Running injuries: Prehab is better

If, like me, you are training for your first marathon, or are one of the many people who have recently taken up running, you will be obsessing about injuries — or rather, how to avoid them. Faced with various aches and pains and with no idea about how to address them, I asked a range of experts for their advice.

The physio
Paul Hobrough is a chartered physiotherapist and runs Physio&Therapy.

“My ethos has always been prehab rather than rehab. Coming in at an early stage is far better than when you are actually injured, but it’s not as good as seeing a physio straight away when you decide to run a marathon. Mainly what we see are chronic injuries that build up slowly over time. The most common are knee-related: runner’s knee, patellofemoral pain syndrome and iliotibial band friction syndrome. They are usually down to the fact that people have an ankle instability, or they are not controlling the legs well with their hip muscles.

“The second-most common is shin splints or medial tibial stress syndrome, then achilles tendinopathies and plantar fasciitis on the underside of the foot. You would struggle to get most people who didn’t want to run a marathon to balance for 20 seconds on one leg. They will almost certainly have an instability somewhere. If you get them to do something functionally close to running, such as a single leg squat, you will notice their knees deviating and hips swinging out laterally. These tests show me that this person isn’t running 26.2 miles [about 42km] without having a lower leg injury.

“My biggest bugbear is when people say they aren’t sure that they are going to take up running and use an old pair of running shoes they’ve had for years, and they get injured and wonder why.

It’s so important to get that fitting done correctly. There is too much information out at the moment about barefoot running as opposed to supportive shoes. Fundamentally, you need to get a good fitting ­somewhere that is well respected. If you want to take up barefoot running, you should ideally have no history of injury, good mechanics and not be an overpronater. The minute that you feel a slight niggle, speak to somebody. Because if you’re thinking in eight weeks’ time I would like to enjoy running a marathon, being physically prepared and able to walk the week afterwards, then what are you waiting for?”

The elite runner
Liz Yelling is an Olympic marathon runner and Commonwealth Games medallist.

“I make sure that injury prevention is as much a part of my plan as the hard training. This includes a small amount of time spent stretching after each run, plus core stability and conditioning work, focusing on my personal weaknesses. I also have regular massage and physio checks to work on any tight areas that could cause a problem. This is supported by good nutrition and hydration, which help the body to recover faster.

“The biggest mistake people make is not listening to their body when they can feel an injury coming on. Pushing on regardless ends up with lost time and enforced rest when immediate action could have got runners back on track quicker. If I get an injury I rest immediately and seek my physio’s advice about the best action to take.

This ensures that I am doing the right thing from day one and that I don’t waste time treating it incorrectly. It is only when I know what is wrong through accurate diagnosis that I can make a call on how long I will need to rest. If this is for a week or more, I can then select the appropriate cross-training to help sustain fitness while allowing the injury to recover.”

The coach
Phoebe Thomas coaches with Nick Anderson as Running with Us, official training partners of the Brighton Marathon.

“If there was just one muscle group I would encourage you to target, it is your glutes. This large set of muscles plays a huge role in stabilising each stride you take. They reduce rotation in the pelvic and hip area and assist in lower-limb stability. The one-leg squat is an ideal exercise to strengthen the glutes: any overpronation will be reduced and you are less likely to suffer from the common running injuries that occur due to other muscles working in the wrong way.”

The podiatrist
Wayne Edwards is a musculoskeletal podiatrist and director of operations at Health and Fitness Solutions clinics.

“The vast majority of running injuries are due to poor foot function and poor muscle balance.

When choosing a pair of running shoes, ensure that they fit properly and feel comfortable. It is a myth that you need to go up a shoe size to ensure this comfort; half a size is adequate. People have a wide variety of foot shapes. Low-arched mobile feet need more support from the shoe — those available for this are often grouped as stability or motion-control shoes. Average-arched feet can be accommodated in most neutral shoe designs. High-arched feet benefit from cushioning. We recommend that people go to a specialist running shop and have video gait analysis to work out the right shoe for them.”

The nutritionist
Mhairi Keil is a performance nutritionist for the English Institute of Sport.

“Paying attention to the nutrients you are consuming is key for minimising injury. Correct nutrition will enhance muscular performance, optimise recovery and support the immune system, helping to prevent illnesses and infections. Muscle damage caused during training will impact on subsequent sessions and failure to repair the tissue can accumulate, resulting in a greater muscle injury. Risk of injury is increased when muscles are fatigued, so pay attention to fuelling-up strategies and energy provision during long or intense runs.

“Nutrition can also play an essential role in the recovery of tissues, should an injury occur. It is important to understand what the type of injury is because certain nutrients play a greater function, depending on the tissue damaged. For example, nutrients essential for bone repair include calcium, vitamin D, protein, magnesium and copper. Muscle injuries would focus more on high-quality proteins and antioxidants, along with vitamin C and zinc for cell replication. Tendon damage can be more difficult to support from a nutritional perspective, however. Factors that can help to control or reduce excessive inflammation, such as the antioxidants found in green tea, omega 3s, polyphenols found in red kidney beans and berries and resveratrol found in red grapes, can play a role.”

The ultramarathon runner
Dean Karnazes is author of Run! 26.2 Stories of Blisters and Bliss.

“Work on building strength in the muscles of your legs by doing squats, lunges and using the cross trainer in the gym. Having strong leg muscles will support your joints and tendons, which take a pounding when training for a marathon. Being in good overall shape helps to support your stride and posture as the miles add up. Train hard one day, then do a lighter training session the next to allow your body recovery.

“Don’t run in shoes that are overbuilt or have extensive motion control gimmicks built into them. An increasing volume of literature is pointing toward the benefits of ‘minimalist’ footwear. If there is time to work on your style, avoid landing on your heel and rolling to your toe. Shorten your stride and land mid-foot with quicker foot turnover. Studies show that heel-to-toe rolling leads to overuse injuries.”

The doctor
Dr Rod Jaques is director of medical services at the English Institute of Sport and has attended four Olympics with the British team.

“I would advise a novice marathon runner to buy a good-quality pair of running shoes, worth £60+ [about R700]. You should change these for every 300 to 400 miles [483 to 644kms] of training. There is no golden recipe: it is very idiosyncratic and depends on your own training base. When you get up to a reasonable level of fitness, you should periodise your training so that you have hard weeks followed by easy weeks. This provides an opportunity for your bone and soft tissues to recover.

“You have to do at least three runs in excess of 15 miles [about 24km] in the lead-up to the marathon. This is to prepare yourself psychologically and physically that you can go over 15 miles. On the day you will do 26.2, but there is evidence that if you train between two-and-a-half to three-and-a-half hours, you’re going to be able to make four or four-and-a-half hours. The crowd effect is very important and that helps to carry you through the last six miles of the race, which will be equivalent to the first 20 miles of the race, in terms of effort.

“If you have a cold, feel fatigued or have an injury, have an easy day training or you don’t train at all. It’s not imperative to train every single day. What is important is to balance your training with your recovery. Taper training prior to the race and do not run for seven days beforehand to allow your glycogen stores to build up to maximum levels.

“Psychologically, you are itching to get going, but physically your fuel stores really do have to be absolutely topped up and you can’t drain them. There is no point entering the race with slight aches. You really need to be absolutely fresh because it’s going to be a very hard day.”

The Kenyan way
Adharanand Finn spent a year in Kenya training with elite runners. His book, Running with the Kenyans, is published by Faber & Faber.

“The best thing that we can learn from Kenyans about preventing injuries is not to be afraid to skip a training session if you’re tired. Their mantra is ‘listen to your body’. Pushing things when you are too tired is a common reason for ­injuries. One of the top coaches in Kenya told me that, because it can be hard to get decent treatment for injuries, they are more careful not to overdo things. ‘We ride close to the edge here,’ he said, ‘but, when we get too close, we have to pull back.’ It helps that Kenyans don’t count up their weekly mileage, which means they’re less inclined to feel bad about missing a session.

“Of course, all of this could be easily misinterpreted by those inclined to feel lazy before a run. The reason Kenyans can take such a relaxed approached and still be successful — I’m generalising here but it is widely true — is because they are so highly motivated to succeed that they wouldn’t skip a session unless they felt it was really necessary.”

The biomechanics expert
Dr Joanna Scurr is head of the biomechanics research group in the department of sport science at the University of Portsmouth.

“We have been investigating appropriate breast support for sport, particularly running, for the past seven years. Our research has shown that sports bras can improve sporting performance, reduce breast pain and reduce the risk of breast sag. However, there is no such thing as the ultimate sports bra. Appropriate breast support is very individual and therefore we recommend that women try on the sports bra before purchasing; jump up and down in the changing room to determine how much support you think the bra will provide, move your arms and upper body around to determine whether the bra will stay in place.”

The gait specialist
Boris Bozhinov is a gait analysis specialist for Nike.

“Pretty much everyone who is training seriously overpronates. So you need support or cushioning to take the force when your feet hit the ground.

“I recommend training with several different shoes that provide a mixture of support, so you can improve your muscles. It won’t happen straight away but will build up in time and lessen your chance of getting injured.” —

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Sarah Phillips
Sarah Phillips. Art History and English Literature teacher for A level Sarah Phillips has over 660 followers on Twitter.

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