Injury Free Running

We are officially in peak running season here in Kansas City. That being said, it’s no secret that running injuries are very common and can really put a damper on your favorite health activity, stress reliever, time to listen to podcasts, or whatever running is for you.  

Running is a tremendously complex process when you break it down. The feet of long-distance runners contact the ground an average of 10,000 times an hour. With each of these foot strikes, our body absorbs 2 to 7 times our own body weight. In the course of say, an average 3 mile run at a 10-minute pace, that’s roughly 250,000 pounds of force that must be dissipated by the body. The human body has adapted greatly to these stressors, and most of the time our body can hold up no problem, but sometimes it’s too much and we have an injury. Hamstring strains, Achilles pain, runner’s knee, ankle sprains…these are all common injuries that occur with running.  

We’ll talk in this blog about some of the best things you can do to prevent injury during your running season. A lot of these things will also not just decrease your chance of injury, they’ll also increase your performance and make you an overall better runner.  

Part 1: What’s the Best Strike Pattern? Heel, Midfoot, or Forefoot Strike?  

This has been a topic of debate for a long time. Many running experts claim that a midfoot strike is going to be the best option for most runners. We would respectfully disagree. A recent study at the University of Wisconsin demonstrated that impact forces were actually highest in runners who struck with their midfoot compared to those who struck with their heel or forefoot. Higher impact forces typically result in higher chance of injury, so that leaves either a heel strike or a forefoot strike left. This is where things get a little tricky…a forefoot strike may be best for faster runners (6:30/mile or faster pace), but for most runners, we would recommend a heel strike pattern. Why? First, the calcaneus (your heel bone) is literally designed for shock absorption. The calcaneus has one of the most extensive supplies of blood of any bone in the body. More blood flow equals faster healing and recovery. Additionally, the calcaneus has a nice and squishy fat pad that is able to maintain its shape upon compression while also acting as a shock absorber at the same time. Another reason to opt for a heel strike is that the tibialis anterior lowers the foot to the ground when heel striking, versus the gastrocnemius (calf muscle) lowering the foot to the ground when forefoot striking. This is important, because the gastrocnemius is a muscle that crosses two joints, and when a muscle crosses multiple joints, it is typically more susceptible to injury.  

With all this being said, a forefoot strike might actually be the best option for faster runners (6:30/mile or faster pace). As faster runners, the ability to utilize larger muscles with greater energy storage and return ability, such as the gastrocnemius (again, calf muscle) improves performance and actually decreases injuries in the long run as these muscles get stronger and more robust, since they will be forced to utilize these muscles to keep up their pace.

Additionally, faster runners typically have a very high cadence (meaning they take more steps than the average runner) which makes it difficult to heel strike in order to maintain pace. To heel strike at a pace faster than 6:30/mile would actually increase their risk of injury, due to the immense amount of hyperextension force that this would put on the knee.  

To sum this up, our general recommendation would be that slower runners (greater than 6:30 pace) opt for a heel strike, while faster runners (less than 6:30 pace) opt for a forefoot strike. Here’s a quick video to sum up our thoughts.  

Part 2: Training Load - Don’t Do Too Much, Too Soon  

One of the primary reasons that runners, especially recreational runners, get injured is that they do too much too soon. They significantly increase their mileage or they significantly increase their pace, or sometimes both. The ideal range of training load increase is 10-15% per week. Anything over 30% increase skyrockets your chance of injury. Additionally, running over 40 miles per week is another proven predictor of injury. These metrics (mileage and pace) can easily be tracked. You can track your mileage and pace with most smartwatches these days, and if you don’t have a smartwatch, you can use an app like Strava or Runkeeper.  

Part 3: Cadence - Should You Shorten Your Stride Length?  

It is often thought that one of the most common ways to reduce running injuries is to shorten your stride length. Is this true?   Shortening stride length can certainly be necessary at times, but it should not be adopted as a general rule for all. For a lot of runners, blindly advising a shortened stride may actually result in MORE injuries, not less. There are a few situations in which we believe a shortened stride would be good advice:  

1) If your contact knee is nearly straight and your leg is angled more than 10 degrees to vertical, you should most certainly shorten your stride. This may seem high tech and difficult to know, but you can find out if you’re in this camp by simply taking a video of your running form from a sideview on a treadmill and then pausing it when your foot makes ground contact.

2) If you have chronic knee pain, often called runners’ knee, you should consider shortening your stride. One of the most common reasons for runners’ knee is overstriding, which often causes a subtle inner collapse of the knee upon ground contact. Shortening your stride when you’ve had chronic knee pain as a runner may be a worthwhile investment.

3) If you have chronic low back pain while running, a shortened stride may be beneficial for you, as this will help to dissipate ground reactive forces and lower the amount of force being transferred to your low back.   Changing to a shortened stride will feel awkward at first and you may feel like your performance takes a hit as you shorten your stride, but this should be temporary and you will likely become more efficient and have better performance in the long run.  

Part 4: Hip Strength - A Key for Injury-Free Running  

One of the best things that runners can do to avoid injuries is to improve their hip strength and flexibility. The hips are the main force generators in running and the hip musculature plays a major role in shock absorption. The gluteus medius is the primary muscle that lowers the pelvis to the ground while running. It is also the primary muscle that keeps you upright and in alignment. The gluteus maximus assists in these tasks as well. The external rotators of the hip assist the gluteus medius in preventing stress fractures of the femur. As you can see, the gluteus medius is an extremely important muscle for runners, and is often times underdeveloped, particularly in recreational runners. If gluteus medius isn’t working hard, the TFL has to work harder, which pulls on the IT band, which causes common running conditions like IT Band Syndrome and Runners’ Knee. Additionally, posterior rotation of the pelvis is one of the greatest aspects of reducing ground forces while running. In order to do this, you must have strong and flexible hips. Here are a few exercises you can incorporate to strengthen your hip muscles. These should be performed 1-2 times per week.  

Part 5: Proper Warmup  

One of the biggest mistakes we see with runners is either not warming up at all, or more commonly, doing some basic static stretching prior to a run. Static stretching is not going to accomplish much prior to a run, as it is not effective for warming up the muscles or for promoting tendon flexibility, two things that we want to prep as much as possible prior to a run. Dynamic stretching drills are a much more effective way to warm up for a run. Here’s an easy, 5-minute dynamic stretching drill that you can do prior to your runs to prepare you for success:  

The great thing about this warmup is that it only takes 5-10 minutes and is simple enough to be used by just about anyone from novice runners to more seasoned runners. Additionally, this warmup can be done just about anywhere, as long as you have flat ground and a little room.  

Wrap It All Up  

While there’s many things you can do to decrease your risk of injury while running, we have highlighted some of the easiest to implement and highest bang for your buck things that you can do to decrease your risk of injury while running. Nobody can reduce their risk to zero, but if you implement these 5 things, you can be confident that you are making great strides in becoming a better, healthier runner.  

If you are a Kansas City runner and have questions about how to stay injury free while running, or have had an injury yourself and need help recovering, give our office a call or schedule an appointment online.