How to avoid a running injury, according to a physio

You've become a runner during lockdown, but how do you know if you've been running too much?
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John Chapman, one half of the Lean Machines (@theleanmachinesofficial), once told me that running should be considered a privilege.

Two years later, having properly taken up running myself I understand why. While it is wonderful for the body and mind, the repetitive movement is hard on the joints, and most keen runners I know, especially those who race, have suffered some sort of injury at some point. Most recover, but for the few that can no longer pound the pavements as a result, it's a huge source of frustration.

With the lockdown running boom showing no sign of slowing down, we caught up with Ascenti physio and running enthusiast Olukayode Faleye for some top tips for injury-proofing your running training schedule.

What are the signs you could be running too much?

There are many signs that you could be overdoing it, from physical indicators like heavy legs, fatigue or an increase in your resting heart rate to more emotional warnings such as mood swings, struggling to sleep at night and starting to see running as a chore. Learning to recognise these symptoms early can be hugely beneficial as it can allow you to take action before you sustain an injury.

How can you progress your running in a safe way?

Gradually. We recommend following the 10 per cent rule, so if you’re currently running 10 weekly miles (and you are not far off that if you are managing three 5km runs each week) then you could increase that to 11 miles the following week. However, if you are a beginner, or recovering from an injury, we suggest increasing your distance more slowly, by around 5 per cent to your total each week.

It’s also important to considering the intensity of your runs and whether you have a proper warm-up and recovery plan. If the majority of your runs involve things like hill running, interval training or trail running then you are putting a lot of pressure on your body. These should ideally be limited to a couple of days each week and can be offset by recovery day runs taken at a slow pace.

What are the most common running injuries?

The fact that running injuries are so predictable - Patellofemoral Pain Syndrome has even been unofficially christened ‘runners knee’, for example - shows that we already know which joints and muscles come under the most pressure through running. With hamstring strains, achilles tendonitis and ankle sprains also common, it makes sense for runners to spend time ensuring that those parts of the body are properly warmed up beforehand. We recommend a good combination of static and dynamic stretching before each run.

How should you recover from a run?

Ensure you stay fully hydrated, walk for five minutes after a run to allow your heart rate to return to normal, stretch major muscle groups and anything that is sore or tight once you finish, eat a meal that is rich in carbohydrates as soon as possible to restore energy and try using a foam roller to massage tight muscles.

What other kinds of training best complement running?

Cross-training can really benefit your running, increasing strength, muscle balance and reducing your risk of injury - many runners also find that they make them a lot faster.

Swimming provides an excellent aerobic workout and is a great way to strengthen the upper body and the core, while cycling does a similar job for the legs - both are low impact, making them ideal for a recovery day.

Pilates and yoga can improve muscular strength, posture and flexibility and reduce the chances of injury. If you want to increase core and spine strength, Pilates is the best option, while yoga provides more of a full-body workout and is often thought to be better at improving runners’ mental focus.

There are also lots of benefits to weight training to build strength, and walking to increase endurance. The key thing, overall, is variety, as by taking on a wide range of exercises you will work a larger number of muscle groups, which will minimise your number of vulnerable areas.

How can you safely get back into running after injury?

Returning from an injury takes patience as well as hard work, but by increasing your activity gradually, you give yourself the best possible chance of reaching your previous levels and remaining injury free for the long-term.

Injuries can be so frustrating, and it's this - and often an innate desire to get back to pre-injury levels as quickly as possible - that often leads to runners doing too much too soon when returning from a setback.

The first step is to ensure that any swelling has subsided and to check that you’re able to complete basic day-to-day activities again without feeling pain. If that’s the case then you can start trying to rebuild some of the lost strength and stability that will have occurred if you’ve been immobilised for any length of time.

Once you’ve restored basic movement and function you can move on to strength building activities such as resistance training or weights. If you’re able to work the muscle without pain, then it will be time to start introducing normal movement and low level training.

It’s very important that you don’t try to rush back to your normal routine though. We’d recommend starting with shorter sessions and low impact activities such as swimming or the cross-trainer and then, once you start running again, to build up your mileage and intensity gradually. Start small and slow, and follow the 10 per cent rule - or less if preferred. If you feel a sudden increase in pain, take a couple of days break and get some specialist advice from a physiotherapist if it persists.