Why Runners Get Injured

At some point in a runner’s career, he or she will experience an injury. Whether minor, like a sprained ankle, or serious, like a stress fracture, injuries are frustrating setbacks that can wreak havoc on a runner’s psyche. Here, common reason that runners get injured will be discussed.

Runners Have Type-A Personalities

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Perhaps the number one reason that runners become injured is because of their personality type. “Type A” individuals are ones that are extremely goal-oriented and struggle to deviate from a training plan. However, they often put their emotional needs (i.e. the satisfaction of working hard and following their training rules) above the physical limitations of their bodies. A main contributing factor to injury among runners is continuing run in spite of pain or physical/emotional fatigue.
In a seminal study¹ performed on the topic in 1985, researchers sought to answer the question of whether runners with Type A personalities were more prone to injury, stress, and illness. A total of 572 adult runners were surveyed. There was a significant correlation between Type A behavior and the number of times each runner had been injured within the previous three months.

Runners Lack Good Recovery Habits

Many runners assume that the key to becoming a better runner is to train hard. However, a more crucial component of training is recovery. Good recovery habits include:
Sleep

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Sleep is an integral component for proper recovery, however, few athletes receive enough sleep each night. Besides providing a time for legs to rest after a long day of exercise and daily tasks, sleep is important for triggering the production of hormones that can aid in the body’s overall repair. For instance, human growth hormone² is secreted during sleep cycles, but only for a limited period of time during each REM cycle. Therefore, a greater amount of sleep each night will increase the amount of growth hormone in the body.
Getting adequate rest is also important for reducing stress levels within the body. When athletes are sleep deprived³, they have higher levels of the stress hormone, cortisol, in their bodies the next morning. Increased cortisol levels have been linked to overtraining syndrome, which can trigger mental burnout, injury, and extreme fatigue.
Massage
Many injuries are the result of muscle restrictions, scar-tissue build up, and poor mobility or range of motion. One way to prevent injury is to receive regular massage⁴, or engage in self-myofascial release⁵, such as foam rolling. However, while many athletes understand that massage (or self-message) is important, there are few who routinely engage in this activity, despite the number of tools available on the market that encourage athletes to have better recovery habits.
Time Off Your Feet
Finally, runners have a tendency to always be on the go, trying to fit as much into their busy schedules as possible. This habit results in a lot of time spent on one’s feet, which can be just as detrimental to bone and muscle health as dramatically increased mileage. For instance, a top contributor to plantar fasciitis is long amounts of time spent standing⁶, particularly on concrete floors. Runners who are able to rest and recover throughout the day will experience a decreased risk of injury.

Runners are Inflexible

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Flexibility is an interesting measurement because in some instances inflexibility can increase running economy by shortening an athlete’s stride and improving cadence. However, many injuries are directly caused by lack of mobility and flexibility, such as hamstring strains, tendonitis, plantar fasciitis, shin splints, illiotibial band syndrome, and runner’s knee, among others. Furthermore, variations in flexibility between two sides of the body can lead to dangerous imbalances that can increase the amount of strain placed on the body.
Overall, functional flexibility is important, particularly in hips, hamstrings, calves, and feet. While stretching might not be useful for treating an injury, regular stretching exercises are good preventative measures in order to prevent scarring and to prevent the shortening of healing tissues. While static stretching is not recommended, particularly prior to running⁷, dynamic warm ups can be beneficial for muscle strain prevention.

Some Runners Have Poor Biomechanics

Until this point, many of the reasons that runners become injured have been controllable. However, poor biomechanics (i.e. a runner’s natural gait) are largely genetic. For instance, numerous athletes have leg length discrepancies that contribute to injury, particularly when the disparity is large. For other athletes, pronation (landing on the inside of one’s foot) and supination (landing on the outside of the foot) can increase the risk of lower leg injuries. Heel striking, i.e. landing predominantly on one’s heel, can also increase the incidence of injuries such as plantar fasciitis, shin splints, and Achilles tendonitis.
For athletes with poor biomechanics it is important to understand his or her limitations while working to mitigate their effects. For instance, runners who pronate or supinate can be fitted for motion-control running shoes to reduce the stress that is placed on certain areas of the body. For other athletes, a strengthening protocol can help to overcome a runner’s natural limitations.

Some Runners Have Poor Biomechanics

Until this point, many of the reasons that runners become injured have been controllable. However, poor biomechanics (i.e. a runner’s natural gait) are largely genetic. For instance, numerous athletes have leg length discrepancies that contribute to injury, particularly when the disparity is large. For other athletes, pronation (landing on the inside of one’s foot) and supination (landing on the outside of the foot) can increase the risk of lower leg injuries. Heel striking, i.e. landing predominantly on one’s heel, can also increase the incidence of injuries such as plantar fasciitis, shin splints, and Achilles tendonitis.
For athletes with poor biomechanics it is important to understand his or her limitations while working to mitigate their effects. For instance, runners who pronate or supinate can be fitted for motion-control running shoes to reduce the stress that is placed on certain areas of the body. For other athletes, a strengthening protocol can help to overcome a runner’s natural limitations.

Runners Don’t Balance Their Training

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Many runners believe that the key to improving performance is to run hard every single day. Often, athletes do not think twice about back to back speed workouts or long runs, and cringe at the thought of a recovery day. However, runners who run hard every day are more likely to experience impact or overuse injuries⁸.
Running generates a lot of force with every step and up to 4x a person’s body weight is exerted onto each foot with every stride. At higher speeds, this force can be multiplied to an even greater extent. During hard training sessions, bone and muscle break down and the body rebuilds these structures to be even stronger.
However, when the rate of break down is faster than the rate of rebuilding, injury is likely to occur. For this reason, it is important that runners balance their work load by running hard on their hard training days and easy on their easy days. Additionally, runners should always take at least one easy day in between hard training sessions, with master’s runners (i.e. those who are over 40 years of age) taking at least 2 days of recovery.

Runners are Impatient

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Another common detriment to runners is their impatience. This personality trait can easily lead to injury when a runner’s body is underprepared for increased workload. For instance, beginning runners or veterans who are returning from injury are often tempted to increase their mileage and/or intensity too quickly.
Sometimes, a runner’s aerobic and anaerobic systems develop at a faster rate than their muscles, bones, and tendons. Therefore, even though a 5-mile run feels great aerobicially (i.e. the athlete is not gasping for breath or feeling aerobically fatigued), his or her body is likely unprepared to handle an 8-mile run.
For this reason, the 10% rule exists, which states that a runner should not increase his or her mileage by more than 10% each week.
Additionally, runners often become bored with easy miles and decide to incorporate speed. While higher intensity running is important for fitness, this training strategy should be met with caution. Before incorporating speed work into your training program, make sure your mileage has stabilized and you have built a strong aerobic base for at least 6 – 8 weeks.

Many Runners Have Poor Nutrition

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Running requires the body to work in different ways than when simply at rest, which should be no surprise to anyone who has ever gone for a run. The metabolic processes involved in both running and recovery require the proper mix of macro and micronutrients.
For instance, carbohydrates are the easiest form of fuel for athletes. Without appropriate carbohydrate storage, the body will burn fat, which is energetically unfavorable, and will even burn muscle when carbohydrate and fat stores are depleted. A number of micronutrients⁹ are necessary for healthy, injury-free running. These include calcium, magnesium, Vitamin D, zinc, iron, and folate. When there are not enough nutrients stored in a runner’s bloodstream or bones, injuries such as stress fractures are likely to occur.
Commonly, nutritional deficiencies that lead to injury are the result of under-eating, especially among female runners¹⁰. Not consuming the proper amount of calories relative to an athlete’s metabolic demands is dangerous for muscle, bone, and tendon health.

Many Runners are Structurally Weak

Strength training is important for all athletes, particularly those who are prone to overuse and impact injuries. Runners can benefit significantly from strengthening commonly injured areas of the body, such as hamstrings, gluteal muscles, and calves.
In one study¹¹, hip strength (or lack thereof) was found to be a major contributing factor to knee injuries among recreational runners. Out of 30 recreational runners who experienced a single leg overuse injury, a strong correlation was found with adductor, hip flexor, and abductor muscle weakness. Runners should find a running-specific strength training plan that incorporates exercises designed to strengthen core, calves, hamstrings, hips, and glutes.

Runners Don’t Always Properly Prepare for Race Day

Finally, runners become injured because they don’t always properly prepare for race day. For instance, when training for a marathon or ultramarathon it is imperative to complete at least one 2-3+ hour run during the training cycle. Otherwise, structural fitness is likely to be lacking, which can lead to injuries such as stress fractures and muscle strains.
Additionally, completing workouts at race pace is important in order to help the body adapt to the required workload and build the functional strength required. Ultimately, a runner should always train with the race conditions in mind. If planning to complete a hilly race, proper muscle and bone strength should be built by completing hilly running routes.

References
1. Schafer, Walter E., and John F. McKenna. “Type A Behaviour, Stress, Injury and Illness in Adult Runners.” Stress and Health. John Wiley & Sons, Ltd, 10 Feb. 2006. Web. 02 May 2017. Link
2. Takahashi, Y., Kipnis, D. M., & Daughaday, W. H. (1968). Growth hormone secretion during sleep. Journal of Clinical Investigation, 47(9), 2079–2090. Link
3. Sleep Loss Results in an Elevation of Cortisol Levels the Next Evening. (1997). Sleep. doi:10.1093/sleep/20.10.865 Link
4. Brummitt, J. (2008). The Role of Massage in Sports Performance and Rehabilitation: Current Evidence and Future Direction. North American Journal of Sports Physical Therapy : NAJSPT, 3(1), 7–21. Link
5. Cheatham, S. W., Kolber, M. J., Cain, M., & Lee, M. (2015). THE EFFECTS OF SELF‐MYOFASCIAL RELEASE USING A FOAM ROLL OR ROLLER MASSAGER ON JOINT RANGE OF MOTION, MUSCLE RECOVERY, AND PERFORMANCE: A SYSTEMATIC REVIEW. International Journal of Sports Physical Therapy, 10(6), 827–838. Link
6. Werner, R. A., Gell, N., Hartigan, A., Wiggerman, N., & Keyserling, W. M. (2010). Risk Factors for Plantar Fasciitis Among Assembly Plant Workers. Pm&r, 2(2), 110-116. doi:10.1016/j.pmrj.2009.11.012 Link
7. Mchugh, M. P., & Cosgrave, C. H. (2009). To stretch or not to stretch: the role of stretching in injury prevention and performance. Scandinavian Journal of Medicine & Science in Sports. doi:10.1111/j.1600-0838.2009.01058.x Link
8. Hreljac, A. (2004). Impact and Overuse Injuries in Runners. Medicine & Science in Sports & Exercise, 845-849. doi:10.1249/01.mss.0000126803.66636.dd Link
9. Ron J Maughan; Role of micronutrients in sport and physical activity. Br Med Bull 1999; 55 (3): 683-690. doi: 10.1258/0007142991902556 Link
10. Clark, N., Nelson, M., & Evans, W. (1988). Nutrition Education for Elite Female Runners. The Physician and Sportsmedicine, 16(2), 124-136. doi:10.1080/00913847.1988.11709434 Link
11. Niemuth, P. E., Johnson, R. J., Myers, M. J., & Thieman, T. J. (2005). Hip Muscle Weakness and Overuse Injuries in Recreational Runners. Clinical Journal of Sport Medicine, 15(1), 14-21. doi:10.1097/00042752-200501000-00004 Link

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