Rethinking Running Health

Why getting injured is a frame of mind.

March 12, 2013


The ambition to reach our full athletic potential also often leads runners to take on more than they can handle in their training. In his clinical work, Gunnar Brolinson, D.O., the head sports physician for Virginia Tech, sees three major training errors among endurance athletes: increasing mileage too quickly, increasing speeds too quickly, and increasing training density too quickly. "As a performance-based athlete, you're going to risk injury," he says. "And because people are always trying to push themselves hard, they will ignore the early signs of injury or illness."

Old running standbys like increasing your mileage by no more than 10 percent a week may seem overly generalized, but they point to a mode of caution that's critical to long-term success. Learning your individual limitations is just as important. If running a speed session leaves you feeling worn down and excessively sore, Larson says, then hitting the track three times per week is probably not in your best interest. Open your mind to alternatives, even if you think it will offend your training partners or coach.

Despite the sales pitches of manufacturers and cure-all gurus, health is not a switch we can easily flip from healthy to injured and back again. Health exists on a continuum with a great deal of gray area between completely healthy and totally immobilized. At one extreme end are athletes like Yoder Begley, whose 2010 U.S. championship in the 10,000m came on less than 30 days of running, and whose sub-15:00 5,000m was earned with a cortisone shot in her Achilles. On the other end is Sage Canaday, a marathoner and mountain runner who has managed five years (and counting) of injury-free 90-mile weeks. Yet even he isn't bulletproof. "Whenever I feel an ache or pain, I back off of my training immediately," he says. "And I've spent years slowly building my mileage up to that level."

Subscribing to health and injury as an all-or-nothing proposition makes us more likely to run through any pain that doesn't stop us in our tracks. As the head coach of the ZAP Fitness elite running group, you might think Peter Rea would have a vested interest in having his runners push through these types of ailments. The opposite is true. Rea views everything through a long-term lens, and acknowledges that just because you can physically run through an injury doesn't mean it's in your best interest.

"It's not a sign of weakness in any way to let us know if something is bothering them," says Rea of the message he and his staff send to their elites. "We want them communicating with us wholeheartedly if there's anything out of the ordinary. Generally the way we react to that is, 'Take the next couple of days and back off.'" A simple step like that often pushes us from the precipice of disaster back to our normal routine in less than a week.


The psychological and physiological causes of injury walk hand in hand. Compulsive, Type A runners may drive themselves to overuse injuries, but the most obsessive runner with picture-perfect form may run for decades without serious injury, while a laid-back runner with knock-knees might feel blessed to get in a 30-minute jog without having to flag down an ambulance. And the injury, in the end, is physical, a breakdown of bone, muscle, tendon or ligament.

To get the full picture of injuries, we need some basic physiology. Thanks largely to the minimalist movement, biomechanics has entered the everyday runner's lexicon in recent years and for good reason. By using a form that increases efficiency while minimizing running's shock to the musculoskeletal system, we offer ourselves the best chance to stay healthy and run our fastest. Scientists such as Harvard's Daniel Lieberman have advocated an ideal set of running biomechanics that's highlighted by landing properly on the forefoot or midfoot. Doing so produces lower impact forces and eliminates overstriding, both of which should help a runner stay healthier over time.

But can a universal standard for biomechanics really hold up? Runners today are a more heterogeneous group than they were during the first running boom. A biomechanical weakness that would have disqualified one from being a runner a few decades ago is simply something to learn to overcome now, and the local weekend warrior who logs 10 miles per week considers himself just as much a runner as the Olympian. Yet their physical characteristics and backgrounds are likely quite different. This makes conducting and interpreting meaningful research more difficult.

To top it off, there's a large subset of the running population that's physically incapable of attaining ideal biomechanics. This is why Brolinson first looks for excessively flat or high-arched feet, extreme overpronation, limb alignment abnormalities, and bowlegs or knock-knees in injured patients. He also spends a great deal of time assessing whether one leg is longer than another, particularly if there's a "preponderance of injuries on one side." Not everyone with a leg-length discrepancy or other physical abnormality is going to get hurt, Brolinson points out, but extremes can cause running injuries.

Rea at ZAP Fitness is a strong believer in adjusting training based on one's physiology. One of his most talented athletes in the mid-2000s, miler Brendan O'Keefe, was severely bow-legged and never able to hold consistent mileage without major injury. After two years of frustration, Rea switched O'Keefe to running only four days per week. The other three days were reserved for cross-training. His weekly mileage rarely exceeded 50, but O'Keefe was able to train consistently for the first time in his life and went on to run 3:40 for the 1500m and qualify for the 2008 U.S. Olympic trials.

Someone with good running form is still at risk of getting injured or significantly slowing down if their muscular endurance is lacking, says author and musculoskeletal therapist Phil Wharton. "Biomechanics is huge, but we've got to be able to hold those biomechanics," he says. "We've got to maintain that postural alignment through the whole stride phase and when we get tired. Otherwise, that's when you see people shuffling."

Andrew Lemoncello, a Scottish distance runner training in Flagstaff, Ariz., who competed in the 3,000m steeplechase in the 2008 Olympics, has spent 18 months and counting trying to figure out the root cause of his problems. He's been battling injury since tearing his left hamstring in the 2011 Fukuoka Marathon.

"I had an ache in that area all year, but we couldn't get it properly diagnosed, as it would go away and then return," Lemoncello says. "I had to pull out of the world championships marathon the day before I was supposed to leave because of this. The strain of racing the marathon put it over the edge and finally tore the tendon."

After a platelet rich plasma (PRP) injection and six months of cross-training in the gym, Lemoncello slowly built his mileage back up. But then in July 2012 he re-injured himself after setting a PR in a 10-mile race. He spent 45 minutes at drug testing after crossing the finish line and by the time he got to cool-down, the hamstring area was already sore and tight. At the beginning of 2013, he could only run up to 60 minutes without pain. He and his sports medicine team are trying to determine if his injury might be connected to sciatic nerve and lower back problems, as well.

"I will go back to Scotland and work with the Institute of Sport there," Lemoncello says. "They will do a full-body assessment to see exactly what is going on to cause this problem, as it is reoccurring. A full biomechanical assessment will be done to make sure that my body is equally strong on each side."

In recent decades, physical therapists have refocused much of their time to looking at muscle imbalances when assessing the root cause of an injury. Simply put, a muscle imbalance occurs when two or more muscles or muscle groups that oppose each other are disproportionate in terms of strength and flexibility. Imbalances can be present in both agonist/antagonist pairings (like the quadriceps and hamstrings) and side-to-side pairings (left hamstring versus right hamstring). A weakness or tightness caused by a muscle imbalance can place undue strain on various joints and soft tissue, negatively altering biomechanics.

When doing an intake exam, Wharton looks for a limited range of motion in the major muscle groups of the legs. Almost across the board, he sees weak abductors (outer thigh) and adductors (inner thigh) among runners, and their glutes "are usually shut down and detrained, not firing at all." This affects the hamstrings and quadriceps, which places unnecessary stress on the knee. This is what medical specialists refer to when they describe looking up and down the kinetic chain, seeing how a dysfunction in one area can lead to an injury in another part of the body.

To fix muscle imbalances, physical therapists recommend specific sets of exercises that isolate the weaker muscle and gradually grow in complexity. For instance, a runner with weak glutes would benefit by starting with an exercise that isolates the glutes (such as donkey kicks), then gradually progressing to more complex exercises that incorporate all the muscles in the upper leg (lunges). Wharton is also a big proponent of running-specific exercises that use full of range of motion and increase strength and balance.