I Can’t believe it, I’ve only just taken up running and I’m injured already!

Unfortunately it is an all too common occurrence for us have a disappointed runner sat in front of us for assessment of a new injury from recently taking up running. More recently with the restrictions on the forms of exercise we can do during the Coronavirus pandemic, combined with the excellent weather during that period, this has become very common with many more people trying out and enjoying more outdoor running.

It has been shown that novice runners face a much greater risk of injury than recreational or competitive runners. This is due to a combination of overload in their tendons and muscles as well as technique and fatigue issues that unduly overload certain areas.

When you are running, multiple times your body-weight in the form of ground reaction force is produced on impact with the ground. This has to be absorbed and controlled by the tendons, muscles and joints in the legs. Over time and with progressive increases in running mileage and duration, the tendons in the lower limbs adapt and strengthen to this, making them less prone to injuries such as acute muscle tears or tendinopathy. Running technique and fitness are also shown to improve which can decrease the adverse and destructive repetitive loading on the joints as well as improve running economy.

The most common injuries we see in new runners, or those runners returning from a lay off tend to be at the front of the knee in the form of a patellofemoral joint irritation (under the knee cap) or patellar tendinopathy (the tendon below the knee cap). It is also very common to see a tear of the calf muscle or pain at the achilles tendon in the form of a tendinopathy. In a runner these are all overuse and overload issues and some of them depending on the severity can result in a lengthy time off running to settle and fix them.

What can I do to prevent these issues?

Most running issues and injuries are really preventable as they are nearly all as a result of overuse. It has been suggested that between 60-70% of all running injuries can be attributed to training errors. Novice runners are the most prone to injury but they are also a group who can easily adapt their training to limit exposure to common injuries and “start as the mean to go on”. Here are 7 simple suggestions for someone who is new to or has recently started running to lessen their likelihood of developing a running related injury.

Be realistic about your current running experience and plan your training to be conservative in the first few weeks with progressive increases in your distance by 10-15% per week.
Initially give yourself a day of rest after each run to allow any tendon or muscle overload to recover a little before your next run.
Don’t be hesitant to adapt your training to something non-impact based like cycling or take a rest day if you feel a niggle in your knee or achilles/calf/foot. This one day of change or rest from running impact may be enough to stop you causing a worse problem and it will likely result in a much shorter time off running.
Do adequate recovery work between runs to release tightness and restore normal muscle and joint range. This can include stretching, soft tissue release such as self-massage or equipment assisted massage like foam rolling.
Strengthen the muscles of the lower legs and core to help prevent muscle tears or tendinopathy and increase the muscles load bearing capabilities
Wear running shoes that you find comfortable. Shoes that do not feel comfortable when running such as when the toes feel squished or the cushioning feels too much or too little is likely to result in you offloading any discomfort and then abnormally loading your soft tissue and joints. Don’t get caught up in the marketing and hype of certain shoes or brands; try on a number of shoes and brands and go with your gut instinct as to which feel most comfortable to you.
Most of your runs should be at easy pace. With greater speed comes greater peak forces and also fatigue. You cannot expose your body to this too often otherwise you will acutely overload the legs and injuries may arise. I’d recommend a 2:1 ratio of easy to hard efforts, where if you do 3 runs a week, then 2 of them should be at your easy pace and one of them at a moderate to difficult effort. For an easy pace you should feel like you could speak normally or if you have a heart rate monitor watch, your heart rate should be at or below a value of 180-your age (eg. 180-36yrs = easy pace of <144 beats per minute). For the remaining session this can be ran a little faster or include variations in speed such as intervals. This approach will also give your musculoskeletal system and your cardiovascular system a chance to adapt well to your running.

Home Exercises to Try - Stretch, Strengthen & Release

Below are some basic strengthening, stretching and muscle release exercises that will benefit most people starting out running. Always work within your own comfort limits on these as they will improve gradually over time and you want to take a consistent and not a torturous approach that you dread the next time. If you can only do part of the movement or a modified / reduced range then that is fine, just do what you can. Try them twice a week to begin with and you should gradually start to feel better and move better.

Exercise 1 and Exercise 2 below are video links to some self-administered soft tissue massage and release for the thigh and calf muscles respectively

Exercise 3

Couch Stretch

In a lunge position have the top of the foot or ankle on the left leg back against a wall or your couch making sure to have some padding underneath the knee left knee.
Pull your lower stomach muscles and belly button inwards while also engaging or contracting the buttock muscles on the left side and imagine lengthening your left thigh bone and knee downwards toward the floor.
This should produce a stretch along the front of the left thigh and up to the front of the left hip. Make sure to keep the tummy in and buttock contracted as this will keep the stretch focused on the front of the thigh and hip and stop you overarching your lower back as can bee seen in picture 2 below.
Hold this position for 1 minute and swap to the other leg. Repeat twice, making sure to ease yourself a little further into the stretch each time.

Exercise 4

Calf Raises

Begin with the ball of the foot on the edge of a step. Using your calf muscles lift your weight up, raising the heel above the level of the step. (Image 1)
Slowly over 2-3 seconds lower the heel below the level of the step (Image 2)
Repeat this movement for 2 sets of 8-15 reps on each side depending on your strength.
If this is too difficult to begin with, you can do the same movement using both feet on the step and aim to progress to using a single leg over a number of weeks.
This movement can also be performed with the knee bent the entire time. This will primarily strengthen the lower portion of the calf (soleus muscle) which is also important in running (Images 3 and 4 below)

Exercise 5

Figure 4 Stretch

Begin by placing your left leg on the wall at 70-90 degrees of hip flexion (knee towards chest)
Place the right ankle just above the knee of the left leg and drop the right knee outwards
You should feel a stretch on the right outer hip and buttock
Hold for 1-2 minutes and repeat on each side twice

Seek Help & Advice Sooner Rather Than Later

If you find yourself injured and unable to run it’s advisable to get your injury seen to and diagnosed as quickly as possible. Getting the right advice early with an injury will significantly decrease the amount of time you will have to take off from your running and it will likely decrease your levels of pain and the stress you experience associated with it.

At Physio Effect our therapists are experienced and highly skilled in advising and managing running related injuries and we will be able to help you reach a diagnosis and an understanding of your injury, including why this likely happened in the first place. We will be able to offer you advice on alternative forms of cardiovascular exercise as well as specific strength training to address your issue so you don’t feel like training has stagnated or regressed. All treatment plans can be time graded and clear to you, with milestones to achieve that not only address your current levels of pain associated with the injury but also the issues that may have contributed to you developing the injury in the first place.

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Thank You

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