A Multi-Disciplinary Insight into Running

Running is the most participated form of physical activity worldwide, with almost 70% of runners experiencing a running-related injury during any given year.

We’ve combined the knowledge of our Physiotherapists, Exercise Physiologists & Podiatrists to give you a comprehensive overview of:

  1. The most common running injuries & what causes them – Sam Campagnale, Physio
  2. Gym training for running & how it can make you faster – Hunter Bennett, Exercise Physiologist
  3. Running footwear myths explained – Steph Howard, Podiatrist

1. Most Common Running Injuries & What Causes Them

Almost a quarter of Australians participate in running, some just for fun and others competitively.

The knee was found to be the most common part of the body to be injured by running, and accounts for approximately 50% of all injuries. The most common knee-related conditions include:

  • Patellofemoral pain syndrome (PFPS)
  • Iliotibial band syndrome (ITBS)
  • Meniscal injuries
  • Patellar tendinopathy

Interestingly, while knees are often injured as a result of running, no evidence has been found to demonstrate a link between increased rates of knee and hip osteoarthritis (OA) and recreational running. Some research suggests that certain levels of running may actually be protective against OA, and help maintain the health of the cartilage of our joints.

Foot and ankle and lower leg conditions such as Achilles tendinopathy, plantar fasciopathy, and medial tibial stress syndrome (MTSS) (or also known as shin splints) accounted for approximately 40% of other running-related injuries.

The cause of running-related injuries is multifactorial and can be influenced by:

  • Running and training factors (including the runner’s load management which may include how often they run, the training surface they run on, running intensity or speed, duration, and potentially any other types of training which are also occurring)
  • Musculoskeletal issues (including previous history of injury)
  • General health and lifestyle factors
  • Running biomechanics

Although no ‘perfect’ running style exists, a health professional such as a Physiotherapist or Podiatrist is able to determine the relevance of a person’s running biomechanics, and identify whether modification of technique is required to maximise running efficiency and performance. 

If you have been injured while running, a Physiotherapist can assess the injury and figure out which of the above factors may be contributing to the issue.

After an initial assessment, Physiotherapists provide hands-on treatment (if applicable), supportive techniques (taping, for example) and prescribe a tailored graded return to running program to help you achieve your running goals.

To book an assessment with a Physiotherapist, you can call us on 8373 5655 or book online here.

2. Gym Training For Running & How It Can Make You Faster

When training to improve distance performance, the most typical method of training progression is to increase your training distance. I’d like to share with you how gym training for running can significantly improve many aspects of your performance, more-so than simply increasing the overall training distance.

Now, while I would be the first to admit that to get good at running (or cycling, or swimming etc. etc. etc.) long distances you do need to undertake some longer training sessions, but they aren’t necessarily the best or only way to improve endurance performance. In fact, I would go as far to suggest that increasing training distance is a somewhat illogical form of progression.

If we train by running a greater distance at the same speed (or possibly even slower) that we normally use during training, we are unlikely to get faster. For many, getting faster (and being able to maintain that faster speed) is the name of the game, right?! Fortunately for us there are other gym-based training methods that we can use to improve performance.

Strength and endurance training are often viewed at complete opposite ends of the training spectrum – where it is typically suggested that improvements in one will lead to subsequent reductions in the other. But in reality, it’s not that simple.

When we really consider endurance performance, we should be able to see that it is effectively the ability to maintain or repeat a given force output repeatedly – each step (or each pedal stroke) represents force being applied to the ground. Which is where getting stronger (or increasing the amount of force we can produce) comes into play.

You see, if someone gets stronger relative to their bodyweight, they can apply more force with each step of the foot, or stroke of the pedal. This means that they will require less relative force each step to maintain the same pace they did prior increasing their strength.

This in turn means that each step uses less energy, as it is at a lower percentage of their maximal force production. As a result, they now have the ability to move faster (and further) each step, despite using the exact same amount of energy.

So why does gym training make me faster?

Strength training has repeatedly shown to improve endurance performance in both recreational, and highly trained athletes. In fact, this research has actually shown that including strength training into an endurance training program will improve endurance performance to a much greater degree than endurance training alone.

These improvements have been measured by improvements in movement economy (also known as energy efficiency), increases in velocity at VO2max, and increases in maximal anaerobic running speed.

In short, it clearly demonstrates that strength training will make you faster at a given energy output – becoming easier!

These specific strength training interventions tend to result in substantial improvements in strength, with only small increases in lean mass – this actually suggests that the strength increases observed are mainly a result of improved neural efficiency, meaning that they result in significant improvements in relative force production, and you wont really get any heavier.

Additionally, this same training has been shown to cause a shift in muscle fibre type from type IIx (Super explosive muscle fibre type) to type IIa (less explosive, slightly greater endurance capacity) fibre types, which has been shown to further improve endurance capacity.

And to top it off, strength training has also been shown to causes an increase in musculotendinous unit stiffness (say that three times fast).

This increased stiffness results in an improved ability to store elastic energy during eccentric muscle actions (eg. landing each step), which in turn increases concentric muscle force (eg. Pushing off the ground). This results in less energy used per step, and a noticeable increase in movement economy.

So, if were to summarise the science – strength training makes you more efficient.Not to mention it also has the capacity to improve your ability to absorb force and therefore protect you from injuries (which is a topic I will save for another day).

If you are a runner who wants to improve their performance – whether that be speed, distance or overall fitness, then you can see an Exercise Physiologist for a individual assessment for a personalised gym-training program based around your goals.

Including two full-body strength sessions per week into your training would be a great place to start, and would be enough to stimulate improvement in strength, and therefore improvements in efficiency.

With this in mind, the focus should be on large compound movements such as squats, deadlifts and lunges to improve lower body strength, working within strength based rep ranges (such as 6×3, 5×4, 4×6). These rep ranges have been shown to elicit neural based strength adaptations, while minimising potential muscle growth – meaning they are the perfect way to maximise your strength without increasing your body weight.

I would also strongly recommend the inclusion of loaded carries, some pulling movements (inverted rows, dumbbell rows etc.), and some direct trunk stability work if time permits, as these can go a very long way to strengthening the muscles of the upper back and core, improving posture and preventing injuries.

If you are not sure where to start, have some questions around introducing strength training into your regime, or would like to see one of our Exercise Physiologists for a running exercise program, you can call us on 8373 5655 or book online here.

3. Running Footwear Myths Explained

There is a lot of information about as to how to protect your feet while running, and which shoes to wear. Here we’ll be addressing the two biggest running footwear myths, which relate to the affect a heel drop has in shoes, and the outcomes of barefoot/minimalist running.

Heel Drops

The myth: A higher heel drop (eg 10mm) is more advantageous than a smaller drop (eg 4mm).

A heel drop is the difference in the shoe between the height of the heel and the height of the toe. This can affect how your foot hits the ground.

A 10mm heel drop has been the ‘norm’ in running shoes over the last 30+ years, however there isn’t any research to say this is more advantageous than a smaller drop (e.g 4mm).

There are theories that a higher heel drop offers increased comfort on harder surfaces, based on anecdotal feedback from runners in terms of cushioning and comfort.

While a higher raise (10mm) is likely to protect the foot, ankle and lower leg, it also has the potential to increase forces at the knee joint (particularly in  those who over-stride).

So in summary, there is no evidence to suggest that it is more advantageous to have a higher heel drop (and in fact it can adversely affect the knee joint), but some anecdotal evidence suggests a higher heel drop may feel more comfortable to the wearer.

Barefoot/Minimalist Footwear

The myth: Barefoot or minimalist footwear will make your feet stronger and reduce the risk of injury.

As we know from the much publicised fall from grace of Vibram 5 fingers, this is not the case. These shoes worked for some but not for most.

As we see it, barefoot/ minimalist shoes sit at one end of a spectrum, with an ultra supportive/ cushioned shoe such as a HOKA on the other. Most people will find that something in the middle of this spectrum will suit them best. Quite often runners will get the best results when wearing footwear which is a combination of minimalistic performance-based racing flat and a more structured, cushioned training shoe.

The general agreement on studies looking at barefoot vs cushioned running shoes on economy is that the advantages associated with cushioning negate disadvantages of increased shoe weight. Studies conducted on the Nike Varporfly 4% (industry funded) have shown significant performance gains can be made through footwear design. 

One of the main arguments for barefoot shoes is that most elite runners mid-forefoot strike, negating the impact of heel height/cushioning. Research published in 2017 actually showed that out of 1843 runners in the Boston marathon 97%, were heel strikers, which highlights the importance of heel padding/ raises.

When should I see a Podiatrist?

Any runner with a foot or ankle injury should seek assessment from a podiatrist with strong biomechanical and running experience. Extensive knowledge of both structure (anatomy) and the forces impacting on the foot allow us to make an accurate diagnosis as well as identifying any contributing factors, leading to the formation of a treatment plan utilising the most effective evidence based treatments including improving the load capacity of the injured muscle, tendon or fascia rather than just focusing on decreasing loads via the use of foot orthoses.  

We can alter loads placed on the lower limb through 2 main avenues- intrinsically- strength and conditioning of muscle and tendon complexes & load/ training modifications. Extrinsically-via footwear, orthoses and braces. It is vital that we have a comprehensive knowledge of the potential affects of these and how they may work in combination to ensure the best results for an individual.

To see a Podiatrist for a running assessment, biomechanicial assessment or footwear advice/fitting, you can call us on 8373 5655 or book online here.

References

The most common running injuries & what causes them – written by Sam Campagnale, Physiotherapist

Ferber, R, Hreljac, A & Kendall, K 2009, ‘Suspected mechanisms in the cause of overuse running injuries: a clinical review’, Sports Health, vol. 1, no. 3, pp. 242-246.

Leech, R, Edwards, K & Batt, M 2015, ‘Does running protect against knee osteoarthritis? Or promote it? Assessing the current evidence’, British Journal of Sports Medicine, vol. 0, no. 0, pp. 1-3.

van Gent, R, Siem, D, van Middelkoop, M, van Os, A, Bierma-Zeinstra, S & Koes, B 2007, ‘Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review’, British Journal of Sports Medicine, vol. 41, no. 8, pp. 469-480.

Williams, P 2013, ‘Effects of running and walking on osteoarthritis and hip replacement risk’, Medicine & Science in Sports & Exercise, vol. 45, no. 7, pp. 1292-1297.

Gym training for running & how it can make you faster – written by Hunter Bennett, Exercise Physiologist

Hoff, Jan, Arne Gran, and Jan Helgerud. “Maximal strength training improves aerobic endurance performance.” Scandinavian journal of medicine & science in sports 12.5 (2002): 288-295.

Kraemer, WILLIAM J., et al. “Compatibility of high-intensity strength and endurance training on hormonal and skeletal muscle adaptations.” Journal of applied physiology. (1995). Vol 78, no.3.

Running footwear myths explained – written by Rob Parish, SA Podiatry

Do Canto 2018, ‘Running Shoes: Myths and Disinformation: RT Chats with Podiatrist, Thomas Do Canto’, https://www.runnerstribe.com/features/running-shoes-myths-and-disinformation-rt-chats-with-podiatrist-thomas-do-canto/?fbclid=IwAR3bNXhPj_EnuS_bzJ7BwZfOBp0EFPpAzkBlC8EpuF8GzVl5Va2Znu0ExEE

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