10 Laws of Running Injuries

1. Injuries are not an Act of God. There are certain injuries that are intrinsic to an individual. Three main factors can be identified. The only constant factor is genetic: our lower limb structure. The two variable factors are the environment in which you train, and training methods.
2. Each running injury progresses through four grades. Running-related injuries generally become progressively more debilitating, passing through four stages or grades:
   • Grade I injuries are those which cause pain only after running
   • Grade II injuries cause pain during running but does not affect performance
   • Grade III injuries cause pain and limits running performance
   • Grade IV injuries are so severe that running is impossible

This allows a rational approach to treatment. Except in the case of stress fractures, or the iliotibial band friction syndrome, which can deteriorate very rapidly, you are not going to move from Grade I to Grade IV all of a sudden. A Grade I injury requires less attention than a Grade IV injury, although it is important not to let it progress.

3. Each injury indicates a breakdown. This simply restates the fact that there is a reason for running injuries, which must be analyzed before effective treatment can begin. The breakdown point is usually because of some change in training routine. You may be training harder or running further. You may be running on different terrain, or in different or worn-out running shoes. Injury resistance comes with an understanding of your own genetic limitations.
4. Most injuries are curable. Exceptions to this are injuries that occur in runners with severe biomechanical abnormalities which cannot be compensated for by conventional methods. Injuries which result in degeneration of internal structures such as the Achilles tendon, and those which happen to people who start running on already damaged or abnormal joints are also exceptions.
5. Sophisticated methods are seldom necessary. Most running injuries affect soft tissues - tendons, ligaments and muscles. These do not show up on X-ray. Rely on someone who takes a good history, and examines you thoroughly with their hands!
6. Treat the cause, not the effect. Surgery, physiotherapy, cortisone injections, drug therapy, chiropractic manipulations and homeopathic remedies will probably fail if they do not address the genetic, environmental and training factors which have caused your injury in the first place.
7. Complete rest is seldom the best treatment. Rest will cure only acute symptoms, and is anyway, generally an unacceptable remedy to most runners who are obsessed with their sport! The only injuries that require complete rest are those that make running impossible, such as stress fractures and grade 3 or 4 ITB problems. Tim Noakes' approach is to advise injured runners to continue running, but only to a point at which they experience discomfort. Pain is not recommended!
8. Never accept as final the advice of a non-runner (MD or other). Make sure that your adviser is a runner. He or she should be able to discuss in detail the genetic, environmental and training factors that have caused your injury.
9. Avoid surgery! Surgery is the first line of treatment only in muscle compartment syndromes and interdigital neuromas. There may also be a role for surgery in chronic Achilles tendinitis which has lasted for more than six months, back pain due to a prolapsed disc, and the iliotibial friction band syndrome, but, only after a more conservative approach has been thoroughly tried, and failed.
10. Recreational running does not appear to cause osteoarthritis. Indeed there is evidence that with age, runners show fewer musculoskeletal problems, and develop them at a slower rate, than do non-runners! Generally sportspeople who develop osteoarthritis have usually had previous joint surgery. This is often as a result of injuries sustained during contact sports, such as rugby. However, there may be evidence that long-term, long-distance and high-intensity competitive running, may predispose to premature osteoarthritis of the hip. This finding comes from a single study, so clearly more research is needed.

adapted from Lore of Running by Tim Noakes, MD

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