Running Injuries: Why They Happen and How to Prevent Them
Although injury happens in every sport, it seems to be prevalent in running, especially for those who return to the sport after a long period away or those who take up the sport later in life. I’m not trying to vilify running by any means. I focus on it only because it seems to be the go-to sport for a lot of adults in their 30s and 40s. I believe there are two main reasons injuries happen in runners – improper body position and improper technique.
When I say improper body position, I am referring to how your body lines up when you are standing in a relaxed stance. The human body is by no means perfectly symmetrical but it needs to be as evenly balanced as possible on all sides (left, right, front, back) to avoid injury and pain with movement. By the time you reach your 30s and 40s, your body has likely been adapting to certain imbalances for several years, if not your whole life. The pelvis is the most common place for imbalance to occur.
When your pelvis is imbalanced it can cause your legs to appear to be different lengths - a condition referred to by therapists as a functional leg length discrepancy. It doesn’t mean that one leg is measurably longer than the other (that would be a structural discrepancy) but when you are standing, one side of your pelvis is higher than the other causing one leg to look longer.
There are a few easy ways to tell if your pelvis is imbalanced right or left:
Stand in front of a mirror with your weight evenly distributed on both feet, put your hands on your hips and see if one hand looks higher.
If you tend to stand with your weight shifted to one leg more than the other, it’s usually because your pelvis is higher on the other side.
If you are uncomfortable standing with your weight evenly on both feet.
If the heels of your shoes are unevenly worn.
Your pelvis can also be imbalanced front to back with either an anterior tilt (forward) or a posterior tilt (backward). The anterior tilt is much more common and is a major cause of back pain for many people. An easy way to tell if you have an anterior pelvic tilt is to lie on the floor on your back and slide your hand under your low back. If you can fit your hand under your back, you have an anterior pelvic tilt. Ideally, your low back should be completely touching the floor. A posterior tilt is much less common.
So how does this imbalance lead to injuries? Well if you spend your life walking and sitting with a pelvic imbalance, the rest of your body has to develop different movement patterns to compensate. Your back will lean more to one side and your head will tilt toward the other just to keep yourself from falling over. This compensation also means that your spinal column is off centre and therefore will not be able to optimally absorb impact. If the imbalances are minor (1/8th -1/4th of an inch), you might not really notice them so much at first because your body will do what it needs to balance itself. What you might start to notice are regular headaches, neck pain, low back pain, knee pain, ankle pain or foot pain. And that’s just when walking or sitting.
When we run, we instantly increase the amount of force placed on our joints. And when those joints have already been compromised by adapting to our imbalance, they are at much higher risk of injury. If you already have occasional pain in the areas noted, running will likely make that pain worse, especially if you are running frequently and for long distances.
Running shoes with a lot of cushion will be a hindrance rather than helpful if you have pain or injuries from running. Your body is designed to run barefoot with no problems and thick-soled runners are more likely to prevent you from feeling problems when they start. Minimalist or barefoot shoes are a better option because they will allow your foot to function better and provide your body with the sensory input it needs to tell you if something feels good or bad. (If you switch from extremely cushioned runners to minimalist shoes, be sure to do so slowly and progressively to avoid aggravating any existing injuries and to allow your body to get used to the change) Minimalist shoes will also show you almost immediately if your technique is wrong which brings me to my next point.
The second major cause of running injuries is improper technique. There are a lot of great resources that discuss running technique so I’m not going to get very specific here. I believe the most common running technique error is heel-striking. Heel-striking occurs when your heel is the first part of your foot that contacts the ground when you run.
Why is heel-striking a problem? When your heel strikes first, it means that your knee is almost straight at the same time your foot hits the ground. This position transmits a lot of force up through your whole lower half. Foot, ankle, knee, hip, pelvis and low back are affected and the weakest link is where the injury will happen. You might even feel symptoms in your upper body. Think about jumping off something and landing with your legs straight instead of with your knees bent. You would never intentionally do that because your body can’t absorb the impact as well. The same principle applies when running.
So how should your foot hit the ground? Your mid-foot should contact first and your heel should touch down briefly to allow your body to optimize shock absorption when running. This position also ensures that your knee is bent when you land. If you run on your toes and don’t allow your heels to touch down, you will over-tax your calves and create other problems.
A few ways to tell if you are heel-striking:
Pay attention when you are running to what part of your foot hits the ground first.
Have someone take a video of you running so you can analyze your technique if you can’t seem to feel what’s happening. (You can also see how you actually look while running rather than how you THINK you look. Be prepared for the shock!)
Run a short distance in your bare feet or socks. You’ll feel right away if your heels are hitting first and your body may instinctively start to shift to your midfoot.
Now it might take some time and effort to adjust your running technique because movement patterns become ingrained in our bodies but as with any bad habit, change IS possible if you’re sufficiently motivated. Pain relief is also possible and with proper treatment from a therapist trained in myofascial release and some regular self-treatment, you can reverse some or even all of the pain and injury and decrease your risk for injury in the future. You might also consider finding a running coach in your area or even online to analyze your technique and provide helpful drills and progressions to change your movement patterns. Remember, your body is your only vehicle that you’ll have your whole life. If you want it to work properly you need to take care of it!