Injury. It’s the endurance athlete’s worst nightmare. It’s an almost inevitable experience that comes with being a runner. Heck, my personal experiences with sports-related injuries have been so poignant as to drive me to center my career around identifying and treating them.
I currently run more based on how I feel than any set training plan; that said, most of my runs are over ten miles. Some weeks I run up to 60 miles, other weeks I might run 20. However, there was a distinct period of time, several years ago, when I noticed my body starting to break down if I went over 30-35 miles per week. Fearing injury and almost constantly plagued with some strange ache, pain, or tightness, I kept my mileage capped at less than 40 miles per week. Looking for a more sustainable way to continue running and also up my mileage, I started to tinker with my habits and daily practices to find a long-term plan to keep me running strong well into adulthood.
We are all an experiment of one, and here’s what I’ve cooked up in my laboratory so far when it comes to preventing running-related injury for myself. My disclaimer is that what works for me might not work for everyone. That said, I came to these methods after years and years of trial-and-error, and only after I’d mustered up the courage to break away from some of the classic dogma that has come to define running as a sport irrespective of science.
I hope these prove useful, and if anyone has any additional insights or experiences to offer, please post in the comments below!
1. I stopped running every day. Prior to 2012, I let my ego get in the way and was intent on running every.single.day. I wanted to be a “streaker“–and I succeeded somewhat, running at least one mile every day for 1,812 consecutive days (or just shy of five straight years). I ran through many minor running injuries, employing band-aid and stopgap therapies to keep me on my feet. However, a traumatic knee injury brought that chapter of my life to an abrupt standstill, and through rest and periodization of training, I learned so much about how my body responds to and recovers from running. In fact, I not only healed well from my injury by significantly cutting back on my running, but I also got faster!
I can’t say that running less is what caused my improvement so much as an integration of all of the following practices listed below. Regardless, I really do think there’s something to taking at least one–but preferably two or three–days off between runs to allow the body time to repair all of the microdamage that occurs to bones, joints, and connective tissue during the run. Today, I run 2-3x per week, but I make those runs really count. I also never run if I don’t feel fully “healed” from my prior running session. I haven’t had an injury in the two years since I’ve implemented this practice.
2. I started pushing heavy resistance. Want to bulletproof your legs? Pedal backwards on the elliptical, at the highest resistance you can maintain for a minute at 150-180 rpm. Rest. Repeat.
I know “elliptical” is a dirty word among running purists, however for me, high resistance training on the elliptical and bike has been the cornerstone of keeping my legs super strong. Pushing heavy resistance here doesn’t mean classic weight training, although I know that targeted strength training can have huge benefits for injury-prone runners. Instead of doing endless squat and lunge variations, which I find cause flare-ups in my patellofemoral pain, I have found that pushing heavy resistance on low- or non-impact cardio equipment, such as bikes and ellipticals, has a significant impact on my ability to push power as well as withstand pavement pounding.
I think that high resistance and lower cadence, especially on the bike, is underrated. This method of training improves both strength and cardiovascular endurance as well as VO2max, and can be sustained for longer periods if done in an interval format. I have had to do some experimentation to find out which types of ellipticals work for me, since some position my feet awkwardly in the foot pedals and screw with my kneecap tracking. Generally speaking, though, the higher-end ellipticals (Precor, Cybex) that allow the user to alter incline and direction in addition to resistance really provide the most bang for your buck, as they allow you to truly tax every major and minor muscle group in the lower body, depending on angle and direction.
3. I cross-train like it’s my job. See above. Hiking, uphill walking, ellipticalling, pool running, trail running, and snowshoeing together comprise far more of my training time than simple road running.
4. I rotate my running shoes. I rarely wear the same shoe two runs in a row. These days, I am running in everything from super minimalist (New Balance Minimus trail shoe, Vivobarefoot Breatho trail shoe) to super maximalist (Hoka One One Bondi B) to everything in between (Mizuno Wave Rider, Pearl iZumi EM Road H3, Brooks Pure Flow, Nike Free 5.0). As an osteopath and biomechanics nerd, I have come to understand that variety, and keeping the body constantly guessing, are key to injury prevention. I keep a wide variety of radically different shoes on heavy rotation, because each shoe causes a very subtle and slight change in my gait, foot strike, and stride, stressing different muscles and aspects of connective tissue. This is why, at least anecdotally, trail runners are far less likely to experience injury than road runners–they are constantly mixing up their terrain, and landing in novel ways depending on the surface presented to them. As for whether or not there is one optimal and pure foot strike for everyone, well, the jury’s still out on that one. But striving to land midfoot certainly can’t hurt.
5. I stopped stretching so much. Disclaimer: I am already incredibly flexible, and prone to hypermobility. In fact, it was my tendency to have hypermobile joints that caused me to injure my knee several years ago, when my kneecap became dislocated. Someone like me needs to work more on restoring stability and strength to the knees, ankles, and hip girdle rather than encouraging them to become even more lax through extreme yoga postures and stretching. If I feel specific tightness in a certain area, I hit the foam roller instead–that way I can target the muscle belly, rather than risk overstretching tendons, ligaments, joint capsules, etc.
6. I alkalized my diet. What does that even mean? Simply put, it means I have made fruits and vegetables comprise the vast majority of my diet. Because of the vitamins and minerals present in plant foods, along with the process by which they are digested, fruits and vegetables encourage the blood as well as body tissues to shift their pH from a more acidic to a more alkaline state. An alklaline state is a healing state; it is naturally anti-inflammatory, and encourages the healing of tissues as well as improved immune function. You can imagine what this means not only for injury recovery, but also for keeping injury at bay.
Alkalinizing foods include pretty much anything fruit and vegetable. On the flip side, acidifying foods include concentrated protein sources (especially animal products such as meat, eggs, and dairy; but also concentrated vegetarian proteins such as tofu, tempeh, seitan, etc.), some oils, some grains, refined flours, refined sugar, and certain fats. Most whole grains, nuts/seeds, legumes, and pulses are either neutral or very slightly acidic.
Highly acid-forming foods, especially animal protein, have such a profound effect on blood pH that eating even moderate amounts can encourage the body to leach calcium from bones, causing demineralization as calcium serves as a very potent buffer of the acidic conditions. Sounds like a recipe for a stress fracture to me.
So, long story short, I eat tons and tons of fruits and veggies. As much as I can. That’s not to say I don’t eat acid-promoting foods; as a whole foods vegan, grains, nuts, seeds, etc. are an important part of my diet. I just eat them in much smaller amounts.
7. I ignored the scale. Many runners tend to be a little too weight-obsessed, in my opinion. Obviously being somewhat on the lighter side is an advantage, but only up to a point. In my experience, I found that I was actually–and this may seem paradoxical–far more injury prone at a lower weight. Why? I’m not sure exactly, but more and more evidence is lending itself to the notion that nutritional status–especially among women–is a crucial component of the body’s ability to deal with stressful exercise, both on a hormonal level as well as a musculoskeletal level. I think that most of us have a “sweet spot” where are bodies are most nutritionally replete while also balancing athleticism and power. We may not look like Kara Goucher or Josh Cox at said sweet spot, but who gives? Running isn’t about how we look anyway–it’s about how we feel. Right? Who’s with me?
8. I stopped weight training. See #2 and #3. While I do still do some strength work, I have found that classical weight training aggravates my joints, especially in my lower body, a little too much to be worth it. I have found high intensity, high resistance cross-training to be more than sufficient in making my lower body strong and bulletproof.
9. I nipped niggles in the bud. Say wha? Okay, this term–”niggle”–is one I stole from Chrissie Wellington. She refers to little odd aches and pains, muscle tightness at an early stage, etc. as “niggles.” A niggle is that very subtle sensation of tightness in your IT band that occurs after a long run. It’s that slight cramp in your calf after a hill workout. Nipping it in the bud involves attacking it–not too aggressively, though–at first sign. My methods of choice involve foam rolling, Epsom salts baths, magnesium oil, Po Sum On (a Traditional Chinese Medicine remedy), and osteopathic manipulative medicine (if I can cajole one of my poor unsuspecting osteopath friends to fix me!).
10. I trashed the ibuprofen. It is only on extraordinarily rare occasions (read: once every two or three years) that I use any sort of NSAID, such as ibuprofen (Advil, Motrin) or naproxen (Aleve). If I do feel that a certain amount of inflammatory pain is hanging around a little too long–which, to be honest, these days is a rarity–I prefer to use herbal anti-inflammatories, such as Boswellia Serrata and Cat’s Claw (both of which are evidence-based for their ability to attenuate musculoskeletal inflammation). These herbal medications have a lighter, more subtle effect than traditional synthetic NSAID drugs, and also have a lower side effect profile. Why not just go for the ibuprofen, you ask? Well, mounting evidence suggests that turning inflammation completely off, as NSAID drugs do, may not be such a good thing, especially when it comes to healing. Rather, a healthy level of post-exercise inflammation is an important impetus for the regeneration and renewal of muscles, tendons, bones, and joints. In summary, a small amount of inflammation encourages the body to recruit healing cells, such as white blood cells, fibroblasts, and chondrocytes, to areas of microtrauma, such as ligaments and tendons. So instead of popping “vitamin I” so I can run the next day, I take a day–or three–off.
So there you have it–my personal prescription for running pain-free high mileage.
How do you keep your running sustainable?