The strongest predictor of running injuries is previous injury. If you’ve had plantar fasciitis, you are far more likely to have plantar fasciitis again than someone who never had it. It’s the same with achilles tendonitis, shin splints, runner’s knee, ITB syndrome, all of them.
Every runner reading this will have had a running injury in the past. Most runners get injured every second year. Injury is also the most common reason that runners quit. So the question of how to avoid re-injury is extremely important.
This is exactly the question Rita brought to me when we had our free call last year. She had injured her left hamstring the previous year and spent a few months rehabilitating that before she injured the right one! That was 9 months ago and she still wasn’t back to full training.
She wanted to get back to running 50 miles a week but she was stuck at 20. What’s worse than that is that she was terrified to injure herself again. So she couldn’t even enjoy those 20 miles!
She was working with a running coach, who also happened to be a physical therapist, but she really didn’t feel like she was getting the support she needed. She was anxious about running more and longed to return to the care-free running she’d enjoyed in the past.
As with most of the runners I work with, Rita loved running as it helped her feel calm and balanced. To get that feeling though, she found that she needed to run quite a lot. Really, Rita should be able to run as much as she wants, without having to be constantly worried about her hamstrings.
The Key to Avoiding Re-Injury
The key to avoiding re-injury, is to identify why you got that injury in the first place. Rita and I spent about an hour discussing the problems she’d faced over the last couple of years. I determined that the way she was training was almost guaranteed to lead to recurring injuries.
We made a game plan to systematically overhaul her training with a focus on three key areas. If you’re worried about re-injury, I’d encourage you to reflect on your own training to see how well you are considering these variables.
Prior to her injury trouble, RIta was running about 50 miles a week, every week. This was working for a while, but it really didn’t leave much room for error. I think of it like a budget.
Imagine you had a job that paid exactly $1000 per week. You also have a budget to spend that $1000 every week. You get it pretty much right most weeks and you stay out of debt. But, what if you went a little over budget every week? Let’s say, $50 over. That debt is going to compound each week and it will grow and grow. Eventually, you’ll have a ton of debt.
In the same way, Rita had been stressing her body just a little bit more than it could handle. That was ok, until it wasn’t. Something had to give. As it turns out, Rita’s weakest link was her hamstrings, so that’s where the injuries happened.
Now, imagine you had that weekly budget of $1000, but every fourth week, you tightened your belt and only spent $500. Now, if you’ve slightly overspent, it’s okay. After the $500 week, you’ll be back in the black.
That’s what we did with Rita. We planned a recovery week every fourth week with about 50% of the running volume. Believe me when I say that she was NOT happy about this. She would try and sneak in extra miles and pushed me every month to let her run more on those weeks. But to her credit, she trusted the process and stuck to the prescribed training plan.
Essentially, all running injuries are the same. You put more stress on that part of the body than it can adapt to, so it breaks down. It doesn’t have the resilience it needs to tolerate that amount of stress. So if you want it to be able to tolerate more stress, you have to increase the resilience. Then it won’t get re-injured.
Running is the best way to condition your body for running. So you should use running to increase the resilience of the injured area.
Rita had been running 50 miles a week, which is a good amount of running. She’d built up quite a lot of resilience in her hamstrings, but it wasn’t enough. The trouble was, all of her running was very similar. She ran at pretty much the same speed, for the same amount of time, each week. This conditioned her hamstrings to tolerate a very narrow range of mechanical stress, leaving them vulnerable.
We got Rita to slow down and run longer some days and do fast intervals on other days. We also added hill sprints and tempo intervals at different times during her rehab. This allowed us to condition the hamstrings to all different kinds of stress and increase their resilience.
The stress that your body experiences when running is attenuated by the strength of your muscles. The stronger you are, the better able your body is to handle the stresses of training. When you get injured, we know that area experienced more stress than it could handle. If the muscles in that area are stronger, they are better able to protect it.
If you want to avoid re-injury, it’s especially important to strengthen the areas where you’ve had previous injuries. Unfortunately, many runners do the exact opposite. Avoiding exercises that might put stress on that area, for fear of damaging it. As a result, the area gets weaker, and more vulnerable. I call this paradox the Danger of Safety.
Rita was actually doing pretty well on this part. Her husband is a Personal Trainer and Rita was doing heavy strength training two or three times a week. So it was really a case of tweaking her strength work, rather than overhauling it.
We made sure that she was going really heavy on her split squats, deadlifts and hamstring curls. We also added some explosive jumping exercises, to ensure that she could express her strength quickly and protect her hamstrings.
Return to Full Training
Rita was patient and disciplined during her rehabilitation. It took time, but we were able to slowly and safely build up Rita’s weekly mileage. Six months after starting with us, she was back to running 50 miles a week and her hamstrings felt fine.
What’s more important though, is that she wasn’t worried about re-injury anymore. She could just relax and enjoy her running. She shared her experience in the post at the bottom of this article.
If you feel like your coach, physio or doctor isn’t listening to you and you’re not feeling confident about your recovery, just click the button below to book a free call with us.