The mechanics of injury in running is not usually connected with a noticeable shock or fall, but with microtraumatic loads applied to the body day after day after day.
A well-balanced training program not only focuses on increasing performance, that is on running faster at longer distances, but also on how to stabilize the body of a runner in order to decrease its potential of getting injured. Every training program requires an adequate levels of stress, consisting of:
- time spent on workouts,
- frequency of workouts,
- intensity of workouts.
If one or more of those aspects of training is too high, it leads to injury by inability of organism to adapt. Another thing that adds up to this equation is biomechanics of running – if a runner has problems with biomechanics, which is often connected with prior injuries or other imbalances or deficiencies – it has a tremendous impact on the ability to adapt to increasing training loads.
And so, we get injured, then what?
Injured runners are often told just to rest or follow RICE protocol (rest, ice, compress, elevate). RICE is an efficient strategy, but it is meant to cure the symptoms and help your organism to get back to the state of being able to work out again. The thing that is in most cases neglected is tackling the real problem that stands behind the visible symptoms.
Sometimes it gets even worse. As RICE is not the most convenient thing to do in our busy life and demanding timetables we try to move on with our training and use drugs as aid. By that I mean NSAIDs (non-steroidal anti-inflammatory drugs). Most popular of them are Aspirin, Ibuprofen, Naproxen, Ketoprofen or Diclofenac. Apart from known adverse effects like increased risk of gastrointestinal problems, kidney problems, heart failure, strokes, heart attacks or erectile dysfunctions, those drugs have another negative aspect for athletes. They impede the process of tissue healing by slowing and delaying the healing response. Because of this effect, the base line tissue functionality is not reached after the injury, which in turn poses a greater risk for re-injury – that sounds familiar, doesn’t it?
The goal when injured should be to heal a broken tissue in an optimal way. This does not only mean NSAIDs or RICE, but rather an active assistance to this process. The goal is also to fix the reason that caused the injury in the first place. It is easy if it is only about poor training plan (unadjusted training load), but sometimes it is about treating and correcting mechanical flaws that caused the excessive stress and strain to the body tissues.
As the most common strategy for injuries is rest, let’s see how it affects the body:
Bones – it weakens collagen structures and mineral density of bones;
Capsules – it shrinks capsules and increases their resistance to movement;
Ligaments – it decreases tensile strength and cross-links of ligaments
Tendons – it disorganizes collagen and decreases tensile strength of tendons
Muscles – it decreases contractile proteins in muscles
Cartilage – it causes swelling and weakens binding agents in cartilage.
As you ask an average runner about doing nothing (avoiding any physical activity) he would probably respond that it is a rather bad thing to do, after all some of us decided to do sports in order not to spend their entire life on a couch. But the same runner asked about a strategy of coming back after injury would probably have problems in proposing anything more than RICE or NSAIDs. The problem is that our bodies are composed of different elements that react to loads in different ways. That is why it is so difficult to create a complex training program that includes all elements of the puzzle. Of course, when we talk about injuries, the safest tactics is first a good medical check of what has really happened and a professional advice of a sports-medicine practitioner. Unfortunately, even such tactics does not always proves successful, as I can’t even count the number of times I was told about poor medical advice, people get from so called professionals.
So, what should be done in order to improve the critical elements of our bodies?
The processes that govern different adaptations in our bodies are sometimes very complex, but generally that is how different tissues of the body get improved:
Bones – their mineral density and strength is being improved by low/moderate levels of compression/vibration
Capsules – they are being mobilized through activity in their physiologic range of motion and by manual work, if needed.
Ligaments – they are being strengthened by progressive tensile stress in the line of force (as much as possible under controlled conditions)
Tendons – their strength and organization of collagen fibers improves by progressive eccentric strengthening (negative motion)
Muscles – their metabolic adaptations are induced by low-load exercise. Different speed and force of contractions triggers different motor units
Cartilage – it is being improved by moderate loads through available range of motion.
Apart from different adaptations that occur on the cellular level, rising thresholds or threshold speed, what every runner needs to run more effectively are: proper mobility in joints, stability and power. Obligatory period of rest after injury will impair all those features, that is why every runner after injury should do specific training to regain mobility, stability and power in an injured body segment and not only add more miles in the following weeks as it is a sure way to re-injury a weakened spot.
This article was based on the book by Jay Dicharry, MPT, SCS “Anatomy for Runners Unlocking Your Athletic Potential for Health, Speed, and Injury Prevention” Skyhorse Publishing 2012.