We’re delighted to share this expert guide from Tom Harrison, Specialist Physiotherapist at PacePhysio in Hove, East Sussex. With years of experience helping runners recover from - and prevent - recurring injuries, Tom knows exactly why so many of us get caught in the frustrating cycle of “run, rest, repeat.” In this article, he explains how to build resilience, recover smarter, and train more effectively so you can run stronger for longer.
Read on to discover Tom’s practical framework for breaking free from repetitive injuries, including recovery essentials and strength benchmarks to smarter training habits
Run stronger for longer without continually picking up injuries with this guide
Are you a passionate runner but seem to spend more time going from one injury to another than actually being able to run? If this sounds familiar, you aren’t alone. Research would suggest that 25% of distance runners are injured at any given time and around 50% have to take time off running due to an injury over a 12 month period. Whilst running is a high impact sport, we can do better in reducing the associated injury rates through sensible training and a better awareness of the things we can do outside of running to reduce future injury risk.
Below are three key questions you need to be asking yourself if you are an injury-prone runner. If the answer is no to any of these then prioritise the advice given to reduce your chances of future injuries.
1. Am I nailing the basics when it comes to recovery?
Adequate recovery is essential to reduce running-related injuries, but many of us are getting it wrong. There are endless gadgets to choose from these days to aid recovery, from ice baths to compression boots. Yes, they may help to some degree but if you are not nailing the basics then the effects might be minimal. There are three key areas that I believe are the most important when it comes to the basics of recovery: sleep, fueling and psychological stress management. Below I expand on each of these:
● Sleep. This essential function is when our body repairs damaged muscles, replenishes
energy stores, and improves our immune system; all vital in injury reduction. I suggest
that runners require seven hours per night at a minimum, but ideally closer to eight
hours, particularly following higher intensity or longer runs. One recent study found that
endurance athletes reporting less than 7 hours sleep per night for the previous two
weeks had a 51% increased risk of new injury compared to those who slept for 7 hours
or more.
● Fueling. We need to take fueling seriously as runners because the consequences of
underfueling can be significant, not just from an injury perspective (think stress fractures)
but chronically underfueling can contribute to a condition called Relative Energy
Deficiency in Sport (RED-S) that has serious consequences on the body as whole. We
should acknowledge that running requires a lot of energy and the primary source of
energy for runners comes from carbohydrates. One study looking at elite race-walkers
found that after only 3.5 weeks of a low-carbohydrate diet, athletes demonstrated poor
bone health putting them at increased risk of stress fractures. I will leave the specific
nutritional requirements to the sports nutritionists but I want to stress the importance of
fueling for running, with a particular emphasis on carbohydrates. Aim to replenish your
carbohydrate stores within 3 hours after your training sessions, as research would show
that delaying intake beyond 3 hours leads to a 30% decrease in exercise performance
the following day.
● Psychological stress management. There’s no denying that modern life can contribute
to increased anxiety and stress and whilst it is not as simple as saying “be less stressed”
it is important to be aware of the impact stress can have on our body and when it might
be good to adapt training in response to particularly stressful periods. Cortisol, for
example, is known as the stress hormone as it is released in times of high stress and
has a key role in nearly every bodily function. In short bouts, cortisol can actually have a
positive effect as it lowers inflammation, however consistently high levels of cortisol can
have the opposite effect and has been shown to negatively affect both tendon and bone
healing. Consequently, runners should consider reducing their weekly volume and/or
limit higher intensity sessions in times of high stress to reduce injury risk.
2. Am I strong enough to run?
There is no hiding from the fact that the demands on our muscles during running are huge. Whilst most of the peak muscle forces increase with faster running speeds, some are constant throughout. The soleus, a deep calf muscle, has to manage forces around six times our bodyweight at all paces (increasing to around eight times during sprinting). Ultimately, our muscles and tendons need to be very strong to be able to run effectively and minimise injury risk.
I use a number of simple tests in the clinic to determine whether a runner is ‘strong enough’ to run. Whilst there is no exact science to how strong each runner needs to be, results from these tests can identify individual weaknesses to work on:
1. Calf raise endurance test: at least 25 reps for males and 20 for females
This is possibly the most important test given that the calf musculature
contributes to over 50% of the propulsive force during each step whilst running.
This should be done at a strict tempo of one second up, one second down. It is
also important to stop if your form starts to break down. For example, starting to
bend at the knee and push from the thigh muscles, losing height of the calf raise
and not keeping up with the strict tempo of the repetitions are all signs the calf
can no longer tolerate the test and it should be stopped.
2. Single leg bridge test: at least 20 reps for males and 15 reps for females
This provides us with a good measure of your hamstring and larger glute
muscles, both of which have a huge role when absorbing the impact of landing
when we run. Set up by lying flat on the floor with your knee at 90 degree angle,
heel on the ground and arms across your chest. Again, aim for a strict tempo of
one second up, one second down whilst driving your hips off the ground until you
are parallel with your torso
3. Single leg hopping on the spot: aim to complete with good control for 20
seconds (males and females)
Given that the nature of running requires us to react quickly to the ground from
one step to the next, hopping can be considered the closest exercise to simulate
many of the forces and demands of running. Hence, we need to be able to hop
effectively to run. For this test, you want to be hopping in one place for at least
20 seconds. You should be landing and taking off with good control in the same
place on the floor. You are not trying to achieve maximum height each hop but
aim for around 50-60% of maximal effort.
Comparing both limbs on these tests can identify any single leg weaknesses. If you are falling short on any of the tests in either one or both legs you need to focus on strengthening these muscle groups. As a starting point, you can use the same tests as home-based exercises to practice but going forward it may be worth working with a physiotherapist or strength coach to create a strengthening plan.
Bonus tip: Whilst having strong muscles is so important to deal with the forces associated with running, we can also use footwear and insoles as a measure to reduce some of the impacts of running resulting in less stress on our body. For example, Enertors’ running insoles have been shown to reduce 51% of running impacts and I have personally found them an excellent addition to reduce injury risk.
3. Am I training sensibly?
This is arguably the most boring but also the most important aspect of injury prevention.
Training errors are the number one reason for running-related injuries. When it comes to
running, I like to think of three key variables that need to be carefully considered:
1. Volume: This refers to the total amount of running within a given time period and we
tend to measure this by weekly volume. A simple glance at a Strava graph gives us a
good idea of whether this has been sensible or not.
2. Frequency: This refers to how often you run. Again, we tend to use a week as the time
period.
3. Intensity: can be defined as how hard your body is working when running. We can use a range of measures to assess intensity, such as pace, heart rate and perceived effort
(1-10).
As a simple rule of thumb, injuries are much more likely to occur if trying to increase more than one of these variables at any given time. This is where I see many people make errors and often see training plans trying to increase both weekly volume and running intensity at the same time. Some individuals are able to deal with this increased stress on the body but many aren’t. When it comes to returning from injury, I suggest the following approach:
● Frequency first. Spend 2-4 weeks building up to an appropriate frequency of say 3-4
runs a week. All of these runs should be fairly low in distance and intensity.
● Volume second. Once you have achieved a desired frequency you can start to build your
weekly volume. This may be adding a little extra distance to each of your runs or
focusing on building one long run into the week. However, all runs are still at an easy
intensity. Continue this over a 3-6 week period.
● Finally, intensity. Adding intensity to your runs is the last variable. This is because it is by
far the biggest increase in demand on your bones, muscles and tendons so should be
introduced once you know your body is handling the other variables well.
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