Running injuries are way too common.  In fact, depending on the study you cite, between 40-72% of runners report an injury every single year.  The reasons for these injuries are varied but the theme is always the same:  Too Much or Too Often.

Here’s a list of 13 things you can check off to make sure you stay healthy year round:

Boil the frog

In the PT clinic the most common cause of injury is simple ‘too much’.  Too much distance.  Too much speed.  Too much too soon in one way or another.  Setting a training plan is a bit trickier for distance running than cycling or swimming because of the amount of impact absorbed by the body.  In cycling we can begin speed work almost immediately if we wanted to.

With running we should employ the “boiling frog” analogy:  How do you convince the frog to jump into the boiling water?  You start with the heat off entirely so he’s jumping into a comfortable bath, then you raise the heat very slowly so he won’t notice it until it’s too late.  Kind of a sadistic analogy, I know, but the premise holds.  When starting to run, begin with the heat off — mileage very low — and raise the heat slowly by increasing mileage incremental, barely noticeable amounts each week.  Before long you’ll be boiling!  Raise the heat too quick and the frog will wise up and jump out — which is when we get hurt.

Land Soft

This sounds simpler than it is.  And I literally mean that you should land lighter on your feet.  Easiest way to govern this is by listening to your foot strikes…make each step quieter.  Can’t hear it or judge the sound well?  Run with a partner — often it’s easier to hear someone else’s footsteps and give feedback to eachother  This will often change the way you run and you might have to begin running at a slower pace or take smaller strides (or both), but the result will be a much more balanced stride with lower impact forces

Heel

Running form has been given a lot of attention the last few years.  Some people (including some coaches) still believe that running is an innate task and we’re just going to run the way we’ve always learned to run.  That trying to correct someone’s form is a fool’s errand.

I will stipulate that it’s difficult to effect change but far from impossible.  I have helped hundreds of people positively alter their running form, and from where I sit (literally) I don’t see running as innate.  Perhaps a few millenia ago when humans had never had shoes or didn’t sit in front of computers all day, but now it’s quite different.  I believe that many of us need help to get back to our proper running form.

One of the most common (and maddening) tips I hear or read about from ‘experts’ online is to land on your midfoot or to land with your foot directly underneath you.  Both of these directives are impossible — as in actually physically impossible to do.  Even the best runners with the best form still land on their heel, and still land with their foot out in front of their center of mass.  It’s the (small) degree to which they do these things which makes their form exceptional.

The directive should change from ‘land on your midfoot’ to ‘just don’t land directly on your heel’.  Long distance runners will still land on their heels in the best of circumstances, but there are degrees to which you can land here.

The instructions I usually start with in my runners are: don’t worry about where you’re trying to land; just don’t land square on your heel.  Many running injuries come from the increased ground reaction force a runner experiences when nlanding squarely on their heels.

Stand Tall

We sit….a lot.  At work.  In the car.  In front of the TV and with our tablet.  Undoutbtedly tyou’ve eard at this point that all this sitting isn’t good for us.  That’s true and it carries forward into our running form.  The more we sit, the weaker our glutes and hip muscles get — they just don’t have to do much work when we sit.  Additionally, sitting causes us to slump forward, round our shoulders and drop our head.  All of these bad habits show up in our running form.

Stand up straight!  Get your shoulders back…they should not be in front of your hips, but all too often I see runners leading with their shoulders in their stopped, ‘falling forward’ gait.  One really good cue for this is to think of initiating your stide by driving the opposite elbow back.  As we drive our elbow back we take advantage of some of the elastic energy in the spine that initiates our opposite hip to glide forward and begin our swing phase.  It also has the tendency to keep our torso upright.

Drive your elbows back to initiate your stride…this helps to get your shoulders back…

Bend your knee!

If I were allowed to only give a runner one instruction to think about to improve their form it would be ‘focus first on bending your knee.’  When a runner is about to lift their leg off the ground and begin their swing phase  the thought I want going through their head would be “bend the knee; heel towards the butt”.  Thinking of knee flexion first has two key outcomes:

First it functionally shortens the leg as a lever that needs to be swung forward so initiating swing requires less energy.

Second, it keeps the leg behind the runner which makes it less likely that they’ll land with their foot far out in front of them.

Don’t go Barefoot

This one is simple.  Just don’t do it.  Barefoot running was a terrible idea.  Again, perhaps a few millenia ago when there was no such thing as concrete or asphalt, this might have been okay, but in our modern world where it’s difficult to get away from hard surfaces it’s not a smart thing to try.

This goes for the toe shoes – the FiveFingers — as well.  Running barefoot on a soft surface for  brief periods can help you strengthen your feet and improve proprioception, but spending a lot of time barefoot is just asking for trouble.

Don’t Wear Moon Boots

This is the counter-point to not going barefoot.

One of the more common questions I get is about proper running shoes.  Here are my simple rules for choosing a shoe:

1. The shoe should be shaped like your foot.  If you have very narrow feet that look like little canoes then you can wear shoes where the toe box has a narrow shape.  If you’re like many of us though, your wide foot will function best in a shoe with a wider toe box.  Many companies are now making shoes with more anatomically shaped lasts which is a step in the right direction.
2. It should have as low a heel offset (also called ‘drop’) as the runner can safely tolerate — no high heel running shoes.
3. The amount of cushioning can vary — the more heel offset the shoe has the less overall cushioning it should have.  A low offset shoe (<4 mm) can have more cushioning to it (30mm, 35mm or more), but it doesn’t have to — this would be according to the runner’s preference.  Why the inverse relationship between offset and cushioning?  This is purely my experience with my clients and patients (meaning I can’t point to a study on this and wanted to be up front about that) — if a runner is doing well in a zero or very low offset shoe they have already corrected a few issue with their running form, especially in regards to stride length and therefore their form shows less negative effect if they choose a shoe with extra cushioning.  Shoes with more cushioing have been shown to increase the amount of time the runner spends on the ground, but other than that there are fewer negative effects to balance and form in this situation.
4. The shoe should be simple:  A shoe should protect your foot, provide a little cushioning and not get in the way of your form.  That’s it.  What about motion control or stability, you ask?  Turns out shoes built and marketed for all these tasks actually don’t do them very well at all.  No gimmicks; apply Occam’s Razor to your shoe buying.  The simplest answer is usually the correct one.

Stay away from big “moon boot” running shoes, espeically those with a high (>10 mm) heel drop) — they will cause more running injuries than they will prevent.

Hips and Strengthening

If there is such thing as a universal rule in running it might be that every runner can benefit from working on their hips.  I have yet to encounter a runner, injured or not, who displays good strength and equal (left to right) balance and coordination through their hips.  There are a lot of ways to skin this cat, of course, but the question of what works best is often confusing.

Should we be doing exercises on all fours like in Jane Fonda’s workout?

Or one leg balance stuff on a Bosu?

That creepy hip machines at the gym that looks like something out of an OB-GYN office?

How about good old fashion dead lifts and squats with free weights?

Strength training is one of those areas where we can never seem to agree and there are enough conflicting studies to cloud the view even further.

We’re pretty sure that strength training helps runners.  At least we  *almost* know that for sure.  I would say it is a safe bet.

But now how should we go about it?  This is where it gets confusing:  if we do heavy weight training, should we do it concurrently with our running program?  Seems like that might be a recipe for fatigue and overuse.

So should we use the weights in the off-season when our running mileage is lower?  But after 6 weeks of no weight training, all the benefits we realized during our lifting period disappear.

Does that mean lighter weights or exercises are a better idea?  What if an exercise isn’t ‘functional’ enough?

Before we get too in-the-weeds on this topic let me go over a few things that might clear things up and get us to an answer quicker:

1) Don’t get stuck on “Functional”

First, ‘functional’ exercise isn’t always the best method for strengthening.  If you’re looking to strengthen or just activate a muscle that hasn’t been pulling it’s weight, there are likely dozens of functional exercises that can get this muscle to activate in the movement pattern of your desired task (whether running, throwing a baseball, or pedaling a bike).  But there’s an even better chance that there’s a non-functional exercise that will actuvate that muscle to an even greater degree.  That non-functional exercise may be the one you should use.  Free weight exercises are often plenty functional but also have the added benefit of activating muscles well.

2) Go Big

In general if your goal is to get something stronger (build) or keep something stromg (maintain in season) then the rule is usually ‘go hard or go home’.  Runners should take their cues from power lifters (after all, who knows how to get strong better than those guys and gals).  Power lifters lift very heavy weights, but they do it with a lot of rest.  For example one of the tried and true methods comes from the Russians where they aim at lifting a weight that is their RM10 (they could lift it 10 reps and then fail on the 11th lift).  They take this RM10 weight and lift it for 5 reps shooting for 5 sets.  This tends to be a very achievable and comfortable lifting regimen (meaning you won’t see them working repeatedly to failure), but also produces significant results.  But an RM10 weight is still pretty high, even for a weakling runner, and that’s the point.  In certain phases of their training powerlifters may just be doing one rep and then take many minutes in between sets — there are even rooms at some of these gyms where they can nap in between workouts.

It’s easy enough to lift heavy in the off-season and build strength but what about losing all of that when we stop lifting in-season?  The key here is to keep lifting, but to do so in a way that has maximal impact impact on our strength mainenance but minimal negative impact on our running.

How is this possible?  That brings me to my third point:

3) Take advantage of neural adaptations

Much of our strength training improvements come from neural adaptations rather than changes in the muscle.  High weight or explosive exercises have been shown to improve running economy and  it’s thought that processes within the nervous system are enhanced and the cause of these improvements.  So the takeaway:  Do just enough work to keep the nervous system primed and firing efficiently.  In-season, performing just a few lifts with heavy weight may be all we need to keep these benefits.

Cross-Train

Do other sports.  Running uses certain muscles a lot and others very little, so do something else.  It’s one of the best ways to keep away running injuries and the syndromes they foster.

Move out of plane a lot

Similar to “Cross-Training” but a bit more specific.  Running is very linear.  We tend to go one direction; forward.  We need to break out of this plane of forward movement because it will move joints in directions and to degrees that they don’t normally see.  Muscles will work in directions they’re not accustomed to (and should be), and the “software” in our central nervous system that manages our movement will be robust and able to handle any movement situation.

If you want to run more, first run more often

When trying to increase speed or distance in your running program it’s best to first add frequency.  This is an easier and safer way to add mileage to your weeks.  It just comes down to simple math:  if you were running 5 miles a day 4 days a week but then you were able to add a fifth running day the next week, and merely run 2-3 miles on that day, over the course of the next few weeks that 5th day could safely get worked up to 5 miles and in a few short weeks you’ve bumped up your mileage by 25%.

Jump Rope

With so many runners transitioning to lower drop and “minimal” shoes, running form has of course begun to change (for better or worse) and more runners are not landing on their heel when they run.  This can be a very good thing when done properly but it does require more of the calf and foot muscles and many/most runners don’t have proper stability in these tissues.  The result has been many instances of common running injuries plantar fasciitis, calf strains, Achilles injuries, stress fractures and more.

One of the simplest and best ways to get the muscles of the feet and lower legs up to speed is to begin with short bouts of jump rope.  Jumping rope is not about theheight but about the speed.  You don’t have to emulate Sly Stallone in the early Rocky films and become a speed demon but being able to jump at a rate faster than your running cadence initiates the stretch-shortening cycle (SSC) in the muscle (via the golgi tendon organ [GTO] and the muscle spindle) differently and more aggressively than when we run.  This provides a greater stimulus for the tissue of the feet and lower legs, making us more injury resistant.

Marathon sessions aren’t necessary either.  Even 5 minutes of jumping after a moderate length run can be helpful.  Jumping rope is also a great substitute worout on those days you can’t hit the road or trail.  Spending 15-20 minutes with the jump rope will not only provide a good aerobic workout in those instances but will make a tremendous diufference in your lower leg tissue stability.

Do a long warm-up

Warming up and cooling down are the two most common areas where runners cut corners.  I get it.  We’re busy and short on time so when only 45 minutes is available for a workout the tendency is to get to get busy and do some work.

Problem with this approach is that it’s a short term gain.  It has more negatives in the long term.  Why?  Simply, jumping into a run before tissues are properly prepared leads to more inflammatory load.  Unprepared tissues experience more micro-trauma which leads to more inflammation and longer recovery times.  Want to recover quicker?  Warm-up better.  Recovery begins in the warm-up before you even start your workout.

Begin by just walking briskly.  I usually shoot for about half to three-quarters of a mile.  Then, as you walk, some small hops, bounces or light skipping for a few hundred yards is helpful to bridge your body to the dynamic movement necessary.   After that, just begin jogging easily and slowly progress your pace.