Running Injury Building Blocks – Part 2: Training Errors

In the Intro to Running Medicine article we discussed the four building blocks that relate to running injury risk: structure, mechanics, dosage, and recovery; or call it anatomy, biomechanics, training, and sleep. This post focuses on dosage / running training.

Exercise is Medicine

 Exercise is medicine, and like a prescription drug, we can prescribe the amount and how often to take it. The three main parts of this dosage are frequency, intensity and time, or F.I.T. for short. Training plans offer a seemingly infinite number of ways to combine these variables. Like with medication, we can also overdose on training, making our graph look like the blog post pic above.

Our biomechanics and anatomy are fine, but our large dosage has put us into the injury range. Not good! Again for the sake of reminding you that recovery is important we’ll keep it separate, but in my mind it shares the box with training. Over-training ≈ under-recovering. While it’s generally agreed that how you train is the biggest factor for both race performance and injury risk, there is a very wide variety of opinions, but not much research on the best way to go about it. While we wait for science to help us figure out the perfect training dosage for everyone, let's try to at least stick to some general advice in the meantime.

Change Your Training Slowly

The most important thing is to ease into any changes. We can often link an injury to a recent change in training, such as new shoes, new running group, or adding in speed or hill work. While these changes can be great in the long run, doing too much too soon can set you back. For example, rather than going all-in with eight 400-meter repeats for your first speed workout, start with just a few easy 400s. Next week add a few more, the following week pick up the pace a little. Taking several weeks to work something new into your routine will help keep you injury free.

It’s helpful to keep in mind that our bodies’ tissues adapt at different rates. While cardiac and muscular improvements can start happening in just a few weeks, structures like tendons, ligaments and bones take months to start catching up to higher training loads.

Frequency > Volume > Speed

Keep in mind this general running training principle as you build mileage - runners can tolerate running frequency > overall training volume > running intensity / speed. Your risk of a running injury will be less by adding another easy run to your week, a little higher when you increase overall volume, and higher still when you increase pace. 

When prepping for a race, follow a training plan. Even if it isn’t a very good one, at least it can be changed and adjusted as needed. If it produces great results, you can follow it again. If you don’t like the results, tweak it or try a new plan next race. Google can pull up multiple plans for any distance race. Your local running shoe store can often help and many offer free group training runs. You can also consider using a coach for a more personalized approach.

Knowing how important training is in relation to running injury free led me to becoming a UESCA certified ultra running coach. So far I’ve helped several runners by first decreasing their volume, slowing their easy pace down, and carefully speeding up their fast days before gradually adding in more volume. These runners have been able to have more productive speed sessions than they ever did before while also running higher volume weeks without injury! But that plan I described in one sentence generally played out over several months!

Walk / Run is a Great Place to Start or Rebuild

For the beginner, perhaps someone considering doing a 5K for the first time, I’d recommend starting with walking. Once you can walk briskly three times a week for 30 minutes, start adding in some jogging. Break up the 30 minutes into six sets of five minutes. Spend most of the five minutes walking, and a little bit of it jogging. Each week, replace some walking time with more running time. In eight to 10 weeks, you’ll be running 30 minutes straight, which will be close to a 5K for most people. You can be regimented about it, increasing by 30 seconds each week, or do it more fartlek style – run when you want, walk when you want.

Beyond this, use the 10% rule as a rough guide to keep building up. Increase your total weekly mileage by no more than about 10%. If you’re injury prone, try 5% instead. Returning to baseline running after a short break? You can likely handle 20% weekly increases. Consider taking a de-loading week once a month – building mileage for three weeks, then reducing your mileage by 20-40% for a week to let your body rest and recover before building again.

Pro-tip: Don't skip de-loading weeks! I think this one of the best ways to reduce running injury risks and also one that too many runners neglect.

Dr. Wilder's Famous Activity Modification Guidelines

Lastly, here is advice on how to know when to push through discomfort or pull back. These guidelines were developed by my mentor Dr. Bob Wilder:

 You can run with mild pain, 1 – 3/10 on the 10-point pain scale, but not moderate or severe, ≥ 4/10.

 No running if you are limping or changing your gait to decrease pain.

 If the pain decreases as you warm up, it’s generally OK to push through. If it worsens the further you go, you need to back off. (I specifically tell clients now that they only have 5 minutes to see if the warm-up is helping pain go down. If not, time to stop. I had to make this addendum after a runner told me that after his 40 minute running warm-up the pain wasn't going away. SMH)

I also recommend seeing a doctor or physical therapist for pain that is sharp or in a joint, or if the same spot hurts for three runs in a row. It’s best to get diagnosed and treated quickly before it becomes a worse problem.

Thanks for reading and happy running!

Kasey Hill, M.D.