Running, The Most Injurious Exercise in the World
The Truth Behind Running Injury Science

I found running to be the most injurious form of physical fitness a year or so ago in one of my more popular Testosterone Nation articles. To say that I took a lot of heat on that article would be an understatement. But guess what? There are more people in the world today participating in running than all other forms of fitness combined!

To just brush running under the fitness rug is a mistake, and that’s exactly why this week on JRx we have Christina Nowak back with her article focusing on improving running, programming and technique to prolong the physical longevity for runners. She also breaks down her go-t0 strength program to have endurance addicts performing and feeling better than ever.

Here’s What You Need To Know…

1. Running doesn’t cause arthritis, but the way we run can cause pain and overuse in the muscles around the hips and knees. Making sure that you’re running with proper form of the hips, knees and ankles will prevent those nagging injuries from starting in the first place or coming back.

2. Loss of strength around the knee can cause knee pain and we lose strength as we get older. Adding strength training in 2-3x/week, focussing on the key lower body muscle groups and core, can keep the knees strong and your mileage climbing.

3. Cross Training can help keep your body healthy and strong. Training the same muscles over and over again can lead to imbalances, which can effect your running game. Try cycling, swimming or other aerobic activities to supplement your training.

4. Don’t move through pain! Pain is a warning sign, not a badge of honor. Running through injuries just makes them worse. Go see a rehabilitation specialist for advice on recovering from nagging injuries to get you back to full speed.

5. Monitor your training volume. You can hit a threshold where the body starts to break down. Know what you need to apply stress to make the body faster but not enough stress to break it down.

Lets Not Pretend Running Isn’t Injurious…

Old wive’s tales tend to be perpetuated in the fitness industry with no evidence to back them up. Getting arthritis from running is just another one of those tall tales that refuses to go away.

Running is one of the most inexpensive ways to exercise and has grown in popularity over the last couple of decades. Really all you need to start being active is a pair of running shoes and off you go hitting the pavement. For the Masters athlete, it’s an easy way to stay active and running feels like an activity that everyone can do. It seems like an innate skill to be able to run. Running is a great form of endurance exercise. It keeps the heart and lungs strong and can help keep you healthy as you get older. Aerobic exercise can improve blood pressure, cholesterol and management of blood sugar – some of the chronic conditions that become more popular as we get older. So it only seems natural that many people gravitate towards running when they consider picking up healthier habits.

When you think about running you think of the pounding on your joints and the rate of injury in running is high. Some estimate that runners experience one injury per 100 training hours (1). So the question becomes, is it bad for you? And more specifically, at what age should you stop running?

East For A Doctor To Say To “Just Stop Running”

As a physiotherapist, it is VERY rare that I tell one of my runner’s to stop running all together. Especially if they like it! Nothing makes a person stop listening to a therapist more than telling a person who loves a sport to simply stop doing it. Not very helpful.

Masters athletes in endurance sports are the highest growing demographic. Over 50% of athletes in the Boston, New York and Chicago marathons are over the age of 40. Performance in these age groups is also leading the way and more records have been set by Master’s athletes than their younger cohorts in the last couple of years.

Lower body injuries are extremely common in runners of all ages but especially the Master’s runner. In a study of Master’s athletes, 89% of persons over 50 reported injuries and 63% of them were overuse in nature (think tendon issues like Achilles pain or patellofemoral pain) (2). Age is associated with decreased joint mobility and decreased overall body strength. That can lead to changes in how a person runs, which can then translate into an injury. Injury is the number one reason why the Masters athlete stops running.

Running has been proven again and again to NOT cause knee OA. The biggest risk for knee OA is a previous injury to the knee. Now if the knee injury was caused by running well then that can be the link. But it’s indirect.

5 Key Points for Managing The Masters Runner

The Master’s runner needs to change their programming to ensure the safety of their joints as they continue to run, especially if pain exists. Here are a couple of ways to get an athlete back to running or ensure that they can continue in their sport.

#1 Master’s Runners Run Differently Than Younger Runners

Master’s athletes take shorter strides than younger athletes. This could be related to a decrease in power that occurs with age, especially if your athlete is not doing any strength training. They can take twice as many steps as a younger athlete to go the same distance. Knee adduction increases, so runner’s knees cave in. Ankle eversion increases, so they roll in, which can effect the knee and hip (1)

THESE are what you need to target when you’re looking at the Masters runner. Coaches should be looking for these compensations and correcting them. Using apps like Coach’s Eye or Coach My Video are free and can look at joint angles and positions to make sure your athlete isn’t being set up for injury.

#2 You Probably Need To Get Stronger

Many Masters runners don’t want to strength train. They are worried that sore muscles will affect their run the next day. Gaining mass, even if it’s lean muscle mass, is also seen as a negative to Masters endurance athletes. This can be the hardest thing to change in the runner’s mentality.

But many of the changes, if not all, we see in Masters runners can be improved through a proper strength training program. Increasing power can effect stride length. Strengthening the hips can prevent the knee from caving in.

The amount of cardio performed by these athletes will blunt the ability for the body to put a ton of muscle mass on and aging slows hypertrophy or the ability to put on lean body mass. Many of the adaptations we see in strength of the Masters athletes are neurological, meaning that the connection of the nerve to the muscle is stronger so it contracts harder. This allows you to put more force into the ground as you run, which would translate into increased power and speed. I don’t see the downside.

#3 Cross Training is a Pivotal Aspect of Running Longevity

With most of the injuries in runners being overuse or repetitive, training different movement patterns can give some of the tissues you use a break and still translate into increases in performance. Swimming, water running, cycling are all great aerobic options to add into your training to ensure your body stays a healthy, aerobic engine.

#4 Rehab/Prehab Aches & Pains

Overuse injuries are common in runners of any age with Achilles tendinopathy (hamstring strains and shin splints being the injuries I see in my clinic). These injuries can really start to nag at you and prevent you from reaching your training goals.

Some “treatment options I typically use are laterally wedged orthotics (for medial knee OA), gait retraining, shoe changes (minimalist shoes actually can be useful here), hip adduction and abductor strengthening, and mobility” (Chris Sweeting MSc, DCh, Personal correspondence).

#5 Lower Training Volume To Ensure Pain Free Gait Cycle and Running Mechanics

Maintaining a high training volume and overload the tissues in your lower body without sufficient recovery leads to breakdown. If all the other attempts to reduce pain have failed, then I’ll suggest lowering the impact or loading on your tissues.

A very small percentage of runners will need to stop running all together. Surgical candidates or advanced knee osteoarthritis will make up that small percentage, just because it hurts too much to continue running. If the pain from running is interfering with your everyday life, and all of the preventative measures have not translated to less pain running, then you might just need to look at other options.

Strength Training For The Masters Runner

Most runners are worried about their legs being sore and it preventing them from running the next day. Doing strength training AFTER running is a way to maximize recovery between runs. Plan your strength training sessions around your running schedule to decrease the likelihood of any soreness.

DAY 1: LOWER BODY EMPHASIS

In this lower body emphasis strength day, we are focusing on the squat pattern in both the box squat and step up variations to target the quads, glutes and hamstrings together as a functional unit that’s function is transferrable to the road.

1. Barbell Box Squats   

Ramp Up Sets: 3-4

Working Sets: 2-3

Reps: 6-8

Tempo: 21X1

2. Single Leg Step Ups

Ramp Up Sets: 2-3

Working Sets: 3

Reps: 5 (Non-Alternatin)

Tempo: 21X1

3. RKC Planks   

Ramp Up Sets: 1

Working Sets: 5

Reps: 30 seconds

Tempo: Maximal Full Body Tension

Day 2: PULL EMPHASIS HYPERTROPHY

With a back and posterior chain emphasis, this hypertrophy day will use higher rep ranges to target both muscular endurance and hypertrophy under higher amounts of metabolic stress, which is very sport specific in nature to running.

1. Single Arm Barbell Rows 

Ramp Up Sets: 3-4

Working Sets: 3

Reps: 12-15

Tempo: 21X1

2. Back Extensions 

Ramp Up Sets: 2-3

Working Sets: 3

Reps: 12-15

Tempo: 2110

3. Hip Thrusts   

Ramp Up Sets: 2-3

Working Sets: 4

Reps: 6-10

Tempo: 21X1

Day 3: PULL EMPHASIS POWER/STRENGTH

The last resistance training session of the week will be centered around the deadlift variation using the trap-bar, which has been shown to be extremely lower back friendly when compared to it’s barbell counterpart. Also, we will be targeting the lower body from a single leg standpoint in another lunge variation, finished off with some core stability work.

1. Trap Bar Deadlifts

Ramp Up Sets: 3-4

Working Sets: 3

Reps: 5

Tempo: 21X1

2. Dumbbell Reverse Lunge

Ramp Up Sets: 2-3

Working Sets: 3

Reps: 8-10

Tempo: 2111

3. Half Kneeling Banded Pallof Press

Ramp Up Sets:1-2

Working Sets: 3

Reps: 10-12 per side

Tempo: 1111

About The Author

Christina Nowak MScPT, CSCS, PhD (c) is a physiotherapist, strength coach and PhD student currently focusing her doctorate level studies on exercise and training for the aging population.  She is currently a treating therapist at Element CrossFit & Element Therapy where she uses largely exercise-based rehabilitation for musculoskeletal injuries. She is a believer in the strength of exercise for rehabilitation, especially in an older demographic including the Masters Athlete . Her passion and specialty in the aging population prompted the launch of her website STAVEoff.ca that provides world class information related to exercise prescription for the Masters age group.

References

1. Lilley K, Dixon S, Stiles V. A biomechanical comparison of the running gait of mature and young females. Gait Post. 2011. 33: 496-500.
2. Wright VJ. Masterful care of the aging triathlete. Sports Med Arthrosc Rev. 2012. 20: 231-36.
3. Leech RD, Edwards KL, Batt ME. Does running protect against knee osteoarthritis? Or promote it? Assessing the current evidence. BJSM. 2015. 0: 1-2.