A Physio Talks Running Injuries

Ben Liddy is a leading Australian physiotherapist and an elite runner. Here he provides a valuable insight into common injuries, training and what he encounters as a physio.

What are the three most common running injuries you come across?

It’s probably more the top 4 and I’d say Achilles tendinopathy, ITB syndrome, plantar fasciitis and stress fractures

What are the three most common causes of running related injuries?

I think every physio will have a different answer for this and I think my opinion comes more from my time as a runner and as a physio than purely from a physio’s perspective. In saying that I think most injuries in distance runners occur due to:

– Running recovery or easy day runs at too fast a pace

– The absence of any strength training in the athletes program

– Not seeking attention at the first sign of a niggle. Most distance runners accept that running with some level of discomfort is normal. Niggles are part and parcel of the distance running game but knowing which ones are safe to train through is the tough part! Unless you’re very body aware, have a good understanding of anatomy or have a long injury history that enables you to recognise a potentially disastrous injury coming on, choosing which niggles to manage while continuing to train through is very difficult. I think a lot of distance runners convince themselves a niggle isn’t too serious and continue training in the hope it will go away. When they finally decide to seek treatment the niggle is either now a serious injury requiring significant time off or they’ve compensated so significantly in their running technique to lessen the load that they now have a new injury.

What is your number one tip for preventing injury?

For distance runners, slow gradual progressions at the start of any training program when returning from an extended lay off. Avoid temptation to rush back into hard training and avoid any long sustained hard sessions until you can safely run 45- 60mins most days of the week without getting sore.

What are the best forms of post-training recovery?

I think using a self trigger point device like a ‘muscle mate’ or golf ball on any areas that are sore or tight following a training session is a great way to prevent any niggles being taken into the next session that could potentially lead to a more serious injury.

Regular massage is also a great tool if it’s accessible. Having that regular appointment in your diary means you’re never too far away from receiving treatment to prevent a niggle from developing further. With a good therapist, they’re also able to identify potential problems that can be treated immediately before they develop into anything.

Is cross training a good way to mitigate against injury?

I think cross training certainly helps to mitigate against injury. Any exercise not involving direct impact forces is certainly going to present lower risk. However, I think most distance runners understand they need to take a few measured risks and complete a particular amount of running training each week to get to the level they desire. For some runners, this won’t require as much running training and cross training can be incorporated into their program, still allowing them to achieve their goals without the increased injury risk.

However, often for more elite level runners so much running is required in their program to achieve their desired performance levels that there isn’t time or enough adaptive energy to incorporate cross training into their programs. If these runners are getting injured on their current program but still determined to train in a similar way then I think there are more options available than just substituting running for cross training.

I’d prefer to sit down with the athletes and their coaches and discuss the amount of training they think is necessary to get to the level they desire. We can then look at modifications in their training, perhaps how they progress to the level of training they require or look at any strength or technical deficiencies that may be making them more susceptible to injury.

What form of cross training best translates to running performance?

Again, I think this comes more from my background as a runner than a physio. The 2 forms of cross training I’ve found most beneficial are pool running and stationary cycling. There are pluses and minuses of both but ultimately at the end of the day I think it is better to stick with the one you enjoy more and feel more comfortable with. You’re more likely to commit to it in the longer term and you don’t want to be going to be bed each night dreading what you have to do the next morning.

For me, I prefer pool running. I get people to tie a resistance band around the lane rope and then take the slack up on it so it keeps them in one spot when they’re running. This keeps them out of the way of other people, and they don’t have to keep turning when they get to shallow water and if their intensity starts to slow they get the immediate feedback from the band which will pull them back in closer to the lane rope.

What training or injury myth do you encounter most often? (EG Running barefoot is good for you)

I think the one big training and injury myth I encounter is that high mileage causes stress fractures. I encounter people who get stress fractures off less than 30km/week and people who have no problems running 150km week+. I think the bigger thing to consider here is how the mileage is structured, the progression into high mileage and the intensity of the mileage. Through additional study and my own research I’ve learnt bones are highly adaptable and that low grade vibration is great for improving bone strength and injury resistance. Long easy running happens to achieve exactly this!

One of the things I look at when reviewing people with stress fractures is to look at how their overall training week is structured. I look at the number of quality sessions included in their week and ensure that if a lot of quality is already structured in the week that there is sufficient easy running being performed to allow the bones to remodel themselves without breaking down further between the quality sessions. This allows the athlete to still get sufficient volume into their program to achieve their performance goals.