There is no shortage of people who want to discourage you from running. “It’s bad for your knees!” they knowingly proclaim. Worryingly, some of these people are Medical and Health Professionals. Aren’t we supposed to be encouraging Australians to be more active? So what’s with this?
Is there evidence to link running and knee injury?
Well yes and no. If you take a group of runners and monitor them over the course of a year, some will get injured- and the most likely part of the body that will sustain the injury is the knees. There are a few studies that have looked at this, and the numbers vary from study to study but the consistent themes are; running comes with injury risk; and the knee is the most likely spot you’ll feel it.
But does this justify the blanket rule that running is bad for your knees? If so, we would also have to conclude the golf is bad for your back, swimming is bad for your shoulders and cycling is bad for your neck. Should we also avoid these forms of physical activity?
Why do some runner’s knees get injured?
There is no single answer to this, and the reality is that injuries that develop over time generally do so because of the convergence of a number of factors. Here is a case study that can illustrate this point:
Steve is 45 and works long hours as a Chartered Accountant. He spends extended stretches of time at his computer, occasionally getting up to make another coffee. He often skips lunch, but when he can sneak out he usually grabs whatever is quick and easy from the Bakery across the road. After work he drops in to his local for a quick beer or two with a couple of mates, before getting home in time for dinner with the family. When the kids are off to bed, the feet are up and he spends more time than he should watching Netflix. His sleep is short and poor in quality as a result.
Steve sees his Doctor who informs him his blood pressure, blood glucose and waist circumference are all trending towards the red-zone, and that he needs to start doing some exercise immediately to turn things around. Steve heeds the warning, so early Saturday morning he laces up his ten year old sneakers he usually wears to mow the lawn, chucks on a t-shirt and shorts and gets out to his local Park-Run 5km. Steve starts out confidently but after about 500m starts to puff and pant. By 2km his knees and lower back are getting sore but he is a determined bugger, so he drags himself across the next 3km with a slow, loping stride. ‘This will only get easier’ he tells himself, and to his credit he repeats this torture for the next 3 weeks.
By Sunday after week 4, his knees are swollen, sore and hot to the touch. He sees his Doctor again the following day and fills him in. “Well you shouldn’t have started running, don’t you know running is bad for your knees?! You should walk, or maybe ride a bike instead”.
Was running the problem here? Or what is that Steve, although well-intentioned, just plunged himself into a task he was completely under-prepared for and hurt himself as a consequence?
Steve’s current lifestyle needs a dramatic overhaul- his overall health could benefit greatly from making some improvements to his diet, reducing his sedentary time, reducing his alcohol frequency and making sleep a greater priority.
Steve could get some advice on footwear by someone who knows what they are talking about. He could also invest some time and money speaking to an expert on how to build his body and his running form so that when he does run he has the strength and the technique to do so more efficiently.
This sounds like an awful lot. But the reality is that running is hard on your body but that is why it can impact our health in such profound, positive way. Our body adapts and evolves to physical stress if it is dosed out appropriately. It is worth making the health changes to equip your body to not only meet the demands of running, but to thrive on them.
Running is not inherently bad for your knees. Running does put your overall health under the microscope, and penalises you for what you neglect. Rather than discouraging people from running, we as Health Professionals should be encouraging our clients to audit and refine how they take care of themselves.
About the Author
The British Journal of Sports Medicine recently published a review of the evidence for Strength Training as a strategy to reduce injuries in Athletes- and the results are impressive! For those that tend to just read the first few lines of an article, take this away. If you are an athlete, or you coach athletes, strength training should be a priority in your programming if you want to reduce injury risk. For the rest of you, please read on.
This article was by Lauresen, Andersen and Andersen (2018). Below is a summary:
- 6 studies were included, totaling 7738 participants aged between 12-40 y.o.
- The average intervention duration was 21.39 weeks.
- Average volume of training was 80 reps per week.
- Average intensity was 8.39 RM (these means the maximum number of repetitions that can be performed for a given exercise).
- Strength Training reduced sports injuries by 66% with a 95% confidence interval of 52% (combined results from 4 of the 6 studies).
- A 10% increase in strength training volume resulted in reduced injury risk of 4%.
- No injuries occurred as a result of the strength training throughout the interventions.
- Strength training was both safe and effective for adolescents as well as adult athletes.
Why? The Mechanisms
The authors can only speculate as to why strength training helped protect athletes from injury, but their proposed mechanisms to explain its effectiveness are:
- Preconditioning- effectively toughening up the muscles/tendons so they can deal with greater loads.
- Variation of loading across the body so that parts of the body that are not stressed by the sport take more of the load in the gym.
- Improved coordination and technique in the gym crossing over to movements in sports.
The authors concluded with the following recommendations for strength training, and I advise that if you choose to trust an Exercise Professional to help you or your athletes commence a strength training program that they can demonstrate an understanding and adherence to these principles.
- Commence with a familiarisation period so that the athletes can develop the confidence and capability to perform the exercises correctly.
- Ensure the athlete is supervised in the gym so that exercises can be completed well and loads are monitored accurately.
- Loads are individualised to the athletes capability and are altered appropriately over a training cycle.
- Exercises are varied across the year of training.
I would add in that it is also important that the strength training program is correctly synchronised with the training and competition schedules, so the Exercise Professional must be in regular communication with the athlete’s coach. For example, during an athletes off-season they can focus on improving function and technique; during pre-season switch to muscle building; and within season aim to build/maintain strength and power. The Exercise Physiologists at iNform have extensive experience managing the strength training programs of athletes across many sports. If you would like to speak to one of our EPs about the services we offer athletes, please contact us!
About the Author
Lauersen, J. B., Andersen, T. E., & Andersen, L. B. (2018). Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. Br J Sports Med, bjsports-2018.
Recently the Journal of Sports Sciences published a Systematic Review detailing the factors associated with injury in Elite Junior Tennis players. It is important that coaches and parents of such athletes are aware of the findings (Oosterhoof et al, 2018).
Risk Factors for Lower Back Injury
Previous Lower Back Injury:
Previous injury is often a good predictor of future injury. Why? That is not clear, but one reason may be that rehabilitation of injuries is often not done to the level that it needs to. Rehab is often done adequately to get a player back on the court, but functional deficiencies can remain. This can predispose the athlete to recurrence, or to injury of another part of the body due to compensation. Elite Junior Tennis players should undertake their rehabilitation under the guidance of a Physiotherapist and Exercise Physiologist that are experienced in this field.
Training Loads > 6hrs p/wk:
Elite Junior Tennis players will be training and playing at least this amount. So how do we mitigate against this as a risk factor? For one, the athlete needs to have a good recovery repertoire and be diligent with it. A recovery program should be personalised for the athlete, but some common features of an athlete recovery plan are; adequate sleep; good diet, hydration and nutritional support (protein especially); massage; stretching and cold-water immersion. Secondly, Functional Resistance training can help build strength in muscles and tendons, mobility in joints, stability in movement, balance and spatial awareness. If your child, or an athlete under your guidance does not have a recovery plan, and/or is not undertaking a quality, personalised functional strength program I would speak to a qualified and experienced Exercise Physiologist to help them build one.
Risk Factor for Upper Extremity Injury
Fewer Years of Playing Experience
The authors do not specify what it meant by ‘fewer years of experience’ so we can only speculate. But generally speaking, when a young person starts at a new sport, their body is going to be exposed to forces that they may not be conditioned to deal with. I recommend that young people new to tennis undertake an overall movement capacity assessment, such as the ‘Movement Screen’ (Movement Screen ). This will identify any functional limitations that can be corrected through a functional strength training program. We use the Movement Screen with all of our young athletes at iNform.
Risk Factor for Lower Extremity Injury
Interestingly, in the studies included in the aforementioned review players that regularly stretched the muscles of the lower body had an increased risk of injury than those that didn’t. This is counterintuitive for most, as stretching is supposed to be good for us, right? Stretching can be useful for increasing the mobility of a restricted joint. However stretching can also acutely reduce our muscles responsiveness and power. So there are pros and cons to stretching for athletes. If an athlete is going to be prescribed stretches, they should be recommended only for areas that display movement restriction (and have shown a positive response to stretching) and should be timed so that performance is not impacted negatively. The Exercise Physiologists at iNform can easily identify whether a young tennis player would benefit from stretching, and recommend when is best to do it.
Whilst there are injury risks associated with playing Elite Level Tennis at the junior level, they can be mitigated by taking an intelligent and strategic approach to the young athletes programming. The Exercise Physiologists at iNform have extensive experience helping Elite Young Tennis players stay strong and healthy and on the court.
About the Author
My Father-in-law absolutely loves wine. As long as it is a big, smooth Barossa Shiraz. I on the other hand like a bit of diversity- a cold, crisp Riesling on a hot summer’s day; a big brooding Cabernet on a cold wintry night; a Pinot, well, there are a lot of contexts where Pinot is appealing! It is much the same with running for me. Some people like to do the same 5km Park Run every week. Great! I however like to run in lot’s of different ways and contexts. So here are my top 5 types of run and where I enjoy doing them the most.
5: Flat Road Running
A long, straight, flat stretch of tarmac in front of me. Feet tapping away with the consistency of a metronome. Breathing in an easy rhythm- every 3rd foot strike. Mind clear, basically meditating. Km’s ticking away without really noticing. This is running relaxation.
Where I do it: The Riverland; Yorke Peninsula (Around Port Broughton or Ardrossan).
From a crouched starting point, then accelerating up to top speed. Driving the knees forward, ripping the elbows back. Completely releasing the brakes. I am sure it feels more impressive than it looks, but in my mind I am flying. The lungs start to bite which is the cue to take the foot off the the accelerator. My legs gradually wind down. I let myself recover, then go again.
Where I do it: Balhannah Footy Oval; Amy Gillett Bikeway
Yes I am serious, I love running uphill. As I approach the incline my mindset shifts. This hill will be like a big meal- just take your time with it and take it one mouthful at a time. I lean forward, focus on pulling my knees through, and get into a nice easy rhythm. I imagine the little engine that could; chug-chugging it’s way up the winding track. The revs are oscillating close to, but always under the red-line until the crest is spotted, then comes an acceleration. Relief as the gradient plateaus.
Where I do it: The (Old) South Eastern Freeway; ‘The Guts’ Track at Fox Creek.
I love narrow, rocky trails. If there is a steep drop-off on one side, excellent. Creek crossing, boulder hopping, ducking under low branches. It can be more like an obstacle course than a run. Agility and power are required to negotiate what the trails offers. One minute I am scampering up tight switch backs; next I am weaving down the other side like a slalom skier. This is an extreme sport!
Where I do it: Sturt Gorge; Morialta
1: Beach Running
This is running stripped (almost!) completely back. Barefoot, wearing just shorts and a hat. Along the shore line, the waves are the soundtrack. Always on a hot day. When the heat gets a bit much the hat gets chucked to one side and in the ocean I go. The first beach run of the summer results in blistered feet and sore calves- but both toughen up pretty quick. For me beach running is heaven.
Where I do it: Normanville to Carrickalinga; Aldinga Beach
I hope to see you out at one of my favourite spots!
I love broccoli, it is my favourite food! I love it so much, it is all I eat- breakfast lunch and dinner. And it’s healthy hey, lots of vitamins and minerals. So yeah, just broccoli for me thanks.
Obviously this is ridiculous. I don’t think you need a degree in Dietetics to appreciate that we need diversity in our diet so we get all of the good stuff that our body needs to maintain health. Broccoli fits within a balanced diet- it is not a diet in itself.
What the heck does this have to do with exercise?
Behold, The Ten Domains of Fitness
- Cardiovascular endurance
In an ideal world, you would challenge these fitness domains on a regular basis to create a diverse range of stimuli to promote adaptation and optimal physical health. Do you?
What if you are a real Yoga devotee. That is all you do, and you do it regularly and you love it. Fantastic. You would be well honed in flexibility and balance and scratch the surface on strength and coordination.
What about if you are a runner? You run 10km every single day, awesome! You are challenging CV endurance and stamina, but probably very little else (in a meaningful way).
For the gym-junkies who just love to lift big weights? Strength. That is about it.
As an Exercise Physiologist, it is my hope that everyone can find a form of physical activity that they truly love and do on a regular basis. But if you are committed to becoming the best version of yourself that you can be, you need to challenge the other fitness domains regularly to give yourself a more balanced exercise diet. This can sound daunting- how the hell do I fit all of that into my already-busy schedule? This is how I do it.
- I do a nice long run and/or mountain bike ride once per week. This takes care of CV endurance and stamina, as well as balance, coordination and accuracy (on the Mountain Bike).
- I do one hill-rep running session per week which I do on some tricky, narrow, rocky trails around Burnside. This challenges power and speed on the way up, and agility on the way back down.
- I do two gym sessions per week, where I always include strength work, power exercises and balance exercises.
- Finally I like to stretch and foam-roll in the evenings when I am watching tv (ad breaks are great for this!).
Someone else may achieve all of these fitness domains in a week by playing netball, going for a hike up Mount Lofty, lifting weights at the gym and doing a Yoga class or two. It can take any number of different forms.
Our body thrives on a diverse diet of physical challenges. And our body (and mind) will adapt in amazing ways if we regularly nourish it with these challenges. iNform’s Exercise Physiologists are here to help you diversify your Exercise Diet and help you become the best version of yourself you can be.
About the Author