Having a history of an injury is the number one predictor of having another injury in the future. For example, rates of reinjury after having an Achilles tendon injury is 70% higher than uninjured runners.
But you did all your exercises and stretches, your PT did Graston and dry needling, and you graduated from PT, so this means you are 100% healed and can go back to your normal running routine and won’t get injured in the future, right?!?
Unfortunately, this is not the case. Our current medical model for treating running injures focuses too much on getting rid of the symptom of pain rather than treating the risk factors for your injury, addressing the root cause of your injury, and overseeing a runner’s return-to-run program.
Here are 3 key reasons why runners experience repeated injuries:
The root cause of their injury isn’t being addressed
Running injuries are load injuries because of the cumulative stress that is placed on the body throughout a training cycle. If the cumulative stress hits a threshold where the tissues are not able to recover effectively, this leads to them getting weaker. The weak tissue can no longer handle a normal amount of running, which then leads to pain.
Runners often look for one run or one race that caused the injury, but running injures are not from acute events. They are due to cumulative stress over many weeks or months. Runners experience the greatest rates of injury 3-6 weeks after they have a spike in training. A spike in training doesn’t simply mean an increase in volume, but also includes speed training, up and downhill running, and switching to a more minimalist shoe. When these types of stress are increased too rapidly and are maintained over many weeks, the body experiences too much breakdown and this leads to injury. Unfortunately, PTs and other running medical professionals don’t look at a runner’s past training to discuss the errors that lead to the injury. This leads to the runner graduating from PT, and then going out and repeatedly making the same training mistakes over and over again which lands them right back into PT again. How frustrating!
Runners are told to stop running when they have an injury
If you have a fracture or pain over a 3/10 when you run, then yes, you should stop running for a bit. But, it is very uncommon that runners will benefit from taking a week or multiple weeks off from running to overcome their injury. Extended rest leads to weakening of all tissues in your body. This is similar to how not exercising doesn't lead to stronger tissues! But why does rest help for a while? After an extended period of rest, runners feel that they are “healed” since they no longer have pain but the reason they no longer have pain is because they have't been running. So, the runner jumps right back into the amount of training they were doing before. This is truly concerning since now they are doing the same amount of training that got them injured in the first place, but their tissues are now even weaker than before! This leads to runners perpetuating the all too common cycle of injury:
The last reason why runners experience chronic injuries is that medical providers aren’t creating and overseeing a runner's return-to-run program
Insurance doesn't cover a monthly coaching-style approach to treating running injuries, which means providers have to do the best they can with the time they are given and perform interventions that insurance will cover. This leads to runners not getting enough guidance on a return-to-run program that is injury-specific but also specific to the individual runner.
Return-to-run programs vary drastically depending on what body part is injured, how much pain you have, your running history, your anxiety levels around pain, your fear of reinjury, and so much more! This is why cookie cutter return-to-run programs aren't sufficient to get runners back to pain free running as quickly as possible.
For example, uphill running is fantastic for rehabbing knee injuries because it decreases stress levels on the knee, but it is terrible for Achilles tendon injuries because uphill running increases the stress on the tendon. Not only do runners need very specific guidance on the surface they should run on, but they also need specific instructions on run:walk interval times, how many times a week they should run, how many miles they should run, how to space their runs out during the week, how fast they should run (most runners run way too fast), signs that it is ok to continue with the plan and signs that they need to dial it back, how to balance their PT exercise program and their running, and how to progress their plan week after week. That's a lot to work on and it is completely unreasonable to expect runners to know how to do all of this on their own.
It is far too common for runners to look at the online training plan they were following for an upcoming race and just decrease the miles slightly rather than focusing on their current injury and load capacity as their starting point and progressing from there. Unfortunately, your injured body doesn’t care about where you are supposed to be in your training but rather, it cares about where it is at right now. Runners also use how they “feel” as a guide for getting back to normal training, assuming that if they “feel” ok for a few runs, it must mean that they are ok to jump back into normal training. Again, this might work for a few weeks, but they will be more likely to experience an injury again 3-6 weeks after the spike in their training.
Runners need more and better guidance, which is why combing PT and coaching in one is the best approach to treat running injuries to help runners get back to what they love quickly and help them avoid future setbacks. Runners need help creating an exercise program to get them back to pain-free running, but they also need a critical evaluation of their training habits so they can prevent injuries in the future.
To get out of your reinjury cycle, you first need to change how you train. Most runners think they are executing a training plan correctly until they work with an expert and realize errors they were unintentionally making with executing their plan. Second, you need to have a weekly strength routine that hits all of your lower body muscles, so that all of your tissues can handle the load of running. Next, look at your cadence. If it is under 160 steps per minute, then you would likely benefit from increasing it. If working on all of these areas still doesn't help, then it is worth having a running expert look at your running form through a gait assessment.
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