep, on some kind of complementary training (such as muscle strengthening), among other factors. In fact, there are several factors involved, which makes the diagnosis and treatment of such injuries more difficult. In summary: The so-called overload injuries of runners occur because there is an imbalance between the load imposed to the body and its capacity to tolerate that load. It is quite common, for instance, to observe in consultation men between 35-40 with this kind of injuries. People who used to do 4 or 5 runs a week, but in the meantime became parents. And they now sleep less hours a night but continue running 4 or 5 times a week. Naturally, their capacity to tolerate that running load is significantly lower. Therefore, the conditions are created for overuse injuries. Other risk factors: shoes and ways of running The shoes for running are also a relevant factor. As such, one should choose adequate footwear. But beware: Running shoes have an expiry date; Typically, most running shoes “last” for 500 to 600 km; Therefore, by the end of that period, the capacity of shock absorption of the shoes is considerably compromised. On the other hand, several studies indicate that a runner, when choosing his running shoes, should try them and feel immediate comfort. It is rather subjective, but fundamental. He should choose the most comfortable ones, not the most appealing, the most expensive or the trendiest. There are some people with slightly different feet – cavovarus feet, with a tendency for calluses, more flat feet… In these cases, it is important that the choice of sports footwear results from medical prescription. As to the way of running, an important advice is to start slowly and acknowledge that it will be necessary to progress gradually, not abruptly. It is fundamental to avoid load peaks. And to do that, one must consider and control three factors: distance, speed and frequency. Someone who starts running, should do it 2 or 3 times a week, setting the duration of the run and adjusting the speed to that duration and to the distance set. It is also important to choose a flat and even ground, especially in an early stage, when the body is still receiving a new and different stimulus to which it is not yet prepared. Running on uneven ground is an additional stimulus. And starting to do trails abruptly is an important risk factor leading to the development of overuse injuries (namely patellofemoral pain or iliotibial band syndrome). Warning signs The warning signs of injuries that should worry runners are: A pain that does not relent, goes away or alleviates considerably after a running session. That, for instance, reappears three days after, when one runs again. A pain that is always there, during exercise. Plus, a pain that extends beyond exercise. Many of these overuse injuries – tendonitis and tendinopathies being a classic example – start by involving pain without affecting the performance, which leads the runner to underestimate the warning sign and not seek medical care. However, the belated seek of a specialist in sports medicine makes it more complicated to treat and longer to recover. Preventing injury in runners Early intervention is essential to avoid long treatments and lengthier recoveries. Ideally, it would be good to start by making the assessment and planning of training with an exercise physiologist and maintain the support of this professional along the period of exercise. That is the most important. Secondly, and in a gym context, for instance, it is fundamental: To train mostly the lower limbs muscles – which during the running will have to support the impact; it will be a strength training to work the resistance of those muscles. To work balance and neuromuscular coordination , so that the athlete develops a smooth and adequate running pattern, during the run cycle. To ensure adequate nutrition and good sleep . Treatment of running lesions It is necessary to start by seeking a physician specialized in sports and exercise medicine. This is the clinical professional indicated to diagnose and prescribe treatment for running injuries. In the diagnosis: Correctly identify the injury. Identify the causes, tracing the history of training and determining all the risk factors that led to the injury. In treatment: In an initial stage, in overuse injuries, most treatment approaches involve a temporary readjustment of the load. In many cases, it is not necessary for the athlete to stop running, but it is required to control the load, reducing the volume of training to a tolerable level that does not aggravate the injury. In a second stage and once identified the factors having contributed to the occurrence of the injury, it may be necessary to mitigate and control those factors, in a gym or physiotherapy context. To make an assessment, for instance, of balance, coordination and running technique of the athlete, can be important in this stage. Finally, there are specific treatments for specific injuries which are done in physiotherapy context. What when you can no longer run like before? Management of the running load is the keyword to solve this question. If tendonitis in the Achilles tendon is diagnosed in someone that runs 5 or 6 times a week, during the period of treatment it will not be possible to keep that level of exercise. But there are other ways of maintaining the aerobic capacity and the practice of exercise, by temporarily opting, for instance, for a modality that puts less load on that tendon, like biking or swimming (and do the so-called cross training). Autor: José Pedro Marques The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
