La Marathon 2016: Part 1

As part of our partnership with the Louisiana Marathon, I have the privilege of writing several blog posts about running and running injuries. While I appreciate this opportunity, it is always difficult deciding where to start and what to talk about. Thankfully, Danny Bourgeois, co-founder and marketing director of the marathon offered up some great ideas on this topic. He also related some of the mistakes he’s made in his running career and the injuries that resulted. This is an all too common story and we are hoping that we can share some advice for both beginner and experienced runners that will help you avoid injuries between here and the finish festival.
While everyone reading this probably knows that running is very healthy for you, many of you also know that it carries its own set of risks. Injuries related to running are very common. Depending on which study you look at, you’ll see that anywhere from 30 – 80% of runners are injured during a given year. The wide range depends on how the study was performed, but most of these involved missing some time from training. While the majority of these injuries are fairly minor, some can be more significant and take months to get over.
Thankfully I’m not in a specialty that deals with life and death on a frequent basis, but the equivalent in Running Medicine is telling a runner they need to take time off from running. I’ve had patients try begging, bargaining, threatening, and crying to get permission to run, sometimes all in the same visit! My mentor, Dr. Robert Wilder, looked at these injuries as initiation into the club, telling patients, “You have runner’s knee. Congratulations, you know you are a runner now!” And the great Philosopher of Running, Dr. George Sheehan, called these running related injuries “Diseases of Excellence.”
Although some may look at injuries as a badge of honor, most of you probably don’t need this type of validation. As John Bingham says, “If you run, you are a runner.” So let’s start looking at some of the risk factors for injury and how we can avoid them. There are 3 main categories that contribute to how we run, and significant problems within these categories can lead to a running injury. Dr. Irene Davis has a great graphic representation of this that I’ve reproduced here:

You can see that your injury risk is a combination of structure, mechanics, and dosage. Let’s briefly discuss each one for now, and then go into some more detail over the next few weeks. Your Structure is your basic anatomy and possibly any orthopedic injuries you’ve had. These are things that we can’t readily change like your knee alignment, foot shape, or retroverted hips which make your feet turn out when you walk and run. FYI: not everyone’s feet should point straight ahead, and not every turned out foot means over-pronation! Some structural issues can be improved with surgery, like bunionectomy or ACL repair. Some can be modified with orthotics and shoes, like someone with prolonged pronation issues using a stability shoe. Your structure is mostly just the genetic hand you were dealt, and you can either blame or thank your parents for it. Your Biomechanics is definitely related to your structure, but tends to be things that we can more easily modify. While not everyone could or should move the exact same way, there are definitely commonalities of great runners and also of injured runners. We know that you need a specific amount of mobility, stability, and strength to run well. Biomechanics tends to be the part of the injury equation where the therapists and I spend most of our time because we can have the biggest effect. The best part of my job is that maximizing mechanics not only fixes injuries, but increases running efficiency. Increased efficiency leads to decreased race times! We will likely have several more posts dedicated to some of the biomechanics of running. The Dosage is your training. What does your training plan call for? How is it manipulating the F.I.T. variables of Frequency, Intensity, and Time? Many folks follow online plans like Couch to 5K or Runner’s World guides. Some run with local clubs or pay for personal coaching. This category is at least as important as mechanics for determining your injury risk. Sudden changes in training are a huge risk for runners. This is the classic ‘Too much, too fast, too soon’. If you have really been a true couch potato for several years, going from zero running to 2.5 miles in a few weeks is not a great idea. Even experienced runners can make silly mistakes in this category. We will discuss this topic further as well in the next post. Finally, we have the evil red line of the injury threshold. Similar to structure, there is likely a genetic component to where this line sits for each of us. I’ve seen runners who follow a very smart training plan and constantly work on mechanics and yet are injured constantly. Likewise, we all know people who do everything “wrong,” but race a half marathon every weekend without so much as a cramp. Unfortunately, many of us have to cross the line and become injured several times before we start figuring out where our line sits. So now you should have a good understanding of the global picture of running injuries. If you have poor structure, terrible mechanics, and don’t train smartly, you will be seeing me in clinic constantly. If you were born with great structure, have wonderful mechanics, and train very smartly, then I’ll just see you on the roads. We know we can’t do a lot to manipulate structure, but if we can improve mechanics and training, we can shrink those boxes and put a buffer between us and the injury line. This was heavy in philosophy, but I think it will be helpful for us to be on common ground, and also good for you to think about your training in a holistic way. Also, if you are unfortunate enough to be in that 30 – 80% injury statistic, please try to find a doctor or therapist who takes an approach like this. If they only look at treating the injured body part without asking about your training or assessing overall mechanics, then you may want to consider seeing someone else. Of course, I would be happy to see you as well. In the coming posts we will dive a little deeper into training and biomechanics to minimize injury risk and keep you running.

Thanks and Happy Running!

Kasey Hill, M.D.