How to avoid running injuries?

Article written in collaboration with Matthieu Giraud, Osteopath

One of the biggest frustrations for any runner is getting injured. When an injury occurs, it suddenly deprives us of our favorite sport and the balance it brings us in our daily lives. It is therefore important to be familiar with the most common injuries for runners and, above all, it is essential to try to avoid them.

First of all, and unfortunately, injuries among runners are much more common than one might imagine. According to a study conducted on more than 600 runners ¹ , nearly half of runners get injured each year. This is unfortunately a very telling statistic. It shows that the risk of injury is to be taken seriously. The question remains how to prevent the occurrence of an injury and what the risk factors are.

What are the most common injuries?

According to a study conducted by several American universities in 2023 on more than 600 runners ¹ , the most common injuries among runners are located as follows:

1. At the foot or ankle 31%
2. At the knee 22%
3. At the hips or groin 18%
4. Calf or Achilles tendon 16%

These injuries can affect any type of tissue that is heavily stressed during running, such as tendons, muscles or joints. They can present themselves in the form of inflammation, such as tendonitis, but also in the form of muscle contractures, strains, or even fractures, as in the case of stress fractures.

There are two key risk factors that can contribute to the onset of the injury. The first is the history. For example, having a weaker ankle, following a sprain or a series of sprains and not strengthening this ankle enough to compensate for the fragility of this ankle can lead to repeated sprains. The second and most common risk factor is overtraining or overexertion. According to a study conducted in Germany ² , 80% of running injuries are due to overtraining, resulting from a mismatch between tissue resilience (improved by recovery) and mechanical stress (linked to regular running).

What advice can you give to limit the risk of injury?

Let's start by identifying the relatively common injuries that can occur among runners. They are very diverse in nature with:

• Achilles tendonitis or tendinopathy
• Muscle tear or strain
• Ankle sprain
• The bulbs
• Plantar fasciitis or inflammation of the plantar fascia
• Runner's knee or patellofemoral syndrome
• Stress fracture
• Tibial periostitis (or medial tibial stress syndrome or TSS)
• Iliotibial band syndrome
• Sunburn or heat exhaustion
• Frostbite or hypothermia

This list of potential injuries is long and can be almost discouraging because the risks seem so numerous. Fortunately, it is possible to greatly limit the risks of injury. There is no 100% guarantee, but following the 10 key tips below will help prevent an injury from happening:

1. Warm up before every race

Warming up before a workout or a race is used to prepare our body to make an effort. The warm-up aims to stimulate the tendons, muscles and joints before the effort. The increase in body temperature that the warm-up will cause will make the tendons, muscles and joints more flexible. It also helps reduce the mechanical resistance of the muscles. The warm-up will help improve or 'activate' our proprioception (our ability to perceive the position of our body in space), increase blood flow to the muscles and stimulate the metabolism.

2. Hydrate regularly

Dehydration of just 2% can result in a 20% reduction in performance. In addition, dehydration has other consequences on the runner's health. It can cause muscular, tendon, digestive or cardiac problems. It is therefore essential to hydrate well during each training session and each race. A simple way to ensure regular hydration (and not to forget to hydrate when you are in full effort and therefore sometimes less lucid) is to drink methodically every 10 or 15 minutes without waiting to be thirsty, just by checking the race time or the time regularly on your watch.

3. Increase the training load gradually

Increasing the training load too quickly does not give the body enough time to adapt. To set up an appropriate progression of the training load, there are two easy rules to apply: 1. do not increase the weekly distance by more than 10% per week and 2. do not increase the training distance and speed in the same week (only one or the other). You must also learn to listen to your body and perceive the first signs of tension or stiffness in the muscles, tendons before the injury appears or the signs of unusual fatigue and know how to rest and postpone a session if necessary.

4. Practice muscle strengthening

Muscle strengthening is a form of protection against the risk of ligament damage. Strengthened muscles will absorb some of the mechanical force exerted on the ligaments during running, particularly at the knees. Muscle strengthening increases the surface area of ​​the tendon and muscle sections to better distribute the load and to be able to run longer while pushing back the first signs of fatigue, in short to become a more enduring runner.

5. Perform a series of stretches after each session

There are two benefits to doing a series of stretching exercises, for example, after each session. The first is to allow the heart rate to gradually return to a normal rhythm after the effort of running. The second is to obtain greater fluidity and better economy of movement, by increasing the range of motion (especially in the calves, hamstrings, quadriceps and hips). For runners who spend a lot of time sitting behind a computer, stretching the shoulders, neck and lower back is also very beneficial. Greater flexibility also allows you to develop a more relaxed, less tense running attitude and ultimately to enjoy running more.

6. Working on your balance

Specific balance work is often neglected by the amateur runner. We often rediscover it when it is too late, that is to say when we have injured an ankle for example and the physiotherapist advises us to do balance exercises on one foot, on inclined planes or half-balls. However, developing good balance and good stability can help us prevent injuries. Conversely, poor balance can cause the runner to move excessively from the foot to the torso. This can lead to either a risk of sudden, traumatic injury such as a sprained ankle, or a progressive overuse injury as the body will naturally try to compensate and control this excessive movement. The most common overuse injuries in runners who lack stability are iliotibial band syndrome and runner's knee. Improving balance and stability will not only reduce the risk of injury but will also increase performance because the body becomes more efficient and no longer (or at least less) expends extra energy to control excessive movements.

7. Running with the 'right shoes'

Running with the right shoes could be the subject of an entire article dedicated to this topic. To summarize, the main reasons for running with the 'right shoes' are related to the key concepts of cushioning, heel height (or drop ), flexibility and protection. Cushioning is necessary simply because when we run, we strike the ground with much more force. And cushioning helps absorb some of the shock, particularly at the heel. Running shoes also provide the arch support it needs to withstand high-impact activity. They protect against injuries by reducing stress on the ankles, heels and toes and help prevent tendonitis, joint pain and stress fractures.

8. Vary the training grounds

Running on different surfaces allows us to work different muscles. For example, when we run on a road, our calf muscles work more than when we run on a softer surface such as a forest trail. By running on different surfaces (road, trail, mat, track, etc.), we can change the impact on our joints, change the muscles used and improve our balance and proprioception. This variety of surfaces can therefore contribute to a reduction in the risk of injury.

9. Vary sports activities

Including a regular session of swimming, cycling, rowing or yoga is a great way to work different muscle groups to avoid overusing any one area. By practicing different sports activities, we can challenge our body in different ways. Conversely, if we focus on only one area of ​​the body related to our favorite sport, the other muscles will weaken or at least not strengthen. To achieve an optimal level of fitness, we should ideally work all our different muscle groups while ensuring at the same time that we plan enough rest time between workouts.

10. Protect yourself from the sun and the cold

Every time we run outdoors, we expose our skin to UV rays. We must protect ourselves by wearing a cap or visor, clothing with sun protection (ideally UPF50+) and sunglasses, or by applying sunscreen on sunny days. Another solution is to plan sessions according to the local UV index.

To protect yourself from the cold, the basic rule is to protect your extremities since it is at the extremities that heat loss is greatest. It is therefore advisable to wear gloves, a hat or a cap. The second rule in very cold weather is to wear three layers of clothing: a breathable layer (close to the body), a thermal layer that will help maintain our body temperature and finally a waterproof layer to cut the wind and protect us from rain or snow.

The key role of recovery

The last but perhaps most important tip to avoid injuries is recovery. Rest days allow the body's muscles to recover, repair and avoid overtraining. Training constantly without any recovery days can be detrimental to the body. By not giving the muscles enough time to rebuild especially after a demanding session, the body can no longer or not sufficiently repair itself. Conversely during recovery days or phases, our tissues repair themselves and our muscles are replenished with glycogen, their energy reserve. Physical exercise creates micro-tears and recovery allows them to heal. Without sufficient recovery, continuous and repetitive movements such as those associated with running will only cause additional tears which can lead to inflammation and injury.

In summary, to avoid running injuries, you must:

• Make sure you train 'well', that is to say plan your warm-up (cardiovascular, muscular, articular), hydrate properly, work on muscle strengthening, flexibility, balance, gradually increase the training load, and 'vary the pleasures' (variation of terrains and sports);
• Equip yourself well, especially with regard to shoes;
• Know how to protect yourself against external elements (sun, heat, cold);
• And above all, don’t neglect recovery.

If there were two major criteria or two key words to remember, they would first be the notions of progressive training and recovery. Training progressively and recovering well are the best ways to avoid injuries due to overtraining.

We hope that these tips will be useful to you firstly to better prevent potential injuries related to running, and also and above all to continue running with maximum pleasure.

Sources

¹ Running-Related Overuse Injuries and Their Relationship with Run and Resistance Training Characteristics in Adult Recreational Runners: A Cross-Sectional Study (Stenerson, Melton, Bland, Ryan)

² Walther M, Reuter I, Leonhard T, Engelhardt M (2005) Injuries and overuse reactions in running / Verletzungen und Überlastungsreaktionen im Laufsport. Orthopäde 34: 3999 10.5435/JAAOS-D-14-00433