As an osteopath specialising in running injuries there are two questions (or variations of them) I am asked regularly:
- How can I run injury free?
- What are the most common running injuries and how do you treat them?
In this article I will try and answer the first of these questions. In my next article I will talk about the most common running injuries and some of the treatment principles that my colleagues and I use to help people recover from injuries and return to running.
THE SIMPLE TRUTH ABOUT RUNNING INJURIES
THE VAST, VAST VAST MAJORITY OF RUNNING INJURIES HAPPEN WHEN YOU TRY TO RUN FASTER OR FURTHER THAN YOUR BODY CAN HANDLE
If you want to enjoy running, get better at running or just avoid injuries, here are my 7 principles for running injury free.
- Most of your running should feel easy
- Structure and monitor your running week/month/year
- Long term goals should trump short term goals
- Increase your distances gradually and sustainably
- Strength training is an integral part of your running routine.
- Make each run a sandwich (what to do before and after your runs)
- Consistency is key
(You might have noticed that the above list doesn’t include: “the best running trainers to avoid injuries”, “running cadence”, “running breathing technique” etc. These are all useful things to consider but, in my experience, they are less important that those which make the list).
PRINCIPLE 1: Most of your running should feel easy
“Easy running” avoids the “running faster than your body can handle” bit of the injury equation. Of course, If you are just starting out running for the first time you may think that “easy running” is a contradiction in terms. However, as the 100,000s of people (and many of my patients) who have completed the “couch to 5k” (C25k) programme will attest too, it is possible. If you have never come across C25k, it is a 9 week programme which helps people achieve a 5km run based on running 3x per week. In week 1, the programme starts with brisk walking, 60 second periods of jogging (6 mins total) and plenty of rest in between for 20minutes total. By the end, the aim is to be able to run for 30mins continuously. You can find the details here https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/. By initially breaking up the running with periods of walking you can avoid that horrible feeling of running out of breath and being forced to stop before you want to.
Once you are running regularly you might be tempted to train hard each time you put your trainers on. Seeing your pace improve is quite addictive and initially this might bring you quicker results. Unfortunately, it is unsustainable in the long term as you are much more likely to get running injuries, burn out, or just plateau. There are two main reasons for this:
- Firstly, when you run hard you put much more impact through your body which eventually leads to injury if you are not physically prepared for it.
- Secondly, when you run harder than you should, it negatively effects your ability to do your harder run(s) properly. You end up fatigued and in the “mediocre middle” – not running easy enough to increase your weekly/monthly distances and not being able to hit top speeds on your hard day(s). Just remember “Keep your easy days easy and your hard days hard”
Why is running at an easy pace so important?
For almost all non-elite runners the most important limiting factor in your ability to run faster or further is your aerobic capacity. Essentially this is the amount of time you are able to keep exercising at a moderate intensity aka stamina. By building up your stamina with easy paced running you can improve your body’s ability to take in and use oxygen (VO2max) as well as improving how efficiently your body achieves this (running economy). Furthermore, by doing it at an easy pace you minimise the risks of picking up those dreaded running injuries.
What do the best runners in the world do? The 80/20 rule for easy running
The best runners in the world train at an easy pace (for them) for approximately 80% of the time. This is a pretty good model to follow. That said, there is no harm in making all your runs easy paced, especially if you are new to running or are coming back after a running injury like “runners’ knee”, plantar fasciitis, or Achilles tendonitis.
So what constitutes an easy running pace?
There are lots of different ways to “measure” your easy pace, but the best way is to do it by feel. Imagine you are running with a friend. Could you hold a conversation without gasping for breath? If you can, then you are probably running at about the right pace for your easy day running. Another fun way to check you are running at an easy pace is to see if you can recite the alphabet in one breath. If you can’t you are going too quickly.
PRINCIPLE 2: Structure your running week/month/year
There are a huge number of different types of runs than you can do on any given day and each one serves a different purpose. For example you might want to work on your:
- aerobic fitness
- speed work: surging during a race, maintain speed at different stages of a run, changing pace
- hill climbing and descending
- race strategy
- running for longer.
- running form/technique
With a plan in place, you can avoid accidently over-training by running too far or too fast. You can also make sure that you cover the skills that you need to become a well-rounded runner. Finally planning and structuring your running helps keep you consistent – you don’t have to think, just stick to the plan.
So how can you structure your week so that you get the right number of easy days and can even start adding in some of the more challenging (in terms of pace or distance) runs listed above?
Whilst the 80/20 rule described in principle 1 is very helpful, there is a lot more to structuring your running week than that. However, before getting into those details, you need to take a moment to think longer term. For that I need to introduce two training concepts: “periodisation” and “base building”
Structuring your running for the longer term: Periodisation and base building
Periodisation is a process of dividing up an annual training plan into shorter phases of training. This in turn allows you to focus on a specific (or a few) attributes during each period – typically lasting 8-12 weeks for shorter running distances and up to 16-20 weeks for a marathon. The concepts and details of periodisation are beyond the scope of this article. However, the first phase in every training plan is the same – BASE BUILDING.
Building your base is another way of saying building up the amount of distance you can run in a week/month. If you are new to running, this might mean gradually progressing from 10km per week to 30km per week. For a more advanced runner the base building phase might come after completing a goal race and having a couple of weeks off. This is the perfect time to decide on your new goals and then train accordingly.
Base building is often mistakenly thought to be synonymous with only doing slow runs. In fact, it is important to use this phase of training to work on a mixture of different skills. Greg McMillan (exercise physiologist and running coach) in his excellent article describes 5 primary goals of base training.
- Build aerobic efficiency,
- Improve musculoskeletal durability,
- Improve your ability to burn fat and spare your carbohydrate (glycogen) stores
- Improve the endurance of your fast twitch muscle fibres and
- Create a tireless state mentally.
Structuring your running: Your running week
OK, so now onto the structure of the running week itself. It is obviously impossible to write out every variation of plan for every runner from beginner to advanced. Instead, I have 5 simple rules you can follow to structure your week.
- Plan your running week to fit with your life. Any plan that you can stick to is better than the most ambitious plan that you have to scrap after a month because you can’t fit everything in.
- Never do two hard running days in a row: This is defined either in terms of pace or your longest run. Please note, one faster paced run a week is sufficient for most runners. Examples of faster paced runs include interval training, threshold runs, hill sprints, fartleks. (See point 3 regarding longer runs).
- Include a long run in your week but keep it to between 20% and 30% of your overall distance (It will usually be on the higher side for people doing fewer miles / km in a week).
- Make time for strength training: Ideally you should be doing body weight strength exercises after every run. If you have access to a gym then you will greatly benefit from working out with heavy weights 2x per week (more details below). If you are running 5 or 6 times per week, these gym sessions should be on moderate or even on hard days (for the very advanced runner), so that you preserve your recovery and rest day – remember keep your easy days easy and your hard days hard. It is preferable to run first and do the weight sessions later in the day (if possible 6hrs apart – to give your tendons and ligaments time to recover).
- Recovery is as important as training: The most important aspect of recovery is getting good quality sleep. Sleep, more than pretty much anything else you can do, disproportionately effects every performance metric that you might want to measure. Easy running is often known as “active recovery” because it is a low intensity exercise but keeps your joints and muscles moving. In addition to these factors, a good diet and massage can also help you perform at your best.
Structuring your running: objective tracking and monitoring of your training
If you are just getting into running you may not see much point in tracking your runs. However, the data that you can collect from even the most basic of running watches can help you;
- objectively measure your progress,
- find areas of your training that need working on and
- help you tweak your weekly plans accordingly.
On the flip side, you don’t want to become too obsessed by the data and looking at metrics which are either not accurate or relevant. The most helpful and simple data you can collect with a GPS enabled running watch is
- Heart rate (chest straps are more accurate, but watches are improving all the time)
- Run distance
- Run duration
There are lots of apps that you can use to track this information over time. Strava is probably the most popular platform for regular runners and cyclists. The social element is also quite a good way to help keep you motivated, although you can set the privacy settings so that only you see your data. There are lots of other apps including Garmin Connect and Apple Fitness which will all do a similar job.
Structuring your running: subjective tracking and monitoring of your training
It is also very helpful to track how much effort you felt the run took to complete “perceived effort” (eg easy run 3/10, hard run 8/10). There are lots of factors which can effect perceived effort and heart rate. These include stress, quality of sleep, what stage of a training cycle you are at, altitude and mental state.
Most apps will allow you to put in subjective data such as perceived effort. If you start to notice that easy paced runs are feeling hard and your heart rate is higher than you would expect, it might be a sign of over training. You should also note if you experienced any pain during your runs. Again, this will help you spot any patterns during the year which you might otherwise have forgotten.
PRINCIPLE 3: Long term goals should trump short term goals
Keeping your eye on longer term goals helps you avoid over training and getting injured. That’s because it is easy to become preoccupied about weekly goals or overly focusing on single races.
Imagine the following scenario. You are following a running plan that states that this week you are meant to run 40km for the first time. Unfortunately, it is Saturday night and you have only managed to do three runs this week adding up to 24km. You might be tempted to attempt a 16km run on Sunday to meet your weekly target. Its just 4km longer than you were meant to do on the long run and it would be a personal best for distance too. So that might feel good right? Wrong!
If you are not used to running 40km in a week and you haven’t run 16km in one go before you are putting too much load on your body in one run. At best, you might just feel sore the following day, but it is still likely to affect your runs for the following week. At worst you might end up getting injured and not being able to run at all for a week or two (or longer).
Long term goals: A monthly focus within a periodised block of training
A better approach for the above scenario is to look at the training load for the coming month. By adding a little extra distance to some easy runs over the next few weeks you will be able to keep the same monthly target and significantly reduce the risk of injury.
As mentioned above, your monthly goals should also fit within a structured period of training (periodisation) which might last between 8 weeks and 20 weeks: the longer the goal race, the longer the training block.
If you are a female runner you may also want to consider how your menstrual cycle affects your running. You may have noticed that there are times of the month when you feel like you have more or less energy. For many women this is between days 5 to 14 and 17 to 20 of their menstrual cycle. This is when oestrogen and progesterone are lowest and glycogen stores are more readily available. These days would be good for planning harder workouts or races (if possible).
Another common issue is when friends ask you to join them for a race or a casual run but at a significantly different pace than you had planned for. Having some flexibility in your planning is fine. However, if you have a goal race that you are training for in 3 weeks, it doesn’t make sense to go for an all out effort in a race tomorrow. A nice way to still take part is to offer to pace someone who is slower than you so that you can run at the training pace you planned for and they can hopefully achieve a personal best.
The other main benefit of focusing on long term goals is that it removes the pressure of running when you body is telling you to take a break. If you find yourself feeling fatigued, low on motivation or constantly picking up niggling injuries, it is almost certainly time to take a break whatever that week’s goal is.
Sadly I have personal experience of the negative effects of focusing on short term goals. Everything had been going really well in my training for the 2021 London Marathon, but after a fairly easy 10km run on Saturday morning I felt my calf tighten up. The following day I was planning to run 26km and hit 90km for the week. I could feel the calf was tight and I knew I should probably rest up, but I really wanted to hit that goal. I ended up tearing my calf at the 18km mark. Not only did I miss my weekly goal, I also destroyed my training for the critical last 6 weeks of my training plan. Although I managed to finish the marathon, it was definitely not the experience I had hoped for.
Examples of longer-term running goals include
- Monthly or yearly distance covered
- Following a 3-4 month running plan.
- Enjoying running through the year, whatever the weather
- Running a minimum number of times in a month
- Running pain free.
- Enjoying running for the rest of your life!!!
PRINCIPLE 4: Increase your distances gradually and sustainably
There is no getting around it. If you want to be a better runner you need to run more. Even if you are an 800m runner you will also get all the benefit described above from lots of easy paced running. However, (and I make no apologies for repeating myself here) remember that:
MOST RUNNING INJURIES ARE THE RESULT OF A PERSON RUNNING FURTHER OR FASTER THAN THEIR BODY CAN HANDLE
Most running coaches agree that a 10% weekly increase in running distance is manageable. However, this obviously can’t continue in a linear direction forever. There are three factors to consider:
- Your body needs time to adapt to the new loads: 1 week in out of every 4-6 (depending on your plan) you should reduce the volume of your running weekly distance by 20%, before returning to adding another 10% to the distance covered the week before.
- What is sustainable for your lifestyle: If you are running 5km in about 30minutes, 50km a week will take at least 5hrs of running time. If you add time for proper warming up and cooling down, as well as a shower (think of your family and friends) that’s probably more like 7hrs. Ask yourself if this is realistic for your circumstances. If it is, great. Otherwise, you might start to feel like the running is becoming a stress instead of a fun way to get physically and mentally fitter.
- Never run for more than 3.5hrs during training: If you are a beginner or just a slower runner who is training for a marathon you may feel that you have to complete the 20 mile long run. However, there is a pretty high risk of doing yourself an injury if you are finishing this distance in over 3hrs. Ideally keep your long runs under 3hrs or at the very most 3.5hrs. A good alternative to the very long “long run, is to follow a plan like the “Hanson’s marathon training plan”. This works through cumulative load, but you never have to run more than 16 miles (26km) in one run.
The one caveat I should mention here is injury. If you find that your body keeps breaking down when you reach a certain weekly mileage eg 50 miles (80km) it may be that you are neglecting to make your body strong enough to handle that volume of work on your body. Strength training really can be the silver bullet to handling higher mileage. Pace also plays a role here. 50 fast miles puts much more strain on your body than 50 easy miles. So, even if you feel that you are aerobically fit enough to handle a higher pace, if you keep picking up injuries it may be time to slow your paces down.
PRINCIPLE 5: Strength training should be a part of your running routine
Principles 1-4 address the “not running too far or fast” bit of the running injury equation. Strength training really focuses on helping you build up your body’s resilience to the loads you place on it by running. Unfortunately, strength training is often badly neglected by many runners.
Table 1: Examples of exercises you can do to improve your running.
|Body weight||Russian twists
|5 – 10 minutes after each run
improves your running form and efficiency.
Makes you more resilient to injuries
Works as a cool down to prevent stiffness.
Helps mobility as you are moving in different ways to the rather repetitive movements of running.
|45min – 60mins twice a week.
Most efficient way to build strength and power
Making your body stronger will mean it breaks down less often, gives you more stability and is better able to tolerate run training
Olympic lifting helps you convert strength into explosive power.
(With or without rope)
|5-7 minutes maximum 2-3 x per week
Especially good if you are prone to tendinopathies or sprained ligaments
Ligaments and tendons don’t have a good blood supply, so fatigue after 5-7mins of activity.
By skipping or rapid jumping (at least 6hrs away from your run) you can strengthen these tissues without adding significant load to your muscles.
You can improve the effectiveness of this exercise by taking vitamin C and collagen an hour before.
|Plyometrics||Single leg box jump
Knee jump to squat
|5-10 mins as a drill after having warmed up but before main run. Also just a good workout
Jumping helps create force more quickly.
Single leg exercises improve balance and stability as well as improving ability to work on weaker side.
More co-ordinated movement makes you a better athlete.
|Cross training||Stair climber
|If you are coming back from injury or are struggling to increase your weekly distances due to impact, these cross-training exercises can help maintain your aerobic fitness with much less strain on your body|
All of the exercises that are listed above will help your running. However, I would especially like to focus on the weight training part of strength training.
Strength training for runners: misconceptions
There is a common misconception that runners, especially long-distance runners, shouldn’t train with heavy weights in case it makes their muscles too big and their bodies too heavy. Instead, those runners that do go to the gym, tend to use light weights and train for “endurance”.
Strength training for runners: heavy weight training
If you have access to a gym, the weight training for runners that I am advocating is 3 x 6 sets of HEAVY weights for compound exercises like squats, deadlifts and hip-thrusters. If you are barely moving on the last one of each set that is ideal. It sends the strongest signal to your brain that you need stronger muscles and stronger connective tissues which support the muscles and transmit much of the load through your body. Regular running will also prevent your leg muscles from getting too big.
Strength training for runners: Olympic lifting
Just like running, weightlifting is a skill and I would strongly recommend getting a few lessons on how to lift weights and what your level is, before attempting to “go heavy”. This is even more important when it comes to Olympic lifting. Olympic lifting is a very technical (but in my opinion fun) form of weightlifting involving 2 movements: the “Clean and Jerk” and the “Snatch”. The benefit of these exercises is they help you convert the strength you gain from squats etc into explosive power. You also need a lot of flexibility in your hips, ankles and back for these movements, which most runners could really benefit from.
Strength training for runners: scheduling
As I mentioned above, the type strength work will dictate when and how often you want to do your training. I would just emphasise that you are doing this training to make your running better. The heavy weight training should, if possible be done later in the day than the running – ideally with a 6 hour gap between them. The body weight / core exercises, on the other hand, should be done after every run.
PRINCIPLE 6: Make each run a sandwich (what to do before and after your runs)
Make each run a sandwich: The warmup – dynamic stretching for running
What you do before and after your runs can make a huge difference to how you progress as a runner. It can also make a significant impact on how often you get injured by making you both more resilient and better able to hold good running form. The principle is fairly simple. Before you run always warm up the muscles of your legs including calves, quads, hamstrings and glutes. It also won’t hurt to get your back and shoulders warmed up too. You can also use drills as warm up exercises to improve your running form. There are loads of exercises you can try, a few of my favourites are in table 2. They are dynamic stretches which encourage blood flow to the areas that are about to work. They also prepare you mentally for your run.
A quick note about static stretches. There is nothing inherently wrong with static stretches. Over time they can increase joint range of motion. HOWEVER, they do not improve muscle flexibility and are not beneficial before a run. There is also research to suggest that they may be detrimental to performance: for example you will never see sprinters stretching their calves before a race.
Table 2: My favourite warm up exercises and drills.
|Main area targeted||Name of exercise||Method|
|Calf muscles||Heel drop||Slowly walk forward putting the front of your foot down first. With your weight on that foot very slowly drop your heel to the ground as if you are slowly squashing a tomato under your heel.|
|Quads and glutes||Lunges||Take a large step forward as if stepping over a fence. When you foot lands, slowly drop the back knee down. Avoid letting the front knee travelling ahead of the toes. Rise back up and then repeat with opposite leg.|
|Glutes||Squats||stand with feet parallel shoulder width apart. Slowly drop down whilst keeping your back straight and your heels on the ground. Start without weights, but add them once you can easily do 3 sets of 15.|
|Glutes and hamstrings||Glute bridges||Lie on your back, legs approx. shoulder width apart with knees bent to 90 degrees and feet flat on ground. Slowly lift up the hips until they are in a straight line with your knees and shoulders. Hold for 5-10secs.|
|Hamstrings||Hip hinges||Extend one straight leg so that the heel is on the ground, whilst the back leg is slightly bent. Then, keeping the back straight bend forward and sweep your arms to feel a gentle pull in the back of your leg.|
|Whole body but especially lower leg||Skips:
|There are many versions of skips but the easiest is the high skip. This is simply a regular skip but with more explosive height on each leap.|
|Whole lower leg||Straight leg bounding||Both legs stay straight throughout this exercise. Extend one leg out with the toes pointing up whilst the ball of the other foot hits the ground under your hips. Focus on pulling the foot back quickly and a fast turnover|
|Quads, hamstrings, glutes||Leg swings||Stand on one leg whilst holding onto a stable surface. Then swing the other leg forward and back|
|Glutes, hamstrings, quads, calves, abs and shoulders||Karaoke (cross over)||Whilst jogging sideways allow your feet to alternate in front of each other, twisting your pelvis to encourage the movement. Allow your arms to rotate together to the left and right whilst keeping your abs engaged.|
Make each run a sandwich: The cool down/core strength work.
Table 1 lists several body-weight exercises that you can do after each run. There are many benefits to improving your core strength. In particular, a strong core helps you maintain better and more efficient running form.
Static stretching: whilst it is not appropriate to do static stretching before a run, there are some small benefits to doing them afterwards. These include
- Increased activation of the parasympathetic nervous system which is associated with improved relaxation
- Increased blood flow to the muscles post stretching.
The most effective static stretches are those that are held for at least 30 seconds and comfortably activate the muscle being targeted. It can feel like an effort, but you shouldn’t be wincing from stretching
Overall, if you are short on time I would advocate the core strength exercises over static stretching.
PRINCIPLE 7: Consistency is key
“Motivation is what gets you started, habit is what keeps you going”
If you manage to stick to your running schedule for several months, gradually increasing the mileage and incorporating your strength training, you will become a better runner. It really is as simple as that. Your body makes wonderful, fundamental adaptations to almost every system. Your heart gets bigger and more efficient. Your blood carries oxygen to your muscles which use it more efficiently. Your muscles and connective tissues become stronger and better adapted to the loads. Finally, you become better at coordinating the movements and skills associated with running.
When did you run your fastest times?
If you speak to experienced runners, they will usually tell you that they achieved their fastest times over distances as wide ranging as 5km – marathon happened during their most consistent period of training. Furthermore, most of that training will have been at an easy pace. They just managed to do more running, so their weekly/monthly total distances increased.
The running habbit
A running habit, is also easier to sustain than if you tend to stop and start. This is not just from your own mental and physical point of view, but also for the people around you. Once people know that you are “a runner” they quickly understand that your runs are an important part of your life. As long as you have made a realistic schedule, they will not only accept it, they will usually be supportive too. You never know, you might even persuade some of them to come along for a jog one day.
But I Already Have a Running Injury!
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About The Author
This article was written by Ben Posen, clinic director of Hampstead Osteopathy. Ben qualified as an osteopath in 2008 and has a special interest in running related injuries. He has done post graduate training in running rehabilitation and is a keen runner himself. He is a England Athletics assistant running coach and coaches at his local running club – Queens Park Harriers. He qualified as a coach in running fitness in 2022.