This blog is written by friend of Neat, Dr Nick Ambatzis MB BS, MSc (SEM), MRCGP.
Nick is a General Practitioner specialising in Sports and Exercise Medicine. He completed his medical degree at University College London Medical School in 2002. Nick worked for almost ten years as a junior surgeon and spent three years in Trauma & Orthopaedics. He attained a Masters in Sports and Exercise Medicine and subsequently trained as a GP practising in Paddington.
From an early age, Nick has been both a keen cross-country runner and water-polo player, having competed at college level. Nick is also an accomplished ultra-marathon runner, having competed in many cross-country and cross-alpine races, ranging from 50-100 miles. He has also been a Crossfit and Crossfit Endurance coach.
There’s no doubt about it; exercise is good for you and there are hundreds of studies to prove the fact. I can’t even begin to list the benefits of exercise they’re that vast. The downside of exercise (there’s not many!) is the risk of injury. If we look at evidence, the incidence of injuries in runners varies from 20-80%, but please don’t let those statistics put you off. After all, the odds of sustaining a catastrophic injury, i.e. one that would stop you from ever competing again, is extremely rare. (We'll look at Injury Management in the next blog).
Whether you're starting from a baseline of no exercise, or just ramping up your training to the next level, there are certain things you need to be aware of in order to reduce your risk of injury. We'll look at other factors at play and how to reduce these risks. Remember, ‘prevention is better than cure’.
Predisposition to injury can be classified under two main categories: Internal and External factors. Internal factors are those that cannot change at a specific point in time, such as age, gender, anthropometrics (height, weight, shape etc), skill and fitness levels, previous injuries, concentration and rest. External factors include things such as your kit, the running terrain, the weather, volume of training, equipment etc. By correcting these factors, we can reduce the risk of injury. Ways of correcting external factors include the right kit for you (see the blog entry on pre-training), taping and bracing and having the right kit for the job at hand. For example you wouldn’t use trail running shoes for a road run and vice-versa.
Taping & Bracing
This is a specialised field and as such, you should consult with an expert before acting. You should never just say to yourself “Oh I think I need a knee brace” and go to the pharmacy to buy one. Without having seen a specialist, this can lead to further injury. When I coached Crossfit, I used to see people taping their bodies from top to bottom in the hope of improving performance or preventing injury. Rarely did this help and more often than not can lead to a false sense of security whilst exercising and thus, injury. If you need that much tape, you probably need to see a doctor.
The type of training you do can have quite a profound effect on reducing your risk of injury. I’m not going to go into various training plans, as there are lots of different ones out there, depending on individual goals. They mostly prescribe the same thing, with some variation and include, slow long runs, tempo runs, Fartleks and/or sprints. What a lot of these plans don’t advise on though, is strength training. A common question is: “I’m going to run a marathon, why do I need to do dead-lifts and pull-ups?” In my experience, runners never want to go to the gym and do strength and conditioning work, as they don’t believe it to be beneficial. More and more evidence has shown us however, that strength work has incredible benefits for running and for your body in general - most importantly it aids in reducing injury. Other benefits include improved performance (both speed and endurance) and improved body composition (increased lean body mass).
One of the ways strength training imparts benefits is by improving core stability. Why does this come up time and again? Your core serves as the anchor for the body’s movements. All movement is generated from your core and then transferred to the extremities. By stabilising your core, you stabilise the extremities and as such, control and improve biomechanics. Other improvements are specifically targeting muscular imbalances. For example a lot of runners present with Ilio-Tibial Band Syndrome (ITBS), which is typically the pain that runners get on the outside of the knee, due to friction of this thick band. The cause of ITBS is nearly always weak and/or poorly balanced hip external rotators/abductors. Improving the strength and function of these muscles is not something that can be done by running; in fact continued running will probably exacerbate the problem. So get in the gym and start doing some strength work. Again there is plenty of information out there on specific exercises, though I always recommend initially seeing a good personal trainer or physio to advise both specific exercises and correct technique.
Studies have shown that warming-up prior to activity can reduce injuries by over 50%. There is no standard warm-up regime; it can be very personal and what counts as a warm-up for some people, constitutes a workout for others. What can be said though, is that it has to be general and activity specific. For example although the general warm-up regime for sprint work and a tempo run can be the same, they will each require specific warm-up exercises to prepare for the coming activity. The warm-up regimen should also include stretching, though again, the type of stretching has to be activity specific.
There are three kinds of stretching: Static, Dynamic and Proprioceptive Neuromuscular Facilitation Stretching (which we’ll call PNF as I’m not typing that out again). Static stretching involves passively taking the joint to its maximal range of motion and holding for 30-60 secs, whilst dynamic involves actively moving the joint through its range of motion. An example of static stretching is a typical calf stretch against a wall, whilst a dynamic stretch would be a set of bodyweight lunges. PNF stretching involves alternating contraction and relaxation of both agonist and antagonist muscle groups. A good example can be seen here: PNF Hamstring Stretch
Appropriate recovery will serve to reduce injury, promote repair and prepare the mind for the next training session. Again, this can be split into two types:
You should always try and include a warm down as part of your training plan, making sure you stretch. I would recommend static stretching and/or PNF stretching at this point. You should also ensure that you stay warm until your heart rate has recovered.
I cannot stress the importance of sleep for recovery. During sleep, the body shuts down lots of unnecessary functions and allows it to enter an anabolic phase where it repairs and builds the damage done by training. If you get less sleep one night, it can be compensated the following night, but keep missing sleep and soon the effects of sleep deprivation will accumulate. Not only will this affect things like concentration and memory, but it will significantly impair your regenerating properties. Soon enough you won’t be achieving the gains of your training. If you suffer from insomnia, the first thing to look at is your sleep hygiene, to see if there are any practical things you can do to improve your sleep. Sleepcouncil.org.uk is an excellent site you might find useful. If you’ve done all you can and you’re still struggling, then go and have a chat with your GP.
Other things to improve recovery include massage, warm baths, music, relaxation tapes and visualisation techniques.
Train smart, train safe, train hard.
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